Orthopaedic Upper limb Flashcards
(29 cards)
What are the leading cause of shoulder pain?
Rotator cuff disorder
Less common shoulder pain
Frozen shoulder (adhesive capsulitis) Osteoarthritis of the shoulder (glenohumeral)
4 muscles of the Rotator cuff
- subscapularis (anterior muscle)
- supraspinatus (posterior muscles)
- infraspinarus (P)
- teres minor (P)
What’s the function of rotator cuff
- Glenohumeral stabilisers
- Stabilise the arm in mid range (capsuloligamentous tissues stabilise end range)
Ant + Mid deltoid EMG peaks between __ - __ degrees abduction in scapular plane
60 - 90
Post operation shoulder rehabilitation (treatment principles)
- Pain must be respected
- Thorough evaluation of the px
- Exercise and techniques are progressively advanced
- Balanced scapula muscle function is integrated into all dynamic exercisses
- Programme is individualised (tissue, personality, surgical concerns)
Post operation shoulder rehabilitation (goals)
- Patient education (pathology)
- Anti-inglammation and pain reduction
- Facilitate collagen healing (gentle stress promotes improved collaged alignment and strength)
- Improve ROM
- Strengthen muscle tendon unit (increase motor unit recruitment, hypertrophy)
- Optimise proprioception
- Improve endurance
Conservative therapy is dependent on status of the rotator cuff. Intact cuff gives generally greater than __ % satisfactory results. Torn cuff gives generally __ % or worse results.
80, 50
Rotator cuff treatment (initial non-operative)
- activity modification
- relieve inflammation - NSAID’s, cortisone
- Physiotherapy … ROM, RC strengthening
If rotator cuff tear, what functional movement must be avoided?
Internal rotation (hand to the back)
When to start resisted rotator cuff strengthening?
3 months (once the collagen lays down load up the tissues)
Adhesive Capsulitis is characterised by …
painful restriction of both active and passive shoulder motion that occurs in the absence of a known shoulder disorder.
Glenohumeral instability: recurrence rate is highest in aged 20 - 30 yrs. T or F?
False
Recurrence rate is high in the younger age; aged 11-20yrs - 94%, aged 20-30yrs - 79%, aged > 40yrs - 10%
why incidence of RC tear in older patient is higher than younger patient?
associated with degeneration, quality of tissue (prone to tear) [30% > 40yrs, 80% > 60yrs]
Total shoulder joint replacement post-operation, when lying supine
use of a pillow under the elbow
Even minimally displaced anatomical neck of humerus fractures have a significant risk of
avascular necrosis (AVN) of the humeral head (due to damaged anterior & posteriot circumfles artery)
The Open Reduction Internal Fixation (ORIF) of the distal humerus is an operation
that fixes fractures in the humerus that are generally difficult to secure with a cast or splint (external fixation).
Shaft of Humerus fracture is usually treated …..
conservatively (with a supportive / hanging cast followed by supportive splint)
Distal radius fracture is common in what group.
older, female (Colles fracture … dorsal (posterior) displacement of the wrist)
Conservative Treatment of “Distal radius” fracture: __ - __ weeks in Long armed cast. __ - __ weeks in Short armed cast.
2 - 4 weeks (LAC)
4 - 6 weeks (SAC)
Palpation of the Scaphoid tubercle and anatomical snuff box is sensitive or specific test?
100% Sensitive test
(Rule out) [74% Specificity]
Goal of any rehabilitation programme should be “ _____ ______” of the patient
functional restoration
Post-op RC cuff tear: one of the difficulties
weakness with arm elevation
Post-op RC cuff tear: most Px encouraged to contimue exercise for at least?
a year (return to sports = 6-9 months)
