Shoulder Instability — MCQs
A patient received an electric shock and fell down. He cannot do external rotation of shoulder and cannot move arm. What is the diagnosis:-
Which of the following tests is used to test anterior instability of shoulder?
Tennis player can spontaneously reduce a shoulder dislocation. He can do it again and again himself. He is suffering from?
Which maneuver is used in the reduction of shoulder dislocation?
In which condition is the Hamilton Ruler test sign positive?
Hill-Sachs lesion is seen in?
Patient had an injury to thumb causing thumb abduction. Which of the following can happen?
A 30-year-old male presents with pain and limited movement in his shoulder following a fall. X-ray reveals an anterior dislocation of the glenohumeral joint. Which of the following structures is most likely to be damaged in this injury?
In a case of recurrent anterior dislocation of the shoulder, posterolateral lesions were found on radiological examination. What are these lesions?
Which activity will be difficult to perform for a patient with an anterior cruciate deficient knee joint?
Shoulder Instability Indian Medical PG Practice Questions and MCQs
Question 1: A patient received an electric shock and fell down. He cannot do external rotation of shoulder and cannot move arm. What is the diagnosis:-
- A. Clavicle fracture
- B. Luxation erecta
- C. Posterior dislocation (Correct Answer)
- D. Anterior dislocation
Explanation: ***Posterior dislocation*** - An **electric shock** or **seizure** can cause strong muscle contractions, leading to a posterior shoulder dislocation. - Inability to perform **external rotation** and limited arm movement are classic signs of a posterior shoulder dislocation. *Clavicle fracture* - While a fall can cause a **clavicle fracture**, the primary symptoms would be pain over the clavicle and a visible deformity, not specifically limited external rotation or global arm immobility. - A clavicle fracture typically doesn't present with the specific inability to externally rotate the arm. *Luxation erecta* - **Luxatio erecta** is an inferior shoulder dislocation where the arm is held in an abducted and externally rotated position, pointing upwards, which is contrary to the described symptoms of inability to move the arm and external rotation. - It is a specific type of dislocation with a distinct presentation. *Anterior dislocation* - An **anterior dislocation** is the most common type of shoulder dislocation, but it usually presents with the arm held in slight abduction and external rotation, not an inability to externally rotate. - Typically results in a visible flattening of the deltoid contour and a prominent humeral head anteriorly.
Question 2: Which of the following tests is used to test anterior instability of shoulder?
- A. Push-pull test
- B. Apprehension Test (crank test) (Correct Answer)
- C. Posterior drawer test
- D. Jerk test
Explanation: ***Apprehension Test (crank test)*** - The **apprehension test** assesses for anterior shoulder instability by passively abducting and externally rotating the arm, which is the position of potential anterior dislocation. - A positive test is indicated by the patient's **apprehension** or fear of dislocation, often accompanied by muscle guarding, as the head of the humerus is forced anteriorly. *Push-pull test* - The push-pull test is used to assess for **posterior shoulder stability**, specifically for **posterior labral tears** or instability. - It involves applying axial compression while simultaneously pulling the humerus posteriorly, looking for pain or a clunk. *Posterior drawer test* - The posterior drawer test is primarily used to evaluate **posterior glenohumeral instability**. - It involves stabilizing the scapula and applying a posterior force to the humerus while the arm is flexed, abducted, and internally rotated. *Jerk test* - The jerk test is used to identify **posterior-inferior glenohumeral instability** or a **posterior labral tear**, particularly a reverse Bankart lesion. - It involves axially loading the arm while moving it from an abducted and externally rotated position to an adducted and internally rotated position, looking for a sudden "jerk" or clunk.
Question 3: Tennis player can spontaneously reduce a shoulder dislocation. He can do it again and again himself. He is suffering from?
- A. Inferior shoulder dislocation
- B. Fracture upper end humerus
- C. Acute shoulder dislocation
- D. Recurrent shoulder dislocation (Correct Answer)
Explanation: ***Recurrent shoulder dislocation*** - The ability to **spontaneously reduce** a shoulder dislocation, and the history of it happening "again and again" strongly indicate **recurrent shoulder dislocation**. - This condition often results from **ligamentous laxity** or damage to the **labrum** (Bankart lesion) that fails to stabilize the shoulder joint after an initial dislocation. *Inferior shoulder dislocation* - This is a **specific type of shoulder dislocation** (luxatio erecta) where the humeral head is displaced inferiorly, but "inferior" alone does not explain the recurrent nature. - While possible in an individual, the key element here is the **recurrence** and self-reduction, not just the direction of a single dislocation. *Fracture upper end humerus* - A fracture of the upper end of the humerus is a **bony injury** and would typically present with severe pain, swelling, and inability to move the arm, not spontaneous reduction. - This injury would usually **prevent** the patient from repeatedly dislocating and reducing their shoulder. *Acute shoulder dislocation* - An acute shoulder dislocation refers to a **single, recent episode** of dislocation. - The patient's repeated ability to self-reduce the shoulder indicates a chronic problem rather than an initial, isolated event.
