Lecture 19, 20 - Non Sports Related Disorders Of The Shoulder, Knee, And Lower Leg Flashcards
Divide the movement of the arm into parts of the shoulder … if that makes sense
Movement of the arm is 2/3 glenohumeral and 1/3 scapulothoracic
If pt has decreased ROM of the Glenohumeral, can they still shrug or lift the shoulder?
scapulothoracic motion can provide motion even with decreased ROM of the other shoulder joints (glenohumeral). Seen by shrugging mechanism when asked to lift shoulder
What is something specific you would want to ask when taking history for a shoulder complaint?
And how is the physical exam done?
Need to determine if the pain originates from the shoulder or neck!
Physical: look at both shoulders, perform ROM and special tests if necessary
What is the MC muscle affected in rotator cuff tear?
Cause?
supraspinatus
If under 40, usually traumatic cuase
Over 40, due to attrition
How to differentiate between shoulder pain and neck pain?
Shoulder pain does not radiate past the elbow! If so, it is a neck/nerve issue.
What is the best diagnostic imaging for rotator cuff tear?
3 view xray and MRI for RCT
2nd best is CT arthrogram
Treat with NSAIDS, PT, injections, surgery
List the special tests for the shoulder and think about how they are done
Speed test for biceps
Impingement sign by painful arc
Drop-arm test for rotator cuff
Empty-can for supraspinatus
Lift-off for subscapularis
Adson’s test for thoracic outlet syndrome
What is Calcification Tendonitis and what is the MC affected?
What causes the pain?
Calcified depositions within the rotator cuff
MC is supraspinatus again !!
Pain occurs when calcium is being resorbed, not deposited !!
How do pts with calcific tendonitis usually present?
They usually say they have trouble sleeping on that side and are able to pinpoint exactly where the pain is
Pain is d/t calcium resorption !
What is Biceps Tendonitis?
What is the MC type?
What is the other type?
how might patient describe?
Which test would be positive?
biceps tendon gets caught between humeral head and coracoacromial ligament
Generally occurs secondary to an inflammatory process within the shoulder (like impingement)
impingement tendonitis is the MC type
Attritional Tendonitis — intense synovial reaction! Can Lead to rupture
Tenderness over bicipital groove, proximal anterior shoulder pain, not at night but does occur with overhead activity (brushing hair)
** - + speed test ** !! Pain with flexion of elbow against resistance
Frozen shoulder is aka ?
Risk factors?
Phases?
Treatment and prevention?
Adhesive capsulitis
Restricted ROM, active and passive, with no known cause. Adhesions form around shoulder joint recesses.
Risk factors:
Immobility, trauma, age over 40, diabetes, and hypothyroidism
Painful phase: gradual onset of diffuse pain for wks to months, hard to sleep on it at night, uses arm less and less
Stiffening phase: slow loss of motion, dull ache, loss of IR/ER/aBduction
Tx: Physical therapy!!, injections, NSAIDS, manipulate under anesthesia and surgery
Key is to avoid prolonged immobilization to prevent a frozen shoulder!!!!!!!!!
What dislocation counts for 50% of all dislocations?
What is the MC?
MC etiology?
glenohumeral dislocations
MC is sub-coracoid anterior
MC is *8traumatic dislocation, d/t direct force (aBduction, extension, ER)**
Exam shows sulcus sign = hollow spot beneath the acromion
always check for axillary nerve function pre- and post- reduction
Brief summary of Grades of AC joint separation
Grade I - painful, sprain
Grade II - AC subluxation, distal end of clavicle can be rocked
Grade III - AC dislocation, high-riding clavicle that is prominent with skin-tenting
Grade IV -posterior subluxation of clavicle
Grade V - exaggerated version of grade II
Grade VI - inferior dislocation
Tx: I and II = sling
III = sling or open reduction
IV - VI = closed reduction, surgery, limit activity for 2 wks
