4.1 of 47 Ratings
A 19-year-old collegiate pitcher presents to your clinic with a right shoulder injury he sustained 6 weeks prior while sliding into a base. He endorses pain and weakness of the right shoulder, especially while bench pressing. Physical examination reveals a positive Kim's test, a negative O'Brien's test, and normal rotator cuff strength. Radiographs are unremarkable. MRI confirms the suspected injury without any evidence of bony abnormalities. The patient would like to proceed with surgical treatment. What is the most likely complication after the appropriate surgical treatment for this patient?
Decreased internal rotation
Glenohumeral joint arthritis.
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An 18-year-old football linebacker reports persistent left shoulder pain for the past 3 months. He complains of a feeling of instability and an inability to perform a bench-press or push-up. He has a positive posterior jerk and Kim test. Radiographs show no fracture and the shoulder is shown to be well-located on the axillary view. Which of the following acts as the primary restraint to posterior displacement of the shoulder in the position of flexion and internal rotation?
Anterior band of the inferior glenohumeral ligament
Middle glenohumeral ligament
Posterior band of the inferior glenohumeral ligament
A 17-year-old offensive lineman presents with acute on chronic right shoulder pain. His season is nearly complete but the pain began months prior as he increased his pre-season weightlifting regimen, emphasizing the bench press and similar lifts. Pain has persisted since then and now bothers him constantly, and is exacerbated when blocking oncoming defenders. On exam, his right shoulder pain is easily reproduced and now with a palpable clunk. What finding would you expect to see on his MRI and what is the best surgical procedure to address this?
Antero-inferior labral tear; arthroscopic labral repair
Posterior labral tear; arthroscopic labral repair
Posterior labral tear; arthroscopic thermal capsulorraphy
Superior labral tear from 12 o'clock to 2 o'clock; arthroscopic labral debridement versus repair
Superior labral tear from 12 o'clock to 2 o'clock; arthroscopic biceps tenodesis
A 27-year-old right hand dominant construction worker falls off a scaffold onto his outstretched arm. Figure A exhibits the radiograph taken at a local emergency room. Following treatment, he is placed in a sling and follows up at your office two weeks later. He complains of a feeling that his arm is going to 'pop out'. Which specific physical examination finding is likely to be present?
Apprehension Sign with shoulder abducted and externally rotated
Which of the following patients may benefit from a lesser tuberosity transfer (modified McLaughlin procedure)?
A kidney transplant recipient with AVN of the humeral head
A patient with severe rheumatoid arthritis
A young man with a locked posterior dislocation following an electric shock injury at work
A patient with a history of previous shoulder surgery that now has subscapularis insufficiency
A patient with a large Hill-Sachs defect following an anterior shoulder dislocation
A 26-year-old football offensive lineman presents with shoulder pain which is affecting his ability to block effectively. On exam, he has a positive jerk test and a positive Kim test. What is his most likely diagnosis?
Posterior labral tear
An acute posterior shoulder dislocation should be suspected in a patient with pain and the shoulder locked in what position?
A football player subluxates his shoulder while blocking with his arm forward flexed and internally rotated. The “Jerk” test is positive. What is his most likely pathology?
Glenohumeral internal rotation deficit
A football linemen has posterior shoulder pain after making a block with his arm in forward flexion and internal rotation. What is the most likely diagnosis?
Superior labral tear
Humeral avulsion of the glenohumeral ligament (HAGL)
A 35-year-old man awoke following a night of heavy drinking with severe right shoulder pain and inability to raise his arm above his head. A radiograph from the emergency room is provided in Figure A. He was treated with a sling for a diagnosis of rotator cuff tear. Six weeks later, he complains of continued pain and difficulty using the arm. Which of the following is the next best step in management?
Physical therapy for range of motion followed by rotator cuff and deltoid strengthening exercises
Axillary radiograph of the shoulder
EMG to evaluate the suprascapular and axillary nerves
Arthroscopic rotator cuff repair
Open subacromial decompression and latissimus dorsi transfer for massive cuff tear
Posterior glenohumeral dislocations are as common as anterior dislocations in which of the following patient groups?
Marfan's syndrome patients
Renal failure patients
A 63-year-old diabetic female complains of left shoulder pain and decreased range of motion 7 months after a fall onto her left side. On physical examination she has marked decrease in external rotation. A radiograph obtained earlier that day at her primary care office is displayed in Figure A. What is the next step in management?
Physical therapy for adhesive capsulitis secondary to chronic 2-part humeral head fracture
Proximal humeral arthroplasty
Obtain further radiographic studies
Open reduction and internal fixation of the chronic 2-part humeral head fracture
Sling immobilization for 10-14 days then begin physical therapy for chronic 2-part humeral head fracture
A 25-year old female with a seizure disorder complains of persistent left shoulder pain after sustaining a seizure 1 week ago. She was placed in a sling in the ER and is following up in your office. Figure A shows the radiograph taken in the ER. On examination, her range of motion is limited and is only able to externally rotate to neutral. What is the next step in management?
Sling use for comfort and follow-up in 2 weeks
Repeat True AP radiograph
Axillary lateral radiograph
MRI of the shoulder
Intra-articular cortisone injection with range of motion exercises