Shoulder Pathos Flashcards by Robert Kerby

what is the most common MOI for ACJ injuries?

medial/inferior force to the ACJ - football or fall

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what is the order of structures injured in an ACJ injury?

AC ligament > CC ligament > delt/trap attachments

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what is a type 1 ACJ injury?

AC ligament sprain

CC ligament intact

delt/trap intact

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what is a type 2 ACJ injury?

AC ligaments disrupted

CC ligaments sprained

delt/trap intact

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what is a type 3 ACJ injury?

AC ligaments disrupted

CC ligaments disrupted (25-100% larger space)

delt/traps detached

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what is the major difference between a type 3 and type 4 ACJ injury?

the clavicle is posteriorly displaced in a type 4 injury

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what is the major difference between a type 3 and type 5 ACJ injury?

ACJ grossly displaced 100-300% requiring surgery

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what is the major difference between a type 3 and a type 6 ACJ injury?

the clavicle is displaced inferiorly

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although the most common ACJ MOI is a direct blow, what are three other MOIS?

FOOSH
elbow jammed upward
traction

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what are the two sports most commonly associated with ACJ arthrosis

baseball and weightlifting

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which three items clue you in to an ACJ pathology?

MOI
focal pain at ACJ w radiation proximally
delt is round, but depressed

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what are the four major special tests you should use to dx an ACJ pathology

o’brien’s active compression
cross body adduction
ACJ TTP
end range painful arc

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what three classifications can be made for impingement?

internal, external subacromial, external subcoracoid

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describe internal impingement

infra/supraspinatus impinges between labrum/glenoid and greater tuberosity causing tendon fraying and pain

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what is the typical patient profile for internal impingement? when does the majority of pain occur?

young overhead throwers during the late cocking phase

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what is tight in internal impingement?

posterior IGHL

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what is the most common structure of acromion associated with impingement?

type 3 hooked in 70% of cadaveric shoulders

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where do we observe external impingement pain in the painful arc test?

60-120 abd > flexion

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what is GIRD? who has it?

loss of GH IR due to bone changes, posterior capsule tightness, or RTC tightness

throwing athletes

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What is the CPG to rule in shoulder pain from muscle power deficits? (4)

symptoms worsen with repetitive overhead mvmts
midrange catching
midrange resistance flx/abd pain
weak RTC

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what is the CPG to rule out shoulder pain from muscle power deficits? (4)

resistive tests pain-free
supra/infra/biceps normal strength
loss of PROM

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define multidirectional instability of the GHJ

MDI: symptomatic laxity in two or more directions, one of which is always inferior

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differentiate between laxity and instability

laxity - extent to which the humeral head can be translated on the glenoid

instability - abnormal increase in GH translation causing symptoms related to sublux/dislocation

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what are the two classifications of instability?

AMBRI and TUBS

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what is AMBRI

atraumatic, multidirectional, bilateral, rehab effective, inferior capsule shift

what is TUBS

traumatic dislocation, unidirectional, bankhart, surgery

what is the most common pathology seen in anterior shoulder dislocations?

bankart lesion

what is a bankart lesion?

(aka Perthes lesion) avulsion of the glenoid labrum in the anterior inferior quadrant

what is are typical MOIs for Bankart lesions?

QB blocked throw, blocked dunk (abd, ext, ER)

what is a hill-sachs lesion? what causes it?

compression fx of the post/lat humeral head occuring over time with anterior dislocations

what do you find on examination of an anterior dislocation?

1. FLATTENED DELTOID 2. increased acromial prominence 3. arm in a protected position, acute

during a fx or complete tear (severe trauma) which nerve are we worried about and what does it supply

axillary - deltoid and teres minor

in what pt demographic are recurrence rates of anterior dislocation highest? (90%)

\< 20 after traumatic dislocation

what exam findings do you expect in this patient?

1. ER \< 0 2. elevation \< 90 3. IR and horiz add cause pain

what causes posterior dislocations? what two anatomical changes can occur?

