Shoulder Joint Quiz

The rotator cuff muscles are: Supraspinatus, Infraspinatus, Teres MINOR and Subscapularis. These muscles can be easily remembered under the acronym S.I.T.S.

Making the correct diagnosis based on quality research is important because it allows the healthcare professional to set up an effective treatment plan. By accurately identifying the patient's condition, the healthcare professional can tailor the treatment specifically to address the underlying problem. This increases the chances of successful outcomes and ultimately leads to the patient's improvement. Without a correct diagnosis, the treatment plan may be ineffective or even harmful, potentially prolonging the patient's suffering. Therefore, it is crucial to rely on quality research and accurate diagnosis to ensure the best possible care for the patient.

Based on the patient's complaints of pain with overhead movements, worsening pain after activities and at night, and a history of shoulder dislocation, along with the findings of pain during abduction and external rotation, and clicking and popping in the shoulder during assessment, it is likely that the patient has shoulder instability. Shoulder instability refers to the excessive movement of the humeral head within the shoulder joint, which can result in pain, clicking, and a feeling of instability. This is often seen in individuals who have experienced a previous shoulder dislocation.

The Clunk test is not a test for shoulder impingement because it is primarily used to assess for glenoid labrum tears and instability. It involves applying anterior and posterior force to the humerus while the shoulder is externally rotated, which can reproduce a clunk or clicking sensation in the shoulder joint. In contrast, the Hawkins-Kennedy test, Painful arc test, and Speed's test are all commonly used to diagnose shoulder impingement. The Hawkins-Kennedy test is performed by flexing the shoulder to 90 degrees and internally rotating the arm, which can reproduce pain in cases of impingement. The Painful arc test involves actively abducting the arm, and if pain is experienced between 60-120 degrees of abduction, it suggests impingement. Speed's test is performed by resisting shoulder flexion with the arm in a forward flexed position, and pain or tenderness in the bicipital groove indicates impingement.

The structures that provide stability of the shoulder joint are muscles, capsule, and labrum. Muscles play a crucial role in stabilizing the joint by providing dynamic support and controlling its movement. The capsule is a strong fibrous structure that surrounds the joint and provides passive stability by limiting excessive movement. The labrum is a cartilaginous structure that deepens the joint socket, providing stability and enhancing the congruency between the bones. Together, these structures work synergistically to maintain the stability and function of the shoulder joint.

The correct answer is the Internal rotation lag test - subscapularis. This test has a 95% sensitivity and a 95% specificity, meaning that it is highly accurate in both detecting true positive cases and ruling out true negative cases. The test specifically targets the subscapularis muscle, which is one of the four muscles that make up the rotator cuff. The subscapularis muscle is responsible for internal rotation of the shoulder joint.

Sensitivity = The % of patients with a positive test outcome who are classified as having the pathology (true positive rate)

Specificity = The % of patients with a negative test outcome who are classified as not having the pathology (true negative rate)

The Apprehension test, Relocation test, and Anterior release test are all shoulder tests used to assess for shoulder instability. The Apprehension test evaluates for anterior shoulder instability by placing the shoulder in a position of apprehension and assessing for pain or a sense of instability. The Relocation test is used to confirm anterior shoulder instability by applying a posteriorly directed force to the shoulder and assessing for a reduction in symptoms. The Anterior release test is used to assess for a labral tear or instability by reproducing symptoms with an anteriorly directed force on the shoulder. These tests are commonly performed together to evaluate for shoulder instability.

The given answer includes red flags specific for the shoulder joint. Bilateral shoulder and neck pain can indicate a systemic cause such as rheumatoid arthritis or polymyalgia rheumatica. Recent convulsion or electric shock can suggest a traumatic injury to the shoulder joint. Positive drop arm test is indicative of a rotator cuff tear. Headache, jaw pain, and blurred vision can be signs of cervical spine pathology affecting the shoulder joint. Therefore, these symptoms should be considered as red flags specific for the shoulder joint. Referred pain to the hand and change in shoulder contour without loss of rotation are not specific red flags for the shoulder joint.