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OSCE > Shoulder > Flashcards

Shoulder Flashcards

(69 cards)

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1
Q

Internal rotation of arm

A

Posterior shoulder dislocation

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2
Q

Serratus anterior pathology

A

Ask patient to push against wall

Scapular winging

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3
Q

jobes test is testing for

A

Supraspinatus

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4
Q

Jobe’s test

A

Patient internally rotates arm whilst in 45 degree abduction and 30 degree forward flexion with an extended elbow
Attempts to further abduct against resistance on the elbow results in pain

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5
Q

Belly-press test and Gerber’s test

A

Test for subscapularis

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6
Q

Belly press test

A

Patient presses on their abdomen

Positive if elbow drops posteriorly as there is pain on internal rotation of the shoulder

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7
Q

Gerber’s test

A

Patient holds hand behind their back with palm facing outwards
Push on patient’s hand while they resist movement
Positive if unable to lift hand away from back

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8
Q

Infrasponatus and Teres minor

A

Flex elbow to 90 degrees and externally rotate against resistance

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9
Q

Rotator cuff tear

A

Drop arm sign

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10
Q

Rotator cuff tear movement

A

Patient lowers arm slowly from 160 degree abduction

Positive if patient can’t control the arm, and it drops quickly to the side

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11
Q

Treatment of rotator cuff tear

A

Analgesia and physio

Tears may need surgical repair

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12
Q

Winging

A

Long thoracic nerve

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13
Q

Pain on 0-20 of abduction

A

Full thickness tear (rupture) of the supraspinatus tendon 0-20

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14
Q

Pain on 20-40 abduction

A

Auxiliary nerve damage

Deltoid not working

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15
Q

Pain on abduction 40-60

A

Adhesive capsulitis

Frozen shoulder

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16
Q

Pain on 60-120 abduction arc

A

Subacromial painful arc

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17
Q

Pain on 120-180 abduction

A

Acromioclavicular painful arc

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18
Q

Painful arc test

A

60-120 abduction

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19
Q

Painful arc test results

A

Pain exacerbated by thumb pointing down (empty can sign)

Pain better with thumb pointing up (full can)

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20
Q

Painful arc between 160-180

A

Acromioclavicular joint pathology e.g. OA

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21
Q

neer’s test

A

Passive flexion of the shoulder with a pronated arm, whilst scapula is stabilised

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22
Q

hawkin’s test

A

Shoulder and elbow both flexed to 90 degrees
Pain on passive internal rotation as the rotator cuff rubs on the undersurface of the acromion- external rotation may relieve pain

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23
Q

Treatment of subacromial impingement syndrome

A

Analgesia
Physio
Steroid injection
Surgery (arthroscopic acromioplasty) if this fails

