Chapter 1 - Shoulder Flashcards
(84 cards)
1
Q
The roof of the shoulder is formed by:
A
a part of the scapula called theacromion
2
Q
What is the false jointis formed where the shoulder blade glides against thethorax(the rib cage).
A
Scapulothoracic joint
3
Q
The strongest muscles of the shoulder + motions
A
Deltoid, takes over lifting when arm is away from the side.
4
Q
Which pulse can you feel, if you put your hand in your armpit?
A
Axillary
5
Q
7 most common shoulder girdle presentation.
A
Instability (trauma/non-trauma); Impingement (tendon, bursar, ligament); Tendinitis/bursitis; Osteoarthritis; Adhesive capsulitis (frozen shoulder); AC joint separation; C-spine referred pain pattern.
6
Q
Arthritides that commonly affect the shoulder are: _____________ where in severe cases ___________tendon can rupture.
A
AS and rheumatoid
Supraspinatus tendon
7
Q
In senior citizens, OA is common and must be differentiated from:
A
Adhesive capsulitis.
8
Q
OA can also appear in younger patient following:
A
Trauma
9
Q
If the pain is: Anterior; Traumatic - Think…
A
Fracture; Dislocation; Sub-acromial bursitis; Capsular sprain; Tendon rupture (long head of bicep); Labrum tear.
10
Q
If the pain is Anterior; Non-traumatic - think…
A
Impingement; biceps tendonitis; Sub-ac bursitis; Subscapularis tendonitis; Subluxation.
11
Q
What is the typical presentation of blows?
A
Contusion
12
Q
What is the typical presentation of FOOSA/H injuries?
A
AC separation, dislocation, labrum tear,
Rotator cuff tears.
13
Q
What can occur when the arm is forced into certain positions and jammed or wrenched.
A
Dislocation,
Labrum tear.
14
Q
Traction on the arm can result in:
A
Brachial plexus injuries;
Subluxation.
15
Q
If a patient experiences sudden pain when lifting heavy objects - think…
A
Tendon rupture;
Labrum tear.
16
Q
Weakness or instability is highly subjective of
A
Un-rehabilitated capsular ligament injury (can lead to concomitant damage to labrum)
17
Q
Nerve damage must be suspected when:
A
Show evident atrophy of the associated muscle.
18
Q
Inherent shoulder capsule weakness is usually: ……
Can be determined with:…
A
Bilateral and can be determined with orthopedic testing.
19
Q
Acute pain without any recent trauma that lasts for weeks before eventually becoming stiff is likely to be:
A
Adhesive capsulitis
20
Q
Hx of trauma & or surgery with resultant pain/restriction - Think…
A
OA
21
Q
Restriction due to pain and weakness is likely due to:
A
Bone blockage or labrum pathology
22
Q
Assessment: Painful Arc is considered to be b/w:
A
70-110 degrees
23
Q
The Zanca or Z view (15 degree cephalad) is utilized for:
A
AC spot shot and Osteolysis of the distal clavicle.
24
Q
Which view is used to observe a Bankart lesion (glenoid lip avulsions associated with labrum tears)
A
West Point view
25
The Stryker-notch view is used for:
Hill-Sachs lesion (also a labrum tear finding)
26
What is the imaging of choice for labrum tears and rotator cuff tears
CT and CT arthrogram
27
Which technology is used to determine full-thickness rotator cuff tears.
Ultrasonography
28
If AS, Rheumatoid or other arthritides are suspected based on the plain film, which lab exam may be ordered?
HLAB-27
29
What is the Shoulder Sully Brace (SAUNDERS OR DON-JOY) designed to treat and protect?
Anterior, multidirectional, inferior and posterior instabilities;
Rotator cuff deceleration;
Shoulder AC separation;
Muscle strains
30
The shoulder joint complex: Nerve supply
Fifth through Seventh cervical nerve roots via its formation into the brachial plexus.
On the lateral aspect of the shoulder, the skin is innervated by a cutaneous branch of the axillary nerve.
31
ROM:
External rotation- ?
Internal rotation- ?
With the arm at 90 degree of ABDuction, total Rotational Arc = ?
Ext. 108 degree
Int. 72 degree
Total rotational arc = 120 degree
32
Which muscles help compress the huméral head into the glenoid?
Rotator cuff - SITS muscles
33
Which muscle of the shoulder provides a shearing force, pushing the humerus upward in the glénoïde labrum at ABDuction?
Deltoid
34
****IMPORTANT****
Most common shoulder issue?
&
2nd Most common.
1 - Impingement syndrome
| 2 - Degeneration
35
Typical signs and symptoms:
- Pain w/ overhead activities
- Medial AC joint ostéophytes (reduction of humeral space)
Causes/etiology
- Overuse, degenerative changes, inflammatory processes, variant structure.
- Co-exist with instability and excessive superior movement of the huméral head.
Impingement syndrome
36
Which structures are commonly assoc. w/ antero-lateral type of Impingement syndrome. (4)
Biceps tendon;
Superior labrum;
Supraspinatus tendon;
Subacromial bursa.
