shoulder Flashcards
(64 cards)
Stability
GH
Joint
Static:
Articular surface shape, glenoid labrum,
capsule, GH ligaments
Dynamic:
Rotator cuffs, LH biceps, Rhomboids, Serratus Anterior, Deltoid
+ pec major and latissimus dorsi overall for shoulder
Epidemiology of Shoulder Complaints
– 3rd most common complaint
– Rotator cuff is the most prevalent; significant because of its effects on ADL’s
– Difficult to correctly diagnosis due to many structures involved and considering the C/S
as a potential cause of pain.
– Prevalence increases with age
– Women report more complaints
Common Sports for shoulder complaints
Repetitive overhead use of the shoulder - hyperabduction & ER
* swimming, volleyball, baseball, tennis players
History taking for shoulder complaint
– Age (important)
– Occupation / rec activity
– Pain location
– previous treatment
– patient medical Hx
Red flags for shoulder
Over 50 – increases risk of RC tears or other pathology
Night pain – tumour
Weight loss – cancer or autoimmune
Fever – systemic infection
Pain unrelated to activity or not relieved with rest — referred from visceral source
Hx of cancer – referral of pain and or metastasis
Cardiac risk factors – MI
Pleuritic pain – Pancoast tumour
Subacromial impingement
Creates a decrease of the space because of some other condition involved [umbrella term] covering multiple conditions such as:
- RC conditions, labral, GH instability, bursitis, anatomical involvement [osteophyte; mc AC joint], OA, scapular dyskinesia.
Labral Injury injury types
Traumatic:
- FOOSH,
- Inferior traction],
- dislocation/subluxation
Degenerative:
- Repetitive microtrauma
- overhead hyperabduction & ER
Clinical Presentation of Labral Injury
MOI: FOOS or direct impact onto shoulder
- Insideous or traumatic posterior shoulder pain
- Clicking and popping [painful]
- Decrease / loss internal rotation
- Overhead motion cause pain
- Decrease strength + endurance of RC and scap stabilisers
- Pain or inability to lie on
Clinical Assessment of Labral Injury
- Passive Compression Rotation Test
- Active Compression Test O’brian
- Crank test.
- Apprehension + relocation test
- Biceps load test I and II
- Resisted Supination ER Test
- Kim’s Test
- Speed’s Test
- Anterior Slide Test
- GH internal Deficit Test
Patho-antomy of Recurrent ASI
Lead to capsule-labral damage and osseous structures
Bank hart lesions most common in recurrent ASI
(labral avulsion - tensile force of anterior band – periosteum break}
Recurrent shoulder instability effects
Bone loss, cartilage loss and more soft tissue damage –>
Leading to: Chronic pain, functional impairment and ADL’s affected
Differentiate
type of shoulder instability
Anterior- discomfort abduction and ER throwing ball
Posterior: IR, adduction and forward elevation (pushing)
Multi- variety of positional symptoms, symptomatic with inferior translation
Physical Examination of Labral
Goals: After Hx, narrow differential diagnosis or confirm, Rule out pathology and obtain new information to influence management
- Strength testing should be done followed by,
- Special tests which should include apprehension testing, followed by,
- Ruling out concomitant pathology such as RCT tears** and labral,
- The assessment will then be concluded by assessing the overall shoulder laxity
General impression for paitent in diagnoses
A football player is likely to have anterior instability than a young underweight swimmer
Over 40 paitent consider rotator cuff tears
Over 60, consider tear, axillary n or brachial plexus injury
Assessing Laxity
The Gagey hyperabduction test. More than 1050 of GH abduction prior to initiation of scapulothoracic movement is considered abnormal
Orthopaedic Assessment for anterior labral
- Apprehension test + relocation
- Load and shift test (anterior & posterior)
- Surprise test
Orthopaedic Assessment for posterior labral
Posterior
1. Load and shift test (anterior & posterior)
2. Jerk test
3. Kim test
Orthopaedic Assessment for multidirectional labral
Multidirectional
1. Sulcus sign/test
Scapular stability test
- Scapulothoracic assistance test
- Scapulothoracic repositioning test
- Punch test
- Pectoralis Major/minor tightness test
Imaging for labral
Plain x-ray: Dislocation, Hill-Sachs lesion, bone loss, patho-anatomy, and or associated pathology
* CT
* MRI or MRA
ASD algorithm decesion operation
Non-Operative
* 10-13 years old (open physis)
* > 25-35 years, sedentary individual – without concomitant injury (fracture, RCT)
* Non-compliant with rehabilitation
* Stiff shoulder (has not regained full ROM)
Physician decision
* 14-35 years
* Presence of glenoid or humeral bone loss (% of loss)
* Athlete (contact vs non-contact) * In-season or off-season
* Instability severity Index Score*
Operative
* 14-35 years old competitive contact athlete – ISIS ≥ 4
* Significant glenoid or humeral bone loss (risk of imminent recurrent instability)
* Recurrent instability
* Humeral avulsion of the glenohumeral ligament
DDx for labral
Rotator cuff injury / or impingement
Labral injury
GH or AC arthritis
Suprascapular Instability
Frozen Shoulder
Referred Pain
Subacromial Pain Syndrome / Impingement
A painful condition of the upper extremity resulting from a structural narrowing of the subacromial space.
Shoulder impingement is now a broad term for non-traumatic, usually unilateral pathological processes involving different structures that induce shoulder pain and create a decrease in the subacromial space [impingement]
Subacromial Pain Syndrome / Impingement types + further classification
**External: **mechanical encroachment of soft tissue bursae or tendon between humeral head and acromial arch that occur 2nd to irritations within the anatomic space i.e inflammation
—> Pain mid range / pain arc 60-120 abduction
Internal: Encroachment of RC tendon between humeral head and glenoid rim often encountered in overhead throws or manual labour
> + anterior-superior
- postero-superior = RC tendon between humeral tuberosity and glenoid posterior superior rim
Further:
Primary: Structural narrowing of space
Secondary: Functional
