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Extremities 2 > 2 - Shoulder > Flashcards

2 - Shoulder Flashcards

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1
Q

Give at least (3) indications of an inferior humerus?

A

(1.) Shoulder visualizes as being low with soft tissue dimpling/ sulcus sign.

(2.) Point tenderness at the anterior aspect of the G-H joint.

(3.) Loss of fluid motion.

(4.) Loss of Appley’s external rotation.

(5.) Anterior deltoid weakness.

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2
Q

Indications of a posterior humerus?

A
  • visualizes normally, no apparent visual change.
  • lost fluid motion
  • point tenderness at posterior aspect of G-H joint
  • Loss of internal rotation
  • Teres major muscle weakness
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3
Q

With any shoulder complaint the Dr. should routinely examine? `

A
  • St-Cl,
  • A-C,
  • G-H,
  • Sc-Th,
  • St-Co,
  • & definitely the spine for subluxation.
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4
Q

On Scapulo-Thoracic Lateral (S-T L) what position do we place the patient’s arm?

A

-Behind the pts. back (side lying) with doctor reaching through the pts. axillary/ arm opening.

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5
Q

Where is #11 of the stabilization hand? S-T L

A

-Over the A-C joint

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6
Q

Where are the fingers?
S-T L

A

-Over the G-H joint

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7
Q

In what direction does the stabilization hand push to bring the joint to tension?

S-T L

A

-S to I

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8
Q

What’s the pain point for S-T L?

A

-Deep to or under the scapula, in the subscapularis muscle.

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9
Q

How to differentiate S-T L (lateral) from S-T M (scapulo-thoracic medial)?

A

1.) Fluid motion,

2.) -visualization of distance from spine

3.) S-T L = (lateral) Appley’s scratch in internal rotation is diminished

4.) S-T M = (medial) Appley’s scratch in external rotation is diminished.

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10
Q

What part of the scapulo-humeral ratio would be decreased with a G-H P?

A

-The Glenohumeral portion.

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11
Q

Scapulothoracic medial, prone: Three most common mistakes for this:

A

1.)-Should have patient’s shoulder off the table

2.)-Should have Dr. stand on opposite side of contact

3.)-Should use inferior hand contact

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12
Q

G-H posterior, prone-LOC?

A

-P-A, be careful to not get any S-I

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13
Q

Where is the patient’s shoulder?

A

-Supported on the table

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14
Q

Why is the shoulder on the table?

A

-For stabilization; we don’t want to dislocate it

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15
Q

Indication of Yergason’s positive?

A
  • Bicepetal tendon instability, usually caused by a shallow groove
  • or a tear or sprain of transverse humeral ligament
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16
Q

Drop Arm test: describe 3 parts least-to-most invasive and diagnosis for each

A

1.) Pt. lowers arm to side against gravity; if it drops fast, it’s often a severe tear of rotator cuff,

grade 3. Supraspinatus muscle.

2) Apply a little pressure while they lower it; some resistance, moderate tear of rotator cuff, grade 2

3) Put an impulse in the abducted arm; fair resistance, mild tear or strain of rotator cuff, grade 1

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17
Q

G-H P, seated: What is most important about LOC?

A

-Straight P-A, drop elbow so it’s level or below the wrist

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18
Q

What ROM’ s do you use to bring it to tension?
G-H P

A

-Abduction & extension

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19
Q

Where is the pain point?

G-H P

A

-Over the posterior glenohumeral joint

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20
Q

How to differentially diagnose a G-HP, from a G-H Inf.?

A
  • Pain point is posterior; visualizes as normal, not inferior.
  • G-HP is decreased ROM on internal rotation, not external rotation

(Appley’s Scratch ROM loss on internal rotation, not external).

  • X-ray shows humeral head is posterior and superior, not inferior
  • Teres major muscle test is weak on G-H P, not the anterior deltoid as G-H I.
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21
Q

Is this the move of choice?
G-H I

A

No

Supine traction. Because you can feel the joint.

