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NBME 23 Answers

nbme23/Block 1/Question#17 (48.9 difficulty score)
A 54-year-old woman comes to the physician ...
SupraspinatusπŸ”
tags: anatomy 

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 +11 
submitted by thomasalterman(150),
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eTh omst taotrmipn tnsih ot hte ousqntei rae sa ol,flsow wtih #2 geibn the smto ifiepscc:

1) ttiapen tsrerpo naip whti hvoeader otnmio and rrseotp eetrurrcn edraovhe mntooi uidnrg okw.r daOrvhee mnooit can dmgeaa het psssatunpariu mescul due ot gmmtpnneiei yb teh monac.oir

)2 Pina si rotsw twih irnlntae aroointt of hte lhorduse - ihst is tetoncssin tihw het nfiindsg fo eth ymctpa-en ,stte cwhhi candtseii a stuipaanssurp nij.ryu

mousie  I was thinking along the lines of overhead motion - damage to the subacromial bursa which is between the acromion and the supraspinatus ... also its the most commonly injured rotator cuff m. so could have guessed this one right +1  
sympathetikey  Thanks for the explanation. I was scratching my head as to why this is correct, since supraspinatus only does 15 degrees of abduction, but you make a lot of sense. +1  
charcot_bouchard  IDK WTF i picked Trapezius +36  
ls3076  why would injury to supraspinatus cause weakness with internal rotation though? +6  
targetusmle  yeah coz of that i picked subscapularis +2  
maddy1994  ya the whole question pointed to supraspinatus ...but last line internal rotation made me pick subscapularis +3  
darthskywalker306  I went for Trapezius. That shoulder flexion thing was a big distraction. Silly me. +1  
lowyield  saw someone post this on one of the other questions about shoulder... and it works pretty good for this https://www.amboss.com/us/knowledge/Soft_tissue_lesions_of_the_shoulder there's some videos in it, this specific one for the question is the neer test +  
psay1  FA2019 pg. 438 +1  



 +3 
submitted by drzed(217),

"During strength testing the patient has pain and weakness with abduction, particularly with simultaneous shoulder internal rotation"

This is a descriptive way of describing Neer's impingement sign, which is a (fairly) specific indicator of shoulder cuff tendon impingement; the most commonly impinged tendon of the rotator cuff being supraspinatus of course.




 +1 
submitted by thotcandy(79),

What is there that rules out deltoid? overhead abduction is >15' so shouldn't that point more towards deltoid?

baja_blast  Deltoid only does abduction from 15 to 90 degrees. So not overhead. +  
donttrustmyanswers  With that logic, supraspinatus only does abduction form 0-15 +8  
rina  the positive empty can test is the biggest thing "pain and weakness with abduction, particularly with simultaneous shoulder internal rotation" - that tells you it has to be one of the SITS muscles (supraspinatus, infraspinatus, teres minor, subscapularis), not the deltoid. tenderness in the right deltoid region tells you it's the supraspinatus which is right underneath the deltoid muscle +1