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Brad 4th Ed Part 2 > Ch.38 Upper Extremity Shoulder > Flashcards

Ch.38 Upper Extremity Shoulder Flashcards

(66 cards)

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1
Q

What rehab should be done in the acute stage of injury?

A

RICE, cardio that doesn’t involved affected limb, gental ROM, stablization exercises

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2
Q

What can be done for pain in acute injury?

A

Cryotherapy, E-stim, NSAIDs, tylenol, opiods, oral/injected steroids

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3
Q

When can a patient advance to the recovery phase of rehab?

A

When pain is controlled and tissue healing occured

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4
Q

What is the emphasis of recovery rehab?

A

Restoration of flexibility, strength and proprioception of injured limb

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5
Q

Open kinetic chain exercises should be used for __.

A

Correcting strength imbalances

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6
Q

Closed kinetic chain execises should be used for __.

A

provide joint stabilization throught muscle co-contraction

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7
Q

When can a patient advance to the functional phase of rehab?

A

Injured limbe gained 80% of strength compared to normal limb and not flexibility imbalances

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8
Q

What is addressed in functional rehab?

A

maladaptive movement patterns, muscle subsitution and full strength obtained

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9
Q

2/3 of sternoclavicular joint dislocations are __.

A

Anterior

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10
Q

Grade I Sternoclavicular Sprain

A

Tenderness to palpation w/o joint laxity

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11
Q

Grade II Sternoclavicular Sprain

A

Tenderness to palpation w/ joint laxity w/ a good endpoint

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12
Q

Grade III Sternoclavicular Sprain

A

Tenderness to palpation w/ significant joint laxity and no endpoint

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13
Q

Tx of Grade I & II Sternoclavicular Sprain

A

nonoperative, sling immbolization for comfort in acute phase, rehab

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14
Q

When can patient return to activity with sternoclavicular sprain?

A

Grade I: 1-2 weeks, Grade II: 4-6 weeks

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15
Q

Tx of Grade III Sternoclavicular Sprain

A

Can be nonoperative but recuires surgery if unstable or for mediastinal compression

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16
Q

80% of clavicle fractures occur __.

A

at middle 1/3 of clavicle

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17
Q

Tx of clavicle fx in good alignment

A

immobilization in sling or figure of eigh bandage

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18
Q

When should surgery be considered for clavicle fx?

A

15-20mm shortening, ope fx, neuovascular compromise or tenting of skin

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19
Q

What are teh Rockwood classifications of AC joint sprains?

A

I: sprain AC ligaments
II: tear AC & sprain CC ligaments
III: tear both AC & CC ligaments IV: III plus posterior displacement of distal clavicle into trapezius V: IV plus rupture of deltotrapezial fascia VI: V plus displacement of clavicle below acromion or coracoid process

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20
Q

Tx of type I & II AC joint sprains

A

nonoperative and rehab

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21
Q

Tx of type III AC joint sprains

A

no-op unless persistent pain, comestic or heavy labors and athletes

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22
Q

Tx of type IV-VI AC joint sprains

A

Surgery

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23
Q

How does osteolysis of the distal clavicle develop?

A

repetive overloading: bech press or military press lifts

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24
Q

What is the hx of osteolysis of the distal clavicle?

A

Gradual onset AC joint pain increased with overhead or bench presses, esp when bar lowered to chest

