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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

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Question 1

Stem 1 of 5

Read 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?
A
Infraspinatus
B
Subscapularis
C
Supraspinatus
D
Teres minor
E
None of the above
Question 2

Stem 2 of 5

On examination, shoulder bulk is observed. Which nerve lesion would be implicated in atrophy of this region?
A
Axillary
B
Median
C
Musculocutaneous
D
Radial
E
Ulnar
Question 3

Stem 3 of 5

The patient’s range of motion is severely restricted, with pain severe. What is the next best stage?
A
Discharge for 4 month follow-up
B
Discharge with no treatment
C
Refer to chronic pain clinic
D
Refer to physiotherapy
E
Surgical repair of cuff
Question 4

Stem 4 of 5

On plain radiography, osteophytes are seen impinging on the tendon attaching to the lesser tubercle. Which of the following actions will likely be affected?
A
Circumduction of the shoulder
B
Extension of the shoulder
C
External rotation of the shoulder
D
Flexion of the shoulder
E
Internal rotation of the shoulder
Question 5

Stem 5 of 5

During the consultation, the patient is asked to abduct their shoulder. Which nerves are tested in this movement? Select all which may apply.
A
Accessory
B
Axillary
C
Median
D
Radial
E
Supraspinous
Question 6

Stem 1 of 6

Read 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?
A
Klinton’s
B
Klumpke’s
C
Kocher’s
D
Kraven’s
E
Kringle’s
Question 7

Stem 2 of 6

The 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?
A
Internal mammary artery
B
Lateral thoracic artery
C
Suprascapular artery
D
Supraspinus artery
E
Supscapular artery
Question 8

Stem 3 of 6

Following 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?
A
Axillary
B
Median
C
Musculocutaneous
D
Radial
E
Ulnar
Question 9

Stem 4 of 6

Which of the following statements are true of the action of shoulder adduction?
A
The lateral pectoral nerve is implicated in adduction
B
The latissimus dorsi is involved in adduction
C
The medial pectoral nerve is implicated in adduction
D
The muscle insertion on the lesser tubercle adducts
E
The normal range of motion lies between 30-40Âş
Question 10

Stem 5 of 6

Imaging of the patient reveals the below finding. Name the lesion.
A
Bankart
B
Cunningham
C
Hill Sacks
D
Reverse Hill Sacks
E
None of the above
Question 11

Stem 6 of 6

What is the gold-standard pre-procedure preparation of this patient?
A
General anaesthesia induction
B
Inhaled entonox
C
Intravenous benzodiazepine and opiate
D
No analgesia required
E
Oral benzodiazepine
Once you are finished, click the button below. Any items you have not completed will be marked incorrect. Get Results
There are 11 questions to complete.
References 

  • Macleod, J., 2018. Macleod’s clinical examination. Elsevier Health Sciences.
  • 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).

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