Shoulder evaluation lecture Flashcards
1
Q
What is the closed pack position for the Glenohumeral joint?
A
90° abduction and full external rotation.
2
Q
What is the open pack position for the Glenohumeral joint?
A
55° adduction, 30° horizontal adduction, neutral rotation.
3
Q
What is the capsular pattern for the Glenohumeral joint?
A
Most limited: external rotation, next limited: abduction, least limited: internal rotation.
4
Q
What is the closed pack position for the Acromio-clavicular joint?
A
90° abduction.
5
Q
What is the open pack position for the Acromio-clavicular joint?
A
Undetermined, most likely with arm at side.
6
Q
What is the capsular pattern for the Acromio-clavicular joint?
A
Lacks a true capsular pattern, most likely pain with extreme ROM.
7
Q
What is the closed pack position for the Sterno-clavicular joint?
A
Max elevation, max protraction.
8
Q
What is the open pack position for the Sterno-clavicular joint?
A
Undetermined, most likely with arm at side.
9
Q
What is the capsular pattern for the Sterno-clavicular joint?
A
Lacks a true capsular pattern, most likely pain with extreme ROM.
10
Q
What is the closed pack position for the Scapulothoracic joint?
A
Undetermined (no joint capsule).
11
Q
What is the open pack position for the Scapulothoracic joint?
A
30-45° internal rotation, slight upward rotation, 5-20° anterior tipping.
12
Q
What is the capsular pattern for the Scapulothoracic joint?
A
Undetermined (no joint capsule).
13
Q
How is the Shoulder Complex often divided for anatomical assessment?
A
Upper Quarter (UQ) Scanning Exam to differentiate between cervical spine and shoulder-related issues.
Cervical Spine vs. Shoulder Complex Exam to determine the primary source of dysfunction.
Specific Joint Assessments, focusing on individual components such as:
• Glenohumeral (GH) Joint
• Acromioclavicular (AC) Joint
• Sternoclavicular (SC) Joint
• Scapulothoracic (ST) Articulation
14
Q
Why should the cervical and thoracic spine be assessed when evaluating the shoulder complex?
A
Because they often present similarly and/or impact each other.
15
Q
What should you be familiar with when evaluating the shoulder complex?
A
Pain patterns in each region, unique sets of symptoms for dysfunctions in each region, associated body segments (cervical spine, thoracic spine, elbow/forearm complex, cardiovascular system).
16
Q
What must be considered when evaluating the shoulder complex?
A
The shoulder as a whole complex and as part of the entire kinetic chain.
17
Q
What are the three causes of shoulder complex dysfunction?
A
- Compromise of passive restraint components.
- Compromise of neuromuscular control.
- Compromise of >1 neighboring joints that contribute to motion.
18
Q
What should be assumed when evaluating shoulder dysfunction?
A
Visceral and serious causes should be ruled out.
19
Q
What are key demographic factors to consider in a patient history?
A
Age, occupation, job requirements, hand dominance, recreational/leisure activities, sports.
20
Q
What types of activities might be relevant in patient history for a shoulder evaluation?
A
Kayaking/boating.
21
Q
What are common mechanisms of injury to consider?
A
Trauma/specific event, insidious onset.
22
Q
What should be assessed as the chief complaint?
A
Pain (NPRS, VAS, Faces), loss of function.
23
Q
How should pain be evaluated in the chief complaint?
A
Duration, constant vs intermittent, irritability, activities that increase/decrease pain.
24
Q
What are signs of tendinopathy in a patient history?
A
Pain with activities, history of repetitive motions.
25
What are signs of instability in a patient history?
Pain with prolonged static positions, pain after activities.
26
What other symptoms should be explored in the chief complaint?
Numbness and tingling, heaviness, decreased grip strength.
27
What shoulder conditions may be seen in children and adolescents?
Humeral epiphysitis or osteogenic sarcoma.
28
At what age is rotator cuff (RC) degeneration typically seen?
40-60 year olds.
29
What is 2° impingement and who is it most commonly seen in?
2° impingement due to instability (caused by weakness), typically seen in teens-20’s, especially with overhead athletes.
30
What age group is most likely to experience calcium deposits in the shoulder?
20-40 year olds.
31
At what age is adhesive capsulitis commonly seen?
45-60 year olds.
32
Can adhesive capsulitis occur at other ages?
Yes, it can occur at any age if related to trauma.
33
What conditions is adhesive capsulitis often associated with?
Diabetes mellitus (DM) and ischemic heart disease.
34
What mechanism of injury is associated with overhead exertion and repetitive motions?
Sub-acromial bursitis/impingement, RC tendinopathy/tear, biceps tendinopathy.
