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pt momints ver 2.0 > MS1: Affectations of Shoulder > Flashcards

MS1: Affectations of Shoulder Flashcards

1
Q

what are the functions of the shoulder

A

position hand
suspend UE
provide sufficient fixation for motion of UE and trunk
fulcrum for arm elevation

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2
Q

what are the 3 bones of shoulder joint

A

humerus, clavicle and scapula

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3
Q

what are the 3 true joints of the shoulder

A

SC - plane
AC - plane
GH - ball nd socket

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4
Q

what is the pseudojoint of the shoulder

A

scapulothoracic
- elev/depress
- protract/retract
- up/down rotation

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5
Q

describe the clavicle

A

s-shaped; strut bone that connects UE to trunk

last bone to ossify - starts at 5 months ends at 22-25 sa sternal end

most commonly fractured
- FOOSH: impact straight to shoulder
- fall on point of shoulder; most common

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6
Q

what is the allman classification of clavicular fracture

A

group 1: fracture of medial third
- most common; 80%

group 2: fracture of distal third
- disrupts CC or AC ligaments
- 12-28%

group 3: proximal third; sternal end
- 3-6%

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7
Q

what are the signs and symptoms of clavicular fracture

A

pain and swelling
tenderness
deformity

affected extremity is splinted close to the body and supported by contralateral UE
- tucked shoulder

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8
Q

what is the diagnosis and management for clavicular fractures

A

diagnosis: xray and CT scan

non-surgical: immobilize w sling for 6-8 wks
surgical: pinning and plating
- open fracture
- neurovascular affectation
- skin tenting > puncture
- midshaft displacement or shortening is 1-2 cm
- type 2 fractures
- non union symptomatic

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9
Q

describe the scapula

A

insertion site for 17 muscles

coracoid and acromion

fracture is uncommon bc muscles protect it
- 76%: thoracic SCI
- 54%: pulmonary contusion

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10
Q

what is floating shoulder

A

2 or more fractures in SSSC

naiiwan yung scapula

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11
Q

what is SSSC composed of

A

glenoid process
coracoid process
CA ligament
distal clavicle
AC joint
acromion process

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12
Q

what are the SSx of floating shoulder and scapular fractures

A

pain and swelling
UE tucked and supported by other UE
painful ROM
comolli sign - triangular swelling of posterior thorax over scapula > hematoma > compartment psi

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13
Q

what is the management of scapular fractures

A

non-surgical: most common; sling for 4-6 wks

surgical: ORIF
- displaced fracture
- intraarticular fracture and displacement
- acromion fracture > impingement
- floating shoulder

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14
Q

describe proximal humeral fracture

A

most common at surgical neck; neer’s 3
least common at anatomical neck; neer’s 2

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15
Q

what are the complications of PHF

A

vascular injury: axillary a.
nerve injury: axillary n.

myositis ossificans: bone forms in muscle > pain in abd/add
shoulder stiffness from immob

osteonecrosis common in anatomical neck fracture

non union or malunion

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16
Q

what is the management for PHF

A

non-operative: for minimally displaced
- sling > early ROM from 7-10 days if fracture is stable to prevent stiffness

surgical: ORIF or arthroplasty

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17
Q

describe the glenoid fossa

A

surrounded by fibrocartilage - LABRUM
- deepens socket by 50%
- retroverted to 5 deg
- pear shaped

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18
Q

what are the ligaments found at anterior scapula

A

superior GH
> foramen of rouvier
middle GH
> foramen of weitbrech
inferior GH
- most important; primary restraint for ant/post dislocation and sublaxation

