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Flashcards in Shoulder Deck (88):
1

clavicle fracture MC in what part of the clavicle?

middle 1/3

2

mechanism of clavicle fx?

falling onto lateral aspect of shoulder
hockey
bball

3

clinical px of clavicle fracture...pain w?

pain on palpation over fracture / region
pain w/ active ROM

4

clavicle fracture imaging

AP
Axial - cephalic at 20

5

non / minimally displaced clavicle fracture tx?

shoulder sling ( remove 3x daily and move up /down 16 each to avoid frozen elbow)
Ice
NSAids
passive ROM
PT +/-

6

displaced clavicle fx / signifies soft tissue injury tx?

surgery -- ORIF
sling to prevent excessive motion
slight AROM
PAIN CONTROL
PT

7

AC joint injury common in

hockey!

8

mechanism of AC joint injury? ( force is directed onto what part of arm? what position is the arm in)

direct force onto lateral aspect w/ arm ADDUCTED

9

clinical PX of AC joint injury?
pain?
rom?

pain in affected shoulder w/ decreased ROM
TTP over ac joint

10

AC joint imaging?

ap w & w/o weights

11

Special tests for AC joint injury

cross arm test

12

Cross arm test?
- what injury
- what is the test

special test for AC joint injury

elevate affected arm to 90
actively ADDUCT

positive = pain in AC joint

13

Grade 1 ac joint

sprain AC ligament

14

grade 2 ac joint

torn ac ligament

15

grade 3 ac joint

torn ac ligament AND torn coroclavciular

16

grade 1 &2 ac joint tx

conservative

17

grade 3 ac joint tx

surgery --> and joint stabilization w/ fixation AC/CC ligament

4-6= always surgery

18

sternoclavicular joint dislocation mechanism of injury

fall on ABDUCTED and extended arm

19

sternoclavicular joint dislocation px?

SCM pain
insidious onset in older pts

20

sternoclavicular joint dislocation imaging

AP
bilateral obliques

21

posterior sternoclavicular joint dislocation tx?

surgery if damage to near structures

22

anterior sternoclavicular joint dislocation tx?

rare to repair surgical

23

proximal humerus fx common in what pt demographic?

increases after what age?
peak?

elderly
increases >60yo
peak 73-78yo

24

is there frequent NV involvement with proximal humerus fx?

yup

25

MCC of proximal humerus fx in elderly?

falls
fall from standing

less common -- direct blow, violent muscle seizure

26

proximal humerus fx clinical px?

shoulder pain that increases w/ movement
swelling
ecchymosis
pt hold adducted arm against side

27

an elderly pt px w/ proximal humerus fx will hold their arm how?

pt hold arm adducted against side

28

suspect proximal humerus fx in elder pt who have fallen and px with?

focal tenderness at proximal humorous
motor fxn is limited 2/2 to pain

29

proximal humerus fx imaging

ap
lateral

30

what NV should be checked w/ proximal humerus fx?

radial nerve and vascular integrity

31

what humerus fx has highest risk of NV injury?

distal fx of shaft

32

w/ proximal humerus fx what else should you check... dislocation of?

shoulder dislocation

33

proximal humerus fx - impacted / non-displaced tx

sling / collar
ice
analgesics
sleep semi-recumbent
gentle ROM 2wk after

34

when should you begin gentle ROM of proximal humerus fx

2 week after

35

proximal humerus fx- unstable tx?

ORIF

36

most shoulder dislocations are?

anterior

37

causes of anterior shoulder dislocations are?

reptive microtrauma leading to joint instability

swimmers
gymnast
pitchers

38

common pt demo of anterior shoulder dislocations

swim
gymnast
pitchers

39

posterior shoulder dislocations cause

fall from heigh (MCC of posterior)
epileptic seizure
electric shock

all lead to joint instability

40

how will a pt w/ shoulder dislocation hold their arm

side of body in EXTERNAL rotation

41

imaging shoulder dislocations (3)
+/- ?

AP
grashey
Y sscap

+/- axillary to determine relationship of humerus to gelnoid

42

what nerve / muscle should check w/ shoulder dislocations

axillary n
RC muscles

43

shoulder dislocations tx

reduce!

