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Regional Orthopedics > Shoulder > Flashcards

Shoulder Flashcards

(74 cards)

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1
Q

Describe resting position for the GH joint

A

55* abduction, 30* horizontal adduction

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2
Q

In what direction do roll and glide go for the GH joint?

A

roll in the same direction, glides in the opposite

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3
Q

What is the CPR for the shoulder?

A

ER > abd > IR

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4
Q

What is closed pack position for the SC joint?

A

full elevation and protraction

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5
Q

What is resting position for the AC and SC joints?

A

arm resting at side

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6
Q

What is the CPR for the AC and SC joints?

A

pain at extreme ROM - especially horizontal adduction & full elevation

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7
Q

What are the expected ROM for the shoulder joint?

A 
180 flex/abd
100 horizontal abd
90 ER
70 IR
60 EXT
45 add/horizontal add
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8
Q

SC joint is a ___ joint, AC joint is a ___ joint.

A

saddle, planar

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9
Q

The SC joint is convex ____ and concave ____.

A

convex superior-to-inferiorly

concave anteriorly-to-posteriorly

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10
Q

In order for maximal abduction of the arm to occur, __* of ___ is required.

A

90* of lateral rotation

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11
Q

In order for the shoulder to abduct 180, the arm has to abduct ___ and the scapula must upwardly rotate __*

A

arm: 120*
scapula: 60*

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12
Q

The rotator cuff helps stabilize/maintain the position of the humeral head in the glenoid fossa. Which depress and which elevate it?

A

depress: infraspinatus, subscap, teres minor, supraspinatus (late stages of abduction)
elevate: deltoid, supraspinatus (early stages of abduction)

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13
Q

What is the most common cause of shoulder pain in adults?

A

impingement syndromes

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14
Q

Impingement syndrome pain has a significant ___ pain component.

A

nocturnal

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15
Q

Extrinsic impingement is a result of ____

A

mechanical wear of rotator cuff against anteroinferior 1/3 of acromion in the suprahumeral space during humeral elevation

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16
Q

Primary extrinsic vs. secondary extrinsic impingement are usually due to:

A

primary: anatomical or biomechanical factors
secondary: hypermobility or instability

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17
Q

The subacromial space is narrowed by excessive ___ and ___ of the scapula

A

anterior tilt & protraction

internal rotation of humerus

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18
Q

What is the most important function of the inferior GH ligament?

A

supports humeral head above 90* abduction by limiting inferior translation

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19
Q

The posterior band of the GH inferior ligament is most effective during __ of the humerus, while the anterior band of this ligament tightens to function most during ___.

A

posterior: medial rotation
anterior: lateral rotation

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20
Q

How would you perform the Active Compression of O’Brien test?

A

Step 1: Patient’s arm is forward flexed to 90, elbow extended, arm adducted to 10-15 and full pronation.
Step 2: Repeat with forearm fully supinated.
Downward force is applied for each of these.

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21
Q

What would be a (+) result for the active compression of O’Brien test?

A

pain on joint line or painful clicking that is apparent in part 1 but eliminated or decreased in part 2

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22
Q

What special test is this?
Patient supine, hold the humerus proximal to the elbow and fully abduct the arm over the patient’s head. Place one hand on posterior aspect of humeral head and push anteriorly while holding the arm in lateral rotation.

A

Clunk test

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23
Q

What special test is this?

Patient’s shoulder is flexed to 90* and medially rotated with elbow flexed to 90*

What can it be adapted to? How?

A

Hawkins-Kennedy

Coracoid impingement test, but you bring the arm 10-20* horizontally adducted before applying medially rotation.