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19
Q

what are the supporting ligaments of humerus and scapula

A

CC: conoid and trapezoid
- primary support of AC joint

CA: roof of shoulder
- prevents separation of AC

CH: restrains biceps tendon w/in the groove

TH: perpendicular to biceps tendon

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20
Q

what are the scapular pivoters

A

traps
rhomboids
serratus anterior
levator scapula

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21
Q

what are the humeral propellers IR

A
  • subscapularis
  • anterior deltoid
  • pec major
  • lats
  • teres major
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22
Q

what are the humeral propellers ER

A

infraspinatus
teres minor
posterior deltoid

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23
Q

what are the shoulder protectors

A

fine tunes HH position during arm elevation

SITS muscles

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24
Q

discuss the insertions and functions of the rotator cuff muscles

A

SIT: greater tuberosity
subscap: lesser

supraspin - intitates abd
infra and teres minor: ER
subscap: IR

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25
Q

what are the static restraints of the shoulder

A

glenoid labrum
articular version nd conformity
neftive intra articular psi
capsule
ligaments

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26
Q

what are the dynamic restraints of the shoulder

A

SITS
biceps tendon
scapulothoracic motion

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27
Q

describe supraspinatus tendinitis

A

most common inflammatory problem in shoulder

from chronic wear nd tear of supraspinatus tendon as it passes under acromion

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28
Q

what are the subacromial syndromes

A

DD for supraspinatus tendinitis
- rotator cuff degeneration
- calcific tendinitis: ca deposits
- subacromial and subdeltoid bursitis
- adhesive capsulitis
- AC joint degeneration

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29
Q

what is the etiology of supraspinatus tendinitis

A

35-50 yo
women > men; sedentary individuals
young pitchers and swimmers

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30
Q

what is the pathogenesis of supraspinatus tendinitis

A

chronic wear and tear during overhead activites

circulation is impaired during shoulder abd

painful arc on resisted abd; 60-120 deg

recurrent impingement > degenerative and inflammatory changes in the RC and subacromial bursa > subacromial syndromes

31
Q

describe acute calcific tendinitis

A

DD - supraspin tendin; pag kita calcification sa xray edi ACT

acute - gradual onset over hours to days
- most painful in shoulder

32
Q

what are the SSx of acute calcific tendinitis

A

preceded by strain or unaccustomed use of shoulder

pain over subacromial area radiates to deltoid insertion, localized pain distal to tip of acromion

sleep disturbed by pain

rotation or abd limited by pain

33
Q

what is the diagnosis and treatment of ACT

A

xrays - amorphous calcium phosphate salt in supraspinatus

symptoms subside sponatenously after 5-10 days onset
- may lead to adhesive capsulitis

34
Q

what are the treatments for supraspinatus tendinitis

A

rest and protection of shoulder w sling; short duration
axillary pillow; medj abd
early gentle ROM; avoid capsulitis
analgesics: 2-3 days
ice packs after 48 hrs heat

35
Q

what is the treatment for ACT

A

ultrasound guided aspiration using saline + steroid; most effective
- yields milky white suspension of Ca salts

36
Q

describe chronic degenerative tendinitis

A

sequelae of ACT; whole rotator cuffs
develops over months
pain less intense but interferes w arm use
awakened when turning to shoulder at night
painful arc: 60-90 deg

DD: 1sr few wks supraspin tendi > chronic degen

37
Q

how to diagnose for CDT

A

MRI and CT scan: osteophyte formation and degen of AC joint

protracted course > adhesive capsulitis

38
Q

wha are the treatments for subacromical syndromes

A

conservative
- avoidance of overhead use
- most heat and analgesics
- initial circumduction pendulum; passive = maintains elasticity

surgical: associated w impingement syndrome
- anterior acromioplasty
- resection of CA ligament
- RC tear reapir
- aspirate calcium

39
Q

describe bicipital tendinitis

A

inflammation of tendon sheath from flex nd supinate; friction in bicipital groove

results in adhesion of the tendon to the bicipital groove and RC

may occur bilaterally
women > men
early 40s

40
Q

what is the pathogenesis of bicipital tendinitis

A

inadequate depth of bicipital groove
abnormal ridges along groove
normal physiologic wear and tear

fraying, shredding and fasciculation of tendon > adhesions occur

associated w impingement syndrome

41
Q

what is the SSx of bicipital tendinitis

A

insidous onset or precipitated by strenous activity

over more anterior and medial region of shoulder of biceps and forearm

tenderness over intertubercular sulcus when rolling biceps tendon w fingers; supinate to feel

