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Self-Assessment Questions

Rheumatology

Shoulder Pain: Review Questions

Janet Burkholder-Krommes, MD

Dr. Burkholder-Krommes is in private practice with Rheumatology Associates, Mercerville, NJ.



Choose the single best answer for each question.

1. A 73-year-old woman presents with a complaint of chronic bilateral shoulder pain and swelling over the past several years. Over the past week, the swelling in her right shoulder has increased significantly, and this morning she noted a purplish discoloration in the anterior shoulder area that extends to the mid-biceps. Which of the following findings is most likely?
  1. Relative preservation of joint space on plain film radiograph
  2. High serum ferritin level
  3. Tear of the bicipital tendon on magnetic resonance imaging (MRI) scan
  4. Positive alizarin stain on synovial fluid analysis
  5. Staphylococcus epidermidis on culture of the synovial fluid
Click here to compare your answer.


2. A 63-year-old man presents with acute onset of pain in the shoulder girdle. Two weeks ago, he began to feel incessant pain in his shoulders, and he has been unable to drive himself to work in the morning. By the afternoon, he is able to lift his shoulders somewhat normally, but overall he feels extremely fatigued. What is this patient’s physical examination likely to show?

  1. Significant weakness on upper extremity muscle testing
  2. Pain with supination against resistance
  3. Discomfort with passive range of shoulder motion
  4. Marked limitation of cervical spine flexion
  5. Tophaceous deposits on extensor tendons
Click here to compare your answer.


3. A 26-year-old mother of 18-month-old twins presents with a complaint of pain in her right shoulder, which started several weeks ago. The pain has progressed significantly, and she finds it hard to perform activities that involve reaching over her head. Physical examination abnormalities include pain in the anterior aspect of the shoulder with palpation as well as pain with resisted elbow flexion and supination of the arm. What is the most likely diagnosis for this patient?

  1. Bicipital tendonitis
  2. Impingement syndrome
  3. Incomplete rotator cuff tear
  4. Degenerative disease of the acromioclavicular joint
  5. Milwaukee shoulder syndrome
Click here to compare your answer.


4. A 64-year-old weekend sailor reports difficulty lifting his arm and severe pain in his right shoulder in the nighttime. Although he has had aching in his shoulder intermittently in the past, the current symptoms started 2 weeks ago after he fell into the mast while sailing. The radiograph of his shoulder shows osteoarthritis of the acromioclavicular joint and superior migration of the humeral head. What is the most appropriate action at this time?
  1. Refer the patient to an orthopaedic surgeon for arthroscopic surgery
  2. Perform an intra-articular injection on the shoulder
  3. Order an ultrasonogram of the shoulder
  4. Initiate a course of physical therapy
  5. Immobilize the shoulder
Click here to compare your answer.


5. A 32-year-old male diabetic has severe nighttime shoulder pain. On physical examination, range of motion is limited in all planes. A radiograph is read as normal, and an MRI scan also is normal. What is the most likely mechanism for the development of adhesive capsulitis in this patient?

  1. Nonenzymatic glycosylation of the rotator cuff muscles
  2. Chronic inflammation of the acromioclavicular joint
  3. Glenohumeral instability
  4. Microvascular disease
  5. Diabetic neuropathy
Click here to compare your answer.
 

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