Shoulder Part 2 Flashcards
(31 cards)
mechanism for humerus fx in younger pts? elderly?
younger pts
simple fall (W >M)
Presentation of humerus fracture?
Severe pain
Limited ROM
Swelling
Ecchymosis
What is used to classify humerus fractures?
Neer classification
location, fx parts and displacement
What is the MC cause of shoulder pain?
Subacromial Impingement Syndrome (SAIS)
What occurs during an impingement syndrome? What are the 2 different types?
Decreased subacromial space
primary & secondary
MOA of impingement syndrome?
Repetitive microtrauma
Supraspinatus tendon
Subacromial bursa
Long Head of Biceps
How does tendon degeneration occur?
Inflammation
Repetitive microtrauma
Reduction in stress tolerance
What acromion morphology puts pts at increased risk of SAIS > increased risk of RC tear? why?
hooked acromion
there is increased subacromial pressure > decreased subacromial space > more contact with RC tendons
what drives primary impingement? who is it usually seen in?
Driven by degenerative changes
> 35 y/o
bone spurs/calcific deposits
Etiology of secondary shoulder impingement? who is usually effected?
Due to repetitive overhead movement
Abduction and ER
<35, overhead athlete, faulty scapular posture
What contributes to faulty scapular posture? Why is this a bad thing?
Forward head, Increased thoracic kyphosis
leads to adaptive muscle imbalances; tight pec minor can cause anterior tilting and protraction
Presentation of subacromial impingement syndrome?
Gradual onset of anterior and lateral shoulder pain exacerbated by overhead activity
night pain/dif sleeping on affected side
TTP over greater tuberosity, subacromial bursa and biceps tendon
When should you order xrays for subacromial impingement?
Always in cases of traumatic injury to r/o fracture
Eval for calcifications / bone spurs (>35)
Evaluation of acromial morphology
Tx of impingement syndrome?
NSAIDS
avoidance of offending activities
Modify sleeping position
PT/home therapy for posture
if no better in 6 wks: subacromial corticosteroid injection + therapy
fail conservative: surg
What surgical procedure is done for subacromial impingement?
subacromial decompression
What is the MCC of rotator cuff tear?
Overuse: Age-related degeneration, chronic mechanical impingement
other: traumatic
Where do rotator cuff tears usually originate?
in the supraspinatus tendon (90%) and may progress
Are full thickness rotator cuff tears common?
uncommon <40
increases >40, especially >60
Presentation of rotator cuff tear?
Recurrent shoulder pain for several months (overuse)
Specific injury that triggered the onset of the pain (traumatic)
Subacromial pain &pain localized to deltoid tuberosity
Night pain and dif sleeping on affected side
Weakness, catching, and grating especially when lifting the arm overhead
PE findings seen in rotator cuff tear?
TTP of the subacromial space
AROM decreased
-Shoulder “shrug” with abduction
PROM normal
+ “drop arm” test
pain/weakness w/ isolation of involved RC (supraspinatus, infraspinatus/teres minor, subscapularis)
What imaging is used to dx RC tear?
Xray: traumatic injuries to r/o fx, eval for calcifications/bone spurs
MR- gold standard: if chronic injury & concern for partial tear order arthrogram
if traumatic, most likely full thickness so +/- arthrogram
Non surg tx options for pts with rotator cuff tear?
if <50%:
NSAIDS, PT, avoidance of overhead activity
+/- steroid injections (decreased inflammation but may also weaken tendon/acclerate propagation of tear)
What is max amount of subacromial injections that a pt should receive/yr?
> 3
Surgical options for RC tear?
pt with sig sxs and failed rehab >3-6mos
pts with acute traumatic cuff tear
-best done acutely
