Shoulder Joint Quiz

1.

Which of the following are red flags specific for the shoulder joint?

A.

Bilateral shoulder and neck pain
B.

Recent convulsion or electric shock
C.

Change in shoulder contour without loss of rotation
D.

Positive drop arm test
E.

Headache, jaw pain, blurred vision
F.

Referred pain to the hand

Correct Answer(s)
A. Bilateral shoulder and neck pain
B. Recent convulsion or electric shock
D. Positive drop arm test
E. Headache, jaw pain, blurred vision

Explanation
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.

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2.

Which of the following is NOT a rotator cuff muscle

A.

Supraspinatus
B.

Infraspinatus
C.

Teres major
D.

Subscapularis

Correct Answer
C. Teres major

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

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3.

Which rotator cuff test has a 95% sensitivity and a 95% specificity? And which muscle does this test test?

A.

External rotation lag test - supraspinatus
B.

External rotation lag test - subscapularis
C.

Internal rotation lag test - supraspinatus
D.

Internal rotation lag test - subscapularis

Correct Answer
D. Internal rotation lag test - subscapularis

Explanation
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.

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4.

Which of the following test is not a test for shoulder impingement?

A.

Hawkins-Kennedy test
B.

Painful arc test
C.

Clunk test
D.

Speed's test

Correct Answer
C. Clunk test

Explanation
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.

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5.

Which structures provide stability of the shoulder joint?

A.

Muscles
B.

Capsule
C.

Labrum

Correct Answer(s)
A. Muscles
B. Capsule
C. Labrum

Explanation
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.

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6.

The apprehension test has a sensitivity of 60% and a specificity of 95% to diagnose anterior shoulder instability. What does this mean?

A.

Of 100 patients with anterior shoulder instability, 60 patients will have a positive apprehension test.
B.

Of 100 patients without anterior shoulder instability, 60 patients will have a negative apprehension test
C.

Of 100 patients with anterior shoulder instability, 95 patients will have a positive apprehension test.
D.

Of 100 patients without anterior shoulder instability, 95 patients will have a negative apprehension test

Correct Answer(s)
A. Of 100 patients with anterior shoulder instability, 60 patients will have a positive apprehension test.
D. Of 100 patients without anterior shoulder instability, 95 patients will have a negative apprehension test

Explanation
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)

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7.

Why do you think it is important to make the correct diagnosis based on quality research?

A.

A correct diagnosis adds value to the quality of literature
B.

A correct diagnosis makes you a better physiotherapist
C.

A correct diagnosis allows you to set up an effective treatment plan and ultimately make the patient better

Correct Answer
C. A correct diagnosis allows you to set up an effective treatment plan and ultimately make the patient better

Explanation
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.

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8.

When a 25 year old patient comes into your practice with the following complaints: - Pain with overhead movements - Pain usually gets worse after activities and at night - Shoulder has been dislocated one year ago During the assessment you notice that the patient has pain when abducting and externally rotating his shoulder. Also, the patient's shoulder is clicking and popping during the assessment. What would you suspect the patient to have?

A.

Shoulder instability
B.

Labrum lesion
C.

Shoulder impingement
D.

Rotator cuff pathology

Correct Answer
A. Shoulder instability

Explanation
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.

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9.

Which tests would you perform on this patient?

A.

Apprehension test
B.

Relocation test
C.

Biceps load II test
D.

O'Brien test
E.

Anterior release test
F.

Neer test

Correct Answer(s)
A. Apprehension test
B. Relocation test
E. Anterior release test

Explanation
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.

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