Shoulder ppt

Question 1

T/F the shoulder is the only joint in the body where tendons pass between bones.

Answer 1

True

rotator cuff tendons pass between acromion and humerus

Question 2

What is the most sensitive indicator of joint disease?

Answer 2

evaluation of ROM

Question 3

What are some traumatic extra-articular injuries of joints?

Answer 3

fracture, dislocation, soft tissue injury to ligaments, tendons, bursae, muscle, fascia, nerve

Question 4

What are some traumatic intra-articular injuries of joints?

Answer 4

fracture, dislocation, soft tissue injury to joint capsule, articular cartilage, synovium, synovial fluid, intra-articular ligaments

Question 5

What are some atraumatic extrinsic/referred causes of joint pain?

Answer 5

systemic disease, referred

Question 6

What are some atraumatic intrinsic extra-articular causes of joint pain?

Answer 6

bone, soft tissue - myofascial injury, overuse injuries, bursitis, joint instability

Question 7

What are some atraumatic intrinsic intra-articular causes of joint pain?

Answer 7

bone, soft tissue - arthritis, synovitis, capsulitis

Question 8

What are traumatic causes of shoulder pain related to the bone?

Answer 8

fractures: clavicle, proximal humerus
dislocations: glenohumeral

Question 9

What are traumatic causes of shoulder pain related to the soft tissue?

Answer 9

ligamentous injuries: acromial clavicular ligament
tendon injuries: rotator cuff
myofascial injuries
joint cartilage or capsule: labral tear

Question 10

What age ranges are clavicle fractures most common?

Answer 10

kids and young adults

Question 11

What age range is proximal humeral fracture most common?

Answer 11

elderly

Question 12

What is scapular fracture associated with?

Answer 12

blunt trauma

Question 13

What is the most common type of glenohumeral dislocation?

Answer 13

anterior

95-97 percent

Question 14

What are the three types of glenohumeral dislocations?

Answer 14

anterior
posterior
inferior

Question 15

What does acromioclavicular joint injury usually occur from?

Answer 15

direct trauma to the superior or lateral aspect of the acromion with the arm adducted
direct blow, falling onto shoudler

Question 16

What are the types of AC injuries?

Answer 16

AC sprain, AC ligament rupture, sprain and rupture of coracoclavicular ligaments

Question 17

What are PE findings for AC joint injuries?

Answer 17

tenderness directly over AC joint, possibly associated with deformity

Question 18

Diagnostic testing for AC joint

Answer 18

single AP radiograph including both AC joints or US

Question 19

What is AC joint dislocation called?

Answer 19

shoulder separation

Question 20

What are the types of AC ligament injuries?

Answer 20

I - stretched
II - partial ligament rupture AC
III - complete rupture AC and CC ligaments
IV - clavicle displaced posterior over acromion
V - clavicle displaced just under skin
VI - clavicle underneath coracoid (very rare)

Question 21

What are the rotator cuff muscles?

Answer 21

supraspinatus
infraspinatus
teres minor
subscapularis

Question 22

What rotator cuff muscle is most commonly injured?

Answer 22

supraspinatus

Question 23

What are risk factors for rotator cuff injury?

Answer 23

rotator cuff impingement, older age

repetitive overhead activity in sport or work

Question 24

What are the symptoms of rotator cuff injury?

Answer 24

shoulder pain, more prevelent with overhead activity

Question 25

What are PE findings of rotator cuff injuries?

Answer 25

tenderness over affected musculature or focal subacromial tenderness at the lateral or posterior lateral border of acromion

Question 26

What are specialty tests for rotator cuff?

Answer 26

``` painful arc neer impingement hawkins test yergason sign empty can test drop arm test ```

Question 27

Diagnostics for rotator cuff injury?

Answer 27

US or MRI

Question 28

treatment of rotator cuff injury?

Answer 28

rest, ice, NSAIDs, physical therapy | ortho referral if no improvement or suspect a tear

Question 29

impingement syndrome

Answer 29

symptoms resulting from compression of the rotator cuff tendons and the subacromial bursa between the greater tubercle of the humeral head and the lateral edge of the acromion process.

Question 30

tendon injury of the rotator cuff

Answer 30

sprain or partial/complete tear occur as the end result of chronic subacromial impingement, progressive tendon degeneration, traumatic injury, or combo of factors most occur in suprapinatus tendon

Question 31

tendinopathy of rotator cuff

Answer 31

chronic injury to the supraspinatus (abduction) and/or infraspinatus (external rotation) tendons develops with repetitive activity, generally at or above shoulder height which leads to tendon degeneration and microvascular insult

Question 32

extrinsic neurologic causes of shoulder pain

Answer 32

``` cervical radiculopathy (C5-C6) brachial plexus lesions herpes zoster spinal cord lesion cervical spine DJD thoracic outlet syndrome ```

Question 33

extrinsic abdominal causes of shoulder pain

Answer 33

hepatobiliary disease | diaphragmatic irritation

Question 34

extrinsic cardiovascular causes of shoulder pain

Answer 34

acute MI | axillary vein thrombosis

Question 35

extrinsic pulmonary causes of shoulder pain

Answer 35

upper lobe pneumonia apical lung tumor pulmonary embolism

Question 36

intrinsic causes of shoulder pain

Answer 36

``` overuse injury shoulder instability rotator cuff tendinopathy or impingement syndrome subacromial bursitis synovitis adhesive capsulitis bicepital tendinitis osteoarthritis myofascial pain septic arthritis gout ```

Question 37

What are the top causes of acute shoulder pain?

Answer 37

``` rotator cuff injury fracture - clavicle and proximal humerus dislocation GH joint acromioclavicular sprain, tear myofascial injury ```

Question 38

What are the top causes of chronic shoulder pain?

Answer 38

rotator cuff disorders adhesive capsulitis shoulder instability shoulder arthritis

Question 39

What are the top causes of life threatening shoulder pain?

Answer 39

septic arthritis | referred pain - acute MI, intraperiotoneal hemorrhage, lung pathology

Question 40

What are the risk factors for septic arthritis?

Answer 40

``` age > 80 yo diabetes mellitus rheumatoid arthritis prosthetic joint recent joint surgery skin infection IV drug abuse alcoholism prior intraarticular costicosteroid injection ```

Question 41

What are PE findings of septic arthritis?

Answer 41

erythema, swelling, warmth, pain | active and passive ROM limited

Question 42

What are signs of systemic disease in septic arthritis?

Answer 42

fever, tachycardia, hypotension

Question 43

Diagnosing septic arthritis

Answer 43

plain film XR - normal with effusion Lab: elevated CBC, ESR, and CRP Aspiration: synovial fluid with WBCs and bacteria

Question 44

Treatment of septic arthritis

Answer 44

Antibiotics: broad spectrum after aspiration and blood cultures surgical washout of joint