FOOSH; reverse bankhart and reverse hill sachs

what is a type 1 SLAP tear

labral degeneration (frayed edges), but no avulsion

what is a type 2 slap tear?

most commonly reported - complete labral detachment from ant/sup to post sup, thus causing biceps tendon instability

what is a type 3 SLAP tear?

bucket handle displacement of labrum into the joint, BUT no instability of the biceps tendon

what is a type 4 SLAP lesion?

similar to type 3 but the labrum AND biceps tendon are detached

what is the CPG for ruling IN shoulder instability? (5)

1. \<40 2. hx of dislocations 3. excessive GHJ accessory motion in multiple planes 4. apprehension at endrange 5. deep ache intermittant pain (w or without click) worse with overhead

what is the CPG to rule OUT shoulder instability

1. no hx of dislocation 2. globally limited ROM 3. no apprehension

how do you identify scapular dyskinesis

SICK for overhead athletes S: scap malposition I: inferior medial border prominent C: coracoid pain K: dysKinesis

how does kibler classify scap diskinesis?

type 1 = inferior type 2 = medial type 3 = superior named after whats visually prominent

an inferior angle will become more prominent with which position cue?

hands on hips

which muscle are weak in type 1 scap dyskinesis

LT, lats, SA

which muscles are weak in type 2 scap dyskinesis?

rhomboids, all traps, and SA

describe kiblers scap assistance test

for PAINFUL type 1 scap dyskinesis, stabilizing the inferior angle of the scap during movement will decrease pain

describe kiblers scap retraction test

for PAINFUL type 2 scap dyskinesis, positive if stablizing the medial border during motion decreases pain

what is flip sign?

resisted ER protrustion of scap signalling weak infraspin and teres minor

what three things cause frozen shoulder?

1. stiffening capsule, lig, tendon 2. adhesions along RTC surface 3. adhesions in biceps tendon

what is the profile for frozen shoulder?

1. 40-65 years 2. female 3. minor injuries 4. non-shoulder surgeries 5. immobility 6. systemic diseases (esp diabetes)

how long does frozen shoulder last?

self-limiting 1-3 years but mob deficits up to 10 years

what is the recurrence for frozen shoulder? unilateral or bilateral?

recurrence and bilateral rare

what are the three stages of frozen shoulder?

1. painful freezing 2. frozen 3. thawing

decribe stage 1 frozen shoulder

3-9 months - severe pain esp lying on side - sleep problems - absence of PROM limitation - synovitis upon arthroscopy

describe stage 2 frozen shoulder

4-12 months - pain gradually diminishes - stiffness increases - PROM limited in all directions by 50% (ER most) - capsule hypertrophy/CHL contracture

describe stage 3 frozen shoulder

12-42 months - pain beginning to resolve - persistent but resolving stiffness

which three systemic diseases are majorly implicated in frozen shoulder

- diabeetus - thyroid disease - autoimmune diseases

what are the CPG criteria to rule in frozen shoulder?

- 45-60 years - gradual onset of pain and stiffness - PROM limited in multiple directions (esp ER) - ER/IR decreases at 90 GH abd

what are the CPG criteria to rule out frozen shoudler

- PROM normal - ER/IR increases at 90 abd - TTP - ULTT repro of sxs

how do you manage highly irritable frozen shoulder pts (4)

1. heat/stim for pain 2. positioning and act mods 3. easy mobs 4. pain free PROM to induce synovium mvmt

how do you manage moderately irritable frozen shoulder patients

same as for irritable but mobilize to R1

how do you manage nonirritable frozen shoulder pts

work em! 1. high amplitude and long duration mobs 2. stretching to pain tolerance

which three outcomes would you use for frozen shoulder

- DASH - SPADI (shoulder pain and disability) - ASES (american shoulder and elbow surgeons)

where can the suprascapular nerve impinge? profile?

supraspinous fossa/suprascap notch 45% volleyball players or RTC full thickness tears

how would you describe suprascapular nerve pain and what would be the major objective finding?

vague, dull, burning, diffuse ache posterolaterally; painless weakness to resisted abduction/ER

what causes a spinal accessory nerve injury and what muscles can it affect?

stretch/whiplash, compression from backpack, lymph node surgery SCM and UT

what causes Parsonage Turner Syndrome (LTN injury) and what muscle does it affect?

prolonged arm traction with head turned away; SA

quadrilateral space syndrome - low yield

humerus shaft, long head triceps, teres minor, teres major contents: axillary n and post humeral circumflex artery dead arm/vague pain and weakness overhead

Shoulder Pathos Flashcards

(69 cards)