Exam Corner

Shoulder

Prepared by Mohamed Sukeik
SICOT Associate Member & SICOT Newsletter Editorial Board Member - London, United Kindgom

 

Questions

  1. The humeral head is normally:

    1. Retroverted 30 degrees to the transepicondylar axis of the distal humerus and its articular surface is inclined 150 degrees superiorly relative to the shaft

    2. Retroverted 30 degrees to the transepicondylar axis of the distal humerus and its articular surface is inclined 130 degrees superiorly relative to the shaft

    3. Anteverted 30 degrees to the transepicondylar axis of the distal humerus and its articular surface is inclined 150 degrees superiorly relative to the shaft

    4. Retroverted 45 degrees to the transepicondylar axis of the distal humerus and its articular surface is inclined 130 degrees superiorly relative to the shaft

    5. Anteverted 30 degrees to the transepicondylar axis of the distal humerus and its articular surface is inclined 130 degrees superiorly relative to the shaft
       

  2. The following structures are related to the rotator interval except: 

    1. Coracohumeral ligament

    2. Supraspinatus

    3. Subscapularis

    4. Transverse humeral ligament

    5. Coracoacromial ligament
       

  3. What is a type VI SLAP lesion?

    1. Bucket handle tear of the labrum with intact biceps anchor

    2. Fraying, intact anchor

    3. Bucket handle tear into the biceps insertion

    4. Superior flap tear

    5. Detachment of the biceps anchor
       

  4. The primary restraint to anterior, posterior and inferior glenohumeral translation for 45-90 degrees of glenohumeral elevation is:

    1. Superior glenohumeral ligament

    2. Middle glenohumeral ligament

    3. Transverse humeral ligament

    4. Inferior glenohumeral ligament

    5. Coracoacromial ligament
       

  5. The Crank test is used to diagnose which of the following pathologies?

    1. Rotator cuff tear

    2. Impingement

    3. SLAP tear

    4. Instability

    5. Cervical spine pathology
       

  6. A Putti Platt procedure is an instability correction procedure and includes:

    1. Subscapularis advancement capsular coverage

    2. Subscapularis transfer to greater tuberosity

    3. Transfer of biceps laterally and posteriorly

    4. Coracoid transfer to inferior glenoid

    5. Pants over vest procedure
       

  7. A Boyd-Sisk procedure is an instability correction procedure and includes:

    1. Subscapularis advancement capsular coverage

    2. Subscapularis transfer to greater tuberosity

    3. Transfer of biceps laterally and posteriorly

    4. Coracoid transfer to inferior glenoid

    5. Pants over vest procedure
       

  8. A Bristow procedure is an instability correction procedure and includes:

    1. Subscapularis advancement capsular coverage

    2. Subscapularis transfer to greater tuberosity

    3. Transfer of biceps laterally and posteriorly

    4. Coracoid transfer to inferior glenoid

    5. Pants over vest procedure
       

  9. Which of the following nerve injuries is associated with lateral winging of the scapula:

    1. Suprascapular nerve

    2. Spinal accessory nerve

    3. Long thoracic nerve

    4. Dorsal scapular nerve

    5. Axillary nerve
       

  10. The following structures are potentially endangered in a posterior approach to the shoulder except:

    1. Axillary nerve

    2. Posterior circumflex humeral artery

    3. Suprascapular nerve

    4. Musculocutaneous nerve

    5. Circumflex scapular vessels
       

 

Answers

  1. b
    Reference: Review of Orthopaedics, Miller

  2. e
    Discussion: The interval includes the capsule and coracohumeral ligament that bridge the gap between supraspinatus and subscapularis. It is bounded medially by the lateral coracoids base, superiorly by the anterior edge of the supraspinatus and inferiorly by the superior border of the subscapularis. The transverse humeral ligament forms its apex laterally.
    Reference: Review of Orthopaedics, Miller

  3. d
    Discussion: Type I - Labral and biceps fraying, intact anchor / Type II - Labral fraying with detachment of the biceps tendon anchor / Type III - Bucket handle tear of labrum with intact biceps tendon anchor / Type IV - Bucket handle tear with detached biceps tendon anchor / Type V- SLAP + anterior Labral tear (Bankart) / Type VI: Superior flap tear / Type VII: SLAP + capsular injury
    Reference: Review of Orthopaedics, Miller

  4. d
    Reference: Review of Orthopaedics, Miller

  5. c
    Discussion: The Crank test includes full abduction, humeral loading and rotation and is used to diagnose SLAP tears.
    Reference: Review of Orthopaedics, Miller

  6. a
    Reference: Review of Orthopaedics, Miller

  7. c
    Reference: Review of Orthopaedics, Miller

  8. d
    Reference: Review of Orthopaedics, Miller

  9. b
    Discussion: Spinal accessory nerve supplies trapezius and is associated with lateral winging of the scapula when injured. Long thoracic nerve supplies serratus anterior and is associated with medial winging of the scapula when injured. Dorsal scapular nerve injury is associated with rhomboideus palsy. Osseous origins for winging include osteochondromas and fractures malunion.
    Reference: Review of Orthopaedics, Miller

  10. d
    Discussion: All of the structures listed are potentially endangered in a posterior approach to the shoulder except the musculocutaneous nerve which is at risk during an anterior approach to the shoulder.
    Reference: Surgical Exposures in Orthopaedics, Hoppenfeld