Lecture 7B: Shoudler Complex Examination And Evluation Flashcards by sophia carrasco

What are 3 casues of shoulder complex dysfucntion

Compromise of passive restraint
components

Compromise of NM control

Compromise of >1 neighboring
joints that contribute to motion

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If someone has a shoulder tendinopathy when will they have pain and a hx of what

Pain w activities and hx of receptive motions

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If someone has shoulder instability when will they have pain

Pain w prolonged static positions and pain after activities

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Children and adolescence may present w what in the shoulder

humeral epiphysitis or osteogenic sarcoma

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when does RC degeneration typically occur

40-60 y/o

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Secondary impinment d/t instability typically seen in who

Teens - 20’s = especially w over head athletes

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Who is calcium deposits in shoulder most common in

20-40 y/o

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Insidious capsulitis typically seen in what age group

45-60 y/o

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Insidious onset of adhesive capsulitis is often associated w what

DM and ischemic heart disease

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If someone has a MOI of overhead exertion w repetitive motions what injuries may they have

Sub-acromial bursitis/impingement
RC tendinopathy/tear
Biceps tendinopathy

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If someone has a MOI of fall on outstretch hand (FOOSH) what injuries may they have

Shoulder/elbow/wrist sprain or strain
Elbow/wrist fx’s
AC joint separations
Clavicle fx’s
GH joint fx’s
GH dislocations

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If someone has a MOI of fall on tip of shoulder what injuries could they have

AC joint separations
Bone contusion
C-spine injury

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If someone has a MOI of forced horixtonal extension of abducted , ER arm what injury may they have

Anterior GH dislocation

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Should pain in swimmers are likely to fatigue what mm

Upper back , RC and pecs

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If pain is relieved w arm elevated over head what do u think

Cervicogenic cause

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If pain is relieaved w elbow supported what do u think

ac joint separation
-RC tears

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If pain is relieved by circumduction of shoulder w accompanying click or clunk what do u think

internal derangement
-GH instability

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If pain is relieved w arm distraction what do u think

Bursitis
RC tendinopathy

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If pain is relieved w arm held in dependent position wht do u think

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If someone has a hx of trauma in the shoulder what may it suggest even if it occurred a while ago

Instability

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What is the three levle staged algorithm for rehabilitation (STAR) classification for shoulder pain

screen ( are thy appropriate for PT or no)
medical dx (shoulder origin or not)
if shoulder then is it RRC/impingment or frozen shoulder or GH instability or post op
then determine rehab classification ( high , moderate or low irritatbility)

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What are thee KEY POSITIVE finding for RC impingment (5)

Impingement signs
Painful arc
Pain w/ isom resist
Weakness
Atrophy

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When someone come in shoulder pain , what is the % that it is RC impingment

50-70%

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What is the key negative findings for RC/impingement

significant los of motin
instability signs

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What is the key **positive** finding for **frozen shoulder** (3)

Spontaneous progressive pain Loss of motion in multiple planes Pain at end-range

What are the key **negative** finding that it is **not** **frozen shoulder**

- normal ROM - younger then 40

Does frozen shoulder have a MOI

What is the key **postive** finding that would make u think **GH instability** (4)

Age < 40 Hx disloc / sublux Apprehension Generalized laxity

What are the key **negative** finding that would make u think it is **not GH instability**

- no hx of dislocation - no apprehension (scared that it is gonna dx)

How do u end up tearing ur RC

Start w impingement —> RC tendinopathy —> RC year

50-70% of all shoulder pain seen in PT related to ___ ___

RC dysfunction

What’s the **MOI** for **impingement/ RC path**

Compression Tensile over load Macrotrauma

**Impingement/ RC** path is a ___ problems anf there is pain w what

Contractile Pain w resisted testing , weakness/atrophy

Is impingement a problem or stymptoms

Symptom

How are RC tears described by

Size , location , direction and depth

The **amount of weakness** of RC is directly related to what

Size of tear

What is the treatment for RC tear

It is conservative - restore joint mobility and as needed and strengthen surrounding mm - sx for SA depression or RC repair w or w/o biceps tendonesis

What is considered a small , medium , large or massive RC tear

Small= < 1 cm Med= 1-3 cm Large = 3-5 cm Massive = > 5 cm

What age , gender and disease is common w **adhesive capsulitis** (frozen shoulder)

