A 52-year-old man comes to the office due to right shoulder pain. He is an avid golfer but has been unable to play for the past 3 months due to the pain. Lately, it has started to interfere with his daily activities, such as getting dressed. An MRI shows thickening and calcification of the supraspinatus tendon. Which of the following shoulder actions is most likely to provoke pain in this patient?

Question

A 52-year-old man comes to the office due to right shoulder pain.  He is an avid golfer but has been unable to play for the past 3 months due to the pain.  Lately, it has started to interfere with his daily activities, such as getting dressed.  An MRI shows thickening and calcification of the supraspinatus tendon.  Which of the following shoulder actions is most likely to provoke pain in this patient?

Quizplus · Accepted Answer

11ec160b_35f0_13cd_9249_25ede7f05c04_MD0001_00 The rotator cuff is made up of the tendons of the supraspinatus, infraspinatus, subscapularis, and teres minor muscles. These tendons, along with the tendon of the long head of the biceps brachii muscle and the ligaments of the glenohumeral joint, contribute to shoulder stability. In rotator cuff syndrome, the most commonly injured tendon is the supraspinatus as this tendon is prone to repeated impingement trauma between the humeral head and the acromion, especially in abduction. The supraspinatus is primarily an abductor of the arm; it originates in the supraspinous fossa of the scapula and inserts on the superior portion of the head of the humerus. Therefore, supraspinatus tendinopathy is associated with pain on abduction of the humerus, especially resisted active abduction. (Choice B) Adduction of the humerus is accomplished by several muscles, including the latissimus dorsi, pectoralis major, coracobrachialis, subscapularis, and teres major and minor. (Choice C) Extension of the humerus is accomplished primarily by the latissimus dorsi, posterior deltoid, and teres major. (Choice D) Flexion of the humerus at the shoulder is accomplished primarily by the pectoralis major, coracobrachialis, biceps brachii, and anterior deltoid. (Choice E) Internal rotation of the humerus is accomplished by the subscapularis muscle, which originates in the subscapular fossa and inserts on the lesser tubercle of the head of the humerus with contribution from the teres major, pectoralis major, anterior deltoid, and latissimus dorsi. Educational objective: The most commonly injured structure in rotator cuff syndrome is the tendon of the supraspinatus muscle. Because the supraspinatus is an abductor of the humerus, injury to its tendon causes pain on abduction of the arm.

A 52-Year-Old Man Comes to the Office Due to Right