35
What injury can occur from a fall on an outstretched hand (FOOSH)?
Shoulder/elbow/wrist sprain or strain, elbow/wrist fractures, AC joint separations, clavicle fractures, GH joint fractures, GH dislocations.
36
What injury can result from a fall on the tip of the shoulder?
AC joint separations, bone contusion, C-spine injury.
37
What injury occurs with forced horizontal extension of an abducted, externally rotated arm?
Anterior GH dislocation.
38
What is the prevalence of shoulder pain in swimmers?
40-91%.
39
What is shoulder pain in swimmers likely related to?
Fatigue of upper back, RC, and pec muscles.
40
What type of injury can lead to impaired dynamic stabilization of the humeral head?
Repetitive stress injury.
41
What symptom behavior is associated with pain relieved when the arm is elevated overhead?
Cervicogenic cause.
42
What symptom behavior is associated with pain relieved when the elbow is supported?
AC joint separation, RC tears.
43
What symptom behavior is associated with pain relieved by circumduction of the shoulder with an accompanying click or clunk?
Internal derangement, GH instability.
44
What symptom behavior is associated with pain relieved when the arm is distracted?
Bursitis, RC tendinopathy.
45
What symptom behavior is associated with pain relieved when the arm is held in a dependent position?
Thoracic outlet syndrome.
46
What is the first question in the Patient Health Questionnaire (PHQ-2)?
Over the past 2 weeks, how often have you had little interest or pleasure in doing things?
47
What is the second question in the Patient Health Questionnaire (PHQ-2)?
Over the past 2 weeks, how often have you felt down, depressed or hopeless?
48
What does the OSPRO-YF assess in terms of psychosocial distress?
OSPRO-YF assesses 3 specific domains of psychosocial distress: Negative mood, Fear-avoidance, Negative affect/coping.
49
Why is shoulder complex dysfunction considered complex?
Shoulder complex dysfunction is complex and multi-faceted.
50
What are some common differential diagnoses for shoulder pain?
Impingement/RC pathology, Adhesive capsulitis, GH instability, Post-op/Other, Serious injury/pathology.
51
What should be the sequence of your shoulder examination?
Sequence your exam to allow for efficient data collection and effective clinical decision-making.
52
What should be considered when reviewing symptoms in the shoulder?
Lots of overlap in symptoms between cervical spine and shoulder.
53
What does a history of trauma in shoulder cases suggest?
A history of trauma may suggest instability, even if it occurred a long time ago.
54
Why is it important to check for neurovascular symptoms during a shoulder examination?
To determine the presence or absence of neurovascular signs and symptoms.
55
What should be considered when examining findings for serious pathology?
Look for consistent patterns like no changes in pain based on position, night pain, or unexplained weight loss.
56
How do yellow flags impact shoulder pain symptoms?
The presence of yellow flags can increase the complexity of symptoms and decrease patient outcomes.
57
What are the key positive findings for rotator cuff/impingement?
Impingement signs, painful arc, pain with isometric resistance, weakness, atrophy.
58
What are the key negative findings for rotator cuff/impingement?
Significant loss of motion, instability signs.
59
What is the progression of Impingement/Rotator Cuff Pathology?
Impingement > Rotator Cuff Tendinopathy > Rotator Cuff Tear.
60
What percentage of shoulder pain seen in PT is related to RC dysfunction?
50-70%
61
What are the mechanisms of injury (MOI) for RC pathology?
Compression, tensile overload, macrotrauma
62
What key findings suggest a contractile problem in RC pathology?
Pain with resisted testing, weakness, atrophy
63
Is impingement a diagnosis or a symptom?
Symptom – must determine where and why it is occurring
64
What factors contribute to impingement?
Intrinsic & extrinsic factors, decreased mobility, decreased strength, poor neuromuscular control
65
What anatomical factor can contribute to shoulder impingement?
Acromion shape/form
66
How does blood supply affect rotator cuff health?
Vascularization of RC muscles can influence healing and susceptibility to injury
67
What role do dynamic stabilizers play in impingement?
Poor function can lead to instability and impingement
68
How can the AC joint contribute to impingement?
Degeneration or abnormalities can affect shoulder mechanics
69
What demographic factor is associated with impingement risk?
Age
70
How does arm position during activity impact impingement risk?
Certain positions increase compression in the subacromial space
71
What muscular factors contribute to impingement?
Muscle imbalances and impaired scapular kinematics
72
How does capsular tightness influence impingement?
Limited mobility can alter joint mechanics
73
What postural factors can lead to impingement?
