Shoulder Injuries

Question 0

inflammation associated with repetitive trauma during every day shoulder movement.
Risk factor: repetitive overhead activity

Answer 0

tendonitis

Question 1

chronic degeneration of the muscles w/ age

pain despite lack of inflammation

Answer 1

tendonosis

Question 2

pain that comes on gradually, deep ache in the lateral shoulder that radiates to the deltoid- point tenderness. Painful ROM, improves w/ analgesics

Answer 2

tendonitis

Question 3

what can be the result of tendonitis progression, impingement, & degeneration?

Answer 3

Chronic tear of the rotator cuff

Question 4

Shoulder pain that is worse at night. Worsening pain with gradual weakness. Weakness does not improve with analgesics. Decreased ROM, especially abduction

Answer 4

Chronic rotator cuff tear

Question 5

what is the specialized exam for a chronic rotator cuff tear?

Answer 5

drop arm sign

Question 6

acute shoulder pain w/ negative radiographs

Answer 6

acute tear

Question 7

etiologies of acute tear (2)

Answer 7

trauma, pathology

Question 8

What are the specialized exams for rotator cuff injuries? (6)

Answer 8

Apley’s scratch test, empty can test, lift off test, Hawkin’s test, Neer’s impingement sign

Question 9

what is the most commonly involved muscle in rotator cuff injuries?

Answer 9

Supraspinatus

Question 10

Treatment of a rotator cuff injury? (5)

Answer 10

ice anterolaterally, NSAIDs if appropriate
weighted pendulum stretching for 5 min to maintain ROM
restrict overhead motions
shoulder immobilizer for very short duration- PT afterwards
subacromial steroid injection- rest afterwards

Question 11

stiffened glenohumeral joint

Answer 11

Frozen Shoulder/Adhesive Capsulitis

Question 12

Chronic shoulder pain w/ decreased ROM, rigid immobility

Answer 12

Frozen shoulder/adhesive capsulitis

Question 13

frozen shoulder tx (2)

Answer 13

intense PT to stretch the joint lining & restore ROM

some will require surgery to remove adhesions

Question 14

shoulder pain w/ abduction, flexion, & internal rotation. Subacromial tenderness. Normal glenohumeral ROM, preserved strength

Answer 14

Shoulder impingement syndrome

Question 15

shoulder impingement syndrome etiology

Answer 15

compression of the rotator cuff tendons & the subacromial bursa between the humeral head and lateral edge of acromion process

Question 16

shoulder impingement syndrome complications? (3)

Answer 16

bursitis
rotator cuff tendonitis
degenerative changes

Question 17

hallmark sign of shoulder impingement syndrome?

Answer 17

pain reproduced by the painful arc of flexion-internal rotation manuevers

Question 18

tests for shoulder impingement syndrome? (3)

Answer 18

Neer’s, Hawkin’s impingement tests

MRI to r/o cuff tear

Question 19

Shoulder impingement syndrome treatments (4)

Answer 19

ice, activity changes
NSAIDs
PT
possible corticosteroid injections

Question 20

bump on the shoulder that is worse at bedtime, AC joint tenderness, pain increases w/ downward traction

Answer 20

Acromioclavicular Injury

Question 21

injured in fall onto the tip of the shoulder w/ arm tucked into side

Answer 21

AC joint

Question 22

AC joint intact, capsular distension, ligament stretch (sprain)

Answer 22

Grade I AC Injury

Question 23

AC ligament is torn, coracoclavicular ligament intact. Unstable AC joint, decreased ROM

Answer 23

Grade II AC injury

Question 24

separation of superior and inferior AC ligaments & coracoclavicular ligaments. Clinical deformity, instability, pain, decreased ROM.

Answer 24

Grade III AC injury

Question 25

Acromioclavicular injury treatment (4)

Answer 25

Shoulder immobilizer for 3-4 weeks to allow ligaments to reattach Ice, rest, NSAIDs activity restrictions corticosteroid injections if not improving after 2-4 weeks

Question 26

what is the usual clavicle fracture?

Answer 26

middle 1/3, displaces superiorly, & may be comminuted

Question 27

concern w/ distal clavicle fx?