37
Which structures are more commonly assoc. w/ Posterior Impingement? (4)
Subscap;
Subcoracoid;
Infraspinatus;
Teres-minor
38
Evaluation for Impingement:
- Hawkins-Kennedy (impingement)
- Neer (Impingemnt)
- Impingement sign to rule out tendinitis or supraspinatus overuse injuries.
- Relocation test for underlying accompanying instability.
39
Sign and symptoms:
- Past Hx of shoulder dislocation
- Pain/weakness when arm placed (overhead) or in apprehension position of 90 degrees flexion coupled with external rotation and horizontal extension .
What is the pathophysiology/etiology
TRAUMATIC INSTASBILITY
- Acute/subacute anterior dislocation of Gleno-huméral joint in 90-95% of cases
- Posterior instability in pt. who chronically dislocate or those who suffer seizures.
- Clavicular fx, muscle contusions & direct blows to the base of the neck can also be included as trauma.
40
Traumatic instability - Evaluation
Apprehension test and it’s variants;
Sulcus sign with L&S test
*If sulcus sign appears to be greater than 3 cm (grade 3) DO NOT perform A-P/P-A shift portion of the test.
41
Presentation:
- Reported painful “Clunking” and locking with specific movements. Loss of strength, decreased ROM and pain AT NIGHT.
- Sense of instability in the shoulder.
Condition????
Labrum tear
42
Shoulder Lesion assoc. w/ multidirectional instability (MDI)
SLAP - Superior Labrum Anterior toi Posterior
43
Tears of the rim below the middle of the Glenoid socket involving the
inferior Gleno-humeral ligament are called ____________ lesions. (Tears of the labrum often accompany dislocation)
Bankart lesions
44
Tests to assess Labrum Tears.
- Clunk test
- O’Brien sign
- Anterior slide test
- Biceps load test to rule out labrum tear.
Rule OUT dislocation:
- Apprehension
- Dugas tests.
Confirm Biceps tendon tears that MIGHT accompany labrum tear:
- Speed
- Abbotts Saunders
- Yergason
Apley and Colman to rule out rotator cuff tears.
Lift Off test to rule out subscap.
45
Management of small Labrum tears
Will respond to conservative treatment:
- rest (sling)
- rehab
- strengthening
- mobilization after acute pain subsides.
Chiro adjustments to restore functional proprioception and alignment.
46
Management of severe Labrum tear.
Referral to Orthopaedic surgeon for assessment -
| Most severe tears will require surgery for repair.
47
Signs/Symptoms and presentation:
Usually asymptomatic.
Pain is felt when there is sudden traction or pulling on the
arm.
Supporting the arm provides relief.
Patient reports fatigue and discomfort when working overhead rather than actual pain.
Condition???
Non-traumatic Instability/Looseness
48
Patient presenting with Non-traumatic Instability/looseness are BORN THAT WAY! And are asymptomatic unless:
- Distraction force subluxates the shoulder.
| - Aggravated by sports activity that continuously stretches the capsule ex: Swimming or throwing.
49
Non-traumatic Instability/looseness - Evaluation
- L&S tests
- Apprehension test (if accompanied by Impingement)
- Pain is reduced by the relocation (Jobe test)
50
What is the appropriate management for Non-traumatic Instability/Looseness?
Strengthening Rotator Cuff and Serratus Anterior for stability Taping can help.
51
Presentation of Adhesive capsulitis (Frozen shoulder)
Usually over 40 yoa
52
Which phase of Adhesive capsulitis is described as:
Moderate to severe pain that limits all shoulder use, Pain when sleeping or with minimum activity.
Acute phase
53
Which phase of Adhesive capsulitis is described as:
Possible past history of acute phase 1-3 months prior, Pain has decreased but discomfort and restricted motion persists when lifting arm or turning out.
Middle phase
54
Which phase Adhesive capsulitis is described as:
Very slow increase in ROM but still significantly reduced.
Final phase
55
Although the cause of adhesive capsulitis remains unknown, it is more commonly seen in patients with:
Diabetes, thyroid pathologies, and COPD.
56
Evaluation of adhesive capsulitis:
IF the patient does not improve at all we suspect:
- Positive Mazion Shoulder Maneuver (most patients present in the stiffening stage or stage 2)
-Restriction and pain are reliable indicators especially in abduction and
external rotation.
** If the patient does not improve at all, a bony blockage is suspected due to
possible osteoarthritis.
57
Management for adhesive capsulitis:
- Cryotherapy
- Extremity adjustment to improve ROM
- E-stim and TENS, Ultrasound (in stiffening stage.)
- Passive and active therapy with contraction and ROM while alternating patterns
58
Presentation:
Typically following an acute trauma such as heavy lifting, a fall or high impact injury. Older patients might not recall an event.
Pain and or weakness is experienced while lifting the arm or performing overhead activities.
Condition???