Poor posture affects scapular positioning and humeral movement
74
Why is repetitive overhead activity a risk factor?
Increases stress on the rotator cuff and subacromial structures
75
How does structural asymmetry relate to impingement?
Uneven mechanics may alter movement patterns
76
What is the significance of humeral resting position in impingement?
Malpositioned humerus can contribute to altered joint mechanics
77
How are RC tears classified?
By size, location, direction, and depth
78
What is the relationship between RC tear size and weakness?
Larger tears result in greater weakness
79
What are the two primary treatment options for RC tears?
Conservative management and surgical intervention
80
What is the goal of conservative treatment for RC tears?
Restore joint mobility and strengthen surrounding musculature
81
What surgical procedures may be used for RC tears?
Subacromial decompression, RC repair, biceps tenodesis/tenotomy
82
What is the Cofield classification for RC tears?
System for classifying RC tears by size
83
What tear size defines a small RC tear?
<1 cm
84
What tear size defines a medium RC tear?
1-3 cm
85
What tear size defines a large RC tear?
3-5 cm
86
What tear size defines a massive RC tear?
>5 cm
87
What are the key positive findings for frozen shoulder?
Spontaneous progressive pain, loss of motion in multiple planes, pain at end-range
88
What are the key negative findings for frozen shoulder?
Normal motion, age < 40
89
What is another name for Adhesive Capsulitis?
Frozen Shoulder
90
What are common risk factors for Adhesive Capsulitis?
45-60 years old, female > male, trauma, diabetes, thyroid disease
91
What percentage of patients with Adhesive Capsulitis develop it in the opposite shoulder?
20-30%
92
What is the etiology of Adhesive Capsulitis?
Unknown
93
What is the typical duration of Adhesive Capsulitis?
12-18 months
94
What are the four stages of Adhesive Capsulitis?
Stage I (<3 months), Stage II Freezing (3-9 months), Stage III Frozen (9-14 months), Stage IV Thawing (14+ months)
95
What characterizes Stage I of Adhesive Capsulitis?
Pain, minimal loss of ROM, often ignored
96
What characterizes Stage II (Freezing) of Adhesive Capsulitis?
Progressive pain, increasing loss of ROM
97
What characterizes Stage III (Frozen) of Adhesive Capsulitis?
Severe ROM limitations, less pain
98
What characterizes Stage IV (Thawing) of Adhesive Capsulitis?
Gradual return of ROM, minimal pain
99
What are key clinical findings in Adhesive Capsulitis?
Progressive pain without MOI, ROM loss in >2 planes, capsular pattern limitations
100
What is the focus of treatment in Stage I of Adhesive Capsulitis?
Pain control (if seen by PT)
101
What is the focus of treatment in Stage II (Freezing) of Adhesive Capsulitis?
Pain control, manual therapy (as tolerated), mobility exercises, self-care emphasis
102
What is the focus of treatment in Stage III (Frozen) of Adhesive Capsulitis?
Pain typically resolved; focus on restoring ROM and strength
103
What is the focus of treatment in Stage IV (Thawing) of Adhesive Capsulitis?
Continue restoring ROM & strength; stretching, strengthening, NM re-education
104
What are key positive findings for Glenohumeral Instability?
Age < 40, Hx of dislocation/subluxation, Apprehension, Generalized laxity
105
What are key negative findings for Glenohumeral Instability?
No Hx of dislocation, No apprehension
106
What is Glenohumeral Joint Instability?
Abnormal symptomatic motion of the GH joint affecting normal joint kinematics
107
What is the relationship between laxity and instability?
Laxity ≠ Instability; instability occurs when laxity leads to symptoms and dysfunction
108
What are the underlying causes of GH instability?
Genetic factors, Collagen abnormalities, Biomechanical factors
109
Is there a normal variation in GH joint translation?
Yes, considerable variation exists in asymptomatic individuals.
110
What are common S&S of GH instability?
Looseness, slipping sensation, pain, subluxation, dislocation.
111
What are the two mechanisms of injury for GH instability?
Traumatic vs Atraumatic.
112
What does TUBS stand for?
Traumatic, Unidirectional, Bankart lesion, Surgery required.
113
What does AMBRI stand for?
Atraumatic, Multidirectional, Bilateral, Rehab first, Inferior capsular shift.
114
What type of problem is GH instability?
Non-contractile.
115
What are common symptoms of GH instability?
Pain with overhead activities & end ROM, weakness, muscle guarding.
116
What is the most common direction of GH instability?
Anterior.
117
What percentage of all shoulder dislocations are anterior?
>90%.
118
What is the typical mechanism of injury for anterior GH instability?
Abduction, external rotation, extension.
