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Flashcards in Shoulder Part 2 Deck (31)
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mechanism for humerus fx in younger pts? elderly?

younger pts

simple fall (W >M)


Presentation of humerus fracture?

Severe pain
Limited ROM


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?


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?


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?



Surgical options for RC tear?

pt with sig sxs and failed rehab >3-6mos

pts with acute traumatic cuff tear
-best done acutely


What is adhesive capsulitis?

frozen shoulder

Idiopathic loss of both active and passive motion, inflammatory process involving the glenohumeral capsule

MCly affects patients 40-60 years of age


What is the MC risk factor for adhesive capsulitis

DM (esp type 1)

other related conditions:
Dupuytren contracture
Cervical disk herniation
Parkinson's disease


Presentation of adhesive capsulitis?

Gradual ROM loss:

Mechanical restriction

Common for patient to be unaware

Primary motions involved:
-External rotation


PE for adhesive capsulitis?

sig red in active/passive ROM: external rotation, flexion and abduction

Pain: dull/achy at rest (deltoid tuberosity), sharp at end range of restricted movements

+/- diffuse shoulder tenderness


Imaging for adhesive capsulitis?

xrays to r/o other path

MRI: contracted capsule and loss of inferior pouch on arthrography or MR arthrogram


What are the phases of adhesive capsulitis?

“Freezing” phase: pain and progressive loss of motion

“Thawing” phase: decreasing discomfort associated with a slow but steady

Takes 6 mos- 2 yrs+ tp resolve

Most patients experience minimal long-term pain or functional deficit