Team Orthobullets 4
American Shoulder and Elbow Surgeons
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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
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An acute posterior shoulder dislocation should be suspected in a patient with pain and the shoulder locked in what position?
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?
Posterior labral tear
Superior labral tear
Humeral avulsion of the glenohumeral ligament (HAGL)
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 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
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?
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 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
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HPI - 58M, s/p motorcycle accident 5 weeks ago.
Isolated LEFT shoulder injury.
Has pain and limited function of left shoulder.
Was seen in ER were he was told x-rays where normal, and now follows up after PMD ordered MRI of shoulder.
Shoulder was normal prior to accident.
What x-ray view would have aided in the initial treatment of this patient?
HPI - 65 yo M alcoholic complains of multiple shoulder dislocations. Most recent dislocation occurred 2 months ago and he has been unable to use the arm for the past 2 months.
Treatment for this chronic posterior shoulder dislocation?