S1_L4: Shoulder and Cervical Spine Conditions

Question 1

TRUE OR FALSE: The shoulder is the fulcrum for arm elevation. It provides sufficient fixation for motion of UE and cervical spine to occur

A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true

Answer 1

C. Only the 1st statement is true

Question 2

TRUE OR FALSE: The Scapulothoracic joint is a “pseudojoint”.

Answer 2

True

Question 3

Match the following classification of clavicular fractures.

1. Fractures of proximal third (where sternum is)
2. Fracture of middle third
3. Fracture of middle third
4. Most common
5. Can cause disruption of the coracoclavicular / acromioclavicular ligament

A. Group I
B. Group II
C. Group III

Answer 3

1. C
2. A
3. B
4. A
5. B

Question 4

The (1)_______ is the first bone to ossify & has the last ossification center to fuse at the (2)_______

Answer 4

1. Clavicle
2. sternal end

Question 5

TRUE OR FALSE: The Clavicle
is a strut connecting upper extremity to the axial skeleton. It is the only bone connecting the UE to the trunk

A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true

Answer 5

A. Both statements are true

Question 6

Match the following special test to its procedure.

1. Pt tries to supinate and flex elbow more from a 90 degree flexed elbow, and PT resists the movement
2. PT elevate/abducts arm or internally rotates then elevates arm of pt
3. External rotate and abduct to touch superior medial angle of the opposite scapula

A. Yergason’s Test
B. Speed’s test
C. Apley’s Scratch
D. Neer’s Test
E. None

Answer 6

1. A
2. D
3. C

Question 7

The following statements are true about Rotator Cuff Tears, EXCEPT:

A. Tenderness palpated below the acromion
B. Inability to initiate and maintain abduction
C. Presents with a painful arc
D. Atrophy of Teres minor in late cases
E. None of the above

Answer 7

D. Atrophy of Teres minor in late cases

Question 8

This is a congenital synostosis of cervical spine, where fusion of all or of only the lower cervical vertebrae into one homogenous mass of bone occurs.

Answer 8

Klippel Feil Syndrome

Question 9

CASE: A patient was diagnosed with a cervical disc herniation at the level of C6-C7. As a knowledgeable PT, what nerve root is affected?

Answer 9

C7

Question 10

CASE: A patient was diagnosed with a cervical disc herniation at the level of C6-C7. As a knowledgeable PT, what deep tendon reflex will most likely be diminished?

Answer 10

Triceps Reflex

Question 11

CASE: A patient was diagnosed with a cervical disc herniation at the level of C6-C7. As a knowledgeable PT, where would the sensory deficit be most prominent?

Answer 11

Dorsal midforearm and 3rd digit

Question 12

CASE: A patient was diagnosed with a cervical disc herniation at the level of C4-C5. As a knowledgeable PT, what muscles will be affected?

Answer 12

1. infraspinatus
2. supraspinatus
3. Deltoid

Question 13

CASE: A patient was diagnosed with a cervical disc herniation at the level of C4-C5. As a knowledgeable PT, where would the pain be distributed?

Answer 13

1. shoulder
2. lateral arm
3. Neck

Question 14

A prolapsed disc can sometimes be called?

Answer 14

bulge disc or protruding disc

Question 15

Match the following terms.

1. annulus and moves into the spinal canal
2. changes causes slight impingement of the spinal canal or spinal nerves
3. nucleus pulposus breaks through the annulus fibrosus but remains within the disc

A. prolapse
B. sequestration
C. disc extrusion

Answer 15

1. B
2. A
3. C

Question 16

This is also known as ”arthritis of the neck”

Answer 16

Cervical spondylosis

Question 17

Disc protrusion or subluxation (slip disc) in the cervical region is most common between?

Answer 17

C6-C7

Question 18

Spurring of cervical spine is common between what spinal levels?

Answer 18

C4-5 and C5-6

Question 19

This is a deformity of the neck that includes both rotation and flexion and affects the sternocleidomastoid.

Answer 19

Torticollis or Wry Neck

Question 20

The following is true about a congenital torticollis, EXCEPT:

A. also known as muscular torticollis
B. non-tender, cylindrical enlargement of SCM
C. spontaneous regression takes place 3 to 6 months
D. more common in boys
E. can cause flattening and shortening of face on side to which the head is tilted

Answer 20

D. more common in boys

Question 21

How many muscles insert at the scapula?

Answer 21

17

Question 22

The following is true about adhesive capsulitis, EXCEPT:

A. Also known as obliterative bursitis
B. Also known as diffuse rotator cuff tendinitis
C. Women > Men
D. Without treatment, resolves in 3-5 years
E. None

Answer 22

D. Without treatment, resolves in 3-5 years

NOTE: It may spontaneously resolve within 2-3 years

Question 23

When Apley’s scratch test is done with internal rotation and adduction, what structure must be aimed to be touched during the test?

