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Viva Exam
Shoulder and elbow structured oral examination question2
EXAMINER : Good afternoon. Can you tell me what is going on in this radiograph of the right shoulder (Fig. 6.2.)? This patient had anterior dislocation 2 years ago and has on-going problems.
CANDIDATE : Well this shoulder is reduced congruently. I cannot see any interposition of bony fragments. And I would like to investigate this shoulder with MR arthrogram.
## EXAMINER : !! What do you want to rule out?
CANDIDATE : Well the risk of re-dislocation of the shoulder is much higher with anterior dislocation due to labral detachment in younger patients and it could be treated successfully if identified with MR arthrogram.
EXAMINER : This gentleman is claustrophobic!
CANDIDATE : I would talk to the radiologist and anaesthetist to find out if it could be done under sedation.
EXAMINER : The anaesthetist is not happy! And your radiologist suggests an ultrasound examination of the shoulder.
CANDIDATE : Ultrasound examination is not the gold standard examination for labral pathology.
EXAMINER : Well, the patient had only ultrasound examination and it shows a subscapularis tear!
CANDIDATE : There is then a high risk of having damaged the anterior labrum also ... I think I have to speak to the anaesthetist again ...
🎓 Another candidate follows this miserable viva of negotiations between anaesthetist and radiologist in the FRCS ortho exam (by the candidate’s own fault).
EXAMINER : Good afternoon. Can you tell me what is going on in this radiograph of the right shoulder? This patient had anterior dislocation 2 years ago and has on-going problems.
## CANDIDATE : Thanks. May I know the age of the patient and the nature of the ongoing problem please?
EXAMINER : This 76-year-old gentleman dislocated his shoulder 2 years ago. Now he has got difficulties in overhead activities and we found out that he is claustrophobic!
CANDIDATE : I suspect rotator cuff tear in this age group following dislocation and also there is a risk of infra-clavicular plexus injury following the dislocations, therefore I would like to assess his cuff muscles clinically.
EXAMINER : He has got weakness on internal rotation and the rest of the cuff power is good. Neurologically he is intact.
CANDIDATE : I suspect subscapularis tendon tear from this clinical assessment and I would investigate this shoulder with an ultrasound examination.
EXAMINER : The ultrasound examination shows subscapularis tear, with proximal migration of the tendon by 4 mm.
## CANDIDATE : I would like to know, what has been done so far? And what are his expectations?
EXAMINER : Nothing has been done so far. He wants to play golf, which he has not been able to in the last 2 years.
CANDIDATE : Well, I would assess his shoulder arthroscopically and repair his cuff.
## EXAMINER : Would you call this a cuff arthropathy as it is going on for 2 years?
