Test 2 Questions

[amanda roura]

Hi I had 2 questions on the test:

#11- The answer is suprascap nerve palsy, but the patient had a +Neers and painful arc. I was under the impression that nerve palsy is typically pain free, and just weak?

#31 The patient had weakness of both ER (3/5) and and (4/5) but the correct answer was spinoglnoid. I know the ER was even weaker, but since there was still some weakness of abd, shouldnt it be suprascap notch?

[marcus williams]

Hey Amanda! Below is some further explanation.

#11 – in isolation we wouldn’t expect pain to be a preliminary chief complaint. However, when dealing with an active individual it’s reasonable to assume the impact of repetitive activity will be some development of shoulder pain, likely non-specific posterior shoulder pain. In this questions, the neers test served as a distraction, the painful arc between 90-120 points to the weakness being a contributor to the symptoms verses it being purely a structural irritation according under the compressive forces at end-range.

#31 – if the supraspinatus was involved, due to entrapment at the supra scapular notch, we would expect to see more appreciable weakness in abduction up to 90 degrees, which would likely result in a MMT of less than a 4/5. Also, atrophy would likely be a little more pronounce across the entire posterior scapula and not infraspinatus.

[marcus williams]

Hey Amanda! Below is some further explanation.

#11 – in isolation we wouldn’t expect pain to be a preliminary chief complaint. However, when dealing with an active individual it’s reasonable to assume the impact of repetitive activity will be some development of shoulder pain, likely non-specific posterior shoulder pain. In this questions, the neers test served as a distraction, the painful arc between 90-120 points to the weakness being a contributor to the symptoms verses it being purely a structural irritation according under the compressive forces at end-range.

#31 – if the supraspinatus was involved, due to entrapment at the supra scapular notch, we would expect to see more appreciable weakness in abduction up to 90 degrees, which would likely result in a MMT of less than a 4/5. Also, atrophy would likely be a little more pronounce across the entire posterior scapula and not infraspinatus.

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