Answer 23

inferior angle or the opposite scapula

Question 24

When Apley’s scratch test is done with external rotation and abduction, what structure must be aimed to be touched during the test?

Answer 24

superomedial angle of the opposite scapula

Question 25

This tells of a triangular swelling of the posterior thorax over the scapula suggesting hematoma resulting in compartment pressure

Answer 25

Comolli sign

Question 26

A scapula fracture may also involve which 2 injuries?

Answer 26

1. thoracic spine injuries 2. pulmonary contusion

Question 27

This occurs if there is disruption of 2 or more of the superior shoulder suspensory complex

Answer 27

Floating shoulder

Question 28

The superior shoulder suspensory complex (SSSC) is a bone-soft tissue ring composed of which 6 structures?

Answer 28

1. Glenoid process 2. Coracoid process 3. Coracoacromial ligament 4. Distal clavicle 5. AC joint 6. Acromion process

Question 29

In which condition or injury is the comolli sign seen?

Answer 29

scapula fracture

Question 30

This is functionally a joint but lacks anatomic characteristics of a true synovial joint

Answer 30

Scapulothoracic joint

Question 31

The glenohumeral joint is a ______ joint.

Answer 31

true synovial ball and socket

Question 32

This shoulder ligament is the primary restraint for anterior and posterior dislocation

Answer 32

Inferior glenohumeral ligament

Question 33

Between the superior and middle glenohumeral ligament is what foramen?

Answer 33

foramen weitbrecht

Question 34

Between the middle and inferior glenohumeral ligament is what foramen?

Answer 34

foramen rouviere

Question 35

The (1)______ ligament is the primary support for AC joint, but the (2)_______ ligament prevents separation of AC joint

Answer 35

1. Coracoclavicular 2. Coracoacromial

Question 36

Determine whether the following muscles are scapular pivoters or humeral propellers. 1. Subscapularis 2. Serratus anterior 3. Latissimus dorsi 4. Teres major 5. Rhomboids A. Scapular Pivoters B. Humeral Propellers

Answer 36

1. B 2. A 3. B 4. B 5. A

Question 37

Enumerate the rotator cuff muscles.

Answer 37

Supraspinatus Infraspinatus Teres minor Subscapularis

Question 38

Who created the classification for proximal humeral fractures?

Answer 38

Neer

Question 39

TRUE OR FALSE: A three part fracture of the surgical neck with shaft displacement is the most common type of proximal humeral fracture

Answer 39

False NOTE: It only splits into 2 parts

Question 40

What artery and nerve most commonly becomes a complication after humeral fractures?

Answer 40

axillary artery and nerve

Question 41

TRUE OR FALSE: If necrosis happens after humeral fractures, amputate the whole shoulder. A shoulder replacement must not be performed as the vessels are already nonfunctional. A. Both statements are true B. Both statements are false C. Only the 1st statement is true D. Only the 2nd statement is true

Answer 41

B. Both statements are false

Question 42

This is the most common inflammatory problem in the shoulder

Answer 42

Supraspinatus Tendinitis NOTE: This is because it is the most superficial of the SITS muscles

Question 43

The following is true about Supraspinatus Tendinitis, EXCEPT: A. Women < Men B. Commonly seen in athletes C. Commonly seen in individuals doing a lot of overhead activities D. Most common cause of shoulder pain E. Results from degeneration at the musculotendinous region of the cuff

Answer 43

A. Women < Men

Question 44

The painful arc in supraspinatus tendinitis is between (1)______ degrees on resisted (2)______.

Answer 44

1. 60-120 2. abduction

Question 45

Which age range is supraspinatus tendinitis commonly seen?

Answer 45

35-50 years old

Question 46

TRUE OR FALSE: Supraspinatus tendinitis may occurs when the circulation about the supraspinatus tendon insertion gets impaired intermittently over the greater tuberosity.

Answer 46

True

Question 47

What is seen in roentgenograms in cases of Supraspinatus Tendinitis?

Answer 47

calcific tendonitis NOTE: Roentgenograms are X-ray photographs. This sees the amorphous calcium phosphate salt in the supraspinatus

Question 48

What is the most effective treatment of severe acute Supraspinatus Tendinitis?

Answer 48

Aspiration of calcium deposit + steroid

Question 49

The following is true about Bicipital Tenosynovitis, EXCEPT: A. inflammation of the tendon-tendon sheath gliding mechanism B. results in adhesion of the tendon to the bicipital groove and rotator cuff C. may be a cause of abnormal physiologic wear and tear D. associated with impingement syndrome E. none of the above

Answer 49

C. may be a cause of abnormal physiologic wear and tear NOTE: In cases of constant flexion, this is a normal physiologic response t wear and tea.

