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Musculoskeletal System > 2 - Ortho: Shoulder > Flashcards

2 - Ortho: Shoulder Flashcards

1
Q

What is the criteria for evaluation of pain?

A 
PQRST:
Provocation/Palliation
Quality 
Region/Radiation
Severity Scale
Timing
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2
Q

What are the two ligaments of the coracoclavicular joint? Locations?

A

Conoid (medial)

Trapezoid (lateral)

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3
Q

What are the ligaments involved with sternoclavicular joint?

A

Sternoclavicular Ligaments
Interclavicular ligament
Costoclavicular ligament

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4
Q

What are the 4 joints of the shoulder girdle?

A

Glenohumeral
Acromioclavicular
Sternoclavicular
Scapulothoracic

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5
Q

What tests are you going to use for assessing G-H instability?

A

Apprehension Test
Relocation Test
X-rays (AP, Axillary, Scap-Y view)

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6
Q

What test should be ordered if a Hill-Sachs Lesion is suspected? KNOW THIS

A

A CT scan, helps understand the depth of lesion accurately

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7
Q

What test should be ordered if you are worried about GH capsular instability?

A

MRI arthrogram to get a good look at all the structures

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8
Q

What type of lesion occurs with an anterior dislocation of the shoulder? Known as a tear of necessity (allows shoulder out of Glenoid)

A

Bankart Lesion - antero-inferior tear of the glenoid labrum

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9
Q

What test should be ordered if nerve involvement (most likely axillary nerve) is suspected with GH instability?

A

Test for sensation over deltoid region
Order an EMG for definitive
(Typically these nerve dings resolve on their own)

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10
Q

Immediate treatment options for a dislocated shoulder?

A

Stimson Technique (weighted pendulum off table): relaxes spasm muscles to help prepare for reduction

Traction-counter traction: “water skiing”

FARES: oscillating abduction of the shoulder then external(supination) at (90

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11
Q

What are the most common injuries associated with a traumatic dislocation of the GH joint?

A 
Anteroinferior Labrum (bankart tear)
Anteroinferior GH Ligament
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12
Q

Describe the clinical pathway acronym of a traumatic instability of the GH

A 
"TUBS"
Traumatic 
Unidirectional
Bankart
Surgical intervention
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13
Q

Describe the clinical pathway acronym of atraumatic instability of GH

A 
"AMBRI"
Atraumatic
Multidirectional 
Bilateral instability
Rehabilitation
Imbrication (surgery to tighten stuff)
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14
Q

What is the likelihood of re-dislocation in an adolescent with open growth plates at time of initial injury?

A

100%!!!!!!!!!!!!!!

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15
Q

What is the re-dislocation rate in 18-30 year-olds?

Over 40?

A

55-95%

<10% (Rotator Cuff Tear more common)

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16
Q

What is the original cause of subacromial impingement, describe the progression.

A

Compression of the rotator cuff muscles in the subacromial space by the acromoin, followed by inflammation of the supraspinatus and its tendon most commonly

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17
Q

What are common CCs of a patient who has subacromial impingement?

A

Painful abduction and/or liftting + working overhead
Difficulty throwing
Crepitance or catching on ROM

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18
Q

What are the common tests to dx a subacromial impingement?

A

Neers sign: passive forward flexion over 90 deg. w/ pronation causes pain

Hawkins Test: Elbow @ 90, Internal Rot. and G-h flexion with passive internal provocation

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19
Q

What types of objective testing would you do on a patient with suspected impingement?

A

X-Ray: DJD of AC joint
Arthrogram: Not Necessary, shows capsular tissue well
MRI: for hypertrophy or congenital downsloping acromion

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20
Q

What X-Ray view is necessary for the assessment of Bigliani Classification?

A

AP
Axillary
Scap-Y - allows to look at supraspinous outlet

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21
Q

Describe the Bigliani Classifications

A

Type I: Flat Acromion - Least Likely
Type II: Curved Acromion - More likely
Type III: Hooked Acromion - More likely

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22
Q

What is the first line of treatment for subacromial impingement?

A

PHYSICAL THERAPY ALWAYS FIRST

NSAIDs, maybe steroid injections

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23
Q

What should you do if the steroids, PT, and NSAIDS don’t improve the symptoms of impingement?

A

Arthroscopic (Acromioplasty): shaving the end of the acromion to relieve the impingement problem.

Mumford Procedure: Arthroscopic distal clavicle resection

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24
Q

What is the OIFN of Supraspinatus?

