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PT OCS Exam > Shoulder > Flashcards

Shoulder Flashcards

(47 cards)

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1
Q

Dx pearls based on patient reports

A

Dec. Neck ROM suggests C/S assessment

Arms Slips suggests instability

Pain overhead suggests impingement

Altered ROM but no associated pain suggests RTC pathology or neuropathy

Heaviness after activity suggests vascular

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2
Q

R Shoulder Pain referral (non-MSK)

A

Liver
Stomach
Pancreas
Pancoast Tumor (apex of R lung)

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3
Q

L Shoulder pain referral (non-MSK)

A

Heart

Spleen

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4
Q

Normal mechanics for overhead elevation require scapula to perform what?

A

Upward rotation and posterior tilt

  • Dec. rotation in RTC pathology, impingement, instability’
  • Excess upward rotation and anterior tilt in Ad. capsulitis
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5
Q

Weak Serratus

A

Winged scapula with dec. Up.Rot. and Post. Tilt

*C5,C6,C7 nerve injury to Long Thoracic nerve possible

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6
Q

Hypertonic Upper Trap

A

Increased clavicular elevation

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7
Q

Hypertonic Pec. Minor

A

Inc. scapula IR and Ant. Tilt

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8
Q

Post. Capsule tightness

A

Inc. Scapula Ant. Tilt

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9
Q

Kyphotic Posture

A

Inc. IR and Ant. Tilt of the scapula with Dec. Up.Rot.

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10
Q

What is GIRD?

A

GH IR deficiency present in athletes with inc. ER, dec. IR
Measured with stable scap at 90/90
Tight Post. capsule with humeral retroversion causes anterior translation of the humeral head

*Can cause impingement related to weak SA, MT, LT with hypertonic UT

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11
Q

What is SICK scapula?

A

(S)capula malposition
(I)nferomedial border prominence
(C)oracoid pain/malposition
dys(K)inesis of movement

*Primarily affects overhead athlete
Dropped scapula on involved side with:
Tight Pec. Minor and possibly LS, Lats., Rhomboids
Shortened biceps

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12
Q

Scapular Exercises

A

Best for LT: Low Row, Robbery
Best for SA: Lawn Mower, Lower Row, Robbery, isometric Inf. glide

*Inc. LT activation also present in push-up with opposite hip Ext.
Low Row with opposite SLS increases recruitment of LT vs. UT

Dec. Hip IR in opposite LE
Inc. Lordosis (Tight Lats?)

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13
Q

SICK scapula DDx

A

Ant. coracoid pain can be confused with instability
(+)Impingement and subacromial pain due to biomechancis
AC joint pain from anterior tilt position
TOS (clavicle position)

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14
Q

Types of dyskinesia in overhead athletes

A

Ant. Tilt - prominence of inferomedial border, Labral involvement
IR - prominence of medial scapular border, Labral involvement
Down.Rot - prominence of superomedial border, Impingement/RTC pathology

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15
Q

Shoulder screening for pathology with ER vs. IR (IRRST)

A

ER painful or weaker than IR (RTC pathology)

IR weaker vs. ER (labrum involvement)

No difference B/T ER and IR (Extra-articular)
LHB, AC joint, Referred pain

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16
Q

Tests for RTC pathology

A

Dropping sign is best to R/O infraspinatus

(Cluster) HK, painful arc, infra MMT is good to rule in impingement and/or RTC pathology

ERLS good to R/I tear of Supra/Infra

IRLS good to R/I and R/O Subscap

Resisted IR good to R/I Subscap

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17
Q

RTC pathology cluster (3/3)

A 
HK (resisted ER/Flx in 90 degrees and IR position)
Infra MMT (resist ER with wrist against stomach)
Painful Arc (pain B/T 60-120 degrees in scapular plane)
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18
Q

SS tendinopathy cluster to rule in pathology (3/3)

A

Age >65
Infra MMT
Night Pain

*ERLS is a better test

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19
Q

Tests for Anterior Instability

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A

Apprehension (R/I) BEST

Ant. Release (R/I and R/O) BEST

Apprehension & Relocation (R/I and R/O)

20
Q

Tests for SLAP

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A

Biceps load I/II (R/I and R/O) BEST

Passive distraction, Active compression (R/I and R/O)

21
Q

Posterior Impingement/Labral Tests

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A 
Kim Test (R/I and R/O)
Jerk Test (R/I and R/O)

Posterior Impingement test (R/O posterior impingement)