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22
Q

What are at least three other alternatives to differentiate this diagnosis from?
G-H I

A
  • G-H posterior, Subacromial bursitis, bicipetal tendonitis,
  • bicipetal instability, sprain or tear of rotator cuff,
  • dislocation, heart attack, gall bladder, spleen
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23
Q

Describe the 3 parts as you’re doing them
Frozen Shoulder

A

1) traction, release; if ROM is gained, go on to part 2

2) traction through ROM gained, back to neutral, release

3) after a few visits if no part 2 progress, traction and take it through the ROM gained, at end-ROM put an impulse down the shaft of the humerus, bring it back to neutral, return to part 2 until no more progress. Post check with ROM and comparing L side to R side.

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24
Q

G-H traction, seated: Dr’s arm in Pt’s. armpit with thumb up.

What are your limiting factors?

A
  • Patient tolerance & visualizing the joint space to open up.
  • (Note: it is important to be visualizing this during the practical)
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25
-Is this the move of choice for a G-H fixation? G-H Traction supine
-Yes, because you can palpate the joint space rather than just visualize it.
26
Give at least ***_“3”_*** diagnoses that G-H traction, supine would work for?
- Frozen shoulder, - inferior humerus, - posterior humerus, - osteoarthritis with fixation, - G-H dislocation.
27
How do you bring this joint to tension before the thrust? + Describe the thrust St-Cl Superior
- Bring the arm into abduction & extension. - Straight S-I, maybe a little torque, fingers point toward the axilla
28
What are we doing with our opposite arm? St-Cl traction seated
-Holding the opposite shoulder back
29
Why do we hold the shoulder back? St-Cl traction seated
-Isolating the st-cl joint, not rotating the thoracics
30
What direction does the clavicle most commonly subluxate St-Cl traction supine
Superipr
31
Is this traction move a post-check for St-cl Superior? St-Cl Traction supine
-NO, this is actually a procedure & should be done before St-Cl S
32
Which part of this takes care of superiority? A-C PS
-Pushing down on the distal end of the clavicle
33
Which part takes care of the posteriority? A-C PS
-Pushing slightly forward and externally rotating the arm.
34
Most common muscle involved with ***_Hyperabduction Syndrome_*** or a positive ***Wright's***?
-Pectoralis minor
35
What causes the pectoralis minor to be shortened or go into contracture?
***(1.)*** Cervical subluxation, ***(2.)*** subacromial bursitis, ***(3.)*** rolled shoulder posture ***(4.)*** other types of TOS
36
Scalenus anticus syndrome is caused by what?
-subluxation usually
37
What to do for scalenus anticus syndrome?
-Adjust subluxation,…. then use moist heat to relax the muscles,….finally stretch
38
***_Positive Eden's_*** indicates?
- Decreased pulse volume or amplitude (not rate), - TOS,….Costoclavicular syndrome
39
How to treat for positive ***Eden's***?
- Find out if it’s muscle guarding often indicating a hypertonic pectoralis major involvement, which needs to be stretched out. - It may also be a _cervical_, _thoracic_ or _rib subluxation_, often helped by adjusting.
40
What questions might you ask if a patient has a ***positive Eden's***?
**-**Do they carry a backpack?….Do they carry heavy objects in front of them at work? **-**Ever had accident with the seatbelt on?...Ever had a fractured or dislocated clavicle,…or shoulder problem? **-**Have they ever **_f**_allen _**o**_n their shoulder or with an _**o_**ut **s**tretched arm/**_h_**and (FOOSH) ?
41
How far up and back do we go with the patient's shoulder? St-Co traction seated
-To patient tolerance or until you feel the joint open up
42
How far up and back would you go for rib 2 compared to rib 5? St-Co traction seated
-Not as far, it won't take as much rotation/extension for rib 2
43
Where is the pain point for this? St-Co traction seated
? -Pain right over the joint space. -(Superior rib) located over the top of rib head. –(Inferior rib) located over bottom of rib head
44
What is the best way to post check? St-Co traction seated
-Have the patient take a very deep breath in while bringing shoulders up, then blow it all the way out while feeling the excursion of the ribs involved.
45