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24
Q

Biceps tendinopathy

A

Speeds test

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25
Speeds test
Ask patient to place arm out in front of them with elbow flexed at 30 degrees and palm facing up Push down on patients palm while they resist movement Positive if pain felt at bicipital groove
26
treatment of biceps tendinopathy
Analgesia (+/- steroid injection but risks tendon repture)
27
Acromioclavicular joint pathology
Scarf test
28
Scarf test
Ask patient to place hand over opposite shoulder as if putting on a scarf Push lightly at the elbow to force abduction Positive if pain at ACJ
29
Shoulder stability
Crank shoulder apprehension test Patient holds their hand out like they’re giving a high-five Then pull back elbow and push proximal humerus forward
30
Function for shoulder
Combing their hair | Put on jacket
31
Adhesive capsulitis (frozen shoulder) symptoms
Reduced active + passive ROM in all directions +/- pain in painful phase
32
Treatment of adhesive capsulitis
Analgesia and physio (if tolerated) | Surgery (manipulation under GA or open/arthroscopic release of adhesions)
33
OA of shoulder history
Often secondary to chronic shoulder instability or chronic rotator cuff tear
34
Treatment of OA
Analgesia and physio +/- steroid injection +/- surgery
35
proximal biceps rupture
Rupture of long head tendon
36
Proximal biceps rupture history
Discomfort after something has ‘gone’ when lifting or pulling
37
Proximal biceps rupture example
‘Ball’ appears in the muscle on elbow flexion like a ‘popeye’ muscle
38
Proximal biceps rupture treatment
repair rarely indicated as function remains | However if tendon insertion is ruptured surgical repair will be needed
39
Distal biceps rupture
Rupture of biceps muscle
40
Distal biceps rupture history
Men involved in heavy lifting | Sometimes ‘tearing’ or ‘popping’ and pain in antecubital fossa with bruising over medial forearm
41
Distal biceps rupture treatment
Needs urgent surgical repair
42
Poly myalgia rheumatica
Pain in shoulders but no weakness, examination of shoulders normal May be associated with mild polyarthritis, tenosynovitis and carpal tunnel syndrome
43
Poly myalgia rheumatica treatment
Prednisolone 15mg/d PO
44
Anterior (glenohumeral) shoulder dislocation history
Usually contact sports with arm forced into abduction, extension, and external rotation
45
Anterior shoulder dislocation exam
Loss of shoulder contour | Anterior bulge from head of humerous
46
Anterior shoulder dislocation investigations
XR
47
Anterior shoulder dislocation treatment
Simple reduction
48
Acromioclavicular dislocation history
Typically direct blow on top of shoulder in young contact-sport athletes or a fall on outstretched hand
49
Acromioclavicular dislocation exam findings
Tender prominence over ACJ | Pain on abduction of arm across body
50
Acromioclavicular investigations
XR
51
Acromioclavicular dislocation treatment
Broad arm sling if minimal displacement | Open reduction and ligament reconstruction for more severe disruption
52
Clavicle fracture history
Direct blow on top of shoulder (common in cyclists) or a fall on outstretched hand
53
Clavicle fracture treatment
Broad arm sling with follow-up on XR at 6 weeks
54
Inflammatory arthritis history
Pain and stiffness in the morning alleviated by movement | Systemic features
55
Inflammatory arthritis investigations
Bloods for inflammatory and autoimmune markers +/- XR
56
Crystal arthropathy history
Acute, extremely painful
57
Gout presentation
``` Elderly Male or post-menopausal female HTN CKD Diuretics (spironolactione, furosemide, thiazides) Diet (alcohol, red meat) Myelo/lymphoproliferative disorders ```
58
CPPD presentation
``` Elderly Haemochromatosis Wilson’s disease Acromegaly Hyper parathyroid is Hypophosphataemia Hypomagnesaemia ```
59
Gout exam
Monoarthritis >50% in 1st MTP Also ankle, foot, hand, wrist, elbow, knee (rare in shoulder) May be tophi found
60
CPPD exam
Acute monoarthritis RA-like polyarthritis or chronic OA with CPPD flares Knee, wrist and shoulder most commonly affected
61
Crystal arthropathy investigations - bloods
Serum urate
62
Crystal arthropathy investigations - Joint aspirate
To exclude septic arthritis In gout- negatively birefringent needle-shaped urate crystals In CPPD- weakly positively birefringent rhomboid-shaped crystals
63
Crystal arthropathy investigations - XR
Gout- soft tissue swelling, then later ‘punched-out’ erosions CPPD- soft tissue calcium deposition and chondrocalcinosis
64
Management of gout
High-dose NSAID/colchicine and rest for acute attack | Allopurinol for prevention
65
Management of CPPD
Rest and cool packs for acute attack | NSAIDs + colchicine for prevention
66
Septic arthritis history and exam
Extremely painful, hot, swollen joint of acute onset | Systemic upset
67
Septic arthritis investigation
Joint aspirate to decompress the joint and send off for Gram stain, MC+s, cytology and polarised light microscopy
68
Septic arthritis treatment
6-12 weeks antibiotics depending on sensitivities | Start flucloxacillin empirically if in doubt
69
Referred pain to shoulder
Neck pathology Cardiac ischaemia (L arm) Pancoast tumour Intra-abdominal pathology touching diaphragm (C3-5 referral)

OSCE (15 decks)

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