Flashcards in Shoulder Injuries Deck (40):
What are the muscles of the rotator cuff?
Supraspinatus, Infraspinatus, teres minor, subscapularis
What tests are included in the PE of a shoulder complaint?
Neer, Hawkins-Kennedy, Empty can test, Drop arm test, Cross arm test, Speed’s, O’brien’s, Apprehension test, Sulcus sign, Load and shift test, Yergason’s test
Who is shoulder impingement common in?
1. Middle-aged people
A. Repetitive lifting or overhead activities
A. Swimmers, baseball, tennis
What are the sxs of shoulder impingement?
1. Pain w/ activity and @ rest
A. Pain worsens w/ lifting or certain movements
2. Anterior shoulder pain radiating to deltoid/upper arm
3. Pain at night
4. Loss of motion and strength
5. Difficulty reaching behind back
What types of xrays are needed for a shoulder disorder?
How is shoulder impingement treated?
1. Activity modification
A. Avoid overhead reaching/lifting
A. Rotator cuff strengthening exercises
4. Subacromial cortisone injection
What type of acromion structures are predisposed to shoulder impingement?
Type 2 and 3
What is adhesive capsulitis?
1. aka “frozen shoulder”
2. Painful inflammation of the GHJ -> eventual fibrosis of the joint capsule -> restriction of shoulder motion
3. Cause of shoulder pain & dec glenohumeral movement
What are the risk factors for adhesive capsulitis?
2. Thyroid Disease
3. Autoimmune disease
4. Prolonged immobilization
C. Inflammatory shoulder conditions
-Biceps / rotator cuff tendonitis
What are the sxs of adhesive capsulitis?
1. Diffuse aching pain that is poorly localized
A. Pain worse @ night
2. Shoulder stiffness
3. Dec active and passive ROM: pathognomonic
What dx studies are used for adhesive capsulitis?
1. X-ray shoulder
A. AP, oblique and outlet views
B. To exclude post. shoulder dislocation and GH arthritis
What is stage 1 of adhesive capsulitis?
1. Stage 1 (first 2-3 mos)
2. Synovial inflammation & limited ROM
What is stage 2 of adhesive capsulitis?
1. Stage 2 (3-9 mos after onset of sxs/ freezing stage)
2. Dec shoulder motion and chronic pain
What is stage 3 of adhesive capsulitis?
1. Stage 3 (9-15 mos)
2. Inc fibrosis w/ significantly dec ROM
What is stage 4 of adhesive capsulitis?
1. Stage 4 (thawing stage)
2. After 15 months, minimal pain & improved ROM
How is adhesive capsulitis treated?
1. Pain control
A. NSAIDs, analgesics, sleep aid
2. Physical Therapy is essential
A. pendulum exercises, wall-walking
3. +/- corticosteroid injection
4. MUA (manipulation under anesthesia)
Define shoulder osteoarthritis
1. Clinical examination is very similar to pts w/ adhesive capsulitis
2. Not as common as knee or hip OA
3. Anterior shoulder pain and stiffness over months to years
4. Pain worse w/ movement, better w/ rest, below shoulder level movements
What are the sxs of shoulder OA?
1. Local GH jt line tenderness & swelling anteriorly
2. Joint crepitus
3. Atrophy of rotator cuff muscles over scapula
4. Loss of ROM of ER and Abduction
What are the general characteristics of an anterior shoulder dislocation?
1. 95% of shoulder dislocations are in anterior direction
2. Caused by fall on an outstretched & abducted arm
What are the general characteristics of a posterior shoulder dislocation?
1. Posterior dislocations are usually caused by:
A. Falls from height
B. Grand mal seizure
C. Electrical shock
2. Arm held internally rotated & slightly abducted
3. Pt unable to externally rotate shoulder
Define dislocated shoulder
1. Traumatic shoulder dislocation can lead to instability of shoulder joint
2. Atraumatic shoulder dislocations are usually caused by
A. Intrinsic ligament laxity
B. Repetitive microtrauma leading to joint instability
What are the sxs of acute traumatic dislocations?
1. Pt usually presents supporting affected extremity w/ contralateral arm
A. Arm adducted & internally rotated
2. Acute pain
3. Obvious deformity with humeral head dislocated anteriorly
What are the sxs of atraumatic or recurrent dislocations?
What dx studies do you want to order for a shoulder dislocation?
1. X-ray shoulder
A. AP and “Y” view (outlet)
2. +/- MRI (usually not in the acute stage)
A. Shows soft tissue injuries to labrum
B. Visualizes asst rotator cuff tears
What nerves may be affected by a shoulder dilocation?
1. Axillary nerve
A. Freq. affected w/ anterior shoulder dislocations
2. Musculocutaneous nerve
A. Freq. affected w/ ant. shoulder dislocations
3. Brachial plexus
How is an acute shoulder dislocation treated?
1. Need shoulder reduction ASAP
2. Stimson procedure least traumatic
3. Then sling immobilization for 2-4 weeks along with pendulum exercises
4. Before and after shoulder reduction neurovascular checks are essential
How is a chronic shoulder dislocation treated?
What is Kocher's Maneuver and what is it used for?
1. Slow external reduction and downward traction of affected arm
2. ANTERIOR SHOULDER DISLOCATION REDUCTION TECHNIQUE
What shoulder deformities may be complications of shoulder dislocations?
1. Hill-Sachs Deformity
2. Bankart Lesion
What is a bankart lesion?
Bankart lesion is an injury of the anterior (inferior) glenoid labrum of the shoulder due to anterior shoulder dislocation. When this happens, a pocket at the front of the glenoid forms that allows the humeral head to dislocate into it.
What is Hill-sachs deformity?
is a cortical depression in the posterolateral head of the humerus. It results from forceful impaction of the humeral head against the anteroinferior glenoid rim when the shoulder is dislocated anteriorly.
What are common characteristics of a clavicular fracture?
1. Most common fracture in children and adolescents
Usually caused by fall on outstretched arm
2. It can be found in up to 3% live births
What are the sxs of a clavicular fracture?
1. Visible deformity usually present
2. Arm is supported by contralateral extremity
3. Check for brachial plexus injuries
C. Sensory abnormalities
4. Proximal portion may be displaced superiorly because of attachment to SCM
What dx studies are used for clavicular fractures?
A. May see bayonette
What is the treatment for a clavicular fracture?
A. Figure of 8 sling
3. Conservative treatment
A. Majority of time
4. Open Reduction internal fixation (ORIF)
What is a separated AC joint?
1. Aka “Separated shoulder”
A. Stretch or Tear of acromioclavicular ligaments
2. Usually caused by fall or impact on tip of shoulder
3. Grades I-VI
What are the characteristics of the grades of a separated shoulder?
1. Grade I, II, III most common
2. Grade III: Refer for possible surgery
3. Grade IV-VI: NEED SURGERY
A. Uncommon, high-energy injury as in MVA
What are the sxs of a separated shoulder?
Patients have clinically apparent step off at AC joint- (Grade III or higher)
What are the dx studies of a separated AC joint?
1. AP view both shoulders
2. Mild separations may require stress films-> pt holds weighted object to reveal separation