Ortho UE- Wells- clin med exam 2 Flashcards
List the Rotator Cuff Muscles (SITS) and their associated functions
Supraspinatus – Abduction, ER
Infraspinatus – ER, stabilizer
Teres Minor – ER, stabilizer
Subscapularis – IR, anterior stability
Function of the Rotator cuff
- Allows you to ABduct arm (as opposed to ADDuct arm)
- Allows for IR and ER of the shoulder but mainly ER
- Pt can have pain in a “painful arc” from 60-120 degrees of abduction
Rotator cuff MOI
- Allows you to ABduct arm (as opposed to ADDuct arm)
- Allows for IR and ER of the shoulder but mainly ER
- Pt can have pain in a “painful arc” from 60-120 degrees of abduction
Diagnostic test for rotator cuff tear (gold standard imaging study)
**MRI
Tx Rotator cuff injury
- -Partial Thickness vs. Full thickness
- Partial often presents like an impingement …pain with abduction, possible weak RC testing
- **>50% tear will need surgical repair, typically arthroscopy as opposed to an “open repair’
Rotator cuff tear– non operative tx
- PT (Typically 2x week x 4-8 weeks)
- –Shoulder stabilization exercises
- -Stretching…get that humeral head down and back
- -Postural strengthening/”retraining”
- NSAIDS
- -Make sure no contraindications (CVD, PUD, pregnancy, bleeding disorders…)
-Injections (usually some form of medium acting steroid “Celestone”,and lidocaine)–> Allowed 3 injections in 1 Year –> otherwise degenerates the tendon making it prone to tearing
If a rotator cuff is NOT surgically repaired.. this can lead to ?
fatty atrophy of the cuff and an irreparable tear resulting is limited treatment options
How long can a Pt with a rotator cuff injury be in PT for?
8-12 weeks
Pt with a rotator cuff injury, what is the last ROM to come back?
Internal rotation is the last to come back!! (ie tucking in a shirt)
Impingement Syndrome- etiology
Causes:
Repetitive overhead movement
Anterior translation of the humeral head with poor posture
Acromial “hook”
Degenerative change
Trauma
Causes micro trauma to supraspinatus/bursa
Describe an Acromial hook
-Type 1- Type VI
=Causes impingement, possible tearing of the supraspinatus tendon
–Typically live with it, however Types IV-VI may need to be burred down…i.e., ”acromioplasty”
Impingement Syndrome- dx:
- History of painful arc
- PE shows pain with impingement testing (Neers, Hawkins…)
-Diagnostic Injection – lidocaine/steroid
- Imaging – treat first, then image, unless concern for trauma, tear, etc…
- -X-ray can show trauma/OA/acromial hook
–MRI can show fraying/degenerative change of the rotator cuff, inflammation of the bursa
Acromioclavicular separation-hx
-typically from a lateral fal, FOOSH, or contact sport injjury, or MVA
Acromioclavicular Separation-tx
- Grade I-III usually tx conservatively–> Sling for comfort, NSAIDs, RICE
- Grade IV-VI often require surgical repair due to instability of the shoulder
“Frozen Shoulder” aka
Adhesive Capsulitis
Adhesive Capsulitis- etiology
Spontaneous or Gradual onset of worsening AROM
Often after a period of immobilization such as shoulder surgery/mastectomy…
Diagnose with H+P
See in 40-60 y/o F>M, watch for with your DM pts
Adhesive Capsulitis- tx
Requires PT or sometimes manipulation under anesthesia
Adhesive capsulitis-pathophys
This is associated with an increased amount of collagen, fibrotic growth factors such as transforming growth factor-beta, and inflammatory cytokines such as tumor necrosis factor-alpha and interleukins. Immune system cells such as B-lymphocytes, T-lymphocytes and macrophages are also noted. Active fibroblastic proliferation similar to that of Dupuytren’s contracture is documented.
Bicep Tendonitis-hx
- Hx of repetitive use, trauma, poor ergonomics, anterior translation of the humerus due to postural weakness, old age
- FLEXORS ALWAYS WIN
- Pain over the proximal long head of the bicep tendon
- Can sometimes elicit pain with flexion testing, pronation/supination of the forearm against resistance, ***Speeds Test
Biceps tendonitis-tx
- PT (postural strengthening, stretching)
- cortisone/lidocaine injection into tendon sheath
- surgery (bicep tenodesis)
Instability (or eventual dislocation)
- Anterior Instability is far more common than posterior or multidirectional instability
- Pt will light up with apprehension test–>.and…Can have a positive “Sulcus Sign”
- Be aware if traumatic…consider other soft tissue injury (SLAP tear)
Causes: Trauma Genetics Treatment PT Surgery if not improving with conservative treatment
Shoulder Dislocation Reduction
-what MUST you do?
- **MUST do Pre-reduction/Post-reduction films (post film needed to male sure post reduction placed the humeral head back in place)
- **Look for Hill Sachs Lesion
- **Look for Bankart Lesion
- Check for Axillary nerve injury* w/ a shoulder dislocation
- Sling pt for comfort after reduction
- May need short course of PT to regain ROM, shoulder stability, inflammation reduction
- Recurrent dislocations will need stabilizing surgical procedure
Axillary nerve lesion (describe)
- axillary nerve may get injured due to downward dislocation of the humeral head OR a fx of the humeral head
- ->Deltoid and teres minor become paralyzed
- Abduction of the shoulder is impaired
- loss of sensation over the lower half of the deltoid
**Bankart Lesion
-results as a complication of dislocation
=an injury of the anterior (inferior) glenoid labrum of the shoulder due to anterior shoulder dislocation.
-Can have bony (glenoid) and/or soft tissue (labrum) trauma
Hill Sachs Lesion***
-(a complication of Dislocation)
=a cortical depression in the posterolateral head of the humerus. Caused by forceful impact of the humeral head against the glenoid rim when the shoulder is dislocated anteriorly.
For Dislocations of the shoulder you can use 2 methods for reduction
- Milch Method of Reduction
- Kocher’s Method of Reduction
- Stimson Maneuver of Reduction
Shoulder Dislocation Complications
Labral Tear
Hill Sachs Lesion
Bankart Lesion/Fracture
Axillary nerve injury
“SLAP Lesion=
Superior Labral Anterior Posterior
-Occurs where the bicep tendon anchors to the labrum
Causes of a SLAP lesion
- A motor vehicle accident
- FOOSH
- Forceful pulling on the arm, such as when trying to catch a heavy object
- Rapid or forceful movement of the arm when it is above the level of the shoulder
- Shoulder dislocation
Gold standard dx test for “SLAP” tear (KNOW!!)
MRI Arthogram****
- Other sx:
- Pt will often complain of painful catching or “clicking” in the shoulder
- Usually caused from traumatic fall or forceful abduction of arm
- Can be watched if not overly symptomatic but often will require surgical repair
- ***Recovery in shoulder immobilizer, longer than RC tear recovery
Pectoralis Major Rupture:
- etiology
- Sx
- tx?
- Acute pain, typically with lifting, bench pressing, etc…
- Presents with bruising, **declivity(scooped out appearance) in the muscle
tx: Typically need surgical repair
Fracture type: stable
broken ends line up
Fracture type: open
bone pierces skin
Fracture type: transverse
horizontal fx
