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NMSKI > Shoulder complex soft tissue conditions > Flashcards

Shoulder complex soft tissue conditions Flashcards

1
Q

common pathologies

A

AC Joint Injury
Frozen Shoulder Contraction Syndrome
Shoulder Instability

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2
Q

which joint is less stable acromioclavicular joint or shoulder joint

A

AC joint

More prone to injury and degenerative changes

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3
Q

types of AC joint injuries

A

levels I-VI

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4
Q

What levels of AC require surgery

A

IV-VI

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5
Q

Identify level 1 AC injury

A

Local pain, swelling and tenderness over the joint

No obvious deformity

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6
Q

how would level 1 AC injury be tested

A

Pain with passive shoulder movements especially horizontal flexion- Scarf test

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7
Q

treatment for level 1 AC injury

A

Initial rest -from aggravating activities, use of analgesics, ice. Start movement after a few days

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8
Q

how would level II AC injury be identified

A

Slight step deformity
Increased pain compared to type 1
Limitation of movement –abduction of the arm >90°.

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9
Q

how would level II AC injury be tested

A

Pain with Scarf Test

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10
Q

treatment for level 1 AC injury

A

Broad-arm sling (elbow supported) for approx 1-2 weeks

Analgesics for pain relief

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11
Q

when will exercise commence after level II AC injury

A

Commence gentle exercise after approx 2 weeks

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12
Q

how would level III AC injury be identified

A

Obvious step deformity

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13
Q

treatment for level III AC injury

A

Treatment:
Sling for approx 2-3 weeks.
Analgesics
Physio post immobilisation

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14
Q

how would level IV-VI AC injury be identified

A

Complete rupture of all ligament complexes
Much rarer
Require surgery

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15
Q

observations made during examination to detect an AC joint injury

A

 step deformity

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16
Q

ROM for AC joint injury

A

Variable – may be limited by pain
Depending on grade
Flexion/Abduction most limited at End of Range (EOR)

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17
Q

palpation for AC joint injury

A

Local tenderness over ACJ

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18
Q

early stage conservative management for AC injury

A

Mx depends on severity
Based on general principles of ligament sprains
POLICE

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19
Q

in the early stage of conservative management of AC injury - how long should the patient rest?

A

Approx 3-4 weeks, but depends on grade

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20
Q

what type of exercises should be prescribed to patients in the later stage of the conservative management of an AC injury

A

Start with gentle active and passive ROM exercises
Strengthening: start with isometric and progress depending on grade and pain
Joint mobs for pain and stiffness at later stage

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21
Q

later stage rest for conservative management of AC injury

A

No return to sport/heavy activity until full pain-free ROM, no tenderness and full strength

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22
Q

surgery for level IV-VI AC injury

A

Insertion of pins, screws
Immobilised for a few weeks post surgery
Following D/C of sling, referral to Physiotherapy
Post-Op Protocol as per Surgeon

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23
Q

frozen shoulder contraction syndrome

A

Condition of unknown aetiology distinguished by painful restriction of shoulder movements, passive and active

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24
Q

how is frozen shoulder contraction syndrome characterised

A

by prominent reduction in gleno-humeral ROM

Other terminology ‘Adhesive Capsulitis’

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25
Q

what age group is affected by frozen shoulder contraction syndrome

A

40-60 yr olds

mainly women

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26
Q

stage I pathology synovitis

A

Vascular inflammatory synovitis

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27
Q

stage II pathology synovitis

A

Predominance of red synovium with early adhesion formation

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28
Q

stage III pathology synovitis

A

Pink synovium and more pronounced adhesion formation

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29
Q

stage IV pathology synovitis

A

Synovitis disappears, marked white capsular restrictions

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30
Q

how is synovitis characterisied

A

pain - followed by stiffness

31
Q

purpose of X ray investigations in synovitis

A

Outrule other pathologies e.g.
Fracture, avascular necrosis
normal or minimal age-related incidental degenerative changes

32
Q

clinical stages

A

freezing
frozen
thawing

33
Q

freezing clinical stages time length

A

10-36 weeks – most severe pain with gradual decrease in articular movement.

34
Q

frozen clinical stages time length

A

4-12 months – pain decrease with no appreciable increase in movement.

35
Q

thawing clinical stages time length

A

12 months to years – gradual return of ROM

36
Q

symptoms of freezing stage

A

Most Painful phase
Pain > stiffness
Pain at night, cannot lie on that side
Pain can be constant, can extend below elbow

37
Q

symptoms of frozen stage

A

Increasing stiffness but decreasing pain
Capsular pattern LAM: most limitation of
Lateral rotation > Abduction > Medial rotation
more or less muscle weakness

38
Q

capsular pattern meaning

A

predictable sequence of loss of ROM

39
Q

how can frozen stage be palpated

A

harder end feel to movement

40
Q

symptoms of thawing phase

A

Recovery Phase
Gradual return of movement- may not return to 100%
Less pain, usually at the end of range
Between 20-50% can have residual pain and stiffness after this time

41
Q

what does treatment of pathology depend on

A

depends on stage
Pain dominant
Vs Stiffness dominant

42
Q

type of medication for pain predominant freezing stage

A

Corticosteroid Injection
Evidence of short-term benefit (Wang et al, 2017)
Oral analgesics or NSAIDs