A

Origin: Suprascapular fossa
Insertion: Greater Tubercle of Humerus
Function: Abduction
Innervation: suprascapular nerve

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25
Q

What is the OIFN of Infraspinatus?

A

Origin: Infraspinous Fossa
Insertion: Greater Tubercle
Function: Lateral/External Rotation
Innervation: Suprascapular Nerve

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26
Q

What is the OIFN of Teres Minor?

A

Origin: Lateral Border of the Scap
Insertion: Inferior Greater Tubercle
Function: External Rotation, Adduction
Innervation: Axillary

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27
Q

What is the OIFN of Subscapularis?

A

Origin: Subscapular Fossa
Insertion: Lesser Tubercle
Function: Adduction, Internal Rotation
Innervation: Sup+Inf Subscapular N.

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28
Q

What is the major CC of a Rotator Cuff Tear?

A

Weakness in active
Full ROM in passive
Pain @ night, cant throw, radiation to elbow, probs with overhead work

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29
Q

What are the two large etiologic theories of rotator cuff tears?

A
  1. Vascular insufficiency at the “critical zone” (supraspinatus insertion point, causing weakness and prone for tearing
  2. Neer’s theory: Micro-trauma due to chronic impingement in the subacromial space, causing eventual complications.
30
Q

What physical tests can you do if you suspect a rotator cuff tear?

A

Drop Arm Test - supraspinatus
Empty Can strength test - supraspinatus
Gerber’s Lift-Off test for subscap

31
Q

What types of objective tests can you order for a suspected RTC tear?

A

X-ray: subluxation of the humerus from the glenoid indicates RTC absence of support (RTC arthropathy. Look for DJD or Spurs or Narrowing

MRI: See tear on MRI TQ!!

Arthrogram: Follow contrast as it moves to spot points of void in cuff, see tear (unlikely)

Ultra sound: to see tear

32
Q

What is a contraindication of ultrasound?

A

Cardiac implants

33
Q

What is the first line of treatment for a RTC tear/

A

Abduction sling
Physical therapy
Meds and Modification of activity

34
Q

What type of CC would make you want to suspect calcific tendonitis? What is it?

A

Very painful, sudden onset shoulder pain,
It is inflammation associated with hydroxyappetitie crystal calcification deposits in the RTC muscle

So painful that people get worked up for an MI!!

35
Q

What objective tests can be done to help diagnose calcific tendinitis?

A

AP X-Ray will show a bone dense mass where muscle should be

MRI: Dark Mass looks like fluid but compare to bone cortex!! Same spot as supraspinatus tear (80%) except supraspinatis will show up white?

36
Q

What is the conventional workup for a patient with calcific tendinitis?

A

Conservative Modalities first!! (NSAIDs, PT, Iontophoresis, Needling (break it up), Cortisone)

Open or arthroscopic surgery if all else fails

37
Q

What is involved in the dx of a biceps tendon rupture?

A

Proximal - popeye deformity

Distal

38
Q

What is the OIFN of the biceps long head

A

Origin: supraglenoid tubercle
Insertion: radial tuberosity
Function: supination and flexion
Innervation: musculocutaneous n.

39
Q

What is the OIFN of the biceps short head?

A

Origin: coracoid
Insertion: radial tuberosity
Funciton: supination and flexion
Innervation: Musculocutaneous

40
Q

What types of objective testing would you do for a suspected BCT tear?

A

MRI

41
Q

What physical test will be done to test for biceps tendinitis

A

Yergason’s test: Arm at side, elbow @ 90, active supination against physician resistance, biceps tendon pain pinpointed

42
Q

Whats involved with a cc that has AC separation?

A

Pain with ROM
Crepitance
Visual elevation of the clavicle from the acromion
Palpable Deformity

Could follow trauma - fall on direct shoulder
Could happen spontaneously - suspect infection

43
Q

What is the grading scale for AC separation?

A

Rockwood Classification

  1. Sprain of the AC ligament
  2. AC Ligament but CC ligs are intact
  3. AC and CC ligs are torn
  4. All torn plus posterior displacement of clavicle into trap muscle
  5. Massive separation (>100%) with deltoid fascia involvement
  6. 5+ clavicle trapped under coracoid
44
Q

What grades of AC separation are operable/non?

A

123 - skillful neglect (perhaps slinging) and let it try to heal

456 - always operable

45
Q

What is involved with a cc of adhesive capsulitis, diff from RTC tear?