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25
What are the pathologic changes on Xray for oteolysis?
distal clavicular subchondral bone loss and cystic changes
26
Tx of distal clavicle osteolysis
avoidance of aggraviting activities, rehab, steroid injection to AC joint, distal clavicle resection
27
What is does a loud grating scapulothoracic crepitus indicate?
Bursitis, fibrotic/atrophic muscle, anomal muscular insertions
28
What is does a loud snapping scapulothoracic crepitus indicate?
Boney pathology: osteophyte, rib/scapular osteochondroma/fx
29
What are the Neer classications of rotator cuff injury?
I: Inflammation & edema of cuffs II: Fibrosis & tendonitis of cuffs III: partial or complete tear of cuff
30
What are the Bigliani classifications of acromion shapes?
I: flat, II: curved, III: hooked
31
What augments rotator cuff contact to posteriorsuperior glenoid rim?
anterior glenohumeral head instability and posterior glenohumeral head capsular tightness
32
Rotator cuff impingement can be caused by:
hooked acromion, thick coracoacromial ligament, glenohumeral joint instability, scapulothoracic dyskinesis and instability
33
What stage of throwing can cause microtrauma to rotator cuffs due to eccentric overload?
External rotators during decceleration phase
34
Rotator cuff muscle strengthening should begin with:
closed chain exercises to promote stability and proprioception
35
Open chain exercises should be used rotator cuff disorders to __.
Correct strength imbalance of shoulder ER relative to IR
36
Hx of long head biceps tendon ruputure
>40yo, hx of rotator cuff dz, "pop" at injury, during lifting or pulling
37
Best imaging for biceps tendon rupture
MRI or US
38
Tx of biceps tendon rupture in >40yo or sedentary pt
Sling for compfort, strengthen shoudler girdle and rotator cuff muscles
39
Tx of biceps tendon rupture in young active pt
Surgery
40
MCC of pectoralis major strain
forceful shoulder adduction & IR (weight lifters & football players)
41
What muscle is important for anterior and posterior glenohumeral joint stability?
Subscapularis
42
What is the most frequent type of unidirectional glenohumeral joint instability?
Traumatic anterior instability
43
What is multidirectional glenohumeral joint instability due to?
Congenital capsular laxity (Marfans or EDS) or chronic repetitive microtrauma
44
What is a Bankhart lesion?
avulsion of anterior-inferior glenoid labrum w/ or w/o bone from glenoid rim
45
What's a SLAP lesion?
Superior labral anterior to posterior lesion
46
What is a Hill-Sachs defect?
compression fx of posterolateral aspec of humeral head from anterior humeral dislocation
47
What is a reverse Bankhart lesion?
Tear of the posterior inferior glenoid labrum causing separation from the glenoid fossa rim
48
What are common sx of shoulder subluxation?
Burning or dead feeling in arm
49
How can an Hill-Sachs defect bee seen on X-ray?
AP view with shoulder IR and Stryker Notch view
50
What does the scapular Y view on xray show?
Assess glenohumeral joint alignment
51
What does the axillary lateral view show on xray?
Anterior or posterior subulxation or dislocation and fx of glenoid rim
52
What are the best views for Bankhar lesion on xray?
Garth view and West Point view
53
What patient has a high rate of redislocation after first time shoulder dislocation?
Young active patient, require surgery
54
When should shoulder immbolization be done after dislocation?
First 24 hrs, then 3 weeks with humer ER 30 deg. if not done in the first day benefits not significant
55
What conditions are associated with adhesive capsulitis?
DM, inflam arthritis, trauma, prolonged immobilization, thydroid dz, CVA, MI, autoimmune dz
56
Sx of adhesive capsulitis in Stage I
Painful and restricted ROM in first 1-3 mo
57
Sx of adhesive capsulitis in Stage II
Painful ROM, progressive loss of glenohumeral motion (3-9 mo)
58
Sx of adhesive capsulitis in Stage III
"Frozen stage": Reduced pain w/ shoulder movement, severely restricted glenohumeral ROM (9-15 mo)
59
Sx of adhesive capsulitis in Stage IV
"Thawing stage": Minimal pain, progressive normalization of ROM (15-24 mo)
60
Type 1 SLAP lesion
fraying of superior labrum w/o detached biceps tendon
61
Type 2 SLAP lesion
Bicep tendon detached from supraglenoid tubercle
62
Type 3 SLAP lesion
Bucket handle tear of superior labrum w/o detachment of biceps tendon
63
Type 4 SLAP lesion
Tear of superior labrum extends to biceps tendon
64
What exam finding can indicate SLAP lesion?
Postive O'Brien test
65
What is the gold standard for dx of SLAP lesion?
Arthroscopy
66
What imaging is used to dx SLAP lesion?
Gadolinium-enhanced MRI

Brad 4th Ed Part 2 (28 decks)

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