43
Q

physiotherapy for pain predominant freezing stage

A

Gentle assist active movement
Joint Mobilisations (Gr II for pain)
Acupuncture-low evidence (Ben-Arie et al, 2020)

44
Q

pros and cons of steroid injections

A

brings pain down short term but allows patient to do physiotherapy

45
Q

physiotherapy for stiffness predominant injury

A 
ROM exercise 
Passive stretching 
Joint mobilisations  (Gr III for stiffness)
AP/PA/inf glides 
AP good to increase LR
46
Q

cons of using manipulation under anaesthetic

A

poor evidence
Risk of haemarthrosis
Requires physio afterwards

47
Q

arthrographic hydrodistension

A

for stiffness predominant
(injection of NaCl into GH joint to distend the contracted capsule)
Requires physio afterwards

48
Q

prognosis for frozen shoulder AC injury

A

Average duration of symptoms =30 months (1-3.5 years)
Although self-limiting
About 10% of patients will have residual shoulder stiffness and disability
Up to 4 years later, 41% reported some ongoing symptoms

49
Q

3 types of shoulder instability

A

traumatic dislocation - torn loose
interior instability - worn loose
multidirectional instability - born loose

50
Q

shoulder instability

A

Pathologic increase in translatory movement that interferes with joint function and causes pain

51
Q

factors contributing to shoulder stability

A

anatomy and dynamic restraints

52
Q

anatomy restraints

A

Glenoid labrum
Ligaments
Intra-articular pressure

53
Q

dynamic restraints

A

Rotator cuff, Long Head of Biceps (LHB)

54
Q

aetiology of traumatic dislocation

A

Force/fall on externally rotated and abducted arm
In the young (<35) can be related to sport e.g. rugby, soccer, gymnastics.
In the older (>35) usually related to fall

55
Q

associated lesions of trauamtic dislocation

A

Tear of capsule
Damage to attachment of the labrum to the anterior glenoid (Bankhart lesion)
Compression fracture of the posterior humeral head (Hills-Sach Lesion)

56
Q

complications of acute dislocation

A

Axillary nerve injury
Brachial plexus injury
Vascular injury (rare)
Rotator cuff injury
Fracture of the greater tuberosity/ humeral head/ glenoid
Recurrent dislocation / instability (long-term)

57
Q

clinical features of shoulder dislocation

A 
Loss of deltoid contour
Hollow under the acromion
Patient holds arm adducted and supported
Patient often reports that his shoulder is “out”
Arm looks longer
Severe pain
58
Q

conservative management of shoulder dislocation

A

Sling and immobilisation 3-6 weeks depending on age of person.
In sling: ROM elbow/scapular movement. Advise re washing and dressing
Pain is usually not a feature once reduced
Progressive strengthening an ROM on r/o sling
Sports Specific rehab

59
Q

conservative treatment on removal of sling after dislocation

A

Assisted active ROM
Progress to Active ROM
Avoid external rotation initially…why?
Ensure normal scapulohumeral rhythm re-established
Focus on Rotator cuff, LHB, scapular stabilisers, Deltoid strength
Combination of open and closed kinetic chain exercise
Functional retraining e.g. Sports-specific
Proprioception training

60
Q

closed chain upper limb

A

upper limb is in contact of object or surface limiting extension of muscle (idk)

61
Q

recurrent dislocation caused by

A

bankart lesion

62
Q

symptoms of anterior instability worn loose

A

Pain with throwing- dependent on the type of instability-History of repetitive use, overhead sports
Deep pain in shoulder
Associated click/clunk with movement
Sharp catches of pain through range.

63
Q

worn loose

A

overstretch capsule - repeated force and overuse

64
Q

typical causes of anterior instability - worn loosed

A

Bankart lesion
Internal Impingement
SLAP lesion
GIRD

65
Q

signs of anterior instability

A

Excessive ROM with end- range pain (ER/ABD)
May have midrange pain if associated impingement e.g. painful arc
Isometrics in midrange are often pain-free and full strength (unless associated impingement)
BUT Weak in EOR / instability position (ER+ Abd)
stability tests - -hard to evaluate w/ muscle guarding

66
Q

apprehension and relocation

A

put patient supine
abduction/external rotation to point of pain an apprehension
can provoke instability - be careful

67
Q

tests for shoulder dislocation

A

load and shift test ant-post movement

sulcus sign - inferior movement

68
Q

SLAP

A

Superior Labral Ant to Post where LHB attached.
Diff Dx: LHB lesion, Bankart lesion
Labral tear

69
Q

subjective feature of labral tears

A

Assoc with throwing sports, carrying/dropping heavy object.
Pain located in posterior shoulder
Aggravated by overhead and HBB
+/- popping, grinding, catching sensation

70
Q

what would be detected in physical exam of shoulder dislocation

A

Pain with LHB tests
Specific SLAP lesion tests: O’Brien’s test
May have positive Apprehension test
Confirmed with MRA (better than MRI) and Arthroscopy

71
Q

internal impingement

A

Impingement of RC against posterior-superior surface of glenoid

72
Q

aetiology of internal impingement

A

Repetitive trauma

Secondary to labral injury

73
Q

GIRD

A

Glenohumeral Internal Rotation Deficit (GIRD)

NMSKI (38 decks)

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