Question 4: Which maneuver is used in the reduction of shoulder dislocation?
- A. Allis manoeuvre
- B. Sultanpur technique
- C. Intramedullary nail
- D. Kocher's manoeuvre (Correct Answer)
Explanation: ***Kocher's manoeuvre*** - **Kocher's manoeuvre** is a classic technique used for the **reduction of anterior shoulder dislocations**, involving external rotation, adduction, and internal rotation. - This method aims to safely guide the humeral head back into the glenoid fossa with a series of controlled movements. *Allis manoeuvre* - The **Allis manoeuvre** is primarily used for the **reduction of posterior hip dislocations**, involving hip flexion, adduction, and internal rotation with axial traction. - It is not indicated for shoulder dislocations. *Sultanpur technique* - The "Sultanpur technique" is **not a recognized medical term** or maneuver for reducing dislocations. - This option appears to be a distractor. *Intramedullary nail* - An **intramedullary nail** is a surgical device used for **fixing long bone fractures**, such as those in the femur or tibia. - It is an orthopedic implant and not a reduction maneuver for dislocations.
Question 5: In which condition is the Hamilton Ruler test sign positive?
- A. Anterior dislocation of shoulder (Correct Answer)
- B. Posterior dislocation of shoulder
- C. Luxatio erecta
- D. Acromioclavicular joint dislocation
Explanation: ***Anterior dislocation of shoulder*** - The **Hamilton Ruler test** is positive when a straight edge, like a ruler, can be laid across the **lateral aspect of the deltoid prominence** from the acromion to the lateral epicondyle. - This is indicative of the **loss of the normal rounded contour of the shoulder**, which occurs due to the humeral head dislocating anteriorly. *Acromioclavicular joint dislocation* - This condition presents with a **"step-off" deformity** at the AC joint and pain directly over the joint, but the overall contour of the shoulder glenohumeral joint is preserved. - The deltoid prominence remains intact, making the Hamilton Ruler test negative. *Posterior dislocation of shoulder* - In posterior dislocation, the **humeral head moves posteriorly**, and the anterior contour of the shoulder might appear flattened, but the characteristic prominent anterior bulge seen in anterior dislocation is absent. - The Hamilton Ruler test specifically assesses for the loss of the lateral deltoid prominence, which is more typical of anterior displacement. *Luxatio erecta* - **Luxatio erecta** is an inferior dislocation of the shoulder where the arm is fixed in an **abducted and externally rotated position**, making it appear "erect". - While a severe type of shoulder dislocation, the specific anatomical changes that lead to a positive Hamilton Ruler test (loss of lateral deltoid prominence with the humeral head moving anteriorly and medially) are not typically present in this configuration.
Question 6: Hill-Sachs lesion is seen in?
- A. Glenoid labrum tear
- B. Anterior dislocation of shoulder joint (Correct Answer)
- C. Posterolateral humerus
- D. Posterior dislocation of shoulder joint
Explanation: ***Anterior dislocation of shoulder joint*** - A **Hill-Sachs lesion** is a **cortical depression** in the posterolateral head of the humerus. - It occurs when the humeral head impacts the **anterior glenoid rim** during an anterior shoulder dislocation. *Glenoid labrum tear* - A **glenoid labrum tear** refers to damage to the cartilage rim around the glenoid socket. - While it can coexist with dislocations and contribute to instability, it is not the direct site of a Hill-Sachs lesion. *Posterolateral humerus* - The **posterolateral humerus** is the specific location where the Hill-Sachs lesion occurs on the humeral head. - However, the lesion itself is *caused by* the anterior dislocation, not an independent finding listed this way. *Posterior dislocation of shoulder joint* - A **posterior shoulder dislocation** is typically associated with a **reverse Hill-Sachs lesion** (also known as a trough line fracture or medial humeral head compression fracture), which occurs on the anteromedial aspect of the humeral head. - The classic Hill-Sachs lesion is specific to anterior dislocations.
Question 7: Patient had an injury to thumb causing thumb abduction. Which of the following can happen?
- A. Kaplan lesion
- B. Game keepers thumb (Correct Answer)
- C. Mallet finger
- D. Bennett fracture
Explanation: ***Gamekeeper's thumb*** - A **Gamekeeper's thumb**, or **skier's thumb**, is an injury to the **ulnar collateral ligament (UCL)** of the thumb's metacarpophalangeal (MCP) joint. - This injury commonly occurs due to a **forceful abduction** and hyperextension of the thumb. *Kaplan lesion* - A **Kaplan lesion** refers to an avulsion fracture of the radial styloid process, usually associated with scaphoid fractures. - This lesion is typically related to wrist injuries, not primarily thumb abduction. *Bennett fracture* - A **Bennett fracture** is an intra-articular fracture at the base of the first metacarpal bone. - It usually results from an axial load applied to a partially flexed thumb, rather than pure abduction. *Mallet finger* - A **mallet finger** is an injury to the **extensor tendon** of the finger, causing the fingertip to remain in a flexed position. - This injury typically affects the distal interphalangeal (DIP) joint of any finger and is not directly related to thumb abduction.