44

impingement syndrome aka RC tendonitis - is frequently caused by?

partial RC tear

45

mechanism of impingement syndrome

compression of tissues btwn humeral head
overactivity

46

impingement syndrome will have onset of pain w/?

active ROM
esp w/ overhead and internal rotation

47

impingement syndrome
PROM? (increased / decreased?)
ACROM?(increased / decreased?)

prom - preserved
acom- decreased

48

imaging impingement syndrome (5)

AP
Lateral
Grashy
y-scap

MRI to eval RC tear

49

impingement syndrome special test

hawkins

50

hawkins test
injury?
use?
action?

impingement syndrome special test

use - eval impingement of RC and subacromical bursa

flex shoulder and elbow at 90 - internally rotate forearm

positive = pain in anterior shoulder

51

RC muscles

teres minor
subscapularis
infraspinatous
supraspinatous

52

RC cuff tears common cause of shoulder pain after what age

40yo

53

acute causes of RC tears

FOOS arm
pulling on shoulder

54

chronic cause of RC tears

receptive injury w/ overhead mvmt and lifting

55

RC cuff tears clinical px

WEAKNESS (moreso than impingement)
night pain
pain w/ overhead movement

56

RC cuff tears imaging (4)

AP
Lateral
y-scap
grashey

57

high riding humeral head is usually d/t a tear in what RC muscle

supraspinatous

58

RC cuff tears MRI will show

RC Tear
tendinosis

59

partical RC cuff tear tx

conservative w/ PT

pt can stregthen muscle to compensate for loss of strengthen
option for older sedentary w/ full tear

60

full thickness RC cuff tears tx

they dont heal well
w/o surgery --> increase in sx
young active pt --> surgically repair!

61

SLAP lesion- what is it?

injury of glenoid labrum at point of attachment of long head of bicep

62

mechanism of injury of SLAP lesion

(think about the pt demo its commonly seen in)

FOOSH
throwing sports (PITCHERS)

63

SLAP lesion px

pain with overhead mvmt

painful "catching" or "popping"

64

SLAP lesion imaging

MR arthrogram

65

SLAP lesion MR arthrogram finding

high signal

66

Type 1 SLAP lesion & tx

fraying of labrum

asx
no tx

67

type 2&3 SLAP lesion require what tx

surgical reattachment

68

adhesive capsulitis aka frozen shoulder MC in what age group and sex?

40-65
women > men

69

adhesive capsulitis aka frozen shoulder MC in women especially in what stage of life / endocrine disorders?

perimenopausal

endocrine esp DM and thyroid

70

phase 1 of adhesive capsulitis aka frozen shoulder

freezing / inflammatory phase

71

freezing / inflammatory phase of adhesive capsulitis aka frozen shoulder

what phase is it? (1,2,3)
how long does it last?
pain?

phase 1

2-9 mo

achy pain w/ pain out of proportion to exam

72

phase 2 adhesive capsulitis aka frozen shoulder

frozen phase

73

frozen phase adhesive capsulitis aka frozen shoulder

what phase is it? (1,2,3)
how long does it last?
pain?

phase 2
3-13mo
decrease pain and increasing stiffness

AROM and PROM restricted

can use shoulder w/o pain but if go outside of restricted ROM - pain

74

phase 3 adhesive capsulitis aka frozen shoulder

thawing

75

thawing phase adhesive capsulitis aka frozen shoulder

what phase (1,2,3)
whats happening?

phase 3

resolution of stiffness

76

imaging of adhesive capsulitis aka frozen shoulder

MR athrography

77

MR athrography can aid in the dx of? shows?

adhesive capsulitis aka frozen shoulder

should marked reduction in joint capacity
- affected shoulder will not take more than a few mm of dye - usually takes 20-30ml


78

conservative adhesive capsulitis aka frozen shoulder tx

NSAIDS
pt
intra-articular corticosteroid injection
+/- oral pred

79

surgical adhesive capsulitis aka frozen shoulder tx

manipulation under anesthesia and arthroscopic release
surgery followed ASAP w/ PT

80

calcific tendonitis common in one age group and sex?

30-60yo

women

81

what endocrine disorder is 4x more at risk for
calcific tendonitis

DM

82

MC spot for calcific tendonitis

supraspinatus

83

px of calcific tendonitis

painful shoulder 2/2 to acute onset inflammation

84

calcific tendonitis tx

conservative - most are self limited

NSAID
anti-inflammatory meds

85

should flexion, extension of elbow / wrist be intact with a clavicle fx?

yes

86

For ac joint injury the acromion is drive driven _ and _ w/ respect to clavicle

inferiorly
medially

87

anterior shoulder dislocations are usually atraumatic or traumatic?

atraumatic

think--> overuse / micro trauma
swimmers, gymnast, pitchers

88

clavicle fx pt will have pain w/ active ROM - especially upon _ and _ of the shoulder?

abduction
flexion