Shoulder Fx Flashcards

Question

# Anterior shoulder dislocation general

Answer 1

Classification: Subcoricoid, subglenoid, subclavicular, Intrathoracic. Mechanism of injury: Abduction, extension, and external rotation. Signs and symptoms: Prominence of acromion process and flattening of normal contour of the shoulder. X-rays: Standard series = AP shoulder + Scapular Y. Post-reduction - *Axillary lateral.

Answer 2

**Stimson** Prone position Arm hanging Traction in forward flexion using 5, 10 or 15 pound weight (15-30 min) Use with scapular manipulation

Answer 3

**Scapular Manipulation** Stimson technique Scapular tip medially Slight dorsal displacement of scapular tip Reduction may be subtle

Answer 4

**Leidelmeyer** Supine Arm adducted Elbow flexed 90° Gentle external rotation

Answer 5

**Milch** Forward flexion or abduction until arm is directly overhead Longitudinal traction Slight external rotation Manipulate humeral head upward into glenoid fossa

Answer 6

**Traction-counter-traction** Supine Bed sheets tied Slight abduction of arm Continuous traction Gentle external rotation Gentle lateral force to humerus Change degree of abd

Answer 7

Classification: (commonly missed) Subacromial, subglenoid, subspinous. Mechanism of injury: Seizures or electric shock, fall on forward-flexed, adducted and internally rotated arm. IR > ER musculature. Signs and symptoms: Anterior flatness, posterior fullness and prominence of the coracoid process. X-rays: Axillary lateral, when in doubt obtain CT.

Answer 8

Treatment: Reduction, sling/shoulder immobilizer, physical therapy, referral to orthopedist - Young patients: immobilize longer 4 weeks - Older patients: early ROM (pendulum exercises to prevent stiffness) Surgical repair for significant soft tissue damage or dislocations that will not reduce, recurrent dislocations

Answer 9

Etiology: degenerative/ mechanical wear & tear of articular cartilage at humeral head and glenoid fossa Primary osteoarthritis Secondary arthritis: post traumatic (dislocation/fx) Increases with age, more common in patients over 60 More common in women Common symptoms/complaints: Pain and stiffness of shoulder, worse with activity Often no pain at rest

Answer 10

Physical exam: Diminished PROM and AROM – IR/ER Palpable grinding/ crepitus with ROM Testing: X-rays: joint space narrowing, osteophytes and possibly subchondral cysts AP/Axillary lateral views

Answer 11

Treatment: NSAIDs Gentle exercise, physical therapy Steroid injections Surgical replacement – TSA, rTSA, hemi Pearls: Use reverse shoulder replacement if RCTs are present with arthritis (uses deltoid for motion and control)

Answer 12

Etiology: A.K.A “Frozen Shoulder” Capsule is inflamed; it then scars and remodels (becomes smaller, tighter) Due to little or no trauma **Commonly associated with diabetes and thyroid disease** Common symptoms/complaints: **Pain out of proportion** to physical exam findings Stiffness – loss of AROM & PROM exercises

Answer 13

Physical exam: Diminished AROM and PROM (very tight and painful) Compare to contralateral extremity Testing: Essentially negative x-rays and MRI – order to rule out other etiology

Answer 14

Treatment: Physical therapy and manipulation under anesthesia (MUA) Sometimes NSAIDs help but not often **Treating underlaying DM & thyroid disease** Pearls: Commonly seen in patients 40 to 60 years of age More common in women than men, especially in peri-menopausal women or in patients with endocrine disorders, such as diabetes mellitus or thyroid disease

Answer 15

Etiology: Tendinitis: inflammation of the tendon within the groove Rupture: tear of the tendon (typically long head) Common symptoms/complaints: Tendinitis: anterior shoulder pain, may radiate down biceps, **weakened elbow flexion because of pain** Rupture: felt a pop and then pain improved, sometimes has weakened elbow flexion

Answer 16

Physical exam: Tendinitis Pain in bicipital groove **+ Speed’s test** - pain with elbow flexion against resistance Rupture “Popeye” deformity ecchymosis Testing: MRI will confirm tear or tendinitis

Answer 17

Treatment: Tendinitis: - Rest, NSAIDs, caution with steroid injection not to inject tendon - Surgery: tenodesis versus tenotomy Rupture: - Surgery

Answer 18

Etiology: Intermittent or continuous pressure on elements of the brachial plexus and the subclavian or axillary vessels by anatomic structures of the shoulder girdle region (often between the anterior or middle scalene muscles and a normal first thoracic rib or a cervical rib) Common in athletic males – overhead motion Anatomical predisposition, neck trauma Common symptoms/complaints: Pain, numbness and weakness in the arm Sensitivity to cold and paleness in the arm

Answer 19

Physical exam: Neck, trapezius * , shoulder pain Weakness, numbness, paresthesia UE heaviness feeling, cyanosis Symptoms can be provoked with holding arm overhead for 60 seconds Testing: Chest radiography identifies presence of cervical rib, C7 transverse process, Pancoast tumor MRI with arms held in different positions useful in identifying sites of impaired blood flow Angiography confirms intra-arterial or venous obstruction

Answer 20

Treatment: Therapeutic Procedures - Conservative measures: physical therapy, activity modification, TENS unit to relieve compression of neurovascular bundle Surgery Required by < 5% of patients Failed conservative tx for >6 months with muscle atrophy 1st rib resection, scalenectomy, neurolysis Vascular intervention – heparin, +/- embolectomy (large vessel), TPA (small vessel), systemic **More likely to relieve neurologic rather than vascular component that causes symptoms**

Shoulder Fx Flashcards

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