Discuss the role of arthroscopy and arthrotomy in dealing with the loose body and its possible site of origin (

A 52 year old school teacher presents with a painful shoulder of spontaneous onset and several months duration. Night pain and pain at rest are prominent. Physiotherapy has not helped, and the patient has been told that she has a frozen shoulder and needs an operation to correct the problem.

The referring doctor has requested your continuing management and encloses the patient’s ultrasound with the referral letter.

No plain x-rays have been taken.

  1. List the likely diagnoses (5 marks)
    List other important possible diagnoses (5 marks)
  2. Outline the clinical assessment (20 marks)
    Discuss the investigations you might request and their usefulness in this setting to help you establish a diagnosis (40 marks)
  3. Investigations reveal a small rotator-cuff tear. Outline the management of this pathology in this clinical setting (30 marks)

Question 4. (1/2 hour)

A 13 year old boy complains of activity related pain in the elbow of the right dominant arm. He also often experiences painful clicking and a sensation of catching as well as post activity stiffness. He is very active in sport and currently pitches for the state baseball team.

List the possible diagnoses (5 marks)

  1. List the pertinent clinical findings for each of your diagnoses (10 marks)
  2. Discuss investigations you would require to reach a diagnosis (15 marks)

The main finding from the investigations is the presence of a loose body within the elbow joint.

  1. Discuss the role of arthroscopy and arthrotomy in dealing with the loose body and its possible site of origin (20 marks)


Question 5. (1/2 hour)

A 60 year old diabetic man presents with a complaint of increasing back pain and fever.

He had a trans urethral resection for benign prostatic hypertrophy one month previously. Examination demonstrates tenderness at the thoraco-lumbar junction, and moderately restricted motion. The ESR is moderately elevated.

  1. List the differential diagnosis (10 marks)
  2. Discuss the investigations you would order to help make a diagnosis (20 marks)
  3. Outline your plan of management of the most likely musculoskeletal diagnosis including any indications for surgical intervention (20 marks)

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