2- Shoulder & Neck Flashcards

Question

Biceps Tendonitis & Rupture: Anatomy - Presentation - Name 3 Tests 🔑 - Management

Answer 1

**ROTATOR CUFF AND BICEP TENDONITIS** * Isolated bicipital tendonitis as the primary cause of shoulder pain is uncommon * It exists along the continuum of rotator cuff tendinitis secondary to its related proximity. * Impingement is a result of biomechanical dysfunction of the shoulder and itself is not a pathologic diagnosis. * This impingement causes pathology by repetitive compromise of the soft tissues of the shoulder girdle **ANATOMY** * Long head of the biceps tendon: supraglenoid tuberosity * Short head of the biceps tendon: coracoid process * Insertion: radial tuberosity **IMAGING** * MRI: tendinopathy or biceps tendon rupture. * Diagnostic US imaging (quick, in-office evaluation) **TENDONITIS** **Examination** 1. Tenderness in the bicipital groove (long head) 2. Positive impingement signs (associated with shoulder impingement syndrome) 3. Yergason’s test 4. Speed’s test **Treatment** 1. ROM 2. Modalities 3. Strengthening as tolerated 4. Injection into the tendon sheath (controversial) **TENDON RUPTURE** **Causes** * Proximal Tear → Chronic impingement & Rotator cuff tears * Distal Tear → Heavy lifting → Sharp pain, audible snap **Examination** 1. Popeye sign 2. Ecchymosis 3. Ludington’s test **Surgical Correction** * Patient requiring heavy lifting or cosmetic Cuccurollo 4th Edition Chapter 4 MSK pg170-172

Answer 2

1. coracobrachialis 2. short head of the biceps 3. pec minor (insertion)

Answer 3

**SHOULDER OA** **Etiology** * Posttraumatic lesions * Chronic rotator cuff pathology **Presentation** * Pain affecting activities of daily living (ADLs) * Pain may be nocturnal and relieved by rest. **Xray** 1. Irregular joint surfaces 2. Flattened glenoid 3. Joint space narrowing (cartilage destruction) 4. Subacromial sclerosis 5. Osteophyte changes 6. Cystic changes in the humeral head **Examination** * Pain in internal rotation and abduction * Tenderness felt on palpation on the anterior and posterior aspects of the shoulder * Manual muscle testing (MMT) may or may not be affected **Conservative** 1. NSAID 2. Corticosteroid injection 3. ROM exercises 4. Rotator cuff strengthening **TOTAL SHOULDER ARTHROPLASTY (TSA)** **Goals** * Relieve pain, protect joint, and restore function **Indication** 1. Pain 2. Avascular necrosis 3. Neoplasm **Precautions status post-TSA** 1. Sling immobilization 2. No active ROM, nonweight bearing (NWB) 3. Avoid active abductions and extension \>0 degrees. 4. No external rotation \>15 degrees **Stage 1: 2 to 6 weeks** 1. Shoulder Sling 2. Gentle PROM (Codman’s exercises) 3. Active range of motion (AROM; wall-walking) 4. Isometrics exercises (progressing) **Stage 2: 6 to 12 weeks** 1. Discontinue sling 2. Active-assist ROM (AAROM), AROM 3. Start isotonics exercises, start light weights. **Stage 3: \>12 weeks** 1. Stretching 2. Active ROM 3. Progressive resistive exercises **SHOULDER ARTHRODESIS** **Indications** 1. Severe shoulder pain secondary to osteoarthritis (OA) 2. Mechanical loosening of a shoulder arthroplasty 3. Joint infection **Position** * 50-degree abduction * 30-degree forward flexion * 50-degree internal rotation Cuccurollo 4th Edition Chapter 4 MSK pg167-168