Rotator Cuff Tears
59
Rotator Cuff Tears are M.C. Associated with tears of:
Supraspinatus
60
Etiology of Rotator Cuff Tear:
Trauma, can occur secondary to chronic degenerative changes
| in the tendinous attachments.
61
Rotator cuff tears assessment:
Supraspinatus: weakness with Empty Can test or Codman’s drop arm (unable to perform) and a positive Apley test.
Subscapularis: Lift-off test weakness.
62
What does Rotator Cuff Tear looks like on a radiograph?
Superior head migration on AP view.
63
Management of Rotator Cuff Tears
- Rehab gradually with isometrics then progressing to strengthening.
- Rotator-cuff full thickness tears might need surgical repair.
64
Presentation:
Trauma/fall/high impact injury on an outstretched arm or on top of the shoulder type onset. Very common in athletes such as football or rugby players. Pain, tenderness and swelling over the AC joint.
AC Joint Seperation
65
Which grade of AC separation is associated with: some tearing of the Acromio-Clavicular ligament without instability.
Grade I
66
Which grade of AC Joint Separation is associated with: Rupture of AC ligament
Grade II
67
Which Grade of AC Joint Separation is associated with: torn AC ligament with a tear of the Coraco-Clavicular (conoid and trapezoid) ligament. Both Grade II and III are considered unstable.
Grade III
68
Which grade of AC Joint Separation is associated with: the clavicle is pushed posterior to the AC joint, fairly unusual in presentation.
Grade IV
69
Which AC Joint Separation is associated with: an exaggerated grade III with the muscles above the AC joint punctured by the clavicle causing a significant bump over the injury site.
Grade V
70
Which AC Joint Separation is associated with: fairly rare, this type of injury sees the clavicle pushed or forced inferior where it becomes lodged below the corocoid.
Grade VI
71
Causes/Etiology of AC Joint separation.
Trauma/fall/high impact sports injury that tears partially or completely the AC or Coraco-Clavicular ligaments.
72
Evaluation of AC Joint Separation
Positive: O’Brien Sign
X-Ray to rule out distal clavicular fracture and determine severity of injury. **Weighted and non-weighted bilat. View would be ordered.
More than 1.3 cm widening of the Coraco- Clavicular space would indicate a Grade III separation.
73
Management of AC Joint Separation
-Support with a Kinney-Howard sling for a short period. Mild Isometrics followed by Isotonics.
74
Presentation:
-Can be secondary to AC trauma or heavy weight lifting regimens.
-Typically a weight lifter will present with diffuse pain felt while bench-
pressing, clean and jerking or dipping. Pain on shoulder abduction
beyond 90 degrees.
Condition???
Osteolysis of the Distal Clavicle.
75
What is the cause/etiology of Osteolysis of the Distal Clavicle?
Trauma/repetitive compression forces and heavy lifting that cause
resorption of the distal end of the clavicle.
76
Why is a Zanca view or AC spot shot and a thorough history is crucial to help rule out differential diagnosis of Osteolysis of the Distal Clavicle?
B/C most orthopedic tests are unremarkable.
77
Management of Osteolysis of the Distal Clavicle.
- Modification of exercises with some rest recommended.
| - Chiropractic spinal and extremity evaluation.
78
Presentation:
Severe shoulder pain increasing with any shoulder movement. Patients
have a supportive posture, holding the arm to their sides to avoid
movement.
Condition???
Acute Calcification Bursitis and Tendinitis
79
Cause/etiology of Acute Calcification Bursitis and Tendinitis
- Following trauma or of insidious onset.
- Bursitis pain occurs often due to resorption of calcium deposition.
This is typically an inflammatory phase
and is very painful. Direct trauma or injury associated with cuff rupture is
considered another common cause.
80
Evaluation of Acute Calcification Bursitis and Tendinitis.
- Dawnbarn (+ with Sub-acromial bursitis)
- Abbott Saunders, speed and Yeargason (+ for bicipital tendinitis)
- Apley test (+ degenerative tendinitis)
- Patte test (Hornblower sign) (+ with infraspinatus or Teres Minor tendinopathy)
- Lift off test (+ subscapularis tendinopathy)
81
Management of Acute Calcific Bursitis and Tendinitis
- Pulsed Ultrasound to resorb calcific deposits for short term therapy
- Chiropractic spinal and extremity adjustments to assist with recuperative healing and functional proprioception.
- Cryotherapy is recommended to reduce swelling and manage pain.
- In acute and inflammatory stages, referral to a medical practitioner is recommended due to severe pain.
82
Presentation:
Young,12-15 year old male baseball pitchers. Pain felt when throwing hard and comes on gradually – sometimes up to as long as 7 months before diagnosis!
Condition???
Little League’s shoulder
83
Little Leaguer’s shoulder is associated with Triangular metaphysical avulsion fracture, also known as:
Salter-Harris Type 2
84
Etiology of Little Leaguer’s shoulder.
Excessive rotational stresses on the growth plate of the proximal
humerus from pitchers who over pitch or pitch too frequently (Salter-
Harris type 1). Type 2 is less common.
