4.3 of 79 Ratings
A 47-year-old woman presents with concerns of chronic right shoulder pain and stiffness without antecedent trauma. She has significantly limited right shoulder active and passive range of motion (ROM) in all planes but full left shoulder active and passive ROM. Her MRI is depicted in Figure A. What is the pathophysiology of her diagnosis and what other findings would most likely be observed?
Isolated posterior capsular tightness; Hemoglobin A1C 11.7%
Isolated posterior capsular tightness; TSH 15 mU/L
Fibroblastic proliferation of joint capsule; Hemoglobin A1C 11.7%
Decreased blood supply to humeral head leading to bony matrix cell death; TSH 15 mU/L
Chronic degenerative tear of shoulder-stabilizing tendons; Hemoglobin A1C 11.7%
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The right shoulder exercise seen in Figure A will put the LEAST amount of stretch on which structure?
Inferior glenohumeral ligament
Superior glenohumeral ligament
Which of the following patients is most likely to have a fibroblastic proliferative process as a cause for their shoulder complaints?
65-year-old man with giant cell arteritis and bilateral shoulder pain and stiffness.
40-year-old man with a history of podagra who now has acute shoulder pain.
50-year-old woman with hypothyroidism and loss of both active and passive shoulder motion.
65-year-old woman with ulnar drift of the fingers and shoulder pain and stiffness.
40-year-old woman with antinuclear antibodies with knee and shoulder pain
A 60 year-old diabetic man presents with increasing right shoulder pain and stiffness for 10 weeks. He works as a lawyer and has been treating the pain with non-steroidal anti-inflammatory drugs with little improvement. He had a previous injury to his right shoulder 15 years ago while playing hockey, but cannot recall any recent precipitants for this presentation. Physical examination shows significant reduction in right shoulder range of motion, with the greatest loss in external rotation. His MRI images are seen in Figures A-C. What would be the most appropriate treatment?
Open supraspinatus cuff repair
Arthroscopic supraspinatus cuff repair
Reverse shoulder arthroplasty
Arthroscopic posterior capsular release
Physical therapy and medical management
A 45-year-old patient with a history of diabetes presents with increasing shoulder stiffness over the course of the past several months. She has tried non-steroidal anti-inflammatory drugs, but they have not alleviated her pain. On examination she has global pain with passive range of motion, forward elevation of 100 degrees, external rotation to neutral, and internal rotation to her iliac crest. Radiographs of the shoulder are normal. An MR arthrogram is most likely to show which of the following?
Massive retracted rotator cuff tear
Proliferative synovial process with hypertrophied synovium and extensive papillary projections
Decreased intra-capsular volume
Subscapularis tear with long head of the biceps subluxation
Fluid extravasation down the humerus
A 42-year-old female presents to your office with pain in the shoulder that has been present for 1 month, and she notes the shoulder is also becoming stiff. She has not previously sought treatment. After a full evaluation, you determine she has adhesive capsulitis, and is in the early stiffening stage. What treatment do you recommend?
Immediate aggressive therapy for active-assisted and passive range of motion exercises
Platelet-rich plasma (PRP) injections
Arthroscopic lysis of adhesions and bursectomy
Reassurance and a gentle stretching program as symptoms allow
Manipulation under anesthesia
Which of the following statements is true regarding the anatomical boundaries of the rotator interval in the shoulder?
Superior border is defined by the biceps long head tendon
Inferior border is defined by anterior band of inferior glenohumeral ligament
Contains the axillary pouch which is a common site for intra-articular loose bodies
Superior border is defined by anterior edge of suprapinatus tendon
Inferior border is defined by middle glenohumeral ligament
A 51-year-old diabetic female has been treated with non-operatively for left shoulder stiffness for the last six months. Despite physical therapy and two corticosteroid injections, she has only been able to achieve 15 degrees of external rotation. She elects arthroscopic treatment. Which of the following interventions would best mitigate the chances of her developing the most common complication of surgical treatment?
Perioperative prophylactic intravenous antibiotic administration
Avoidance of inadvertent division of the subscapularis tendon
Post-operative oral non-steroidal anti-inflammatory drug (NSAID) usage
Immediate range of motion and physical therapy
Taking care not to divide the inferior capsule further than the thickness of the capsule alone
Which of the following is a known risk factor for the development of adhesive capsulitis of the shoulder?
All of the above
Which of the following is the most common outcome following non-operative management of adhesive capsulitis with a stretching program?
Functionally limiting pain
Decreased range of motion compared to contralateral shoulder
Recurrence of adhesive capsulitis
Need for operative intervention
Development of rotator cuff arthropathy