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Difficulty: HardOrthopedic Surgery

Match each patient's clinical presentation and physical examination findings with the most likely injured shoulder structure and its corresponding functional deficit.

  • A 62-year-old carpenter presents with difficulty lifting objects overhead. He has a positive Jobe's (empty can) test and pain during the first 15 to 30 degrees of shoulder abduction.Supraspinatus tendon tear; characterized by impaired initial abduction of the glenohumeral joint.
  • A 45-year-old man falls onto his extended arm. He now has a positive Gerber's (lift-off) test and increased passive external rotation compared to the contralateral side.Subscapularis tendon tear; characterized by impaired internal rotation and loss of anterior stabilization of the humeral head.
  • A 50-year-old recreational pitcher experiences posterior shoulder pain. He has a positive Hornblower's sign and inability to maintain the arm in external rotation when the shoulder is abducted.Teres minor tendon tear; characterized by impaired external rotation specifically when the shoulder is in the abducted position.
  • A 28-year-old bodybuilder feels a sudden, sharp pain while doing heavy curls. Examination reveals a noticeable bulge in the lower anterior arm and mild weakness in forearm supination.Long head of the biceps tendon rupture; presents with a characteristic cosmetic deformity but usually maintains functional elbow flexion.

Answer

The correct matches are: 1) Supraspinatus tear for the carpenter with initial abduction weakness, 2) Subscapularis tear for the man with the positive lift-off test, 3) Teres minor tear for the pitcher with Hornblower's sign, and 4) Biceps tendon rupture for the bodybuilder with the Popeye deformity.
Each shoulder pathology presents with a distinct pattern of weakness that precisely corresponds to the anatomical function of the injured muscle or tendon. These specific deficits can be elicited and isolated by targeted physical examination maneuvers.

Step-by-Step Solution

1
Evaluate the first patient's presentation (positive Jobe's test, abduction pain)
Corresponds to the supraspinatus tendon.
The supraspinatus initiates shoulder abduction. The empty can test specifically isolates this muscle from the deltoid.
2
Evaluate the second patient's presentation (positive lift-off test, increased passive external rotation)
Corresponds to the subscapularis tendon.
The subscapularis is the only rotator cuff muscle that internally rotates the humerus. A tear leads to internal rotation weakness (lift-off test) and unresisted, increased passive external rotation.
3
Evaluate the third patient's presentation (positive Hornblower's sign, weakness in abducted external rotation)
Corresponds to the teres minor tendon.
While the infraspinatus externally rotates the arm at the side, the teres minor is primarily responsible for external rotation when the arm is abducted to 90 degrees.
4
Evaluate the fourth patient's presentation (sudden pop, distal muscle bulge, supination weakness)
Corresponds to the long head of the biceps tendon.
Proximal rupture of the long head of the biceps tendon causes the muscle belly to retract distally, creating the classic 'Popeye' muscle appearance.

Key Concept

Clinical diagnosis of shoulder pathologies using specific provocative physical examination maneuvers
Estimated Time:2m 0s
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Topics

Orthopedic Surgery

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