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Musculoskeletal pathophysiology > Shoulder cards > Flashcards

Shoulder cards Flashcards

1
Q

Pediatric shoulder pathologies

A

Sprengel’s deformity

Erb’s Palsy

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2
Q

Sprengel’s deformity

A

Failure of scapula to descend.
Decreased Abduction, Lateral motion & rotation.
Decreased scapulothoracic motion.
GH joint is normal with normal ROM

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3
Q

Erb’s palsy

A

Brachial plexus traction injury during birth involving C5-C6 nerve roots.
Shoulder Adducted and IR, forearm pronated, wrist flexed.
Biceps reflex absent.

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4
Q

Adult Soft Tissue Dysfunctions

A
  • Rotator cuff disease – tendinopathy.
  • Biceps tendinitis.
  • Subacromial (subdeltoid) bursiti.
  • Adhesive Capsuliti.
  • Capsuloligamentous dysfunctions/instability
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5
Q

Tendonopathies

A

Tendonitis – inflammatory state of the tendon. Tendonosis – intra-tendon degeneration

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6
Q

How many stages are in the Neer Classification of Rotator Cuff Disease?

A

3 stages

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7
Q

Neer Stage I

A

reversible edema and inflammation <25 yrs, usually responds to conservative RX

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8
Q

Neer Stage II

A

fibrosis of the cuff, permanent and irreversible changes, 25-40 yr

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9
Q

Neer Stage III

A

bone spurs under anterior acromion and partial or full-tendon tear (determined by MRI), >40 yrs

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10
Q

RC Theories of Injury

A
  • Avascularity - “wringing out “concept
  • Mechanical Wear
  • Trauma-micro ormacro
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11
Q

What is one factor that will increase incidence of RC disease?

A

jobs/ activities with prolonged/repetitive overhead work

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12
Q

Which RC muscle is most commonly involved in RC pathologies?

A

Supraspinatus, although infraspinatus and subscapularis can also be affected.

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13
Q

What constitutes conservative management of RC pathology?

A

NSAIDS, PT

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14
Q

What are surgical interventions for RC pathology?

A

Tendon repair

  • Arthroscopic debridement
  • Acromioplasty – removal of end of acromion to allow more room for subacromial structures. May also remove coracoacromial ligament
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15
Q

Subacromial/subdeltoid bursitis

A

Inflammation of the bursa
 Often associated with RC pathology
 May see calcific deposits within bursa
 Usually presents as pain near end of Rom

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16
Q

Biceps (long head) tendonopathy

A

Inflammation or degeneration of the long head of biceps in the bicipital groove.  Anterior shoulder joint pain especially with elbow and shoulder flexio.  Could lead to rupture within the groove

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17
Q

Adhesive Capsulitis Frozen Shoulder

A

Adhesion or shortening of the glenohumeral capsule  Post trauma  Idiopathic

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18
Q

Idiopathic Adhesive Capsulitis

A

Self limiting inflammatory condition of the capsuloligamentous structures of the glenohumeral joint
 12-18 months
 More common in middle age (40-60yrs )
 Woman > Men
 Loss of motion is usually in a capsular pattern
 Diabetics - increased risk –may have a different pattern of limitation

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19
Q

Stages of Idiopathic Adhesive Capsulitis

A

Freezing - first 4-6 months - very painful losing ROM
Frozen - second 4-6 months - pain decreases , very stiff
Thawing - third 4-6 months - less pain and increasing motion

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20
Q

Management of Idiopathic Adhesive Capsulitis

A
  • pain control
  • maintain ROM but consider natural healing and recovery – most regain functional ROM and
    use of shoulder
  • intra-articular cortisone injection - most effective only if done very early
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21
Q

What is Glenohumeral Instability?

A

Capsuloligamentous laxity allowing > normal motion in the joint.

Can be unidirectional or multidirectional

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22
Q

Causes of GH instability

A

Often 2° repetitive use of the shoulder in extreme positions

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23
Q

Clinical Presentation of GH Instability

A

Pain with motion
 Feeling that arm may go numb
 Increased PROM beyond normally expected
 More prone to RC tendonopathies

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24
Q

GH instability is common in what population?

A

athletes e.g. pitchers, swimmers

25
Q

Management of GH instability

A
  • Conservative – strengthening program

* Surgical only if severe or sport/occupation demands it

26
Q

What usually causes GH dislocations?

A

Usually traumatic but may be chronic

subluxator 2° severe laxity

27
Q

In what directions are the most common GH dislocation?