42
Q

how to test for bicipital tendinitis

A

speeds: pt arm at 90 shoulder flex and has to resist motion into extension while supinated

yergasons: pt elbow in 90 deg flexion; ER while supinating against resistance

43
Q

what is the treatment for bicipital tendinitis

A

conservative
- rest, moist heat
- avoid painful ROM
- NSAID + therapy
- steroids + anesthetic

surgical: failed conservatice
- biceps tenodesis w reaatachment below bicipital groove or coracoid

44
Q

describe adhesive capsulitis

A

starts w/ any of the subacromial syndromes

chronic; worsens over 3-12 moments > gradual improvement > normal or near

pain
LOM
women > men
> 40 yo

45
Q

what is the pathogenesis of adhesive capsulitis

A

low grade inflammation from immob
- edema, fibrosis, round cell infiltration
LOM
head fixed at glenoid
ER LIMITED bc od CH and subscap contracture
articular surfaces are intact

46
Q

what is the SSx of adhesive capsulitis

A

onset followed by direct or indirect trauma

associated w CVA, MI and cervical root affectations; any that causes immob

LOM > frozen shoulder

night time pain

dec active and passive ROM; ER and abd

47
Q

what are the 3 phases of adhesive capsulitis

A

freezing: acute/painful
- lasts 3-9 mo.
- gradual onset of pain at rest, + stifness at all planes; unable to sleep

frozen: adhesive/stiffening
- 4-12 mo.
- pain subsides
- progressive loss of GH motion
- pain at extremes of movement

thawing: resolution
- 12-42 mo.
- motion gradually improves
- complete recovery may not occur

48
Q

what is the conservative treatment of adhesive capsulitis

A

w/o treat > 2-3 yrs

conservative
- moist heat
- gravity free excerices w/in pain free range; pendulum
- AIF and analgesics
- steroids
- anti grav in later

49
Q

what is the non conservative treatment of adhesive capsulitis

A

anesthetic block of suprascap nerve @ fossa ; temporary
manipulation while pt sleeps; contra in acute
hydrodilatation

surgical: failed non-op
- MUA
- arthrocscopic capsular release
- acromioplasty
- AC joint resection

50
Q

describe rotator cuff tears

A

always trauma - esp young

sudden powerful arm elevation

elderly - extensive tears w minor trauma due to degeneration; incidence inc w age

partial thickness tears are more frequent; progression to full 28-53%

51
Q

what is the etiology for rotator cuff occurs

A

laborers
> 40 yo.
transient sharp pain for days/months
tenderness below acromion
sulcus appreciated betw acromion nd RC tendon

52
Q

what are the SSx of RC tear

A

weak abd

inability to initiate and maintains abd

painful arc
- GH: 60-120
- AC: 170-180

atrophy of supraspin and infra in later cases; drop arm test

53
Q

what is the treatment of RC tear

A

MRI - gold standanrd

nonoperative
- avoid provocative motions
- splint in abd
- NSAIDs
- physical therapy
- corticosteroid injection

operative: arthroscopic
- failed non-op
- acute traumatic tears in young
- acute loss of strength and motion
- good quality of muscles w/o fatty infiltration and arthritis

54
Q

describe the shoulder hand syndrome

A

shoulder pain w homolateral hand pain and swelling
- frozen shoulder
- hand: sudecks atrophy; pain, swell, vasomotor instability, trophic changes, patchy osteoporosis

sequelae of shoulder lesion, MI, CVA, trauma, cervical arthritis

55
Q

what is the etiology of shoulder hand syndrome

A

5th decade or older

pain, tenderness, stiff shoulder
hand swelling and edema of hand

atrophy and finger flex deformity and extension contracture of MCP; may be permanent

