Shoulder

Question 1

How do you treat impingement syndrome?

Answer 1

NSAIDs, stretching posterior capsule

Subacromial injection

Question 2

How do you treat a RTC injury?

Answer 2

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 3

How do you treat a shoulder dislocation?

Answer 3

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

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

Question 4

How do you treat adhesive capsulitis?

Answer 4

NSAIDs, PT

Consider manipulation under anesthesia after 3 months of failed treatment

Question 5

How do you treat shoulder arthritis?

Answer 5

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

Replacement surgery

Question 6

How do you treat a clavicle fracture?

Answer 6

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 7

How do you treat a proximal humerus fracture?

Answer 7

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 8

How do you treat a scapula fracture?

Answer 8

Sling
ROM 1-2 weeks after injury

> 2 cm separation of glenoid → surgery

Consider pulmonary contusion if fracture of scapular body

Question 9

How do you treat a biceps tendon rupture?

Answer 9

Conservative – PT

Elderly is frequently associated w/ RTC tear

<40 years or active → surgery

Question 10

treatment for acromioclavicular joint

Answer 10

Type I + II = sling

Type III = controversial

Type IV+ = surgery