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Ortho Exam 2 > RC Pathology - Shoulder Pathologies > Flashcards

RC Pathology - Shoulder Pathologies Flashcards

(88 cards)

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1
Q

RC pathologies AKA

A

RC dz

RC syndrome

RC tendinopathies

RC tears

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2
Q

RC pathologies are

A

one of most common musculoskeletal disorders in adults

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3
Q

% of all shoulder problems that are caused by RC

A

50-70%

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4
Q

RC pathologies could be –> SXS

A

asymptomatic

minimally or severely symptomatic

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5
Q

acute RC tears

A

5-10% of all tears

20-30 y/o

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6
Q

chronic RC tears

A

about 90-95% of all tears

> 45 y/o

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7
Q

chronic RC tears happen secondary to

A

history of shoulder dysfxn, poor posture and decreased SA space

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8
Q

RC tendinitis (opathy) involves

A

supraspinatus 90% of the time

b/c of its position underneath the anterior acromion

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9
Q

2nd most common RC tendinitis involves

A

infraspinatus

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10
Q

typical presentation of an RC tear

A

weakness of active ABD +/or ER

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11
Q

management of RC tear

A

small rotator cuff tears

full thickness injuries

severe chronic full thickness tears

poor tissue quality

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12
Q

small rotator cuff tears –> management

A

conservative care

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13
Q

full thickness injuries –> management

A

surgical repair

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14
Q

severe chronic full thickness tears –> management

A

conservative

depending on the pt’s fxnal needs

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15
Q

poor tissue quality –> management

A

may need to do a reverse TSR

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16
Q

RC injuries occur d/t–> etiology

A

trauma

attrition

compression

tensile overload

aging

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17
Q

trauma–> etiology

A

macrotrauma

microtrauma

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18
Q

macrotrauma –> etiology

A

FOOSH

fall directly on shoulder

fall downstairs but hold onto hand rail

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19
Q

microtrauma –> etiology

A

recreation

vocational overuse (work)

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20
Q

attrition = –> etiology

A

degenerative

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21
Q

attrition –> etiology

A

fraying of tendon

supraspinatus zone of avascularity near its insertion

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22
Q

fraying of tendon –> attrition –> etiology

A

d/t poor blood supply, poor posture

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23
Q

supraspinatus zone of avascularity near its insertion –> attrition –> etiology

A

makes it very vulnerable to degeneration

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24
Q

compression is similar to –> etiology

A

impingement

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25
compression --> etiology
direct trauma to supraspinatus tendon and eventual deterioration
26
direct trauma to supraspinatus d/t--> compression --> etiology
decrease in size of SA space decrease in joint stability poor posture
27
tensile overload --> etiology
attempts to resist horizontal adduction, IR, anterior translation and distraction forces
28
typically occurs --> tensile overload --> etiology
during throwing (deceleration phase) and hammering
29
age --> etiology
decreasing blood supply
30
impingement syndrome
most common non-sport related injury to the RC
31
what does impingement syndrome occur d/t
SAIS
32
what is impingement syndrome
supraspinatus tendon passes beneath the acromion is pinched when arm is raised overhead
33
where are rotator cuffs more common
dominant arm
34
what does a RC tear in one shoulder indicate
increased risk of tear in other shoulder despite lack of pain or other sxs
35
biceps tendinopathy --> what happens
long head: supraglenoid fossa, interscapular, into superior labrum can simply get "overload" resulting in tendinopathy
36
what are biceps tendinopathy sometimes associated w/
labral tears
37
biceps tendinopathy --> etiology
heavy biceps too much overhead repetition or heavy load
38
classifications of RC tears
acute v. chronic location size/degree
39
location of the tear --> classification
bursal side articular side
40
degree of tears
partial or full tear
41
partial tears are classified by --> degree of tears
size may be fraying or the majority of the tendon with the tendon still remaining substantially to the humeral head
42
can partial tears still function?
can still maintain fxn
43
full thickness tears --> classification
tears involving complete detachment of the tendon(s) from the humeral head
44
will a full thickness tear impair the shoulder
yes will impair shoulder motion and fxn significantly
45
size of tear
small medium large massive
46
small tear --> classification
< 3 mm
47
medium tear --> classification
3-6 mm
48
large tear --> classification
> 6 mm
49
grade of RC tears
1-3
50
tendinopathy/tear sxs
variable pain +/or weakness and possibly decreased shoulder active mobility impingement window pain
51
variable --> sxs of tendionopathy/tears
does not always correspond to the size of the tear
52
impingement window pain --> sxs
painful arc
53
sxs are initially
dull ache w/ referral into upper arm
54
when are sxs worse
at night w/ activity when laying on that shoulder reaching overhead putting on a coat
55
older pt sxs
insidious could go to bed fine at night and wake up w/ full RC tear
56
objective exam
observation palpation UQ screen
57
observation --> objective exam
posture postural protection signs compensatory shoulder shrug w/ movement
58
posture --> observation --> objective
cervical thoracic scapula shoulder
59
postural protective signs --> observation --> objective
use of opposite UE to support shoulder if not use sling
60
palpation --> objective
atrophy in supraspinous and maybe infraspinous fossa pain in supraspinatus
61
UQ screens --> objective
r/o C/S, elbow, wrist/hand
62
STT --> ROM
AROM < PROM
63
STT --> AROM
maybe painful arc of movement decreased AROM usually w/ pain at end range
64
STT --> PROM
could be decreased d/t pain/muscle guarding PROM > scaption versus cardinal plane scaption usually get greater range and less pain
65
STT --> contractile tissue
pain w/ isometric resistance of one or more rotator cuff tendons if full tear --> might be pain free and weak
66
special tests
positive possibly negative
67
positive special tests--> tendinopathy/impingement
hawkins/kennedy painful arc ER weakness
68
possible special tests --> tendinopathy/impingement
neurodynamics
69
negative special tests --> tendinopathy/impingement
sulcus sign apprehension relocation clunk posterior drawer
70
positive --> RC tear
painful arc drop arm weakness ER (lag)
71
possible --> RC tear
neurodynamics
72
negative --> RC tear
sulcus signs apprehension relocation clunk posterior drawer
73
differential dx for shoulder pain
referred C/S pain cardiac origin visceral origin somatic pathology
74
sources of shoulder pain
radiating pain from cervical spine cervical facet referral pain
75
radiating pain from C spine --> sources
C5/C6 dermatome DTRs weakness of distal myotomes
76
cervical facet referral pain --> sources
somatic source of referred shoulder pain
77
dx tests
MRI (gold standard) diagnostic ultrasound
78
rotator cuff management
conservative management and then surgery surgery --> after conservative tx has failed
79
conservative management
acute acute and on-going
80
acute
PRICE or RICE modalities gentle ROM to surrounding structures anti-inflammatory meds --> only if necessary
81
acute and ongoing
PEACE & LOVE education maintain PROM and AROM progressive strengthening stretch/mobilization postural training
82
candidates for surgery
full thickness tears
83
full thickness tears w/ --> candidates for surgery
pain at night and at rest severe loss of fxn + MRI no changes w/ conservative care
84
when do we do a repair --> pain
if pain doesnt improve w/ non-surgical methods continued pain is the main indication for surgery
85
when do we do a repair --> sxs
have lasted 6-12 months
86
when do we do a repair --> tear
more than 3 mm
87
when do we do a repair --> weakness and loss of fxn
significant loss of strength and loss of fxn
88
when do we do a repair --> MOI
recent, acute injury

Ortho Exam 2 (17 decks)

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