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Discussion Starter #1
Basic anatomy:

65-year old male, was fell down in icy road. Medication: enalapril for hypertension and acetaminophen for mild artrhosis genu l. dx. He comes 3 days later to your practice complaining pain in right shoulder. In inspection you don't see any remarkable bruises. Clavicula, scapula and humerus is intact when palpated. Patient complaints pain in abduction and elevation, but active movements in both direction is over 100 degrees. He cannot put his right hand to opposite shoulder. What muscle could be damage during accident?

A) deltoid
B) teres minor
C) supraspinatus
D) infraspinatus
 

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D) supraspinatus

  • Supraspinatus muscle is the most commonly injured muscle (especially its tendon) in the rotator cuff (SITS muscles). Shoulder pain on initiation of arm abduction is most likely due to injury of this muscle or its tendon.
  • It's the main initiator and maintainer of abduction of the arm up until the horizontal plane. Deltoid muscle does play a role in arm abduction, but only a smaller role. (some research believes the opposite is correct). Further abduction above the horizontal plane is accomplished mainly by serratus anterior muscle.
  • Supraspinatus muscle is innervated by suprascapular n. (C5-6).
 

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Discussion Starter #5
D) supraspinatus

  • Supraspinatus muscle is the most commonly injured muscle (especially its tendon) in the rotator cuff (SITS muscles). Shoulder pain on initiation of arm abduction is most likely due to injury of this muscle or its tendon.
  • It's the main initiator and maintainer of abduction of the arm up until the horizontal plane. Deltoid muscle does play a role in arm abduction, but only a smaller role. (some research believes the opposite is correct). Further abduction above the horizontal plane is accomplished mainly by serratus anterior muscle.
  • Supraspinatus muscle is innervated by suprascapular n. (C5-6).
I mean that he cannot put his right hand to his left shoulder (inaccurately explained from me).
 

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Discussion Starter #7
I think deltoid ... not sure :eek:
Subscapularis is the rotator cuff muscle which adducts and medially rotates shoulder. it should be the correct answer, but also teres major do this... i had little memory loss and but it there, but i chahged it correct know
 
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