Welcome to another MedGuide quiz. This is part two of the Upper Limb Disorder series of presentations, focusing on the shoulder and brachial plexus clinical anatomy and imaging. Good luck!
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Clinically Applied Shoulder Anatomy
Stem 1 of 5Read the following vignette and then answer the subsequent questions:
A 22YO male fell whilst on a jog yesterday. He presents to his primary care practitioner with crepitus of the shoulder joint, reduced range of motion in abduction and external rotation - notable by being unable to carry his coat into the consultation room - and generalised weakness of the proximal upper limb due to the pain.
Which muscle is least likely implicated in the patient’s diagnosis?
None of the above
Stem 2 of 5On examination, shoulder bulk is observed. Which nerve lesion would be implicated in atrophy of this region?
Stem 3 of 5The patient’s range of motion is severely restricted, with pain severe. What is the next best stage?
Discharge for 4 month follow-up
Discharge with no treatment
Refer to chronic pain clinic
Refer to physiotherapy
Surgical repair of cuff
Stem 4 of 5On plain radiography, osteophytes are seen impinging on the tendon attaching to the lesser tubercle. Which of the following actions will likely be affected?
Circumduction of the shoulder
Extension of the shoulder
External rotation of the shoulder
Flexion of the shoulder
Internal rotation of the shoulder
Stem 5 of 5During the consultation, the patient is asked to abduct their shoulder. Which nerves are tested in this movement? Select all which may apply.
Stem 1 of 6Read the following vignette and then answer the subsequent questions:
A 43YO female was walking through the office at work when she tripped on a wet floor, catching herself with arms outstretched as she fell forward. Her shoulder felt "out of place", and a colleague brought her to ED for assessment. She is cradling her shoulder in an internally rotated position, mid-flexed at the elbow on presentation.
Given the presentation of the patient, which manoeuver is indicated?
Stem 2 of 6The surgical neck of the humerus receives the humeral circumflex artery which supplies portions of the rotator cuff. Which other arteries from the list below are integral to this group of muscles?
Internal mammary artery
Lateral thoracic artery
Stem 3 of 6Following the patient’s anterior dislocation, they are complaining of tingling in the forearm “just above my thumb”. Which irritated nerve is the most likely cause?
Stem 4 of 6Which of the following statements are true of the action of shoulder adduction?
The lateral pectoral nerve is implicated in adduction
The latissimus dorsi is involved in adduction
The medial pectoral nerve is implicated in adduction
The muscle insertion on the lesser tubercle adducts
The normal range of motion lies between 30-40º
Stem 5 of 6Imaging of the patient reveals the below finding. Name the lesion.
Reverse Hill Sacks
None of the above
Stem 6 of 6What is the gold-standard pre-procedure preparation of this patient?
General anaesthesia induction
Intravenous benzodiazepine and opiate
No analgesia required
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- Moore, K.L. and Dalley, A.F., 2018. Clinically oriented anatomy. Wolters-Kluwer india Pvt Ltd.
- Patel, M. (2020). Bankart lesion. Available: https://radiopaedia.org/cases/bankart-lesion?lang=gb. Last accessed August 2020.
- Williams, N.S., O’Connell, P.R. and McCaskie, A. eds., 2018. Bailey & Love’s Short Practice of Surgery: The Collector’s edition. CRC press.
- Winstanley, J., 2008. Churchill’s Pocketbook of Surgery (3rd edn).