22
Q

AC joint (test cluster to R/I)

Study These Flashcards
A

Crossbody ADDuction
O’brien’s
AC resisted extension

23
Q

Upper Cross Syndrome

Study These Flashcards
A

Shortened: UT, LS, SCM and Pec. Minor

Weak: SA, Rhomboids, LT, DNF

24
Q

Primary Impingement

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A

Caused by Abnormal relationship between the RTC and coracoacromial arch (Type 3 Acromion)
Age > 40
Unable to sleep on involved side
Ant. and upper lateral arm pain

25
Secondary Impingement
``` Dec. in subacromial joint space (caused by instability) Biomechanical Younger patients, overhead athletes "Dead Arm" SICK scapula ```
26
Posterior Impingement (undersurface impingement)
ABD+ER (Cocking phase of throwing) | Associated with anterior instability
27
RTC tendinopathy rehabilitation
IR ROM deficits common * FF AROM causes SAI * ER AROM @90 causes internal impingement ER strength deficits common followed by supraspinatus *Strength deficits magnified by poor scapular position in protraction
28
SLAP tear classification
Type 1 - Labrum frayed, biceps intact Type 2 - Biceps anchor pulled away Type 3 - Bucked Handle, biceps intact Type 4 - Bucket Handle with biceps tear *Types 2 and 4 require repair of biceps
29
Cuff Repair Types
Arthroscopic - weaker fixation Mini-Open - Allows for early deltoid AROM Open - 6-8 weeks restriction of deltoid AROM
30
RTC Tear classification
Small 5cm
31
GH Laxity grading
Normal - mild translation Grade 1 - Feel GH ride up to glenoid 25-50% Grade 2 - GH overrides glenoid but reduces Grade 3 - GH overrides glenoids but no reduction
32
Shoulder instability classification (FEDS)
Frequency (episodes in last year?) Etiology (Traumatic?) Direction (which way did it go out?) Severity (needed help to 'pop' it back in?)
33
Presentation of shoulder dislocation
Arm held at side and painful, prominent acromion *Axillary nerve regularly involved so there is weakness in the T. Minor and Deltoid (Anterior Dislocation)
34
Shoulder Dislocation clinical exam
Load/Shift test Apprehension/Relocation Sulcus sign (>2 cm vs. uninvolved is clinically significant)
35
Shoulder XR to perform after reduction to R/O other lesions
Scapular A/P (Glenoid fx) Striker Notch (Hill-Sachs) Westpoint Mod. Axillary view (IGHL avulsion, Bony Bankart, Ant.Inf. Glenoid insufficiency)
36
Labrum radiological exam
MRI with contrast, hemarthtrosis serves as contrast in acute injuries
37
Prox. humerus fracture
85% minimally displaced Benefit from early scapular ROM GH joint mobilization as early as 2 weeks to restore normal elevation by 27 days (1 month) *Immobilization longer than 3 weeks is of NO benefit
38
Calcific Tenonitis recommendations
R/O non-MSK conditions by timeframe which usually resolves in 1 week with NSAIDS Benefit from high dose U/S (20+ visits at 3.3 mhz)
39
Frozen Shoulder
Predictors: Age 40-65 ER or IR limited above 90 deg Passive ER limited with ADDuction *(R/O if PROM normal) Will usually resolve by 12-18 months
40
Shoulder Functional Outcomes for Ad. Capsulitis
DASH ASES SPADI
41
Adhesive Capsulitis
Early intra-articular injection recommended if highly irritable and painful in acute phase (0-3 months)
42
Stages of Adhesive capsulitis
Stage 1 (0-3 months) (pain with A/PROM) Stage 2 (3-9 months) FREEZING (significant ROM restriction) Stage 3 (9-15 months) FROZEN (pain only at end range) Stage 4 (15-24 months) THAWING
43
Treatment of Impingement with T/S HVLA (3+/5)
Symptoms
44
Radiology for Labral teat
MRA is best but arthroscopy is the gold standard
45
ROM goals for RTC and Labral Repairs
Full ROM expected by 10-12 weeks
46
ROM precautions for TSA and RTSA
TSA: excessive ER should be avoid (more than 45 degrees in first 6 weeks can indicate a possible subscap tear) RTSA: Avoid ADDuction/IR/Extension
47
Test for Subscap. tendinopathy or tear
IRLS **BEST to R/I and R/O tear** Lift Off (better) and Resisted IR tests are best for diagnosing a tendinopathy

PT OCS Exam (8 decks)

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