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Physical Exam Course > Shoulder > Flashcards

Shoulder Flashcards

(84 cards)

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1
Q

History: Pain over lateral deltoid

A

Rotator cuff

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2
Q

History: Peri-scapular pain

A

Radiculopathy
Myofascial pain

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3
Q

History: “1-finger sign”

A

AC joint

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4
Q

History: Burning Pain

A

Nerve injury

  • Radiculopathy
  • Parsonage turner/brachial neuritis
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5
Q

History: Clicking

A

Instability
Labral involvement

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6
Q

Shoulder Inspection: Step-off deformity

A

AC joint separation

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7
Q

Inspection: ER + Abduction

A

Anterior dislocation

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8
Q

Inspection: Adduction + IR

A

Posterior Dislocation

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9
Q

Inspection: Dropped shoulder

A

Spinal accessory neuropathy

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10
Q

Inspection: Elevated shoulder

A

Levator spasticity
Cervical dystonia

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11
Q

ROM: Preliminary screen

A

Touchdown sign (if normal move on)

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12
Q

ROM: Apley Scratch Superior

A 
Abduction + ER
Normal T4 (Scapular spine)
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13
Q

ROM: Apley Scratch Inferior

A

Adduction + IR
Normal: T8 (inferior angle of scapula)

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14
Q

GIRD Definition

A

Glenohumeral Internal Rotation Deficit
> 20-25 degree side-to-side difference in IR in dominant vs non-dominant arms

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15
Q

GIRD population

A

Throwing Athletes
Swimmers

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16
Q

GIRD causes

A

Tight posterior capsule
Humeral retroversion (young patients)
Muscle Thixotropy

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17
Q

GIRD Complications

A

Rotator cuff impingement
Rotator cuff tears
SLAP tears
> 25% more likely to have SLAP lesion

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18
Q

GIRD treatments

A

Posterior capsule stretching

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19
Q

Scapulothoracic Motion: GH vs Scapula

A

2: 1 ratio of glenohumeral to scapular motion for abduction
- GH motion: 120 degrees
- Scapular motion: 60 degrees

> Scapular Substitution: Scapulothoracic motion can provide 90 degrees of abduction if necessary

