4.1 of 56 Ratings
A 13-year-old baseball pitcher presents with persistent pain of the right shoulder over the last 2 years. He denies any antecedent trauma or dislocations. They report sensations of instability when performing activities with external rotation and abduction. Physical examination reveals an internal rotation deficit of 10 degrees on the right shoulder. The patient is able to hyperextend the elbows and knees to 12 degrees, can place both palms on the floor with knees fully extended, and hyperextend the small finger MCP joint past 90 degrees. There is a positive anterior and posterior load and shift test with a positive sulcus sign. What is the likely diagnosis and next best step in management?
Labral tear; MRI of the shoulder
Glenohumeral internal rotation deficit; sleeper stretches
Multidirectional instability; periscapular muscle training
SLAP tear; MRI arthrogram of the shoulder
Little leauger's shoulder; refrain from pitching for 3 months
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A 17-year-old gymnast comes to your clinic reporting multiple atraumatic shoulder dislocation events. She has been able to reduce her shoulder on her own without a single trip to the emergency department. Radiographs are normal and an MRI arthrogram is seen in Figure A. Which of the following physical exam findings is most likely to be present?
Cross-body adduction test
Increased external rotation in adduction
A 19-year-old female presents with bilateral shoulder pain and instability during volleyball practice. She denies any injuries. Physical exam elicits pain when her arm is internally rotated with her shoulder forward flexed to 90 degrees. In the seated position there is a 2cm sulcus present with inferior traction on each arm. Radiographs are unremarkable. Her representative MRI images from her right shoulder are seen in figures A and B, which are identical to her other side. What is the most appropriate initial treatment?
Bilateral glenohumeral corticosteriod injections and physical therapy
Bilateral subacromial corticosteriod injections and physical therapy
Bilateral staged arthroscopic labral repair and capsulorrhaphies
Bilateral staged open capsular shifts
Which of the following is true regarding closure of the rotator interval in patients undergoing arthroscopic shoulder stabilization?
It can lead to recurrent instability
It restricts external rotation predominately in the "arm cocking" phase of throwing
It restricts combined flexion and cross-body adduction
It restricts external rotation predominately with the arm at 0 degrees of shoulder abduction
It restricts internal rotation predominately with the arm at 90 degrees of shoulder abduction
A 16-year-old swimmer has pain and weakness in her dominant shoulder with overhead use. Her physical examination demonstrates a +2 anterior and posterior load and shift test. There is 1.5cm of sulcus sign evident with the arm at adduction and 30 degrees of external rotation. Her radiographs are normal. What is the most appropriate next step in management?
Arthroscopic anterior and posterior labral repair
Arthroscopic anterior and posterior labral repair with rotator interval closure
Home stretching program with emphasis on posterior capsular stretching
Dynamic stabilization therapy
Sport specific bracing
What procedure can eliminate a sulcus sign?
Rotator interval closure
A freshman collegiate swimmer complains of right shoulder pain after increasing his workout duration and intensity. He denies trauma and admits to popping his shoulders in and out voluntarily since the age of 8. Exam reveals bilateral anterior shoulder apprehension and relocation, positive jerk test, and a 2cm sulcus bilaterally. O’Brien active compression tests are negative bilaterally. Radiographs are normal and MR arthrogram of his right shoulder is shown in Figures A and B. What is the best initial treatment?
Shoulder range of motion program with emphasis on posterior capsular stretching
Shoulder arthroscopy with anterior and posterior capsulolabral plication with superior shift
Shoulder arthroscopy with thermal capsulorrhaphy and rotator interval closure
Shoulder arthroscopy with repair of humeral avulsion of the glenohumeral ligament (HAGL) lesion
Rotator cuff and peri-scapular muscular strengthening program
A 20-year-old girl reports a shoulder dislocation while reaching for a high shelf. Her history reveals multiple past dislocations with spontaneous reduction and no obvious traumatic event at onset. A photograph of her hand is shown in figure A. What is the most likely etiology of her shoulder instability?
inverted pear glenoid with bone deficiency
long thoracic nerve palsy
An 18-year-old high school volleyball player is being treated for multidirectional instability of the right shoulder with a physical therapy program. She has intermittent pain and instability and episodic numbness and weakness in the ipsilateral hand. All of the following are characteristic features of a generalized connective tissue disorder EXCEPT:
Elbow hyperextension of the left arm
Left 5th finger passive extension beyond 90°
Genu recurvatum of the bilateral knees
Excessive supination of the left forearm
Abducted thumb to reach the ipsilateral forearm (thumb-to-forearm test) of the right hand