Shoulder

Question 1

Anterior + lateral shoulder pain, pain with overhead motion
Night pain w/ sleeping on shoulder
Pain with internal rotation (getting dressed)
+/- crepitus or catching

Answer 1

impingement syndrome

Question 2

Tendinitis, shoulder bursitis causing impingement of acromion, coracoacromial ligament, AC joint inflammation → can lead to RTC tear

Answer 2

impingement syndrome

Question 3

Neer impingement sign
Hawking’s impingement sign
Empty can test - pain without weakness
PE: tenderness over the greater tuberosity + subacromial bursa
Crepitus w/ROM
Atrophy
Can inject for diagnosis

Answer 3

impingement syndrome

Question 4

How do you treat impingement syndrome?

Answer 4

NSAIDs, stretching posterior capsule

Subacromial injection

Question 5

Weakness + pain with overhead movement
Night pain

Answer 5

RTC injury

Question 6

MCC = supraspinatus
Partial can cause impingement syndrome

Answer 6

RTC injury

Question 7

PE: limited AROM, but PROM is normal
Empty can
+/- tenderness

Large tears = patient cannot raise arm when asked – only can shrug

MRI
Can consider ultrasound, MR arthogram/shoulder

Answer 7

RTC injury

Question 8

How do you treat a RTC injury?

Answer 8

Partial tear can heal w/ scarring, PT, NSAIDs, steroid injection

Young, active patient w/ acute full thickness tear → surgery

Older, sedentary patient w/ full thickness tear = PT, surgery if no response

Question 9

ANTERIOR:
Obvious deformity, patient holding arms externally rotated

POSTERIOR:
Patient holds arm internally rotated, hard to push door open

ATRAUMATIC/CHRONIC: sliding sensation with spontaneous reduction

Answer 9

shoulder dislocation

Question 10

anterior or posterior shoulder dislocation: arm externally rotated

Answer 10

anterior

Question 11

anterior or posterior shoulder dislocation: arm internally rotated

Answer 11

posterior

Question 12

shoulder dislocations are mostly —-

Answer 12

anterior

Question 13

What are two types of lesions that can help verify a shoulder dislocation?

Answer 13

“Hill-Sachs” lesion → indented compression fractures at posterior superior part of humeral head = anterior

Bankart lesion → tear in the anterior labrum surrounding the shoulder joint

Question 14

Always, always, always check –

Answer 14

neurovascular status

Question 15

How do you treat a shoulder dislocation?

Answer 15

ACUTE: reduce ASAP
→ TUBS - traumatic, unilateral, Bankart lesion, surgery

CHRONIC: PT, activity modification
→ AMBRI: atraumatic, multi-directional, bilateral, rehab, inferior capsule repair

Question 16

TUBS

Answer 16

shoulder dislocation – ACUTE
traumatic, unilateral, Bankart lesion, surgery

Question 17

AMBRI

Answer 17

shoulder dislocation – CHRONIC
atraumatic, multi-directional, bilateral, rehab, inferior capsule repair

Question 18

Limited ROM w/ active + passive movement
Painful, tender at joint

Answer 18

adhesive capsulitis

Question 19

What are RF for adhesive caspulitis?

Answer 19

40-65 years
women>men
Hypothyroidism
DM

Question 20

What are the three phases of the “frozen shoulder”?

Answer 20

Inflammatory (4-6m)
Freezing (4-6m)
Thawing (~12m)

Question 21

For adhesive capsulitis, you should – to rule out tumor or deposits, or fractures

Answer 21

XR

Question 22

How do you treat adhesive capsulitis?

Answer 22

NSAIDs, PT

Consider manipulation under anesthesia after 3 months of failed treatment

Question 23

Pain and stiffness –
Around shoulder + upper arm
Night pain
Progressive loss of motion
Difficulty with ADLs
commonly in >50

Answer 23

shoulder arthritis

Question 24

What can be causes of shoulder arthritis?

Answer 24

Osteoarthritis
Rheumatoid arthritis
Post-trauma
RTC arthropathy

Question 25

Wasting of muscles, tenderness all around shoulder Crepitus Decreased ROM w/ active + passive XR: joint space narrowing, osteophytes, cysts

Answer 25

shoulder arthritis

Question 26

How do you treat shoulder arthritis?

Answer 26

NSAIDS, activity modification, ice/heat, ROM exercises, steroid injection Replacement surgery

Question 27

Cannot raise arm, bump at fracture site, grinding with ROM Skin “tented” over fracture

Answer 27

clavicle fracture

Question 28

What are the MC bone injuries?

Answer 28

clavicle fracture

Question 29

How do you treat a clavicle fracture?

Answer 29

Closed treatment - sling/immobilizer/figure of 8 harness 3-4 weeks if <12 years 4-6 weeks if >12 years ROM No contact sports 6-12 weeks Surgery becoming more common

Question 30

Pain, swelling, discoloration, w/ inability to move arm, open or closed deformity

Answer 30

proximal humerus fracture

Question 31

proximal humerus fractures are common in --

Answer 31

elderly, obese, women w/ osteoporosis

Question 32

a proximal humerus fracture happens from --

Answer 32

high energy trauma, fall on outstretched arm

Question 33

proximal humerus fracture diagnosis

Answer 33

Check for brachial plexus + axillary artery injury (numbness/tingling, radial pulse) XR: AP/lat/Y views CT scan for pre-op

Question 34

How do you treat a proximal humerus fracture?

Answer 34

Minimal displacement <1cm = sling for 1 week, ROM at least 1 week >1cm = surgery 4 part fracture often needs shoulder replacement, especially if >40 years old

Question 35

Pain on back of shoulder, skin abrasions, tenderness, pain w/ motion common with many, many other injuries, often overlooked

Answer 35

scapula fracture

Question 36

How do you treat a scapula fracture?

Answer 36

Sling ROM 1-2 weeks after injury >2 cm separation of glenoid → surgery Consider pulmonary contusion if fracture of scapular body

Question 37

Sudden, sharp pain in upper arm w/ audible snap Bulge in lower arm

Answer 37

biceps tendon rupture

Question 38

Bicep tendon rupture is more common in

Answer 38

older men

Question 39

bicep tendon ruptures are associated with --

Answer 39

rtc tears

Question 40

Ludington’s test accentuates bulge (show me your muscles) Ecchymosis in mid-lower arm XR: negative Arthrogram if suspected RTC tear Popeye sign

Answer 40

biceps tendon rupture

Question 41

How do you treat a biceps tendon rupture?

Answer 41

Conservative – PT Elderly is frequently associated w/ RTC tear <40 years or active → surgery

Question 42

Pain to palpation, cannot lift arm Grade III = clear deformity Commonly from fall onto tip of shoulder w/ arm tucked in, contact sports

Answer 42

acromioclavicular joint injury

Question 43

---- classification for acriomioclavicular joint injury

Answer 43

rockwood

Question 44

treatment for acromioclavicular joint

Answer 44

Type I + II = sling Type III = controversial Type IV+ = surgery