Rotator Cuff Pathology — MCQs
In painful arc syndrome, which movement is painful?
Patient with shoulder dislocation has axillary nerve injury. Which movement will be most affected?
First-line treatment for non-displaced scaphoid fracture
Most common muscle affected in rotator cuff group is -
Painful arc syndrome is caused by impingement of ?
Lift off test is done to assess the function of:
A 35-year-old male wrestler is admitted to the emergency department with excruciating pain in his right shoulder and proximal arm. During physical examination the patient clutches the arm at the elbow with his opposite hand and is unable to move the injured limb. Radiographic studies show that the patient has a dislocation of the humerus at the glenohumeral joint. Which of the following conditions is the most likely?
Patient is able to abduct, internally rotate and take his arm up to lumbosacral spine but not able to lift off. What is the probable diagnosis?
Which one of the following tests will you adopt while examining a knee joint where you suspect an old tear of anterior cruciate ligament?
A 52-year-old female complains of increasing pain in the right shoulder. She is also finding it increasingly difficult to do overhead abduction of the affected joint. She had been diagnosed as a diabetic 20 years back and is on treatment since then. What is the most likely cause of her clinical condition?
Rotator Cuff Pathology Indian Medical PG Practice Questions and MCQs
Question 1: In painful arc syndrome, which movement is painful?
- A. Abduction between 60 and 120 degrees (Correct Answer)
- B. Abduction beyond 120 degrees
- C. Abduction between 0 and 60 degrees
- D. Pain throughout the full range of abduction
Explanation: ***Abduction between 60 and 120 degrees*** - Painful arc syndrome, often associated with **rotator cuff tendinopathy** or **subacromial impingement**, causes pain during the middle range of shoulder abduction. - In this range, the **supraspinatus tendon** and **subacromial bursa** are most likely to be compressed under the acromial arch. *Abduction beyond 120 degrees* - Pain during abduction beyond 120 degrees typically suggests pathology involving the **acromioclavicular (AC) joint** or other superior structures after the subacromial space has cleared. - This range is usually less painful in classic painful arc syndrome because the rotator cuff structures have passed beneath the acromion. *Abduction between 0 and 60 degrees* - Pain in the initial phase of abduction (0-60 degrees) often indicates a problem with the **deltoid muscle** or a more severe rotator cuff tear, where initiating movement is difficult. - In painful arc syndrome, the initial movement is usually pain-free. *Pain throughout the full range of abduction* - Generalized pain throughout the entire range of abduction points towards a more diffuse problem, such as **adhesive capsulitis (frozen shoulder)** or severe **glenohumeral arthritis**. - A painful arc specifically implies a localized source of impingement that only occurs within a certain range of motion.
Question 2: Patient with shoulder dislocation has axillary nerve injury. Which movement will be most affected?
- A. Forward Flexion
- B. Internal Rotation
- C. Shoulder Abduction (Correct Answer)
- D. External Rotation
Explanation: ***Shoulder Abduction*** - The **axillary nerve** innervates the **deltoid muscle**, which is the primary muscle responsible for **shoulder abduction** beyond the initial 15 degrees. - Injury to this nerve would significantly impair the patient's ability to lift their arm away from their body. *Forward Flexion* - **Forward flexion** of the shoulder is primarily carried out by the **anterior deltoid**, **pectoralis major**, and **coracobrachialis muscles**. - While the anterior deltoid is affected, other muscles can still contribute to this movement, making it less severely impaired than abduction. *Internal Rotation* - **Internal rotation** is largely controlled by the **subscapularis**, **latissimus dorsi**, **teres major**, and **pectoralis major**. - These muscles are not innervated by the axillary nerve, so internal rotation would be largely preserved. *External Rotation* - **External rotation** is primarily performed by the **infraspinatus** and **teres minor muscles**. - These muscles are supplied by the **suprascapular nerve** and **axillary nerve** (for teres minor), respectively, but the deltoid's role is minimal, so overall external rotation would be less affected compared to abduction.
