Shoulder
Core concepts
A candidate must master shoulder instability, rotator cuff pathology, the SLAP/biceps complex, acromioclavicular joint injury, adhesive capsulitis, glenohumeral arthritis, and nerve injuries around the shoulder. Know the difference between traumatic anterior instability and multidirectional laxity; the apprehension-relocation test and its modifications; and the roles of glenoid bone loss and Hill-Sachs lesions. For cuff disease, distinguish partial from full-thickness tears, understand the Jobe, drop-arm, external-rotation lag, and lift-off tests, and recognize cuff tear arthropathy. SLAP tears require careful biceps anchor assessment because isolated superior labral signal is common with age.
Traps
Questions often blur pseudoparalysis from a massive cuff tear with true axillary nerve palsy; check deltoid function and sensation. Do not label every painful arc as a cuff tear-subacromial pain and calcific tendinitis mimic it. In instability, a positive apprehension test alone is not diagnostic; pain without apprehension suggests labral or cuff pathology. Frozen shoulder is a diagnosis of exclusion: exclude septic arthritis, dislocation, and tumor, especially in a diabetic patient with night pain and systemic features. In AC separations, grade the coracoclavicular interval and screen for posterior sternoclavicular displacement.
Worked example
A 22-year-old first-time anterior dislocator has 15% glenoid bone loss and a small Hill-Sachs lesion. Rule of thumb: glenoid bone loss approaching 20–25%, or an engaging Hill-Sachs, shifts the decision toward bony stabilization rather than isolated soft-tissue repair. Always document neurovascular status before and after reduction.