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20
Q

Scapular Winging: Muscles

A

Medial: Serratus anterior
Lateral: Trapezius, Rhomboid

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21
Q

Scapular Winging: Trapezius innervation

A

Spinal accessory

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22
Q

Scapular Winging: Rhomboid innervation

A

Dorsal scapular

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23
Q

Scapular Winging: Serratus anterior innervation

A

Long thoracic

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24
Q

Scapular Winging: Lateral winging

A

Rhomboid/Trapezius
- Inferior angle of scapula rotated laterally

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25
Scapular Winging: Lateral Winging testing
Abduct arm to 90/180 degrees
26
Scapular Winging: Medial winging cause
Serratus anterior
27
Scapular Winging: Medial winging testing
Forward flex arms to 90 degrees
28
Neurologic Exam: Sensation C4
Distal Clavicle
29
Neurologic Exam: Sensation C5
Lateral epicondyle
30
Neurologic Exam: Sensation C6
Thumb
31
Neurologic Exam: Sensation C7
Middle finger
32
Neurologic Exam: Sensation C8
Little finger
33
Neurologic Exam: Sensation C5
Biceps
34
Neurologic Exam: Sensation C6
Pronator
35
Neurologic Exam: Sensation C7
Triceps
36
Painless weakness in overhead athlete
Suprascapular neuropathy
37
Refractory pain + weakness in young overhead athlete
Suprascapular neuropathy
38
Volleyball shoulder
Suprascapular nerve palsy
39
Suprascapular nerve function
Motor: Supraspinatus + Infraspinatus Sensory: Deep sensation/proprioception of joint
40
Suprascapular neuropathy: Compression sites
Suprascapular notch: Supraspinatus + Infraspinatus Spinoglenoid notch: Infraspinatus only
41
Suprascapular neuropathy at suprascapular notch
Supraspinatus + Infraspinatus
42
Suprascapular neuropathy at spinoglenoid notch
Infraspinatus notch
43
Suprascapular neuropathy: Diagnosis
EMG - Significant difference in distal motor latency (Supraspinatus/Infraspinatus) - Spontaneous activity, abnormal MUAPs, recruitment on needle (Supraspinatus/infraspinatus) MRI - Evaluate for space occupying lesions (peri-labral cyst) - Evaluate for atrophy of muscles
44
Suprascapular neuropathy: Treatment
- Activity modification - PT: RC strengthening, scapular stabilization - Suprascapular nerve block/ablation - Surgery (if space occupying lesion)
45
Special Tests: Rotator Cuff Impingement
Neers Hawkins
46
**Special Tests:** Rotator Cuff Pathology
* *_Impingement_** - Neer's - Hawkins * *_Supraspinatus_** - Empty Can - Drop arm tear (complete supraspinatus tear) * *_Infraspinatus/Teres Minor_** - Resisted ER - Hornblower's (Teres Minor) * *_Subscapularis_** - Lift off test - Belly press test
47
**Rotator Cuff:** Pain w/ preserved strenght
Tendonitis/Tendinopathy
48
**Rotator Cuff:** Pain w/ weakness
Rotator Cuff Tear
49
**Special Tests:** Bicipital Tendonitis
Speeds test Yergason's test
50
**Special Tests:** arm flexed 30 degrees, elbow extended, hand supinated, resisted downward force
Speed's Test
51
**Special Tests:** Arm adducted, elbow flexed 90 degrees, patient supinates hand against resistance w/ passive ER of shoulder
Yergason's
52
**Special Tests:** AC Joint
1. Cross Arm/Scarf Test 2. Dugas Test: Actively touches opposite shoulder 3. AC Distraction (Bad Cop): Passive touches opposite shoulder 1.
53
**Special Tests:** Pt touches opposite shoulder w/ affected arm
Dugas Test
54
Acromion Types
**Type 1:** Smooth **Type 2:** Curved **Type 3:** Hooked
55
AC Joint Separation Grades
*Severity of ligament tear* **Type I** **Type II** **Type III** *Direction/degree of clavicle displacement* **Type IV** **Type V** **Type VI**
56
**Special Tests:** Labral Pathology
1. Obrien Test 2. Anterior Slide 3. Crank test
57
**Special test:** *arm flexed to 90 degrees, elbow extended, internal rotation, adduct past neutral, resist downward force*
Obrien Test _Positive Test:_ Pain w/ clicking
58
SLAP definition
Superior Labral Tear in Anterior to Posterior Direction
59
**SLAP Tear:** 4 types
**Type I:** Degenerative fraying **Type II:** Detachment of biceps **Type III:** Bucket handle tear of superior labrum w/ intact anchor **Type IV:** Bucket handle tear w/ involvement of biceps tendon
60
**Special Tests:** Instability (4)
1. Sulcus sign 2. Apprehension/Relocation 3. Release 4. Load and shift
61
**Special Tests:** (+) Sulcus sign
\>½ inch movement= Hypermobility
62
**Special Tests:** Release Test (shoulder instability)
At end of relocation test abruptly stop applying force (85% sensitivity, 87% specificity)
63
**Shoulder Instability:** Most common direction of instability
Anterior + Inferior
64
**Shoulder Instability:** TUBS
Anterior Dislocation * Traumatic * Unidirectional instability * Bankart lesion * Surgery= treatment of choice
65
**Shoulder Instability:** AMBRII
Posterior Dislocation * Atraumatic * Multidirectional * Bilateral involvement * Rehab= treatment of choice * Inferior capsule shift if surgery required * Interval lesion
66
**Shoulder Instability:** Bankart lesion
Anterior labral tear associated w/ anterior dislocation
67
**Shoulder Instability:** Hills-Sachs lesion
Compression fracture of posterior lateral humeral head related to repeated subluxation/instability
68
Impingement of subscapularis tendon associated w/ soft tissue/bursa between the coracoid process and lesser tuberosity of humerus
Subcoracoid impingement
69
**Subcoracoid Impingement:**
Impingement of subscapularis tendon associated w/ soft tissue/bursa between the coracoid process and lesser tuberosity of humerus
70
**Subcoracoid Impingement:** Position of maximal impingment
Flexion Adduction Internal rotation
71
**Subcoracoid Impingement:** Risk Factors
Long/excessively lateral coracoid process Posterior capsule tightness
72
* Anterior shoulder pain worse w/ flexion/adduction/IR * Driving * Drawing on blackboard * Throwing follow through * Tender over coracoid process
Subcoracoid impingment
73
**Special Tests:** Subcoracoid impingement
**Subcoracoid impingement test** * Flex arm to 90, passively adduct and internally rotate w/ elbow extended
74
**Subcoracoid impingment:** Imaging
* **CT:** Measure coracohumeral distance * **US:** Measure coracohumeral distance * **MRI:** Assess for rotator cuff/subcapularis integrity
75
Impingement of superior/bursal aspect of supraspinatus
External impingment
76
Impingement of articular side of supraspinatus/undersurface of rotator cuff
Internal impingment
77
**Internal Impingment:** Cause
Excessive external rotation: Throwing athletes, GIRD * Fraying of posterior cuff * Articular sided cuff tears * Posterior superior labral tears * Damage to posterior capsul/glenoid
78
* Poorly localized posterior shoulder pain * Worse w/ throwing during late cocking/early acceleration phase * Increased external rotation * Decreased internal rotation
Internal Impingement
79
**Shoulder Imaging:** AP + Axilar lateral/trans scapular
Dislocation
80
**Shoulder Imaging:** West Point View
Bankart lesion
81
**Shoulder Imaging:** Stryker notch view
Hill's Sach's Lesions
82
**Shoulder Imaging:** Serendipity View
Sternoclavicular joint Medial ⅓ of clavicle
83
**Shoulder Imaging:** MRI
Rotator cuff pathology Soft Tissue Abnormalities
84
**Shoulder Imaging:** MR Arthrogram
Labral injuries Undersurface cuff tears

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