Question 3: First-line treatment for non-displaced scaphoid fracture
- A. Compression Plating
- B. Compression Screws
- C. Conservative (Correct Answer)
- D. Traction
Explanation: ***Conservative*** - Non-displaced scaphoid fractures are typically managed conservatively with **cast immobilization** due to the bone's precarious blood supply. - This approach aims for sufficient **healing without operative risks**, with a long casting period (often 6-12 weeks) to ensure union. *Compression Plating* - **Compression plating** is generally reserved for **complex or displaced scaphoid fractures** that require more robust fixation. - It is an **invasive surgical option** that carries risks beyond what is typically necessary for a non-displaced fracture. *Compression Screws* - **Compression screws** (e.g., Herbert screw) are used for **surgical fixation** of scaphoid fractures, particularly displaced or unstable types. - This method is more invasive than conservative management and involves risks like **avascular necrosis** or **non-union** if not properly performed. *Traction* - **Traction** is rarely used as a primary treatment for scaphoid fractures; its application is more common in **dislocations** or **certain complex fractures** to maintain alignment. - Applying traction to a scaphoid fracture could potentially exacerbate instability rather than promote union.
Question 4: Most common muscle affected in rotator cuff group is -
- A. Teres minor
- B. Infraspinatus
- C. Subscapularis
- D. Supraspinatus (Correct Answer)
Explanation: - ***Supraspinatus*** - The **supraspinatus** muscle is the most frequently injured and commonly affected muscle within the rotator cuff group. - Its tendon passes beneath the **acromion**, making it susceptible to **impingement** and tears, especially during overhead activities. - *Teres minor* - The **teres minor** muscle is located inferior to the infraspinatus and is involved in external rotation of the shoulder. - While it can be injured, it is much less commonly affected than the supraspinatus. - *Infraspinatus* - The **infraspinatus** muscle is a major external rotator of the shoulder and is located on the posterior aspect of the scapula. - Tears or injuries to the infraspinatus are less common compared to the supraspinatus but more frequent than those of the teres minor. - *Subscapularis* - The **subscapularis** muscle is the largest and most powerful rotator cuff muscle, located on the anterior aspect of the scapula. - It is primarily responsible for internal rotation and adduction, and while tears can occur, they are generally less frequent than supraspinatus tears.
Question 5: Painful arc syndrome is caused by impingement of ?
- A. Sub acromial bursa
- B. Sub deltoid bursa
- C. Biceps tendon
- D. Rotator cuff tendon (Correct Answer)
Explanation: **Rotator cuff tendon** - Painful arc syndrome, particularly involving pain between **60 and 120 degrees of abduction**, is a classic sign of **rotator cuff tendon impingement**, most commonly the **supraspinatus tendon**. - Impingement occurs when these tendons are compressed between the **humeral head** and the **acromion** or **coracoacromial arch** during arm elevation. *Sub acromial bursa* - While **subacromial bursitis** can cause shoulder pain and is often associated with rotator cuff tendinopathy, the primary structure being impinged in the "painful arc" is usually the **tendon itself**, leading to inflammation of the bursa as a secondary effect. - Bursitis alone without tendon involvement is less likely to produce the specific **painful arc** pattern often seen with rotator cuff tears or tendinitis. *Sub deltoid bursa* - The **subdeltoid bursa** is continuous with the subacromial bursa and serves a similar function (reducing friction). However, direct impingement of the subdeltoid bursa specifically, independent of the subacromial bursa or rotator cuff tendons, is not typically cited as the primary cause of the painful arc. - Pain isolated to the subdeltoid bursa may be due to direct trauma or inflammation but would likely present differently than the classic **impingement-related "painful arc."** *Biceps tendon* - Impingement or pathology of the **long head of the biceps tendon** typically causes pain in the anterior shoulder, often worse with **flexion and supination** against resistance (e.g., Speed's test). - While biceps tendinopathy can coexist with rotator cuff issues, it is not the **primary structure** responsible for the characteristic **painful arc** during abduction, which is more indicative of rotator cuff impingement.
