L4 Shoulder Conditions

Question 1

Type 3 Acromial shape

Answer 1

more common in patients with impingement and full thickness RC tears

Question 2

Tensile overload

Answer 2

repetitve intrinsic tension

Question 3

Macrotrauma Tendon failure

Answer 3

traumatic injury reulsting in tearing of one or more RC tendons

may have history of tendonosis that predisposed tendon to failure during traumatic event

Question 4

RC integrity

Answer 4

0 = normal
1 = some fat
2 = more muscle than fat
3 = equal fat to muscle
4 = more fat than muscle

Question 5

Size classification of RCT

Answer 5

Small <1 cm
Medium 1-3 cm
Large 3-5 cm
Massive >5 cm

Question 6

Full thickness tear

Answer 6

complete defect in the tendon, extending from teh articular surface completely through to the bursal surface

Question 7

Partial Thickeness Tear

Answer 7

based on portion of tendon that is torn

Articular, Bursal, Interstitial

Question 8

Different shapes of RCT

Answer 8

Crescent
Longitudinal: L or U shaped
Massive
Arthopathy

Question 9

RCT Arthropathy

Answer 9

small tears over time
leads to reverese total shoulder

combination of massive chronic tear, cartilage destruction, osteoprosis, humeral head collapse

Question 10

Static restraints of GHJ

Answer 10

ligaments
labrum
articular
vacuum effect

Question 11

Dynamic restraints of GHJ

Answer 11

RC
biceps
periscapular
proprioception

Question 12

Traumatic anterior instability

Answer 12

Hx: traumatic event, feeling of instability, shoulder pain caused by dislocation

Question 13

MOI of anterior instability

Answer 13

posteriorly directed force on the arm when shoulder is in abd and ER

Question 14

TUBS

Answer 14

traumatic, unidirectional w/bankart lesion requiring surgery

gross instability, common shoulder injury

those who are younger have a higher reoccurence

80% of TUBS are older than 60

Question 15

Bankart lesion

Answer 15

avulsion of the anterior labrum and anterior band of IGHL from anterior inferior glenoid

present in 80-90% of those with anterior dislocation

Question 16

Bony bakart lesion

Answer 16

fracture of anterior inferior glenoid
present in up to 49% of patients with recurrent dislocations
higher risk of failure in surgery

Question 17

Hill sachs defect

Answer 17

chondral impaction injury in posteriorsuperior humeral head, secondary to contact with the glenoid rim

present in 80% of traumatic dislocations and 25% of traumatic subluxations

Question 18

Dislocation and nerve injury

Answer 18

axillary is the most commonly injured

increased age, vascular injury, and delayed reduction increase risk

Question 19

Humeral fracture and nerve injury

Answer 19

very frequent in displaced fractures
presence of fracture in dislocation doubles risk of nerve injury

Question 20

Posterior Dislocations

Answer 20

less common than anterior
50% go undiagnosed in ED

risk factors: laxity of ligaments, glenoid retroversion

MOI: elbow ext, IR, contact with ground

common in older adults w/fall risk

Question 21

Associated injuries w/Posterior instability

Answer 21

fx of anatomical neck or lesser tuberosity

Question 22

Microtrauma and Posterior instability

Answer 22

may lead to labral tear, labral avulsion, or erosion of posterior labrum.

instability leads to gradual stretching of capsule

present in weightlifters, lineman, overhead athletes

Question 23

Observation of Posterior dislocation

Answer 23

prominent posterior shoulder and coracoid

limited ER

shoulder locked in IR

Question 24

Inferior Dislocation

Answer 24

very rare, has greatest risk of neurovascular injury

MOI: arm forced into elevation w/distraction

Exam: presents w/arm overhead with shoulder in abduction and elbow flexed

Question 25

Atraumatic Instability S/S

Answer 25

pain, weakness, paresthesia, crepitus, shoulder instability during sleep

Question 26

Signs of generalized hypermobility

Answer 26

patella hypermobility genu recurvatus elbow hyerpextension MCP hyperextension thumb abduction to forearm knee and elbow hyperextension

Question 27

Pathoanatomy of atraumatic instability

Answer 27

rotator interval deficiency reverse bankart lesion spread widely apart inferior capsule

Question 28

AMBRI

Answer 28

atraumatic multidirectional bilateral rehab inferior capsular shift peaks in 20s to 30s

Question 29

pathophys of AMBRI

Answer 29

microtrauma from overhead overuse general ligamentous laxity

Question 30

Translation Classification

Answer 30

0 = normal GH translation 1 = humeral head translation up to glenoid rip 2 = over glenoid rip with reduction once force is withdrawn 3 = over glenoid rim w/locking

Question 31

Normal values of GH translation

Answer 31

Posterior: 3-20 mm Inferior = 5-15 mm Anterior = 2-13 mm

Question 32

Anterior labrum

Answer 32

anchors IGHL link that leads to bankart lesion

Question 33

Superior labrum

Answer 33

anchors biceps tendon leads to SLAP lesion

Question 34

Glenoid labrum

Answer 34

blocks subluxation creates cavity-compression and 50% of glenoid socket depth

Question 35

SLAP tear

Answer 35

may occur on own or with internal impingement, RCT, instability

Question 36

MOI of SLAP

Answer 36

overhead fall on outstretched arm with tensed biceps traction on arm

Question 37

Pathophys of SLAP

Answer 37

tightness of posterior IGHL shifts GH anterior/superior and increases shear force on superior labrum lesion increases strain on anterior band of IGHL and compromises stabilty of shoulder

Question 38

S/S of SLAP

Answer 38

vague, deep shoulder pain popping and clicking weakness, easy fatigue, decreased athletic performance

Question 39

SLAP classification

Answer 39

1 = anchor intact, fraying labrum and biceps 2 = labral fraying, biceps detached 3 = bucket handle tear w/attached biceps 4 = bucket handle tear w/detached biceps