Acute Shoulder Injuries

Open Ended

What is your Differential Diagnoses for Acute Shoulder Injuries? Consider Bone, Muscle, Ligament, Neurovascular causes

Multiple Choice

A 17-year-old high school football wide receiver is tackled during a game and lands directly on the lateral aspect of his shoulder while his arm is adducted. He complains of pain at the top of the shoulder. On exam, there is a prominent step-off at the distal clavicle and tenderness over the AC joint. Pain is reproduced with cross-body adduction. What is the likely diagnosis?

• ACJ Sprain, Grade III

• Clavicle Fracture

• RTC Tear

• SCJ Sprain

Multiple Choice

A 15-year-old soccer player falls onto the lateral shoulder during a collision. He holds his arm close to his chest and reports pain over the mid-shaft of the clavicle. On exam, there is swelling, tenderness, and visible skin tenting. Gentle palpation produces crepitus.

What is the diagnosis, and does it require emergent surgical evaluation?

• Mid-clavicular Fracture, no

• ACJ Dislocation, no

• Mid-clavicular Fracture, yes

• SCJ sprain, yes (reread the question stem)

Multiple Choice

A 21-year-old college basketball player goes up for a rebound and lands on his arm and shoulder after being pushed in the air. He has difficulty lifting up his arm. He gets subbed out, and on evaluation, The shoulder appears squared-off and he cannot lift his arm up. He is neurovascularly intact except for mild decreased sensation over the lateral deltoid. What is his diagnosis?

• RTC Tear

• Anterior Shoulder Dislocation

• Posterior Shoulder Dislocation

• Inferior Shoulder Dislocation

Multiple Select

What is the most common finding(s) after an anterior shoulder dislocation?

• Bankart lesion

• Hill-Sachs lesion

• Proximal humerus fracture

• Rotator cuff tear

Multiple Select

Which of the following are important pearls for sideline reduction of a shoulder dislocation?

• Always check neurovascular status before and after reduction

• Try at most 2 times

• If unable to reduce, send to the ED

• The gold standard reduction technique is the Kocher method

Multiple Choice

A 21-year-old college baseball pitcher slid headfirst into second base and felt a sudden pop in his shoulder. He immediately developed deep shoulder pain and noticed a catching sensation when trying to throw. Shoulder ROM is full but painful at the extremes of abduction and external rotation. Lift-off and belly-press tests are negative. What is the most likely diagnosis and a commonly used special exam test?

• Posterior Impingement, Kim's Test

• Acute SLAP Tear, O'Brien's

• Anterior Shoulder Subluxation, Apprehension

• Distal Biceps tendon rupture, Hook Test

Multiple Choice

A 47-year-old recreational tennis player felt a sudden “pop” in the shoulder while reaching overhead for a serve. He has weakness with lifting his arm up. What is the likely diagnosis, and what is the likely tendon involved?

• RTC Tear, Subscapularis

• Labral Tear

• RTC Tear, Infraspinatus

• RTC Tear, Supraspinatus

Multiple Choice

A 16-year-old high school linebacker experiences a sharp burning sensation radiating down the arm after a tackle where his head was forced laterally. Weakness is noted in shoulder abduction and elbow flexion but resolves within 10 minutes. Exam shows normal cervical spine alignment, full ROM, and symmetric reflexes. What is the diagnosis, and can he return to play?

• Cervical Radiculopathy, yes

• Brachial Plexus Neuropraxia, No

• Cervical Radiculopathy, no

• Brachial Plexus Neuropraxia, Yes