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Flashcards in shoulder pain Deck (25):
1

rotator cuff disorders

tendinopathy
partial tear
complete tear

2

progressive fibrosis of joint capsule → painful loss of shoulder ROM
later on: reduction in pain, then return to near normal ROM
*loss of active + passive ROM

adhesive capsulitis

3

osteoarthritis: degeneration of articular cartilage with associated synovitis, effusion, osteophyte formation

glenohumeral (trauma, dislocation hx, autoimmune arthritis, loss of active + passive ROM)
acromioclavicular (most common, overhead activities, heavy weight lifting, may have prominent AC joint)

4

shoulder instability

subluxation
dislocation

5

shoulder anatomy

humerus
clavicle
scapula: acromion, coronoid, glenoid

6

shoulder joint articulations

sternoclavicular
acromioclavicular
glenohumoral
scapulothoracic

7

soft tissue stabilizers of shoulder joint

static: bony support, joint capsule, glemohumeral ligaments, glenoid labrum
dynamic stabilizers (keep humerus centered in glenoid during movement): rotator cuff muscles, long head of biceps tendon

8

rotator cuff muscles

loss of active ROM ONLY
"painful arc": pain with active ROM between 60-120 deg
supraspinatous
infraspinatous
teres minor
subscapularis

9

if weak static or dynamic stabilizers

risk for shoulder subluxation (transient dislocation) or frank dislocation

10

most common shoulder subluxation/dislocation

anterior
fall with arm abducted and externally rotated

11

complication of subluxation/dislocation

damage to labrum - lead to chronic instability/dislocations

12

repetitive overhead activities
recurrent impingement of rotator cuff between humerus and acromion
tendinopathy (inflammation) → partial tear → complete tear of rotator cuff tendon

impingement syndrome

13

occurs secondary to primary rotator cuff injury

subacromial bursitis

14

abduction strength tests (arm at 90)

supraspinatous

15

internal rotation strength tests

subscapularis

16

external rotation

infraspinatous/teres minor

17

hawkins impingement test: passively forward flex arm to 90, internally rotate arm to end point

rotator cuff injury:
trap rotator cuff tendon (often supraspinatous) between bony head of humerus and undersurface of acromion
positive: pain

18

empty can test: abduct to 90, forward flex the arm 30 deg

supraspinatous injury (more effective than abduction strength test)
positive: pain + weakness

19

subscapularis lift oft=F test: dorsum of hand against low back - pt lifts hand off and examiner resists

subscapularis
positive: pain and/or weakness

20

drop arm test: passively abduct to 160 degrees, ask pt to slowly lower arm to side

large rotator cuff tear needing surgery:
positive: arm not lowered in controlled fashion

21

AC joint test

bring patients arm across contralateral shoulder (adduction)
positive: pain in AC joint

22

apprehension test: lie supine, abduct to 90 deg with elbow flexed to 90 deg, examiner applies external rotation

anterior shoulder instability/DISLOCATION
positive: apprehensive

23

sulcus sign: examiner applies inferior force down on wrist

multidirectional instability
positive: suclus or indentation is created between acromion and proximal humeral head

24

acute injury, arthritis, calcific tendinosis - imaging

xray

25

if fail conservative management for 6-8 wks

MRI and suspect rotator cuff tear