119
Which sports are commonly associated with anterior GH instability?
Football, swimming, baseball.
120
What is the conservative treatment for anterior GH instability?
Gradual return to full AROM, strengthen scapular and RC muscles, NM re-education.
121
What is the surgical treatment for anterior GH instability?
Labral repair, salvage procedures.
122
What is the mechanism of injury for SLAP tears?
Trauma (fall, catching a heavy object) or repetitive microtrauma (throwing).
123
Why is the differential diagnosis (DDx) for SLAP tears difficult?
Symptoms are similar to rotator cuff disease and GH instability.
124
What is the conservative treatment for SLAP tears?
Gradual return to full AROM, strengthen scapular and RC muscles, NM re-education.
125
What are the surgical treatments for SLAP tears?
SLAP repair, labral debridement, biceps tenodesis/tenotomy.
126
What is the mechanism of injury for posterior glenohumeral instability?
Flexion, adduction, internal rotation; associated with seizures, electric shock, diving into a shallow pool, and MVAs.
127
What is the treatment for posterior glenohumeral instability?
Conservative: gradual return to full AROM, strengthen scapular and RC muscles, NM re-education; Surgical: labral repair, salvage procedures.
128
What is the mechanism of injury for inferior glenohumeral instability?
Carrying heavy objects and hyperabduction.
129
What is the treatment for inferior glenohumeral instability?
Immobilization.
130
What is multi-directional glenohumeral instability?
Instability in more than one direction, typically insidious onset.
131
Who is more likely to experience multi-directional glenohumeral instability?
Females are more likely than males (laxity).
132
What is the treatment for multi-directional glenohumeral instability?
Conservative: strengthen scapular and RC muscles, NM re-education; Surgical: capsular shift, capsulorrhaphy.
133
What are the potential causes of shoulder pain post-op?
Fractures, epiphysitis, AC joint issues, neural entrapment, myofascial pain, fibromyalgia.
134
What is epiphysitis?
Inflammation of the growth plates, often affecting the shoulder in children and adolescents.
135
What is the role of the AC joint in shoulder dysfunction?
AC joint can be a source of pain, often due to degenerative changes or separations.
136
What is neural entrapment?
Compression or irritation of nerves around the shoulder, leading to pain, numbness, or weakness.
137
What is myofascial pain?
Pain originating from muscle tissue, often associated with trigger points in the shoulder muscles.
138
How does fibromyalgia affect the shoulder?
Fibromyalgia can cause widespread pain, including in the shoulder, and is often accompanied by fatigue and sleep disturbances.
139
What is the typical post-op concern for shoulder arthritis?
Post-op concerns include managing pain, restoring mobility, and preventing stiffness or further joint degeneration.
140
What is scapular dyskinesis?
Alterations in the normal position or motion of the scapula during coupled scapulo-humeral movements (e.g., arm elevation).
141
What causes scapular dyskinesis?
The condition is often insidious but may follow traumatic injury or immobilization.
142
What are the typical symptoms of scapular dyskinesis?
Pain, abnormal scapular motion during shoulder movements, and potentially weakness or fatigue in surrounding muscles.
143
What is the main mechanism of injury (MOI) for scapular dyskinesis?
Typically insidious, but can occur after trauma or prolonged immobilization.
144
How is scapular dyskinesis treated conservatively?
Gradual return to full AROM, strengthening of scapular and RC muscles, NM re-education, and correction of deficits in surrounding joints.
145
Why is scapular dyskinesis important in shoulder rehabilitation?
It may contribute to altered mechanics and potential shoulder dysfunction or pain, impacting overall shoulder function.
146
What is traumatic OA?
OA that occurs in individuals over 45 years old, typically following trauma that causes changes in bony morphology.
147
What is the mechanism of injury (MOI) for traumatic OA?
Bony morphology changes following trauma that lead to degenerative changes in the joint.
148
What are the conservative treatment options for traumatic OA?
Active rest, activity modifications, medications, maintaining or improving pain-free ROM, strengthening scapular and RC muscles, NM re-education.
149
What are the surgical treatment options for traumatic OA?
Total Shoulder Arthroplasty (TSA) or Reverse Total Shoulder Arthroplasty (RTSA).
150
When does traumatic OA typically occur?
In individuals older than 45 years old, often due to past traumatic injury.
151
What are the goals of conservative treatment for traumatic OA?
Manage pain, maintain or improve joint mobility, and strengthen muscles around the shoulder to support function.
152
What percentage of patients with shoulder pain have AC joint sprain?
31% of patients with shoulder pain have an AC joint sprain.