A

95% - anterior-inferior

5% posterior

28
Q

Clinical Presentation of GH Disclocation

A
  • traumatic - very painful
  • anterior dislocation - cannot touch opposite
    shoulder
  • posterior dislocation - cannot ER arm
29
Q

Bankart Lesion

A

Glenoid Labral Tear associated with

GH dislocation

30
Q

SLAP lesion

A

Superior labrum – anterior-posterior lesion

 A forceful tearing of the labrum near the insertion of the biceps tendon

31
Q

What can cause a SLAP lesion?

A

fall on an outstretched arm – often with dislocation of shoulder

32
Q

Hill-Sachs lesion

A

Posterolateral Indentation fracture of the humeral head associated with an
anterior GH dislocation
 Incidence 35-40%
 80% in recurrent dislocations

33
Q

Can a Hill-Sachs lesion be repaired?

A

No. it is a source of possible degeneration.

34
Q

Conservative Management of Dislocations

A

Reduction
 Immobilization in sling up to 3 weeks
 Progressive mobility – P→AA→AROM
 Shoulder strengthening – emphasis on RC

35
Q

Surgeries for GH Chronic Instability/Dislocation

A

Arthroscopic [Bankart, Capsular Shift/ETAC]. Arthrotomy [Bristow]

36
Q

Bankart procedure

A

Arthroscopic procedure for repair of labrum and capsule suturing.

37
Q

Capsular Shift

A

tightening of the anterior capsule

• ETAC – electrothermally assisted capsular shift

38
Q

Bristow procedure

A

Arthrotomy for recurrent dislocations.

coracoid moved to ant glenoid.

39
Q

AC Joint Sprain or Dislocation

A

often 2° downward force on the acromion. 3 grades.

40
Q

Grade I, AC joint sprain/dislocation

A

tender at AC, sprain of AC ligaments no deformity

41
Q

Grade II, AC joint sprain/dislocation

A

increased displacement of clavicle, tear of both superior and Inferior AC Ligaments

42
Q

Grade III, AC joint sprain/dislocation

A

complete disruption, marked deformity, tear of AC ligs and CC (trapezoid and conoid) ligaments obvious step deformity

43
Q

AC joint dislocation: Piano key sign

A

gross instability

* Push down on the distal clavicle and it springs back up like a piano key

44
Q

Management of AC joint dislocation

A
  • ImmobilizeinKenny-HowardSling 3-
    6 wks
  • ORIF – with Rockwood screw only if severe
45
Q

PT Considerations post AC dislocation

A

Precaution with Horizontal Adduction

Precaution with Abduction > 90°

46
Q

Sternoclavicular Joint Sprain or Dislocation

A

Usually 2° considerable trauma like MVA , direct blow to sternum, or fall on outstretched arm
* Clavicle moves superior or posterior
* If posterior may be medical
emergency 2°
proximity to trachea and subclavian artery/nerve

47
Q

Proximal Humeral Fractures

A

Usually from a fall on an outstretched arm or a direct fall onto the arm
2:1- female :male ratio

48
Q

Neer Classification of Shoulder Fractures

A

4 part system based on the relationship of the following bone parts and the amount of displacement

1) Articular fragment of the head
2) Lesser tuberosity
3) Greater tuberosity
4) Shaft

49
Q

Conservative Management of Proximal Humeral Fx

A

sling for 10-21 days IF non-displaced or minimally displaced

Then gradual mobility

50
Q

Surgical Management of Proximal Humeral Fx

A

if displaced by >1 cm or if in

45° angulation will be in sling for several week post op

51
Q

lipohemarthrosis

A

Mixture of fat and blood in joint capsule following trauma

52
Q

What could potentially be injured in a humeral shaft fx?

A

Radial nerve in the spiral groove.

53
Q

PT considerations post humeral fractures

A

Potential for post-immobilization adhesive capsulitis
 Stability of fracture
 Potential for shoulder-hand syndrome
 A type of complex regional pain syndrome

54
Q

Clavicular Fx

A

Usually 2° fall on outstretched arm or fall onto the shoulder
 Weight of arm displaces distal fragment down

55
Q

Conservative Management of Clavicular Fx

A

Usually in Sling for 2-3 wks

 Then gentle mobility

56
Q

Slings for clavicular fractures

A

Either standard sling (more comfortable) or “figure 8”

57
Q

Surgical Management of Clavicle Fractures

A

Plate and screw Fixation –for severe fractures only

58
Q

GH Osteoarthritis (OA)

A

arthritis in GH joint

59
Q

Rx and PT implications of Erb’s Palsy

A

Rx: immobilization 7-10 days then gradual mobility.
~ 75% recover completely.
PT implications – educate parents re: PROM.

Musculoskeletal pathophysiology (3 decks)

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