SSx may occur together or may mauna

56
Q

what is the pathogenesis of SHS

A

sympathetic dysfunction due to injury or compression

immobilized shoulder > frozen shoulder > swelling of hands > limited finger motion

reflex-like response to pain by sympathetic nerves > vasomotor reax that reduces blood flow to tissue in pain

57
Q

what are the diagnosis and DD of SHS

A

xray: osteoporosis and normal/minimal joint changes

labs: ESR is normal

DD:
- RA
- thoracic outlet syndrome
- scleroderma
- post-infarct sclerodactyly

58
Q

what are the stages of SHS

A
  1. burning hand pain, cold and clammy, sensitive tou touch/pressure
  2. hand appears white, creaseless, thick skin, inc cold and stiff
  3. hand is pale, thin, atrophied
59
Q

discuss treatment and prognosis of SHS

A

conservative
- relieve provocative if known
- brief splint and PT ROM daily
- eliminate inflammation and relieve pain
- regain strength and encourage motion
- inc peripheral circulation: sympatholytic drugs, sympathetic ganglia block, ganglionectomy, periarterial sympathectomy

prognosis
- good
- recovery slow: some w permanent stifness
- psych factor: poorly motivated > poor recov

60
Q

describe rupture of bicepsbrachii

A

infrequent
men 40-60 yo
involves dominant side

distal bicep tendon avulses from radial tuberosity

@ bicipital groove assoc w degenerative

61
Q

where can rupture of biceps occur

A

at/near origin
bicipital groove
musculotendinous junction

via singe traumatic event; unexpected extension applied to 90 deg flexion

62
Q

SSx of biceps tendon rupture

A

sharp pain and audible snap
local tenderness
popeyes sign

weakness in flexion and supination
insertion > loss of flexion strength
rupture of long head = 20% loss of flexion

63
Q

diagnosis and treatment of biceps tendon rupture

A

xray: avulsion of glenoid rim

non-surgical: strength regained after 4-6 mo.

young - surgical repair
- tenodesis: fixed at coracoid or floor of bicipital groove

64
Q

describe anterior dislocation of shoukder

A

most common; abd, ext, ER and force from back

traumatic and unilat; may injure axillary n.

65
Q

describe posterior dislocation of shoulder

A

assoc w seizures or electrical shock bc pt is pushed dow or anterior force

66
Q

what are usually assoc w shoulder disloc

A

bankart lesion - injury to the labrum due to repeated anterior dislocs
- leads to recurrent disloc in patients arnd 30 yo.

hill sachs lesion - humeral head gets impacted during anterior disloc

fracture of greater tuberosity

67
Q

what is the epidemiology of reccurent SD

A

50-57%

high for acute disloc < 20 yo.

immob after reduction for 3 wks dec chance
more common anterior SD

68
Q

describe RSD

A

succesive dislocs require lesser force; w/o movement

pain decs in mga sunod and reduction easier

atrophy will develop

sudden pain and audible click when abd and ER

69
Q

what are risk factors for RSD

A

incomplete healed tears
relaxation of capsular ligaments
shoulder muscle weakness
congenital or acquired changes in head or glenoid fossa

70
Q

what is shoulder arthroplasty

A

TSA is surgical typically reserved for elderly patients w/ cuff deficiency or arthritic shoulders

71
Q

what are indications for TSA

A

tumors
RA
pagets
osteonecrosis of humeral ehead
fracture and recurrent disloc
unremitting pain more than LOM
loss of function
failure of conservative

72
Q

what are the requirements for TSA

A

strengths of
- SITS
- deltoid
- traps
- rhomboids
- serratus ant
- lats
- pec major and minor

shoulder stretching before operation may improve postsurgical function

73
Q

what are the two types of shoulder arthroplasty

A

partial: head of humerus replaced w metal head and stem

total: replacing both joint surfaces; metal head and stem w plastic glenoid

74
Q

what are the contraindication for TSA

A

active sepsis of joint
severe osteoporosis
charcot joint
obesity >200 lbs.
bedfast
poor cognition
baka pwede lesser invasive; osteotomy
children; active growth plates

pt momints ver 2.0 (14 decks)

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