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Medicine II: Orthopedics > Shoulder and Elbow > Flashcards

Flashcards in Shoulder and Elbow Deck (75)
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1

Identify the anatomical structures of the shoulder and elbow

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2

Rotator Cuff Tendonitis

Supraspinatus tendon is most often initially involved. Impingement syndrome, characterized by overhead activity

3

Physical Exam for Rotator Cuff Tendonitis

Pt may occasionally be awakened by pain at night. Active ROM is limited by pain; no atrophy present; passive ROM shows mild weakness. Neer impingement sign positive and improves with lidocaine.

4

Rotator Cuff Tears

Most common at the humeral insertion site of the supraspinatus tendon

5

Cause of Rotator Cuff Tears

Degenerative changes, microtrauma, intrinsic or extrinsic compression; acute trauma. Partial tears or full thickness tears.

6

Patient Presentation with a Rotator Cuff Tear

Pain and weakness (overhead), deltoid insertion (referred). Insidious, more common in older population. Consistent Night pain

7

Physical Exam for Rotator Cuff Tears

Rotator cuff weakness with external rotation, abduction and internal rotation. Tender to palpation on the rotator cuff. Positive impingement signs.

8

X-rays for Rotator Cuff Tears

Acromial hook, Acromioclavicular joint, DJD. Superior migration of humeral head (massive tear).

Can also get: US/Arthrogram or MRI +/- contrast- very sensitive (too sensitive?)

9

Treatment for Rotator Cuff Tears

PT, NSAIDs, Injection, Surgery (open vs. arthroscopic)

10

Treatment for Bursitis

Activity modificiation, PT, oral antiinflammatory meds; surgery after failure of tx

11

Bursitis

Inflammation of the subacromial bursa

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Bursitis

Neer impingement sign positive (impingement of the supraspinatus tendon) and improves with lidocaine

13

SLAP Lesion

5-7% of first time dislocators, O’Brien test: + test if pain is worse when thumb is down. Superior labrum anterior posterior lesions = origin of long head of biceps brachii and superior capsulolabral structures. Type II most common

14

Diagnosis and Treatment for a SLAP Lesion

Diagnostic arthroscopy remains the best means to dx SLAP definitively. Active compression test may be the most useful maneuver

15

Shoulder Impingement Syndrome

Abnormal calcification of the CA ligament, Abnormal acromial morphology. Dynamic factors- rotator cuff dysfunction.

16

Patient Presentation with Shoulder Impingement Syndrome

Insidious onset, pain (anterolateral shoulder, overhead, reaching behind, night, insidious)

17

Physical Exam for Shoulder Impingement Syndrome

Tenderness over rotator cuff/greater tuberosity. Sometimes limited motion 2 degree pain. Positive for impingement signs. Strength sometimes dimished due to 2 degree pain.

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X-rays for Shoulder Impingement Syndrome

Acromial hook

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Treatment for Shoulder Impingement Syndrome

Physical therapy: rotator cuff strengthening, NSAIDs, Injection (diag + ther); Surgery- arthroscopic subacromial decompression.

20

Shoulder Instability (uni- and multi directional)

Test anterior, posterior and inferior instability. Multidirectional = positive sulcus sign. Classification based on direction of instability that elicits symptoms and presence or absence of hyperlaxity.

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Tests for Shoulder Instability (uni- and multi directional)

Anterior = apprehension test or relocation test.
Posterior = circumduction test or Jahnke test.
Inferior = sulcus sign

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TUBS: Shoulder Instability (uni- and multi directional)

caused by Traumatic event, Unidirectional, Bankart lesion associated; often requires Surgical treatment

23

AMBRI: Shoulder Instability (uni- and multi directional)

Atraumatic, Multidirectional instability that may be Bilateral and best treated by Rehabilitation

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Adhesive Capsulitis aka:

Frozen Shoulder

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Cause of Adhesive Capsulitis

Idiopathic: endocrine (DM, hypothyroidism)

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Who is more prone to Adhesive Capsulitis

Diabetics and Females >40yo.

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Presentation and Exam of a patient with Adhesive Capsulitis

Global, mostly anterior pain. Pain with any motion, especially sudden movements.

Active = passive ROM. Shoulder stiffness, painful, significant restriction in both active and passive ROM
Articular surfaces are normal and joint is stable, yet there is restricted ROM. Painful External Rotation.

28

Imaging for Adhesive Capsulitis

Not typically helpful

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Treatment for Adhesive Capsulitis

THERAPY!!!! (Do specific exercises), athroscopic release, closed manipulation.

30

Lateral Epicondylitis

Most common problem of the elbow, 80% will have symptom improvement at 1 year; “tennis elbow”. 4th and 5th decade,