Shoulder

Question 1

Med/Lat Pec

Answer 1

pec major C5-T1
pec minor (med only) C8-T1

Question 2

Thoracodosral

Answer 2

lats

C6-C8

Question 3

Axillary

Answer 3

deltoid, TMinor

C5-C6

Question 4

Suprascapular

Answer 4

RTC

C5-C6

Question 5

Musculocutaneous

Answer 5

coracobrachialis

C5-C6

Question 6

Spinal Accessory

Answer 6

trap

CN XI

Question 7

Dorsal Scapular

Answer 7

rhomboids, LS

C5

Question 8

Long Thoracic

Answer 8

SA

C5-C7

Question 9

Special Tests - instability/laxity

Answer 9

load and shift - A/P instability
sulcus - MDI
A/P draw - A/P lax
apprehension (crank) - shoulder instability
Fowler's Sign - ant GH instab

Question 10

Passive Stabilizers

Answer 10

superior GH lig - prevents inf HH sublux (limits ER 0 deg abd)
middle - limits ant trans 45 deg abd
inf - 3 bands (post, inf, ant)
post capsule - blends with RTC, enhances stab

Question 11

Special Tests - RTC/Impingment

Answer 11

possible RTC tear - empty/full can, ER lag sign, DA, belly press

impingement - HK, neer

Question 12

Special Tests - Labral

Answer 12

SLAP - biceps load, compression/rotation

labral involvement - crank

Obrien’s - slap vs ac involvement

Question 13

Special Tests - Biceps

Answer 13

Yergason’s - biceps tendon irritation

Speed’s - LH pathology, may indicate SLAP

Ludington’s - biceps rupture

Question 14

Imaging

Answer 14

trauma - axillary, Y view scap, AP
non trauma - routine axillary

US good for RTC full thickness
west point/striker - bankart and hill sach’s
zanca - AC jt

Question 15

Clavicular Fx (CET)

Answer 15

C - FOOSH, direct impact (most common in sports)
E - tilt head toward affected side with chin toward unaffected side, tender, possible deformity
T - sling/swath, immob 6-8 wks, sometimes surgery

Question 16

Scapular Fx (CET)

Answer 16

C - direct impact or force through humerus
E - swelling, pt tender
T - sling 3 weeks

Question 17

Humerus Fx (CET)

Answer 17

C - FOOSH, dislocation, direct blow
E - pain, inability to move arm, swelling
T - splint and immediate referral (shock possible), shaft 3-4 mo, prox 2-6 mo

Question 18

SC Jt Sprain (CET)

Answer 18

C - blow to clavicle, torsion of post ext arm (not very common)
E - swelling, possible displacement, pt tender
T - RICE, reduction if necessary, immob 3-5 wks

Question 19

AC Jt Sprain (CET)

Answer 19

C - direct impact to tip of shoulder, FOOSH on add/part flex arm
E - pain, tender, deformity > grade III
T - I (sling 2-4 days) II (sling 10-14 days) III (sling 2-3 weeks) IV+ (surgery)

Question 20

AC Jt Sprain Grades

Answer 20

I - mild sprain of AC/CC lig
II - complete tear of AC, CC sprain
III - complete tear AC/CC
IV - complete tears, clavicle separation
V - clavicle goes through trap
VI - clavicle locker under coracoid process

Question 21

RTC Tear (CEST)

Answer 21

C - trauma in younger pop, degeneration in older pop
E - nigh pain, weak, tender
S - cluster (DA, painful arc, infra)
T - conservative for partial or older, surgery

Question 22

RTC Repair

Answer 22

days 1-6
- abd brace until wk 6, PROM to 110, ER/IR in scap plane < 30

wk 2-7
- PROM to tol, scap iso, begin walking/bike for aerobics

wk 7-12

• initiate AAROM, DC brace, full PROM by wk 8, periscap ex, GH rhythmic stab
• initiate AROM when ROM WFL (no shrug)

wk 12-18

• full AROM by 12-14 wks, dynamic shoulder stab and strengthening, gradual return to fxnl activities
• wk 16 - low level plyo

wk 18 - light sports
wk 24 - interval sports program

Question 23

Anterior Instability

Answer 23

occurs after trauma in ER/abd
higher risk for bankart and SLAP
90% of all dislocation

Question 24

Posterior Instability

Answer 24

2-10% dislocations

higher risk of posterior labral tear

Question 25

MDI

Answer 25

not usually associated with traumatic events | may result in recurrent sublux or dislocations

Question 26

Anterior Stabilization

Answer 26

wk 1-3 - sling at all times, isos at wk 3 wk 4-5 - continue use of sling, PROM (caution with ER/abd) wk 6-7 - wean from sling, full PROM, start AROM, isotonic/RS for RTC wk 8-12 - progress wk 12-16 - golf and tennis (serve at 4 mo), weight lifting (low weight, high reps) wk 16-20 - interval sports program

Question 27

SLAP Tear (CEST)

Answer 27

C - FOOSH, dislocation, peel back lesion from throwing E - feeling on instability popping, dec throwing power S - Obrien's, biceps load, clunk T - arthroscopic most common

Question 28

SLAP Types

Answer 28

I - degenerative fraying of sup labrum, biceps attachment intact II - biceps anchor has pulled away from attachment at glenoid III - bucket handle tear of sup labrum with intact biceps anchor IV - similar to III but extends into biceps anchor I/III - debride, II/IV - repair

Question 29

SLAP Repair (II/IV)

Answer 29

day 1-wk 2 - sling 4 weeks, no AROM (PROM/AAROM), no biceps contractions, submax iso RTC wk 3-4 - DC sling, RS exercise, continue PROM/AAROM wk 5-6 - initiate AROM, PNF shoulder, no resisted biceps wk 7-9 - begin isotonics, Throwers 10, submax painfree iso biceps wk 10-12 - continue TT, resisted biceps 12 weeks wk 12-14 - light, restricted sports (light swimming, half golf swing), light plyo wk 16-20 - interval sports training progarm mo 6-9 - RTS accordingly

Question 30

Bankart Lesion (CET)

Answer 30

C - most common with anterior shoulder dislocation (often accompanied by Hill Sach's) E - feeling of instability, popping, dec throwing power T - arthroscopic

Question 31

Arthroscopic Bankart Repair

Answer 31

wk 0-6 - sling for 3-4 wks, PROM/AAROM, AROM 4-6 wks, submax sho isos at 4-6 wks wk 6-12 - full AROM by 10-12 wks, isotonics, RS wk 12+ - begin plyos, sport specific exercises wk 20-24 RTS mo 6-9 - RTS accordingly

Question 32

AC Jt Osteolysis (CET)

Answer 32

C - repetitive microtrauma, subchondral microfx overtime, heavy weight lifting (bench press, OH press inc incidence) E - localized pain, swelling, weakness, (+) cross body add test, pain with resisted flex, crepitus T - activity modification, allow for new bone formation, anti-inflammatories