USMLE Step 1 Soru Silsilesi

Rotator Cuff Tendinitis and Impingement Syndrome

Tendinitis of the rotator cuff is the major cause of a painful shoulder and is currently thought to be caused by inflammation of the tendon(s). The rotator cuff consists of the tendons of the supraspinatus, infraspinatus, subscapularis, and teres minor muscles, and inserts on the humeral tuberosities. Of the tendons forming the rotator cuff, the supraspinatus tendon is the most often affected, probably because of its repeated impingement (impingement syndrome) between the humeral head and the undersurface of the anterior third of the acromion and coracoacromial ligament above as well as the reduction in its blood supply that occurs with abduction of the arm . The tendon of the infraspinatus and that of the long head of the biceps are less commonly involved. The process begins with edema and hemorrhage of the rotator cuff, which evolves to fibrotic thickening and eventually to rotator cuff degeneration with tendon tears and bone spurs. Subacromial bursitis also accompanies this syndrome. Symptoms usually appear after injury or overuse, especially with activities involving elevation of the arm with some degree of forward flexion. Impingement syndrome occurs in persons participating in baseball, tennis, swimming, or occupations that require repeated elevation of the arm. Those over age 40 are particularly susceptible. Patients complain of a dull aching in the shoulder, which may interfere with sleep. Severe pain is experienced when the arm is actively abducted into an overhead position. The arc between 60° and 120° is especially painful. Tenderness is present over the lateral aspect of the humeral head just below the acromion. NSAIDs, local glucocorticoid injection, and physical therapy may relieve symptoms. Surgical decompression of the subacromial space may be necessary in patients refractory to conservative treatment.
Kaynak: Harrison's Internal Medicine

The supraspinatus muscle originates on the posterior and superior aspect of the scapula, passes beneath the acromion, and inserts on the great tuberosity of the humeral head. It initiates arm elevation and abducts the shoulder. It also balances the power of the deltoid, keeping the humerus centered in the glenoid during deltoid contraction. The infraspinatus originates on the posterior scapula just inferior to the scapular spine. It inserts on the posterior aspect of the greater tuberosity and acts primarily as an external rotator of the arm . The teres minor originates on the lateral border of the scapula just inferior to the infraspinatus and inserts on the posterior aspect of the humerus. It works with the infraspinatus to provide external rotation . The subscapularis is the only rotator cuff muscle that arises from the anterior aspect of the scapula. It attaches to the lesser tuberosity of the humeral head and provides internal rotation of the arm.

Kaynak: Tintinalli's Emergency Medicine

m3rcury wrote: Peki ben de yukarida ilk olarak rotator cuff ornegini vermemin anisina bir rotator cuff sorusu koyayim. Aslinda yine ilk yasanan karisikligin anisina ilk soru olarak koymayi dusunuyordum ama benden erken davranmissiniz:)

SORU:
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

cevabi yarin tahminleri alalim.

gokhansaid wrote: 4. soru için bende deltoid diyorum... son but over 100 kelimesini algılayamadım ama uykum gelmiş sanırım

gokhansaid wrote: bı de ben spoiler kısmını anlamadım

bu kısım yeni bir başlık altında düzenlenirse
veya bu başlık anlattınız gibi düüzenlenirse güzel olacak