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Anatomy
Upper Limb
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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