***_St-Co S***_ or _***St-Co I_*** Which rib levels may commonly need St-Co thrusting type adjusting procedures?
-Ribs 2 – 5.
46
What's patient placement? ***_St-Co S***_ or _***St-Co I_***
-Supine, on the center of the table
47
Doctor's stance? ***_St-Co S***_ or _***St-Co I_***
-Straightaway so that you don't have body drop
48
What type of breathing would show aberrant motion with a St-Co S?
-On expiration, the rib doesn't come down
49
Where is the pain point? St-Co S
-Right over the sternocostal joint of the involved rib
50
What if the pain is running along the rib all the way around?
***(1.)*** Probably subluxation of the thoracic spine; ***(2.)*** shingles, ***(3.)*** intercostal neuralgia, ***(4.)*** fracture, ***(5.)*** Tumor, ***(6.)*** Heart Attack if on the left
51
What do you do for patient safety on ***St-Co S***?
-Turn their face away so you don't put your elbow in it,
52
What do you do to get an S-I, LOC?
-Drop your elbow down close to the chest wall
53
What breathing instructions do you give the patient on a ***_St-Co S_***
-Blow air all the way out and hold
54
Why do you give the breathing instructions? St-Co S
- "blow out" air so that musculature is pulling down on rib & opens up the joint space underneath the rib - "hold" to keep from forcing out residual air
55
Breathing instructions? St-Co I
-Take a deep breath in and hold
56
What's the best post-check? St-Co I
-Fluid motion
57
How would you do fluid motion on St – Co I .
-Put fingers above and below rib you're testing, breath in and out
58
Which should you see improvement on, inspiration or expiration? St-Co I
-Inspiration
59
When not to use mentholated rubs?
- Allergies, - Pneumonia, - they are oil-based & will leave residue in lungs.
60
Patient placement St-Co Traction supine
-Supine, shoulder way off the table, especially for lower ribs
61
Which way should Dr.'s fingers point? St-Co traction supine
-M-L, some (S-I) or ribs 2-3rd or (I-S) 4-5th to follow the involved rib attitude depending on how low in the rib cage you are.
62
What is the limiting factor for bringing arm up and back? St-Co traction supine
-Patient tolerance or until you feel the joint open
63
Visualization Steroclavicular joint
-superior clavicle: compare proximal ends of the clavicles to see if one sits higher than the other
64
Visualization AC
- posterior superior clavicle: one distal end of clavicle sits higher than the other. - Compare trapezius muscles on each side to see if there is a smooth transition over the distal clavicle. (Step sign.)
65
Visualization GH
-inferior humerus: roundness of one shoulder is sitting lower in relation to the acromion process (dimpling) (Sulcus sign).
66
Visualization: Scapulothoracic
-lateral/medial scapula: vertebral border of scapula has flared laterally/medially w/ respect to midline (spine)
67
Most common shoulder misalignment?
-***G-H I*** (Inferior, due to gravity)
68
Most common shoulder dislocation? Why?
- Anterior-inferior; - gravity pulls it down & forward, - carrying things pulls it down & forward - the anterior glenoid labrum is shallow
69
What tests will help differentially diagnosis (ddx) an inferior & posterior humerus?
- Yergason's, - Dawburn's, - Supraspinatus Extra information use: (Appley’s Scratch & Teres Major for internal / external ROM )
70
***_Kocher’s Maneuver:_***
-Traction,.…external rotation,…adduction,…internal rotation,.…finalize support as in Dugas
71
What three systems do you want to check on your post check? Kocher's Maneuver
Neuro Vascular Musculoskeletal
72
Why do a 3-part procedure vs. surgery for frozen shoulder (Adhesive Capsulitis)
-Less risk of fractured humerus, dislocated glenohumeral joint
73
Most important component of ***frozen shoulder*** treatment?
-Find out what caused them to stop using their shoulder allowing it to "freeze", then address the problem. Could be due to scar tissue buildup, or DJD / Arthritis.
74
Most common ***_AC misalignmen_t***
-posterior superior.
75
What is "***shoulder separation***"?
-_dislocation_ (vs. subluxation) of AC joint
76
ROM vs. immobilization for AC joint?
- Subluxation w/fixation……-do ROM, not immobilize - Dislocation ……-immobilize with brace or "reminder” tether
77
**\***"_Move of choice" for G-H joint?_
-traction with patient supine because you can palpate the joint during this procedure.

Extremities 2 (7 decks)

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