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24
Q

A (+) result for the Hawkins-Kennedy test would be either…

A

pain –> supraspinatus tendonosis or secondary impingement

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25
CPR for the acromioclavicular joint is...
??
26
CPR for the sternoclavicular joint is...
pain at extreme end ROM - especially horizontal adduction and elevation
27
During abduction at the GHJ, the first _ ribs ____, while all others elevate
2 ribs descend
28
When the arm abducts at the GHJ, the clavicle will __ and ___ rotate
elevate & posteriorly rotate
29
If total arm elevation is 180*, how much is scapulothoracic?
60*
30
GH head depressors include:
SITS mm - supraspinatus only in mid to late stages of abduction
31
GH head elevators include:
supraspinatus (early stages) | deltoid
32
What is the most common cause of shoulder pain in adults?
impingement syndromes
33
Impingement syndromes see pinching of the rotator cuff and subacromial tissues between the ___ and ____
coracoacromial arch and proximal humerus
34
This shoulder condition has a "toothache like discomfort with a significant nocturnal component"
impingement syndromes
35
Extrinsic impingement is believed to occur as a result of the RC mm against the _____ of the ____
anteroinferior 1/3 of the acromion in the suprahumeral space during elevation of the humerus
36
Differentiate external (primary & secondary) vs. internal impingement
external occurs anteriorly internal occurs posteriorly
37
Who does internal impingement most commonly occur in, and what happens?
overhead athletes get the undersurface of the RC mm caught with the posterior-superior glenoid labrum when arm is pretty close to being in closed pack position
38
What three tests would you use to confirm a shoulder impingement dx?
Hawkins-Kennedy, infraspinatus test, and painful arc
39
What distinguishes stage 2 from stage 1 impingement?
pain at night, not alleviated by rest
40
What distinguishes stage 3 from stage 2 impingement?
diffuse pain may refer to wrist usually after 40yoa - M/C with women degeneration & bony changes
41
Describe stage 4 impingement
complete RC mm tear & atrophy surgical candidates usually necessary to limit GH movements
42
Where is the subacromial bursa found?
between the acormiom/deltoid muscle and the supraspinatus muscle
43
Which shoulder bursa typically DOES communicate with the joint capsule?
subscapular bursa
44
Describe the pain character/onset of bursitis
acute pain arising suddenly over 12-72 hours building to severe, disabling pain intense, dull, throbbing, often with referral - all movements limited & painful. disturbs sleep EMPTY end feel (cannot complete ROM d/t extreme pain)
45
Anterior shoulder dislocation occurs when...
an anterior force is applied to the arm in abd & ER
46
Repetitive forces against a forward flexed humerus OR a FOOSH can result in...
posterior dislocation
47
Which type of shoulder dislocation is commonly seen in people with hemiplegia?
inferior
48
4 possible directions for shoulder dislocation are:
subacromial, subglenoid, subclavicular, and subspinous
49
Which location of humeral dislocation is most common?
subcoracoid (anterior & inferior)
50
Sulcus sign is associated with ___, step deformity is associated with ___
sulcus: dislocations step deformity: A/C separation
51
The foramen of Weitbreicht is found where?
between the superior and middle GH ligaments
52
Which 3 ligaments can be affected with AC sprains/separations? Where do they attach?
CORACOCLAVICULAR LIGAMENTS: trapezoid: coracoid process & clavicle conoid: coracoid process & clavicle (more medial) ACROMIOCLAVICULAR LIGAMENTS
53
Which 3 ligaments can be affected with AC sprains/separations? Where do they attach?
CORACOCLAVICULAR LIGAMENTS: trapezoid: coracoid process & clavicle conoid: coracoid process & clavicle (more medial) ACROMIOCLAVICULAR LIGAMENTS
54
Differentiate grade 1 vs. grade 2 AC separation/sprain
grade 2 sees sublux of AC joint and disruption of AC ligaments, step deformity grade 1 sees damage to AC without displacement of clavicle
55
Pain from labral tears will be described as at what location, typically?
posterior or posterior-superior joint line, especially in abd, exacerbated by overhead and behind the back arm movements
56
What is a BANKART LESION?
tear of the anteroinferior labrum, M/C d/t traumatic anterior dislocation leading to anterior instability
57
What is a SLAP LESION
superior labrum injured possibly involving the biceps
58
Bankart lesion is found at what clock position of the labrum?
3pm-7pm
59
SLAP lesion is found at what clock position of the labrum?
10am-2pm
60
True or false: labrum tx goals include posterior capsule stretching
True
61
Are intraarticular adhesions of adhesive capsulitis a cause or result?
may be more of a result... unsure
62
Adhesive capsulitis humeroscapular movement ratio is usually...
1:1
63
What are the 3 stages of frozen shoulder?
1 - freezing (gradual onset, pain at night) 2 - frozen (pain diminishing, possible disuse atrophy) 3 - thawing (pain local to lateral arm & diminishing, motion/function gradually return)
64
Which 3 RC mm are most frequently torn?
supraspinatus, infraspinatus, and subscapularis
65
What is Kehr's sign?
Kehr's sign is the occurrence of acute pain in the tip of the shoulder due to the presence of blood or other irritants in the peritoneal cavity when a person is lying down and the legs are elevated
66
The liver/gallbladder refer pain to the... the left shoulder will feel pain referred from the...
right shoulder... spleen
67
Which type of SLAP lesion is: bucket-handle tear of labrum that may displace into joint, labral biceps attachment still intact
type III
68
Which type of SLAP lesion is: bucket handle tear of labrum extending into biceps tendon, allowing the tendon to sublux into joint
Type 4
69
What is the most common type of slap lesion? Describe it
Type II: superior labrum has small tear, instability of labral-biceps complex
70
Differentiate grade 1 and 2 shoulder impingements
grade 1: pure impingement with no instability | grade 2: secondary impingement and instability d/t chronic capsular or labral microtrauma
71
Differentiate grades 3 and 4 of shoulder impingement
Grade III: secondary impingement and instability d/t generalized hypermobility/laxity Grade IV: primary instability, no impingement
72
Differentiate grade 1 vs. grade 4 shoulder impingement
1: pure impingement with no instability 4: primary instability with no impingement
73
What is the typical MOI for a Galeazzi fracture? What IS a Galeazzi fracture?
spiral fracture of radial shaft at RUJ , may include ulnar nerve lesion FOOSH with rotational component
74
What is the typical MOI for a Monteggia fracture, and what is it?
direct blow to anterior forearm dorsally angulated fracture and dislocation of radial head

Regional Orthopedics (6 decks)

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