Question 8: A 30-year-old male presents with pain and limited movement in his shoulder following a fall. X-ray reveals an anterior dislocation of the glenohumeral joint. Which of the following structures is most likely to be damaged in this injury?
- A. Long head of biceps tendon
- B. Acromioclavicular ligament
- C. Supraspinatus tendon
- D. Anterior inferior glenohumeral ligament (Correct Answer)
- E. Coracoclavicular ligament
Explanation: ***Anterior inferior glenohumeral ligament*** - This ligament is a primary static stabilizer against **anterior dislocation** of the shoulder; thus, it is frequently stretched or torn during such an event. - Damage to this ligament is often associated with a **Bankart lesion**, which is an injury to the anterior inferior labrum that can lead to recurrent dislocations. *Long head of biceps tendon* - While the **long head of the biceps tendon** can be injured in shoulder trauma, it is more commonly associated with chronic overuse or superior labral tears (**SLAP lesions**), rather than primary anterior dislocation. - Injuries to this tendon might occur as a secondary complication but are not the most likely primary soft tissue damage in an acute anterior dislocation. *Acromioclavicular ligament* - The **acromioclavicular ligament** stabilizes the **acromioclavicular (AC) joint**, which is distinct from the glenohumeral joint. - Injuries to this ligament typically result from direct trauma to the top of the shoulder, causing AC joint separation, not glenohumeral dislocation. *Supraspinatus tendon* - The **supraspinatus tendon** is part of the rotator cuff and is most commonly injured in impingement syndrome or rotator cuff tears, which can result from falls but are not the primary structure damaged in an **anterior glenohumeral dislocation**. - Its role is mainly in abduction of the arm, and while it can be involved in large tears associated with advanced age, it is not the initial or most common structure to fail in this specific injury. *Coracoclavicular ligament* - The **coracoclavicular ligament** is composed of the conoid and trapezoid ligaments, which are crucial for the stability of the **acromioclavicular (AC) joint**. - Injury to this ligament is indicative of a more severe AC joint separation (usually **type III or higher**) and is not the primary structure damaged in a glenohumeral dislocation.
Question 9: In a case of recurrent anterior dislocation of the shoulder, posterolateral lesions were found on radiological examination. What are these lesions?
- A. Bankart's lesion
- B. Hill-Sachs lesion (Correct Answer)
- C. Reverse Hill Sachs lesion
- D. Putti-Platt lesion
Explanation: ***Hill-Sachs lesion*** - A Hill-Sachs lesion is an **impaction fracture** of the posterolateral aspect of the **humeral head** caused by its collision with the anterior glenoid rim during anterior shoulder dislocation. - Its presence is a common finding in **recurrent anterior shoulder dislocations**, as described in the case. *Bankart's lesion* - A Bankart's lesion is an injury to the **anterior-inferior labrum** of the glenoid, often involving an avulsion of the capsule attached to the labrum. - This lesion is typically located on the **glenoid side**, not the humeral head, and is caused by the humeral head forcing against the glenoid rim during dislocation. *Putti-Platt lesion* - A Putti-Platt lesion describes a tear or avulsion of the **subscapularis tendon** and capsule from the anterior aspect of the glenoid. - This lesion is less commonly encountered as a distinct radiographic finding in the same way as a Hill-Sachs or Bankart, and refers more to surgical repair. *Reverse Hill Sachs lesion* - A reverse Hill-Sachs lesion is an impaction fracture on the **anteromedial aspect** of the humeral head. - This lesion is characteristic of a **posterior shoulder dislocation**, which is not the case described in the question.
Question 10: Which activity will be difficult to perform for a patient with an anterior cruciate deficient knee joint?
- A. Getting up from a sitting position
- B. Walk downhill (Correct Answer)
- C. Walk uphill
- D. Sitting cross-legged
Explanation: ***Walk downhill*** - An **anterior cruciate ligament (ACL) deficient knee** experiences anterior tibial translation, especially when the muscles can't compensate, leading to instability. - Walking downhill places higher **anterior shear forces** on the knee joint and often involves knee extension or hyperextension, which dramatically increases the risk of the tibia translating anteriorly relative to the femur. *Getting up from a sitting position* - This activity primarily involves **quadriceps muscle contraction** and a concentric movement of the knee, which stabilizes the joint. - It does not typically place significant **anterior shear stress** on the ACL, even in a deficient knee. *Walk uphill* - Walking uphill often involves knee flexion and places the knee in a more protected position against **anterior tibial translation**. - The quadriceps and hamstrings work synergistically to **stabilize the joint** during this motion, reducing stress on the ACL. *Sitting cross-legged* - This position primarily involves **hip and knee flexion and external rotation**, but it is generally a static and non-weight-bearing position. - It does not impose significant **dynamic loads** or shear forces that would cause instability in an ACL-deficient knee.
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