Flashcards in shoulder/elbow Deck (76):
Common shoulder problems for young people:
common shoulder problems for middle age
rotator cuff, frozen shoulder
common shoulder problems for elderly
What's the first classification you want to make when working with a shoulder dislocation?
Trauma or not? Unidirectional vs multi-directional
Patient c/o lateral pain from deltoid down to elbow. Where is this typically coming from?
Patient c/o shoulder pain that radiates to hand, where is this typically coming from?
What shoulder problems cause loss of ROM?
1) Adhesive capsulitis
3) cuff tear
What comorbidities are particularly relevant to MS issues?
DM, thyroid, smoking and any serious med problem that would r/o candidacy for sx
Stephanie: biceps tear
What problem most commonly causes muscle wasting?
If you can get more ROM from the shoulder passively than actively, what are you thinking first?
If you have lost passive ROM in the shoulder, what are you thinking first?
OA, adhesive capsulitis
supraspinatous, infraspinatous, teres minor, subscapularis
SITS muscle fxn
2) infraspinatous--external rotation
3) teres minor--multidirection accessory
4) subscapularis--internal rotation
What special test is checking internal rotation?
Gerber lift off is checking what muscle strength?
What is the belly press test checking?
Which PE tests are looking for impingement of the rotator cuff?
Neer (arm raise) and Hawkin's
If you passively moved the arm in adduction across the body, what would you be checking for?
pain reproduced at AC joint
(also can reproduce impingement pain)
The _________ sign shows a tear in the _________ and is concerning b/c it limits the ability for patients to perform ADL's like brushing teeth/hair, feeding
Hornblower's sign, teres minor
Infraspinatous is responsible for ______ rotation. If a patient's arms are passively placed in jazz hand position, but they cannot maintain it, this is a positive ____________
external rotation, Lag test
What are the signs of shoulder instability?
A) Apprehension, humerus feels like it will pop out anteriorly
B) Jobe relocation, feels better if you push posteriorly on proximal humerus
C) Augmentation--feels worse if you pull anteriorly
D) Release--Release of JOBE feels bad
What are the grades of the load and shift test for shoulder stability?
1--humeral head to the glenoid labrum
2--humeral head over glenoid rim
A sulcus sign is suggestive of __________________
ligament laxity = multidirectional instability
How could you test posterior instability of shoulder?
Jerk test: arms out like linebacker, push posteriorly and listen/feel for jerk/clunk
superior labrum, anterior/posterior
What is a common cause for young people to get a SLAP tear?
What test can you do to check a SLAP tear?
O-brien's test/empty can test. Arm is horizontal, 10 degrees adducted. Pain worse with thumb down
2 tests for biceps?
speed test (wolverine) and yergason test (elbow flexion).
Long thoracic nerve palsy is a/w ___________
medial winging of serratus anterior
Lateral winging is caused by __________ nerve palsy, and is a/w what muscle?
CN XI, trapezius
How can you tell the difference b/t medial and lateral winging?
Medial--wall push up produces vertical wing.
Lateral--external rotation produces oblique wing
What type of imaging is best for the rotator cuff/SLAP region?
MRI with contrast
What type of shoulder problems are mostly bony and should be evaluated with a CT?
Hill-Sach's, Bankart, Glenoid morphology
90% of all shoulder dislocations are _______
90% of first time anterior shoulder dislocations are _______________
What is actually the damaged structure in a bankart lesion?
anterior inferior glenoid labrum
What complication is often a/w a bankart lesion?
Hill Sach's lesion/fx of the humeral head
What will a patient's arm look like if there is an anterior shoulder dislocation?
prominent humeral head with external rotation
What must you check in the event of an anterior shoulder dislocation?
How do you tx anterior shoulder dislocation?
conscious sedation, reduction, sling, sx for repeaters
What can cause a posterior dislocation aside from posterior directed force?
violent muscle contractions in sz or electrocution
What will the arm look like in a pt with a posterior shoulder dislocation?
internally rotated, unable to abduct
What are you looking for on xray for posterior dislocation?
light bulb sign, empty glenoid
how do you tx a posterior shoulder dislocation?
sedation, reduction by external rotation and push humeral head anteriorly, then immobilize x 6 weeks
How can you tx recurrent instability of shoulder?
PT, sx to repair labral tear, reconstruction of bone loss
A fall onto the shoulder or catching a backwards fall with your elbows is likely to cause __________
AC joint separation
This is an idiopathic condition characterized by pain and stiffness of the shoulder at rest. Pain increases at extremes of ROM. Ability to perform AROM is equal to PROM
adhesive capsulitis is thought to be related to what systemic conditions?
endocrine (DM, thyroid)
how do you tx this frozen shoulder?
PT, NSAIDS, CS inj, arthroscopy
What's the difference b/t a subacromial impingement and a rotator cuff tear?
spectrum of severity.
What imaging is used for rotator cuff tear eval?
MRI for uncertain dx or pre-sx
Most common mgmt for cuff tear?
Term for when the rotator cuff cant contain the humeral head withing the glenoid
rotator cuff arthropathy
What can be done for rotator cuff arthropathy?
Reverse TSA (total shoulder arthroplasty) for pts with no rotator cuff fxn (fossa becomes ball, humerus becomes socket)
What does high-dose steroids increase the risk of?
Tx of OA in shoulder
NSAIDS, Cox2, PT, CS inj
how are non-displaced proximal humerus fx's treated?
ORIF with sling/immobilization
long recovery, residual stiffness!!
where is the most common location for a clavicular fx?
when do you repair a clavicle fx?
if > 2cm of shortening
the trochlea articulates with the ________
coronoid process of the ulna
The capitellum articulates with the __________
radial head fossa
what are you thinking if there is ttp over the medial epicondyle of the elbow?
1) medial epicondylitis
2) MCL injury
3) medial epicondyle avulsion
A positive Tinel's sign in ulnar nerve distribution indicates _________
Where is the tenderness in tennis elbow?
lateral epicondyle/radial head/capitellum
What is the milk test?
like your doing a delt stretch and you milk the thumb, which creates valgus stress and reproduces pain in problem with the ulnar collateral ligament
MOI for UCL injury
land on palm, valgus stress from supination
what is the most common problem of the elbow?
What does lateral epicondylitis look like on PE?
tenderness is anterior and distal to lateral epicondyle, wrist extension exacerbates
How do you tx epiconylitis?
NSAIDS, CS inj, orthotics, PT, LASERS, sx
Lateral epicondylitis is an inflammatory disorder, what about medial epi?
more of an overuse injury (especially pronation)
Which nerve is a/w neuropathy in 50% of medial epicondylitis cases?
Medial epicondylitis is a/w with increased pain during what movements?
pronation and wrist flexion
What are the 3 tx's for radial head fx?
2) ORIF for young or displaced >2mm
3) replacement--older, severely comminuted
The _______ is a fracture of the distal radius with dislocation of the distal radioulnar joint
galeazzi fx (distal, radial fx)