Question 50

Give 2 special test for Bicipital Tenosynovitis

Answer 50

1. Yergason’s Test 2. Speed's Test

Question 51

TRUE OR FALSE: Adhesive Capsulitis is associated with CVA, myocardial infarction (MI), and cervical root affectation

Answer 51

True

Question 52

The Thawing stage during Adhesive Capsulitis lasts for how many months?

Answer 52

12-24 months

Question 53

Which stage in Adhesive Capsulitis is stiffness present in all planes?

Answer 53

Freezing stage

Question 54

The Frozen stage during Adhesive Capsulitis lasts for how many months?

Answer 54

4-12 months

Question 55

The Freezing stage during Adhesive Capsulitis lasts for how many months?

Answer 55

3-9 months

Question 56

What is the gold standard to diagnose Rotator Cuff Tears?

Answer 56

MRI

Question 57

The following is seen in Rotator Cuff Tears, EXCEPT: A. Weak shoulder abduction B. Sulcus may be appreciated between acromion and RC tendon C. Tenderness below the acromion D. Transient sharp pain lasts for months E. None of the above

Answer 57

D. Transient sharp pain lasts for months NOTE: Transient sharp pain only lasts for days. Severe pain lasts for months

Question 58

A PT tells a patient to abduct their shoulder and asks the pt to slowly put it down. As it reaches 30 degrees down, it immediately fell. What test is being done in the scenario?

Answer 58

Drop arm test

Question 59

This often develops secondary to injury, impingement, muscle overuse, muscle degeneration, GH instability, RCT or calcium deposits. A. Shoulder-Hand Syndrome B. Subacromial Bursitis C. Rupture of the Biceps Brachii D. Bankart Lesion E. Hill Sachs Lesion

Answer 59

B. Subacromial Bursitis

Question 60

The following is true about Shoulder-Hand Syndrome, EXCEPT: A. Shoulder Pain with bilateral hand pain and swelling B. Sequelae of MI, stroke (CVA), trauma, cervical arthritis C. (+) Atrophy and finger flexion deformity and extension contracture of MCP joint D. Sympathetic dysfunction due to injury or compression E. None

Answer 60

NOTE It is a Shoulder Pain with homolateral hand pain and swelling

Question 61

In Shoulder-Hand Syndrome, a reflex-like response to pain sensation by sympathetic nerves triggering a reactive (1)______ which reduces (2)______ to the tissues involved in the pain pattern

Answer 61

1. vasomotor reaction 2. blood flow

Question 62

TRUE OR FALSE: In Shoulder-Hand Syndrome, Osteoporosis is seen on X-rays. In lab tests, ESR is elevated. A. Both statements are true B. Both statements are false C. Only the 1st statement is true D. Only the 2nd statement is true

Answer 62

C. Only the 1st statement is true

Question 63

TRUE OR FALSE: Rupture of the Biceps Brachii occurs in men between 30-40 years old. The cause is usually a single traumatic event where an unexpected extension force is applied to an elbow flexed to 90°. A. Both statements are true B. Both statements are false C. Only the 1st statement is true D. Only the 2nd statement is true

Answer 63

D. Only the 2nd statement is true NOTE: Common age range is between 40-60.

Question 64

What sign is commonly seen during a Rupture of the Biceps Brachii?

Answer 64

Popeye sign

Question 65

The following ae sites where Rupture of the Biceps Brachii may occur, EXCEPT: A. at or near the origin B. musculotendinous junction C. bicipital groove D. insertion site E. none

Answer 65

E. none

Question 66

TRUE OR FALSE: In Rupture of the Biceps Brachii, there is weakness in elbow flexion and forearm supination. X-rays will show a small avulsion fracture of glenoid rim. A. Both statements are true B. Both statements are false C. Only the 1st statement is true D. Only the 2nd statement is true

Answer 66

A. Both statements are true

Question 67

What is the most common direction for shoulder dislocations?

Answer 67

Anterior or anteroinferior

Question 68

Anterior dislocations are usually caused by an indirect force in the shoulder while it is (1)_____, (2)_____ and (3)______.

Answer 68

1. abduction 2. extension 3. external rotation

Question 69

This condition is an osseous defect on the posterolateral aspect of the humeral head resulting from forceful impaction to the anteroinferior glenoid rim during anterior dislocations

Answer 69

Hill Sachs Lesion

Question 70

This is an injury to the antero-inferior glenoid labrum due to repeated anterior shoulder dislocations

Answer 70

Bankart Lesion

Question 71

Recurrent Dislocation is characterized by (1)_____ and (2)______ when arm is abducted and ER.