45-60 Females DM and thyroid disease

What are the 4 stages for frozen shoulder

Stage I (pt typically ignores) for <3 months Stage II (freezing) for 3-9 months Stage III (frozen) for 9-14 months Stage IV (thawing) for 14+ months

There is progressive ___ w no MOI in frozen shoulder

Pain

In **frozen shoulder** there is **progressive loss of ROM** in how many planes

2 or more

What is the **treatment** for **stage 1 and 2**( freezing) of adhesive capsulitis

Stage I – pain control (if seen by PT) Stage II – pain control + manual therapy (as tolerated) + mobility ex’s Emphasize self care here

What is the **treatment** for **stage 3( frozen) and 4 (thaw)** of adhesive capsulitis

Stage III – pain typically has resolved; focus on restoring normal motion and strength where possible Stretching as tolerated Stage IV – continue to restore normal motion & strength as able Stretching + strengthening + NM re- education

What is Abnormal symptomatic motion of the GH joint that affects normal joint kinematics

GH joint instability

What is the underlying **causes** of **GH instability**

Genetic Collagen Biomechanical factors

What is the S&S of **gh instability**

- feelings of looseness or slipping , pain , subluxation or dislocation

What is the MOI for **GH instability**

Traumatic vs atraumatic TUBS vs AMBRI

What is the difference between TUBS vs AMBRI

TUBS = Trauma , Unidirectional , Bankart , SX AMBRI= Atraumatic , Multidirectional , Bilateral , Rehab , Inferior

What is the **most common direction** of **instability** in the GH joint

What direction is >90% of all shoulder dislocation

What is the **MOI** for **anterior** **GH instability**

Abduction , ER and ext Sports like football ,swimming , baseball

What is the **conservation** tx for **anterior GH instability**

Gradual return to full AROM , strengthen scapular and RC mm , NM re ed

What is the **sx** tx for **anterior GH instability**

Labral repair, salvage

What is the **MOI** of the **superior labrum anterior and postieror instability ( SLAP)**

Trauma , fall , catching a heavy object Repetitive microtrauma - throwing

why is DDx difficult for a SLAP instability

SYMTOMS similar to RC disease and GH instability

Where does a SLAP lesion usually occur in the labrum

10- 2on a clock

What is the **MOI** for a **postieor GH instability**

Flexion , add , IR Associated w seizures , electric shock , diving into shallow pool and MVAs

What is the **MOI** for **inferior GH instability** (very uncommon)

Carry heavy object s, hyper abduction

What is the treatment for **inferior** GH instability

Immobilization

What is classified as mult directional instability

Instability in > 1 direction More common in males

What is the **MOI** of **multi directional** GH instability

Typically insidious

What is common with **multi directional GH instability**

RC pain and scap dyskinesia

What is the **sx** treatment for **multi directional GH instability**

Capsular shift , capsulorrhaphy

What is the conservative tx for **multi directional GH instability**

Strengthen scapular and RC ,, , nm re ed

What is **scapular dyskinesis**

Alterations in normal position or motion of the scapula during coupled scapulo-humeral movements

What is **conservative** treatment for **scapular dyskinesis**

gradual return to full AROM, strengthen scapular and RC muscles, NM re-education, correct deficits in surrounding joints`

What occur in **people > 45** adn their MOI is **bony morphology** changes **following trauma**

Traumatic OA

What is the **SX** treatment for **traumatic OA**

TSA - intact RC RTSA- torn RC

What is present in **31%** of pt w **shoulder pain**

AC sprain

What is the **MOI** for **AC joint dysfunction**

Trauma - fall onto tip of shoulder Or chronic - secondary to OA , RA or mechanical dysfunction

What are the treatments for the different sprains for AC joint *+(6 kind)

Types I-II – conservative management Type III – controversial Types IV-VI – surgical reduction

Is AC or SC joint dysfunction more common

What kind of dislocations in the SC joint can be life threatening

Postieor

What s the **MOI** for **SC joint dysfucntion**

Sprain vs dislocation 2/2 fall on flex/add or ext/ add arm

What is the most common fx bone in childhood

Clavicle

What is the sx treatment from clavicle fx

ORIF if fx displaced

What is the most common humeral fx in children and elderly

Proximal

What are outcome measures for the shoulder

* DASH (Disability of Arm, Shoulder and Hand) * QuickDASH * Penn Shoulder Score * SPADI (Shoulder Pain and Disability Index) * K-JOC Score (