A

Can’t raise arm, different from RTC in that passive ROM is greatly decreased as well.

46
Q

What type of objective tests will be done with an adhesive capsulitis workup

A

MRI: show loss of axillary pouch or thickening of the anterior capsule

47
Q

What types of treatment will be done for adhesive capsulitis?

A

Physical Therapy and Medications
Last resort will be aggressive manipulation under anesthesia (careful could fracture humerus)
Possibly arthroscopic release if manipulation fails

48
Q

What are the stages of adhesive capsulitis?

A

Freezing
Frozen
Thawed

49
Q

What is involved with DJD of the shoulder?

A

Pain, Loss of Motion, Warmth, Crepitance, Loss of strength.

50
Q

What differentiates it from other pathologies?

A

XRay - loss of roundedness of humeral head, whitening of both surfaces in the bone, loss of joint space

You can feel the crepitance in the shoulder with ROM

51
Q

What are the possible treatments for DJD in the shoulder?

A

First line - meds, injections, PT

Surgery (Joint Replacement)

52
Q

What physical test will be done for thoracic outlet suspicion?

A

The Adson’s Test: Cervical Compression, Extend/Sidebend/Rotate head and feel for RadialPulse changes in ipsilateral arm, pain or paresthesias

53
Q

What objective testing can be done for workup of Thoracic Outlet symptoms?

A

EMG

Angiotests

54
Q

Common treatments for TOS?

A

PT, MEDS

Surgical removal of 1st rib

55
Q

What region of the clavicle is most likely to have a fracture?

A

Middle 1/3 (80%)

Lateral 1/3 (15%)

56
Q

What are some common complications of distal 1/3 clavical fractures?

A

Usually require orthopedic management
May require surgery
May result in post traumatic a/c arthritis

57
Q

When is surgery indicated for mid 1/3 clavicle fractures?

A

With significant displacement, comminution, or spiked fragments/kick-stand fragments with risk of lung injury

58
Q

What are some common complication in all clavicle fractures?

A

Fibrous Non-union - lays down a lot of bone, but doesnt fully fuse (movement is still seen)

Pneumothorax - fragment pierces the pleura

Subclavian artery injury

59
Q

What is the usual treatment for a proximal clavicle fracture?

A

Usually require ortho intervention

60
Q

What type of injury is usually seen along with a fractured scapula?

A

Pulmonary contusions

Possible Rib Fractures due to the force required to fracture the scapula

61
Q

Which types of scapular fractures generally require surgical innervention?

A

Glenoid involvement - displacement or intra-articular involvement

62
Q

What does the name Codman have to do with the shoulder/fractures?

A

Recognized that proximal humeral fractures in adults generally occur along the lines of old physeal scars

  1. greater tubercle
  2. lesser tubercle
  3. humeral head
  4. humeral diaphysis
63
Q

Who typically present with proximal humeral fractures?

A

Old ladies who fall on outstretched hand (osteopenia/porosis)

64
Q

What are the 4 types of proximal humeral fractures described by Neer’s?

A

1 Part - Impacted
2 Part - Greater tuberosity
3 Part - Head separates from shaft at surg. neck and greater tuberosity separates like a 2 part
4 Part - Head, greater, and lesser tuberosity all involved.

65
Q

What is a common complication of a 4 part proximal humerus fracture

A

AVN

66
Q

Describe treatment for a 1 part proximal humerus fracture?

A

Non-surgical
1-3 weeks immobile
Pendulum and ROM btw 3-8 weeks
Elbow ROM

67
Q

Describe treatment for a 2 part proximal humerus fracture. (surgical neck)

A

surgery

68
Q

Describe treatment for a 2 part proximal humerus fracture. (Greater tuberosity)
Lesser?

A

Surgical ORIF if displacement is greater than 5mm due to the impingement on the acromion

usually screw wire suture

Lesser - not as common, suture fixation or possibly remove a bone fragment and refix subscap to the fracture site

69
Q

Describe treatment for a 3 part proximal humerus fracture

A

Very unstable
ORIF with wires or suture
Use locked plates with osteoporotic bone to ensure fixation

70
Q

Describe treatmetn for a 4 part proximal humerus fracture

A

Poor results with ORIF, due to high incidence of AVN

Preferred treatment is prosthesis with secure fixation of tuberosities to allow early motion

71
Q

What is the main blood supply to the humeral head?

A

Anterior circumflex humeral artery off of the axillary artery

Musculoskeletal System (21 decks)

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