Shoulder Pathology

Question 1

2 kinds Labral lesions

Answer 1

1) SLAP

2) Bankart

Question 2

Labral lesion Sx

Answer 2

1) dull/throbbing
2) difficulty sleeping on shoulder
3) loss of strength
4) **instability
5) popping/clicking/catching

Question 3

What is the most common cause of Labral tears

Answer 3

*impact injury (not age)

Question 4

What is a Labral lesion

Answer 4

Tearing of glenoid labrum

Question 5

What is SLAP Labral lesion

Answer 5

“Superior labrum anterior posterior”

-injury to anterior/posterior attachment of bicep tendon

Question 6

SLAP Labral lesion Sx

Answer 6

1) impingement/catching with overhead force/pushing

2) pain with movement (above head/throwing)

Question 7

cause of SLAP Labral lesion

Answer 7

1) fall outstretched arm
2) forceful pulling arm (catching heavy object)
3) rapid/forceful movement above shoulder level

Question 8

Risks for SLAP

Answer 8

1) overuse (weightlifting, throwing)
2) shoulder dislocation
3) MVA

Question 9

On a clock where do SLAP lesion occur

Answer 9

10 and 2

Question 10

On a clock where do Bankart lesion occur

Answer 10

3 and 6

Question 11

What is a Bankart lesion

Answer 11

-anterior (inferior) glenoid labrum

Question 12

2 kinds of Bankart lesions

Answer 12

1) soft- labrum

2) bony- anteroinferior glenoid rim bone

Question 13

SX of Bankart lesion

Answer 13

1) pain worse with arm behind back

2) hill-Sachs lesion- posterolateral humeral head compression fracture= promotes future dislocation

Question 14

Cause of Bankart lesion

Answer 14

Anterior shoulder dislocation

Question 15

What other pathologies to differentiate for Labral lesions

Answer 15

1) ALPSA (anterior Labral posterior sleeve avulsion)
2) cuff fraying
3) rotator cuff tears
4) SLAP lesion
5) impingement

Question 16

What is bursitis

Answer 16

Inflammation of the bursa

Question 17

Etiology of bursitis

Answer 17

Inflammation-> increase synovial cells-> increase collagen/fluid production in bursa-> decrease lubrication outside bursa

Question 18

Cause of bursitis

Answer 18

1) repetitive trauma/friction (micro-trauma)
2) impact
3) rheumatoid arthritis
4) infection

Question 19

Sx of bursitis

Answer 19

Impingement syndrome

Question 20

What are other names for impingement syndrome

Answer 20

“Sub criminal impingement, painful arc syndrome, supraspinatus syndrome, swimmers shoulder, throwers shoulder”

Question 21

Etiology of impingement syndrome

Answer 21

Decreased sub acromial space= impingement (of supraspinatus tendon, subacromial bursa, long head bicep tendon)

Question 22

Cause of bursitis

Answer 22

1) intrinsic/primary- rotator cuff degeneration/weakness
- subacromial bursitis
2) extrinsic/secondary- subacromial bone spurs
- osteoarthiritic Spurs from AC joint
- variation of acromion shape
- thickening coracoacromial ligament
- poor posture (anteriorly)
- weak scapular stabilizers (rhomboids/traps)
- tight mm (pecs, serrated anterior)

Question 23

Predisposing factors for impingement syndrome

Answer 23

Overhead activities

Question 24

Sx of impingement syndrome

Answer 24

1) pain front/side shoulder
2) onset- sudden (trauma) OR gradual (micro trauma)
3) increase pain- overhead activity/lying on shoulder
4) decrease strength with pain
5) decreased ROM
6) painful arc movement- forward elevation (60-120)
7) crepitus

Question 25

Differential for impingement syn

Answer 25

1) rotator cuff tear (pain resolves, weakness persists) | 2) supra scapular nerve entrapment

Question 26

Diagnosis for impingement syn

Answer 26

1) Hawkins-Kennedy test 2) painful arc sign 3) weakness in external rotation with arm at side

Question 27

What is adhesive capsulitis

Answer 27

"Frozen shoulder"

Question 28

Types of adhesive capsulitis

Answer 28

1) idiopathic 2) trauma 3) post surgery 4) vaccine related

Question 29

Etiology of adhesive capsulitis

Answer 29

Decrease synovial fluid-> thickening shoulder capsule-> adhesions within capsule/connective tissue

Question 30

Cause of adhesive capsulitis

Answer 30

Trauma with autoimmune component

Question 31

Risks for adhesive capsulitits

Answer 31

1) tonic seizures 2) diabete mellitus 3) stroke 4) LU Dz 5) connective tissue Dz 6) thyroid Dz 7) HT Dz

Question 32

Sx for adhesive capsulitis

Answer 32

1) constant pain 2) pain increases at night/cold 3) progressive loss AROM/PROM 4) provoked by certain movements (pain and cramping)

Question 33

Normal course of healing of adhesive capsulitis

Answer 33

1) stage 1 (freezing/painful)- 6week-9 month - slow onset - increase pain= decreased ROM (vice versa) 2) stage 2 (frozen/adhesive)- 4-9 month - pain= slow improvement - stiffness 3) stage 3 (thawing/recovery)- 5-26 months - motion slowly returns to normal

Question 34

2 kinds of rotator cuff tears

Answer 34

1) partial (fraying)/ 1-2 degree | 2) full thickness/ 3 degree

Question 35

What is included in 3 degree

Answer 35

1) small pinpoint tear 2) large buttons hole tear 3) majority of tendon, tendon still attached to humeral head 4) complete detachment of tendon from humeral head

Question 36

Etiology of rotator cuff tear

Answer 36

1) injury (acute)- varying amts of stress - supraspinatus tendon/rotator interval - severe pain radiates thru arm - limited ROM- abduction 2) degeneration (chronic) - extended use and poor biomechanics/mm imbalance

Question 37

Sx of rotator cuff tear

Answer 37

1) sporadic worsening of pain 2) debilitating mm atrpohy 3) pain during rest 4) crepitus 5) ROM (abduction/flexion)

Question 38

Risks for rotator cuff tear

Answer 38

1) repetitive stress 2) decrease blood (supraspinatus) ***CUPPING 3) impingement syndrome

Question 39

What is a rotator interval

Answer 39

Triangular space between suprascapularis/supraspinatus, coracohumeral/superior glenhumeral ligaments, long head bicep tendon, anterior joint capsule

Question 40

What is VOMIT

Answer 40

"Victims of medical imaging technology" - MRI studies - 20% partial rotator cuff tear - 15% full thickness tear - 50% rotator cuff tear of ppl over 60- no pain/injury - 40% pro baseball players- partial/full thickness, no pain, even after 5 years