Answer 27

brachial plexus involvement

Question 28

concern w/ proximal clavicle fx?

Answer 28

evaluate internal organs

Question 29

clavicle fx tx? (4)

Answer 29

conservative for nondisplaced or minimally displaced fxs in adults, nearly all peds Sling/swatch, analgesics, muscle relaxers, sleeping upright

Question 30

clavicle fx healing?

Answer 30

most within 4-6 weeks, some 8-10 weeks

Question 31

clavicle fx ortho referral? (2)

Answer 31

displaced midclavicle fxs | all proximal and distal fxs

Question 32

inflammation, possible degeneration of bursa. Associated w/ repetitive movement or acute injury. May result from systemic disease

Answer 32

Subacromial bursitis

Question 33

inflammation, pain w/ ROM & rest, decreased ROM due to pain, localized tenderness to palpation

Answer 33

Subacromial bursitis

Question 34

subacromial bursitis treatment (3)

Answer 34

ice & NSAIDs restriction of overuse aspiration & corticosteroid injection

Question 35

inflammation of the long head of the biceps tendon as it passes through the bicipital groove, associated w/ repetitive lifting

Answer 35

Biceps tendonitis

Question 36

pain in the anterior shoulder w/ abduction and external rotation. Maximal point of tenderness along bicipital groove. Popping sensation, weakness

Answer 36

Biceps tendonitis

Question 37

specialized exams for biceps tendonitis? (2)

Answer 37

Yergason's sign, Speed's test

Question 38

Biceps tendonitis treatment? (4)

Answer 38

NSAIDs rest PT Surgery for younger pts who are active

Question 39

shoulder instability, arm guarded, sulcus sign

Answer 39

glenohumeral subluxation/dislocation

Question 40

detachment of anterior inferior labrum from glenoid rim

Answer 40

Bankart lesion

Question 41

depression of the posterolateral humeral head when its impacted by anterior rim of glenoid

Answer 41

Hill Sachs lesion

Question 42

Apley scratch test? and what conditions it evaluates?

Answer 42

touch the opposite scapula to test shoulder ROM frozen shoulder, rotator cuff

Question 43

Empty can test? and what conditions it evaluates?

Answer 43

resistance against forward flexion in hyperpronation (thumbs down), elbow extension, & abduction rotator cuff: supraspinatus injury/tear

Question 44

lift off test? and what conditions it evaluates?

Answer 44

hand on back, shoulder internally rotated. Push against resistance Rotator cuff: subscapularis injury

Question 45

Hawkin's test? and what conditions it evaluates?

Answer 45

passive flexion to 90* & forceful internal rotation of the shoulder. pain --> impingement --> rotator cuff concerns rotator cuff, shoulder impingement syndrome

Question 46

Neer's impingement sign? and what conditions it evaluates?

Answer 46

passive flexion w/ arm pronated & scapula stabilized. Empty can w/ assist to full ROM pain --> subacromial impingement --> rotator cuff concerns rotator cuff, shoulder impingement syndrome

Question 47

gradation of Neer's test for shoulder impingement syndrome?

Answer 47

Pain at 90* = mild impingement Pain at 60-70* = moderate impingement Pain at 45* or below = severe impingement

Question 48

Cross over test? and what conditions it evaluates?

Answer 48

passive cross body adduction AC injury

Question 49

Yergason test? and what conditions it evaluates?

Answer 49

elbow flex at 90* w/ forearm pronated. Supinate forearm & externally rotate humerus against resistance Bicipital tendon assessment

Question 50

Speed's test? and what conditions it evaluates?

Answer 50

arm extended in full supination w/ shoulder flexed. Elevate arm against resistance bicipital tendon

Question 51

Apprehension & Relocation test? and what conditions it evaluates?

Answer 51

elbow flexed at 90*, arm abducted at 90*. Apply external rotation at the shoulder & note apprehension, pain glenohumeral dislocation/subluxation

Question 52

Sulcus sign

Answer 52

arm in neutral, relaxed position. Provider will pull the arm downward, resulting in a depression or "sulcus" in the shoulder near the acromion. Pt may show this voluntarily glenohumeral instability