153
What are the two main mechanisms of injury (MOI) for AC joint dysfunction?
Trauma (fall onto the tip of the shoulder) and chronic issues (OA, RA, mechanical dysfunction).
154
How many types of AC joint sprains exist?
There are six types of AC joint sprains.
155
What is the treatment for AC joint sprains of types I-II?
Conservative management, including rest and physical therapy.
156
What is the treatment for an AC joint sprain of type III?
The treatment is controversial and may depend on the severity.
157
What is the treatment for AC joint sprains of types IV-VI?
Surgical reduction is typically required for types IV-VI.
158
What is AC joint arthrosis/arthritis?
Degenerative or post-traumatic arthritis of the acromioclavicular (AC) joint.
159
Is SC joint dysfunction more or less common than AC joint dysfunction?
SC joint dysfunction is less common than AC joint dysfunction.
160
What is the main mechanism of injury (MOI) for SC joint dysfunction?
The main MOI for SC joint dysfunction is trauma (e.g., MVA, sports injuries).
161
What are the two main types of SC joint injuries?
Sprain and dislocation are the two main types of SC joint injuries.
162
What are the typical mechanisms of injury for SC joint sprain or dislocation?
Fall on flexed/adducted or extended/abducted arm.
163
Why is posterior SC joint dislocation considered dangerous?
Posterior dislocations can be life-threatening due to potential compression of vital structures (e.g., trachea, major vessels).
164
What is the treatment for SC joint dysfunction?
Conservative treatment includes immobilization followed by gradual ROM return, strengthening, and NM re-education.
165
When is surgery typically needed for SC joint dysfunction?
Surgery is typically needed when a fracture is present in the SC joint.
166
What percentage of all fractures in the body are clavicle fractures?
Clavicle fractures account for 5-10% of all fractures in the body.
167
What is the most commonly fractured bone in childhood?
The clavicle is the most commonly fractured bone in childhood.
168
What is the most common mechanism of injury (MOI) for a clavicle fracture?
The most common MOI is trauma, such as a fall on an outstretched hand (FOOSH) or a direct blow.
169
What is the conservative treatment for a clavicle fracture?
Conservative treatment includes immobilization followed by a gradual return to full ROM, strengthening, and NM re-education.
170
When is surgery required for a clavicle fracture?
Surgery (ORIF) is required if the fracture is displaced.
171
What part of the humerus is involved in proximal humerus fractures?
Proximal humerus fractures involve the proximal 1/3 of the humerus.
172
What is the most common group affected by proximal humerus fractures?
Proximal humerus fractures are most common in children and the elderly.
173
What is the mechanism of injury (MOI) for proximal humerus fractures?
The MOI is trauma, such as a fall on an outstretched hand (FOOSH) or a direct blow.
174
What is the conservative treatment for a proximal humerus fracture?
Conservative treatment includes immobilization followed by a gradual return to full ROM, strengthening, and NM re-education.
175
When is surgery required for a proximal humerus fracture?
Surgery (ORIF) is required if the fracture is displaced. Total Shoulder Arthroplasty (TSA) or Reverse Total Shoulder Arthroplasty (RTSA) may be required depending on the severity of the injury and the quality of surrounding tissue.
176
What percentage of all fractures in the body do scapular fractures account for?
Scapular fractures account for 1% of all fractures in the body.
177
What is the mechanism of injury (MOI) for scapular fractures?
The MOI includes trauma such as motor vehicle accidents (MVA), falls, direct blows, and forceful muscle contractions.
178
What is the conservative treatment for a scapular fracture?
Conservative treatment includes immobilization followed by a gradual return to full ROM, strengthening, and NM re-education.
179
When is surgery required for a scapular fracture?
Surgery (ORIF) is required if the fracture is displaced. Total Shoulder Arthroplasty (TSA) or Reverse Total Shoulder Arthroplasty (RTSA) may be required depending on the severity of the injury and the quality of surrounding tissue.
180
What is the full form of the DASH score?
Disability of Arm, Shoulder, and Hand.
181
What is the QuickDASH?
The QuickDASH is a shortened version of the DASH score, designed for quicker assessments of arm, shoulder, and hand disabilities.
182
What does the Penn Shoulder Score assess?
The Penn Shoulder Score assesses shoulder function and outcomes, focusing on pain and ability to perform everyday activities.
183
What is the SPADI score?
SPADI (Shoulder Pain and Disability Index) is used to measure pain and disability in patients with shoulder conditions.
184
What is the K-JOC score?
The K-JOC (Kerlan-Jobe Orthopaedic Clinic) score is a shoulder-specific outcome measure, often used in sports medicine for evaluating shoulder function.
