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Questions Answered: 238

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200
38

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Anatomy

Upper Limb

Question 8 of 239

A 29 year old man presents with pain in his right shoulder. You are performing a full shoulder examination including special tests. You ask the patient to position his arms elevated to 90 degrees in the scapular plane, with the elbow fully extended, with full medial rotation of the arm, and full pronation of the forearm with thumbs pointing downwards. You ask the patient to resist the downward force you apply to his forearms. Which of the following muscles is being assessed:

 

Answer:

This is the empty can test used to assess the supraspinatus muscle. The test is positive if the patient has pain or weakness.

Rotator Cuff Injury

Anatomy / Upper Limb / Shoulder

Last Updated: 25th January 2019

The two main disorders of the rotator cuff are impingement and tendinopathy.

The supraspinatus muscle is the most commonly injured rotator cuff muscle as it passes beneath the acromion and the acromioclavicular ligament. This space is fixed, therefore any swelling of the supraspinatus muscle, excessive fluid in the subacromial/subdeltoid bursa or subacromial bony spurs, may produce significant impingement when the arm is abducted. The blood supply to the supraspinatus tendon is relatively poor and the tendon is susceptible to degenerative change, which in turn, makes it more susceptible to trauma and partial or full-thickness tears may occur. This will result in painful or weak abduction of the arm at the shoulder.

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  • Biochemistry
  • Blood Gases
  • Haematology
Biochemistry Normal Value
Sodium 135 – 145 mmol/l
Potassium 3.0 – 4.5 mmol/l
Urea 2.5 – 7.5 mmol/l
Glucose 3.5 – 5.0 mmol/l
Creatinine 35 – 135 μmol/l
Alanine Aminotransferase (ALT) 5 – 35 U/l
Gamma-glutamyl Transferase (GGT) < 65 U/l
Alkaline Phosphatase (ALP) 30 – 135 U/l
Aspartate Aminotransferase (AST) < 40 U/l
Total Protein 60 – 80 g/l
Albumin 35 – 50 g/l
Globulin 2.4 – 3.5 g/dl
Amylase < 70 U/l
Total Bilirubin 3 – 17 μmol/l
Calcium 2.1 – 2.5 mmol/l
Chloride 95 – 105 mmol/l
Phosphate 0.8 – 1.4 mmol/l
Haematology Normal Value
Haemoglobin 11.5 – 16.6 g/dl
White Blood Cells 4.0 – 11.0 x 109/l
Platelets 150 – 450 x 109/l
MCV 80 – 96 fl
MCHC 32 – 36 g/dl
Neutrophils 2.0 – 7.5 x 109/l
Lymphocytes 1.5 – 4.0 x 109/l
Monocytes 0.3 – 1.0 x 109/l
Eosinophils 0.1 – 0.5 x 109/l
Basophils < 0.2 x 109/l
Reticulocytes < 2%
Haematocrit 0.35 – 0.49
Red Cell Distribution Width 11 – 15%
Blood Gases Normal Value
pH 7.35 – 7.45
pO2 11 – 14 kPa
pCO2 4.5 – 6.0 kPa
Base Excess -2 – +2 mmol/l
Bicarbonate 24 – 30 mmol/l
Lactate < 2 mmol/l

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