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Questions Answered: 238

Final Score 84%

200

Reference Ranges

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Anatomy

Upper Limb

Question 54 of 239

A 75 year old woman presents with pain and stiffness in her left shoulder joint. You are teaching a medical student how to perform a full shoulder examination. You position the patient with her right arm fully adducted, and with the elbow flexed to 90 degrees. You ask the patient to laterally rotate the arm against resistance. Which of the following muscles is primarily being assessed:

x ✓ Supraspinatus 9%
x ✓ Infraspinatus 50%
x ✓ Teres major 6%
x ✓ Teres minor 26%
x ✓ Subscapularis 9%

Answer:

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

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Rotator Cuff Muscles

The rotator cuff is a common name for the group of four distinct muscles and their tendons that provide strength and stability during motion of the shoulder. They are also referred to as the SITS muscle with reference to the first letter of their names:

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

Table: Function and Assessment of the Rotator Cuff Muscles

Muscle (Innervation)	Function	Assessment
Supraspinatus (suprascapular nerve)	Initiation of abduction of arm to 15 degrees at glenohumeral joint	Empty Can Test: Position the patient with arms elevated to 90 degrees in the scapular plane, with the elbow extended, and full medial rotation and pronation of the forearm with thumbs pointing downwards. Ask the patient to resist the downward force being applied to the forearm. Test is positive if patient has pain or weakness.
Infraspinatus (suprascapular nerve)	Lateral rotation of arm at glenohumeral joint	Infraspinatus Test: Position the patient with the arm fully adducted, with the elbow flexed to 90 degrees. Ask the patient to resist the medially directed force being applied to the arm. Test is positive if patient has pain or weakness.
Teres minor (axillary nerve)	Lateral rotation of arm at glenohumeral joint	Hornblower’s Test: Position the patient with the arm elevated to 90 degrees in the scapular plane and the elbow flexed to 90 degrees. Ask the patient to laterally rotate the arm against resistance. Test is positive if patient has pain or weakness.
Subscapularis (subscapular nerves)	Medial rotation of arm at glenohumeral joint	Lift-off Test: Position the patient in full medial rotation with the dorsum of the hand on the lower back. Ask the patient to lift their hand away from their back against resistance. Test is positive if patient has pain or weakness.

Rotator Cuff Muscles. (Image by Henry Vandyke Carter [Public domain], via Wikimedia Commons)

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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Questions Answered: 238

Final Score 84%

Reference Ranges

Questions

Anatomy

Upper Limb

Answer:

Rotator Cuff Muscles

Anatomy / Upper Limb / Shoulder

Last Updated: 20th February 2019

Table: Function and Assessment of the Rotator Cuff Muscles

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