Shoulder Dysfunction Flashcards
Sprengel’s deformity is the failure of the scapula to descend (left > right, 3:1 female:male). What causes Erb’s palsy?
An obstetrical brachial plexus traction injury.
-involves C5,6 (shoulder abduction, ER, forearm supination and wrist ext)
What is it important to clear the biceps tendon when examining shoulder pain?
Rotator cuff pain usually radiates to the lateral brachium.
Differentiate tendonitis from tendonosis.
Tendonitis – inflammatory state of the
tendon
Tendonosis – intra-tendon
degeneration
Neer’s Classification of Rotator Cuff Disease has 3 stages. Describe them and typical findings in each.
Stage I – reversible edema and inflammation
-40 yrs
During adduction, avascular conditions can be created for the supraspinatus tendon. How does this occur?
Through a wringing and twisting motion due to its fiber orientation. This functioning can contribute to degenerative changes.
-Especially with people who do a lot of overhead work
Through what 3 instances does an injured muscle produce pain? What specifically do you see with subacromial busitis?
- AROM or stretch
- Palpation (directly over tendon)
- Resistance (resisted isometrics)
- inflammation of the bursa
- possible calcific deposits
- pain near end of ROM
A biceps (long head) tendonopathy can lead to a rupture of the bicipital groove. What types of pain does it present with?
- Inflammation or degeneration of the long head of biceps in the bicipital groove
- Anterior shoulder joint pain especially with elbow and shoulder flexion
Post traumatic adhesive capsulitis is believed to be caused by prolonged fixation of the GH joint after injury. What about idiopathic AC?
IDIOPATHIC ADHESIVE CAPSULITIS
- don’t know what causes it
- Self-limiting process that takes 12-18 months to resolve itself
- affects women much more than men (young middle age 30s, 40s)
- capsule gets stuck in capsular pattern
Can a capsular pattern be determined in AROM?
No, only PROM.
Describe the 3 stages of adhesive capsulitis. What are the management steps?
- 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
- pain control
- maintain as much ROM as possible but consider natural healing and recovery – most will regain functional ROM and use of shoulder
- intra-articular cortisone injection - most effective only if done very early (reduces inflammation onset)
Common in athletes such as swimmers and pictures, GH instability presents clinically as ___?
- Pain with motion
- Feel the arm may go numb
- Increased PROM beyond normally expected
95% of GH dislocations occur in the ___ fashion. Describe the clinical presentation of both anterior and posterior dislocations.
Anterior-inferior.
ANTERIOR
-can’t internally rotate
POSTERIOR
-can’t externally rotate
A Bankart lesion is associated with an anterior, inferior dislocation and labrum tear. Do people need surgery?
No, not unless the person is a chronic dislocator. Most people can be put in a sling for a few weeks and heal.
SLAP lesions usually occur from a fall on an outstretched arm, often with shoulder dislocation. Describe the lesion further.
SLAP = superior labrum, anterior-posterior lesion
-A forceful tearing of the labrum near the insertion of the biceps tendon
35-40% of dislocations involve a Hill-Sachs lesion. What is it and how is it treated?
Posterolateral Indentation fracture of the humeral head associated with an anterior GH dislocation.
- can’t really be repaired
- whole piece of round head with smooth articular cartilage is missing, becoming a source for potential degeneration in the future (post-traumatic arthritis)