Question 6: Lift off test is done to assess the function of:
- A. Supraspinatus muscle function
- B. Infraspinatus muscle function
- C. Subscapularis muscle function (Correct Answer)
- D. Teres Minor muscle function
Explanation: ***Subscapularis muscle function*** - The **Lift-off test**, or Gerber's Lift-off test, specifically assesses the integrity and strength of the **subscapularis muscle** by evaluating its internal rotation and extension strength. - A positive test occurs when the patient is unable to lift their hand off their back, indicating a **subscapularis tear or weakness**. *Supraspinatus muscle function* - The **supraspinatus muscle** is primarily tested with the **empty can test** or full can test, which assess its role in shoulder abduction. - These tests evaluate for **impingement** or **tears** of the supraspinatus tendon. *Infraspinatus muscle function* - The **infraspinatus muscle** is mainly responsible for external rotation and is assessed using tests like the **resisted external rotation test** with the arm at the side. - This test is used to detect **infraspinatus tears** or weakness. *Teres Minor muscle function* - The **teres minor muscle** also contributes to external rotation of the shoulder, often tested in conjunction with the infraspinatus. - Its function can be isolated by testing resisted **external rotation** in 90 degrees of abduction and external rotation.
Question 7: A 35-year-old male wrestler is admitted to the emergency department with excruciating pain in his right shoulder and proximal arm. During physical examination the patient clutches the arm at the elbow with his opposite hand and is unable to move the injured limb. Radiographic studies show that the patient has a dislocation of the humerus at the glenohumeral joint. Which of the following conditions is the most likely?
- A. The head of the humerus is displaced posteriorly.
- B. The head of the humerus is displaced superiorly.
- C. The head of the humerus is displaced inferiorly.
- D. The head of the humerus is displaced anteriorly. (Correct Answer)
Explanation: ***The head of the humerus is displaced anteriorly.*** - **Anterior dislocations** are the most common type of glenohumeral dislocation, accounting for over 95% of cases. They often result from an injury mechanism involving **abduction and external rotation** of the arm, consistent with a wrestling injury. - Patients typically present with the arm held in slight abduction and external rotation, but may also clutch the arm as described, indicating strong muscle spasm and pain. The humeral head is palpable anteriorly below the **coracoid process**. *The head of the humerus is displaced posteriorly.* - **Posterior dislocations** are rare and typically occur with forceful **adduction, internal rotation**, and axial loading, such as from an epileptic seizure or electrocution. - The arm is usually held in **internal rotation and adduction**, which is contrary to the typical presentation of anterior dislocation. *The head of the humerus is displaced inferiorly.* - **Inferior dislocations** (luxatio erecta) are very rare and typically result from extreme **hyperabduction** of the arm. - The arm is classically found **fixed in complete abduction**, with the hand often resting on the head, which is not described in this scenario. *The head of the humerus is displaced superiorly.* - **Superior dislocations** are extremely uncommon and usually involve severe trauma resulting in fracture of the **acromion or coracoid process**, as the humeral head would otherwise impinge on these structures. - This type of dislocation is associated with extensive soft tissue damage and is not consistent with the typical presentation of a glenohumeral dislocation.
Question 8: Patient is able to abduct, internally rotate and take his arm up to lumbosacral spine but not able to lift off. What is the probable diagnosis?