Answer 71

1. Sudden pain 2. Audible click

Question 72

Shoulder Arthroplasty is indicated when the following conditions are present, EXCEPT: A. axillary nerve injury B. rheumatoid arthritis C. recurrent dislocations D. bone tumors E. osteonecrosis of the humeral head

Answer 72

A. axillary nerve injury

Question 73

These are the key muscles to examine preoperatively in Shoulder Arthroplasty, EXCEPT: A. latissimus dorsi B. pectoralis major and minor C. trapezius D. serratus posterior E. None

Answer 73

D. serratus posterior

Question 74

A total shoulder arthroplasty (TSA) is a surgical option typically reserved for (1)_____ patients with (2)______ & (3)______

Answer 74

1. elderly 2. cuff-deficiency 3. arthritic shoulders

Question 75

In Partial Shoulder Arthroplasty, what is replaced?

Answer 75

head of the humerus

Question 76

There are 4 types of replacement components have traditionally been used in Shoulder Arthroplasty. Enumerate all 4 types.

Answer 76

1. Unconstrained 2. Constrained 3. Semi-constrained 4. Reversed ball and socket

Question 77

Determine which type of replacement component is being described. 1. glenoid and humeral components are coupled and fixed to bone 2. consists of a small humeral socket that slides on a larger ball-shaped glenoid component 3. most widely used component A. Unconstrained B. Constrained C. Semi-constrained D. Reversed ball and socket

Answer 77

1. B 2. D 3. A

Question 78

Determine which type of replacement component is being described. 1. tends to absorb the majority of joint stresses, which increases the potential for loosening or fracture of prosthesis or the surrounding bone 2. involves the use of a smaller and spherical humeral head with a head–neck angle of 60 degrees 3. designed for patients who had severe deterioration of the rotator cuff but with a functioning deltoid A. Unconstrained B. Constrained C. Semi-constrained D. Reversed ball and socket

Answer 78

1. B 2. C 3. B

Question 79

Determine which type of replacement component is being described. 1. consists of a humeral component that exists with scapular component 2. reproduces the anatomy of the joint as much as possible 3. no physical connection holds the components together A. Unconstrained B. Constrained C. Semi-constrained D. Reversed ball and socket

Answer 79

1. A 2. A 3. A

Question 80

In Wry Neck, tilting of the head toward the (1)_____ side and rotation of chin to the (2)______ side occurs.

Answer 80

1. same/ affected 2. opposite

Question 81

The following are causes of Acquired Wry Neck, EXCEPT: A. Arthritic B. Cicatricial C. Hysterical D. Neoplastic E. None

Answer 81

E. None

Question 82

What are the risk factors for spontaneous atlanto-axial subluxation?

Answer 82

1. Down’s syndrome 2. Morquio’s syndrome 3. Bone dysplasia 4. Osteogenesis imperfecta

Question 83

Spontaneous atlanto-axial subluxation is caused by the laxity of the (1)_____ ligament of the (2)______ and other ligaments and (3)______ inclination of the facet surfaces

Answer 83

1.transverse 2. atlas 3. forward

Question 83

Spontaneous atlanto-axial subluxation is caused by the laxity of the (1)_____ ligament of the (2)______ and other ligaments and (3)______ inclination of the facet surfaces

Answer 83

1.transverse 2. atlas 3. forward 4.

Question 84

What are the 2 s/sx for

Question 85

What are the 2 s/sx for spontaneous atlanto-axial subluxation?

Answer 85

1. Unexplained neck stiffness or pain in a child with or without torticollis 2. Hyperactive reflexes

Question 86

A disorder of the cervical spinal nerve root and, most commonly, is caused by a __________

Answer 86

cervical disk herniation

Question 87

TRUE OR FALSE: The farther your head goes away from the fulcrum, the heavier it gets

Answer 87

True

Question 88

This is a group of disorder associated with pressure on nerves and vessels in the region of the thoracic outlet

Answer 88

Thoracic Outlet Syndromes

Question 89

TRUE OR FALSE: Thoracic Outlet Syndromes are more common in men. Weakness and atrophy starts with the muscles of the chest and back. A. Both statements are true B. Both statements are false C. Only the 1st statement is true D. Only the 2nd statement is true

Answer 89

B. Both statements are false NOTE: It starts with the intrinsic muscles of hands, then later involving entire limb.

Question 90

Costoclavicular syndrome is a (1)______ that may occur in space between the (2)____ and the (3)_____

Answer 90

1. neurovascular compression 2. clavicle 3. first rib

Question 91

A Whiplash injury is associated with a (1)_____ and affects the (2)____ and (3)____ of the neck.

Answer 91

1. motor vehicular accident 2. muscles 3. ligaments