Answer 4

**ADHESIVE CAPSULITIS** * Synovial tissue of the capsule and bursa become adherent **ETIOLOGY** 1. Trauma 2. Immobilization 3. Intracranial lesions: CVA, hemorrhage, tumor 4. CRPS 5. Clinical depression 6. Parkinson’s disease 7. Diabetes 8. Hypothyroid 9. Autoimmune **STAGES** 1. Painful stage: Progressive vague pain lasting roughly 8 months 2. Stiffening stage: Decreasing ROM lasting roughly 8 months 3. Thawing stage: Increasing ROM with decrease of shoulder pain **PRESENT** 1. Painful shoulder with restricted glenohumeral motion 2. Painful ADLs **EXAM** 1. Significant reduction in both AROM and PROM 2. External rotation and abduction ROM typically lost first. 3. Contracture of the shoulder joint **INVESTIGATION** 1. Plain films (AP view) 1. To rule out underlying tumor or calcium deposit 2. Osteopenia → due to mechanical unloading 2. MRI 1. Thickened GHJ capsule and synovium **TREATMENT** **Stages 1 and 2 → Reduce pain and inflammation** * Pain modalities * Analgesics * Nonsteroidal anti-inflammatory drug (NSAID) * Oral steroids * Activity modification * Up to three intraarticular corticosteroid injections * To shorten the duration of the condition * Decrease pain to maximize therapy **Early ROM** * Postural retraining to reduce kyphotic posture and forward humeral positioning * Passive joint glides * Passive and active assisted ROM exercises should be initiated. **Strength as Tolerate** * Scapular stability exercises * Closed chain rotator cuff exercises * Active ROM along with open chain and proprioceptive exercises. **NO PROGRESS IN 6 MONTHS** 1. Xray to rule tumor or calcium deposit 2. Arthroscopic lysis of adhesions 3. Manipulation under anesthesia Cuccurollo 4th Edition Chapter 4 MSK pg169 Braddom 6th Edition Chapter 35 UL MSK pg720-721

Answer 5

**STATIC STABILIZERS** 1. Glenoid 2. Glenoid Labrum - Cup-shaped rim of cartilage that reinforces a ball-and-socket joint - Increases overall contact of the humeral head with the glenoid by 70% - Attachment site for the glenohumeral ligaments - Prevents anterior and posterior humeral head dislocation 3. Shoulder capsule 4. Glenohumeral ligaments - Superior glenohumeral ligament: Prevents translation in the inferior direction in a neutral position. Provides stability of the shoulder from 0 degrees to 90 degrees of abduction - Middle glenohumeral ligament: Prevents anterior shoulder translation - Inferior glenohumeral ligament: Stabilizer above 90 degrees. Prevent posterior subluxation 5. Coracohumeral ligament (CHL) 6. Negative intraarticular pressure **DYNAMIC STABILIZERS** 1. Rotator cuff muscles 2. The long head of the biceps tendon → Curls 3. Deltoid, and teres major 4. Latissimus dorsi **SCAPULA STABILISERS** 1. Trapezius → Shrug, Press Up, Up Right Rows 2. Serratus anterior → Push Up-Plus, Punches 3. Rhomboid Major & Minor → Rowing, Scapula Retraction 4. Levator Scapula → Shrug, Press Up, Up Right Rows Cuccurollo 4th Edition Chapter 4 MSK pg149-154

Answer 6

**EARLY** 1. Muscle: Acute Compartment Syndrome 2. Nerve: Nerve Injury 3. Vessels: Hemarthrosis, Vascular Injury 4. Bone: Fat Embolism 5. Skin: Cellulitis **LATE** 1. Bone: Delayed, Non, Malunion, Shortening/Growth Disturbance 2. Vessels: AVN 3. Joint: OA, Contracture 4. Nerve: Compression 5. Muscle: Osteomyelitis, Weakness & Atrophy

Answer 7

**PROXIMAL HUMERAL FRACTURES** **Etiology** * Occur primarily in older osteoporotic patients after a low-energy fall * Young patients that experience a high-energy trauma **Presentation** * Pain, swelling, and ecchymosis in the upper arm * Exacerbated with the slightest motion * Loss of sensation is seen if there is neurologic involvement * Diminished radial pulse if the fracture compromises the vascular supply **Complications** 1. Avascular necrosis (AVN) of the humeral head (humeral circumflex artery) 2. Brachial plexus injuries 3. Axillary nerve injury 4. Axillary artery compromise 5. Radial and ulnar nerves may be affected as well. 6. The median nerve is the least affected. **FOUR PARTS** 1. Humeral head / Anatomical neck 2. Humeral shaft / Surgical neck (most common) 3. Greater tuberosity 4. Lesser tuberosity **NEER CLASSIFICATION** 1. One-part humeral fracture: Nondisplaced fractures, All parts still in alignment. 2. Two-part humeral fracture: One fragment is displaced 3. Three-part humeral fracture: Two fragments are displaced. 4. Four-part humeral fracture: All fragments are displaced **IMAGING** * X-ray (trauma series): AP view, scapular Y view, axillary view, apical oblique view, and west point axillary view **MANAGEMENT** **One part (mean non-displaced and joint still in one unit structure)** * Sling immobilization and early rehabilitation (6 weeks) * Early ROM: Codman’s exercises and AROM as early as tolerated **Surgical (ORIF)** * Greater than one part (displaced \>2 cm)

2- Shoulder & Neck Flashcards

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