- A. Teres major tear
- B. Subscapularis tear (Correct Answer)
- C. Acromioclavicular joint dislocation
- D. Long head of biceps tear
Explanation: ***Subscapularis tear*** - The patient can perform **internal rotation** but has difficulty lifting the arm *off* the lumbosacral spine, indicating weakness in **subscapularis function**. - The **lift-off test** is a specific clinical test for subscapularis integrity, where the inability to lift the hand off the back suggests a tear. *Teres major tear* - A tear in the **teres major** would primarily affect **adduction** and **internal rotation** of the arm. - The patient's ability to internal rotate and abduct the arm makes a primary teres major tear less likely. *Acromioclavicular joint dislocation* - This condition presents with **pain** and **tenderness** over the AC joint, and a visible deformity ("step-off"). - While it can cause shoulder pain and limit movement, it does not typically present with the specific internal rotation and lift-off deficits described. *Long head of biceps tear* - A tear of the **long head of the biceps** usually presents with a "Popeye" deformity and pain with **supination** and **flexion of the elbow**. - The symptoms described (difficulty with lift-off, intact internal rotation) are not characteristic of a biceps tear.
Question 9: Which one of the following tests will you adopt while examining a knee joint where you suspect an old tear of anterior cruciate ligament?
- A. Mc Murray test
- B. Lachman test (Correct Answer)
- C. Pivot shift test
- D. Posterior drawer test
Explanation: ***Lachman test*** - The **Lachman test** is considered the most sensitive and reliable test for detecting an **anterior cruciate ligament (ACL) tear**, especially in the acute setting or for an old tear. - It assesses the **anterior translation of the tibia** on the femur at 20-30 degrees of flexion, minimizing hamstring guarding and improving diagnostic accuracy for subtle instabilities. *Mc Murray test* - The **McMurray test** is primarily used to detect **meniscal tears**, not ACL tears. - It involves internally and externally rotating the tibia while extending the knee to elicit a click or pain due to a torn meniscus. *Pivot shift test* - The **pivot shift test** is highly specific for an **ACL tear** but is often difficult to perform and requires a fully relaxed patient, sometimes necessitating anesthesia. - It detects rotatory instability and gives a clinical indication of the degree of **anterolateral rotatory instability** caused by an ACL tear. *Posterior drawer test* - The **posterior drawer test** is used to assess the integrity of the **posterior cruciate ligament (PCL)**. - It involves pushing the tibia posteriorly on the femur at 90 degrees of knee flexion to check for excessive posterior translation.
Question 10: A 52-year-old female complains of increasing pain in the right shoulder. She is also finding it increasingly difficult to do overhead abduction of the affected joint. She had been diagnosed as a diabetic 20 years back and is on treatment since then. What is the most likely cause of her clinical condition?
- A. Frozen shoulder (Correct Answer)
- B. Bacterial arthritis
- C. Osteoarthritis
- D. Rotator cuff tear
Explanation: ***Frozen shoulder*** - The patient's presentation with **increasing pain** and **difficulty with overhead abduction** of the shoulder, especially in the context of long-standing **diabetes**, is highly characteristic of **adhesive capsulitis** (frozen shoulder). - This condition is marked by **progressive stiffness** and **restricted range of motion** in the shoulder joint due to inflammation and fibrosis of the joint capsule. *Bacterial arthritis* - **Bacterial arthritis** typically presents with an **acutely painful**, **swollen**, and **erythematous joint**, often accompanied by systemic symptoms like **fever** and **malaise**. - The chronic, progressive nature of the patient's symptoms and the absence of acute inflammatory signs or fever make bacterial arthritis less likely. *Osteoarthritis* - While **osteoarthritis** can cause shoulder pain and stiffness, it usually presents with **pain that worsens with activity** and is relieved by rest, often with **crepitus** and a more gradual loss of range of motion. - The pronounced restriction in **overhead abduction** in this patient, particularly given the diabetic history, points away from primary osteoarthritis as the most likely cause. *Rotator cuff tear* - A **rotator cuff tear** typically presents with pain and weakness, especially during **abduction** or **external rotation**, and may have a specific mechanism of injury. - While abduction can be difficult, the classic presentation of a frozen shoulder with severe, global restriction of both active and passive range of motion is a stronger fit for the described symptoms.
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free