Shoulder Problems

Question 1

Which muscles make up the rotator cuff and which movements are they responsible for?

Answer 1

Supraspinatus - initiates abduction
Infraspinatus + teres minor - external rotators
Subscapularis - internal rotator

Question 2

Which muscle is responsible for abducting the arm?

Answer 2

Deltoid

supraspinatus initiates

Question 3

What is impingement syndrome of the shoulder?

Answer 3

Painful arc between 60-120 degrees

- tendons of rotator cuff (mainly supraspinatus) are compressed in the subacromial space during movement –> pain

Question 4

What are some causes of impingement syndrome?

Answer 4

Tendonitis
Subacromial bursitis
Acromioclavicular OA + inferior osteophyte
Hooked acromion
Rotator cuff tear

Question 5

What are the clinical features of impingement syndrome?

Answer 5

Painful arc 60-120 degrees
Pain radiates to deltoid and upper arm
Tenderness below lateral edge of acromion
Hawkins-Kennedy test induces pain

Question 6

How is impingement syndrome diagnosed?

Answer 6

Clinically

Can be confirmed with MRI

Question 7

What is the management for impingement syndrome?

Answer 7

NSAIDs, analgesia, physio + subacromial steroid injection (up to 3x)
If no response in 6 months –> subacromial decompression surgery

Question 8

What is the usual clinical picture in a patient with a rotator cuff tear?

Answer 8

Sudden jerk in a patient > 40 –> pain + weakness

Question 9

Which muscles are usually affected in a rotator cuff tear?

Answer 9

Usually supraspinatus

Large tears may extend into subscapularis + infraspinatus

Question 10

What are the examination findings in a rotator cuff tear?

Answer 10

Weakness of initiation of abduction (supraspinatus) +/- internal and external rotation

Question 11

Which tests can be done to identify tears in specific rotator cuff muscles?

Answer 11

Jobe’s test –> supraspinatus (weakness)
Gerber’s test –> subscapularis
Posterior cuff test –> infraspinatus + teres minor

Question 12

How is a rotator cuff tear diagnosed?

Answer 12

USS or MRI

Question 13

What are the management options for rotator cuff tear?

Answer 13

Conservative first line:
- analgesia, physio +/- steroid injection
Surgery - rotator cuff repair
- tends to fail because tears usually occur in diseased (degenerative) tendons

Question 14

What is another name for frozen shoulder?

Answer 14

Adhesive capsulitis

Question 15

Which age group tend to get frozen shoulder?

Answer 15

40-60 years old

Question 16

What is the usually clinical course in frozen shoulder?

Answer 16

Initially pain predominates
Then becomes very stiff
Gradually ‘thaws’
Resolves after about 18-24 months

Question 17

Which conditions are associated with frozen shoulder?

Answer 17

Diabetes
Hyperlipidaemia
Dupuytren’s disease

Question 18

How is frozen shoulder diagnosed?

Answer 18

Clinically

Question 19

What is the management for frozen shoulder?

Answer 19

Physiotherapy, keep exercising
Paracetamol + NSAIDs
Steroid injection/oral steroids if failing to improve
If still no better –> manipulation under anaesthetic or surgical capsular release

Question 20

What is acute calcific tendonitis?

Answer 20

Acute severe shoulder pain due to calcium deposits in supraspinatus tendon

Question 21

How is acute calcific tendonitis diagnosed?

Answer 21

Xray –> calcium deposits seen just proximal to greater tuberosity

Question 22

What are the clinical features of biceps tendonitis?

Answer 22

Inflammation of tendon of long head of biceps –>

• anterior shoulder pain
• pain on resisted biceps contraction
• tendon can rupture –> bunched up muscle ‘Popeye deformity)

Question 23

What is the management of biceps tendonitis?

Answer 23

Analgesia, ice therapy, physio

US guided steroid injections

Question 24

Which structures may cause referred pain in the shoulder?

Answer 24

Neck
Cardiac
Diaphragmatic irritation