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Extremities 2 > 2 - Shoulder > Flashcards

2 - Shoulder Flashcards

1
Q

Give at least (3) indications of an inferior humerus?

A

(1.) Shoulder visualizes as being low with soft tissue dimpling/ sulcus sign.

(2.) Point tenderness at the anterior aspect of the G-H joint.

(3.) Loss of fluid motion.

(4.) Loss of Appley’s external rotation.

(5.) Anterior deltoid weakness.

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2
Q

Indications of a posterior humerus?

A
  • visualizes normally, no apparent visual change.
  • lost fluid motion
  • point tenderness at posterior aspect of G-H joint
  • Loss of internal rotation
  • Teres major muscle weakness
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3
Q

With any shoulder complaint the Dr. should routinely examine? `

A
  • St-Cl,
  • A-C,
  • G-H,
  • Sc-Th,
  • St-Co,
  • & definitely the spine for subluxation.
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4
Q

On Scapulo-Thoracic Lateral (S-T L) what position do we place the patient’s arm?

A

-Behind the pts. back (side lying) with doctor reaching through the pts. axillary/ arm opening.

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5
Q

Where is #11 of the stabilization hand? S-T L

A

-Over the A-C joint

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6
Q

Where are the fingers?
S-T L

A

-Over the G-H joint

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7
Q

In what direction does the stabilization hand push to bring the joint to tension?

S-T L

A

-S to I

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8
Q

What’s the pain point for S-T L?

A

-Deep to or under the scapula, in the subscapularis muscle.

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9
Q

How to differentiate S-T L (lateral) from S-T M (scapulo-thoracic medial)?

A

1.) Fluid motion,

2.) -visualization of distance from spine

3.) S-T L = (lateral) Appley’s scratch in internal rotation is diminished

4.) S-T M = (medial) Appley’s scratch in external rotation is diminished.

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10
Q

What part of the scapulo-humeral ratio would be decreased with a G-H P?

A

-The Glenohumeral portion.

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11
Q

Scapulothoracic medial, prone: Three most common mistakes for this:

A

1.)-Should have patient’s shoulder off the table

2.)-Should have Dr. stand on opposite side of contact

3.)-Should use inferior hand contact

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12
Q

G-H posterior, prone-LOC?

A

-P-A, be careful to not get any S-I

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13
Q

Where is the patient’s shoulder?

A

-Supported on the table

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14
Q

Why is the shoulder on the table?

A

-For stabilization; we don’t want to dislocate it

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15
Q

Indication of Yergason’s positive?

A
  • Bicepetal tendon instability, usually caused by a shallow groove
  • or a tear or sprain of transverse humeral ligament
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16
Q

Drop Arm test: describe 3 parts least-to-most invasive and diagnosis for each

A

1.) Pt. lowers arm to side against gravity; if it drops fast, it’s often a severe tear of rotator cuff,

grade 3. Supraspinatus muscle.

2) Apply a little pressure while they lower it; some resistance, moderate tear of rotator cuff, grade 2

3) Put an impulse in the abducted arm; fair resistance, mild tear or strain of rotator cuff, grade 1

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17
Q

G-H P, seated: What is most important about LOC?

A

-Straight P-A, drop elbow so it’s level or below the wrist

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18
Q

What ROM’ s do you use to bring it to tension?
G-H P

A

-Abduction & extension

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19
Q

Where is the pain point?

G-H P

A

-Over the posterior glenohumeral joint

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20
Q

How to differentially diagnose a G-HP, from a G-H Inf.?

A
  • Pain point is posterior; visualizes as normal, not inferior.
  • G-HP is decreased ROM on internal rotation, not external rotation

(Appley’s Scratch ROM loss on internal rotation, not external).

  • X-ray shows humeral head is posterior and superior, not inferior
  • Teres major muscle test is weak on G-H P, not the anterior deltoid as G-H I.
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21
Q

Is this the move of choice?
G-H I

A

No

Supine traction. Because you can feel the joint.

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22
Q

What are at least three other alternatives to differentiate this diagnosis from?
G-H I

A
  • G-H posterior, Subacromial bursitis, bicipetal tendonitis,
  • bicipetal instability, sprain or tear of rotator cuff,
  • dislocation, heart attack, gall bladder, spleen
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23
Q

Describe the 3 parts as you’re doing them
Frozen Shoulder

A

1) traction, release; if ROM is gained, go on to part 2

2) traction through ROM gained, back to neutral, release

3) after a few visits if no part 2 progress, traction and take it through the ROM gained, at end-ROM put an impulse down the shaft of the humerus, bring it back to neutral, return to part 2 until no more progress. Post check with ROM and comparing L side to R side.

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24
Q

G-H traction, seated: Dr’s arm in Pt’s. armpit with thumb up.

What are your limiting factors?

A
  • Patient tolerance & visualizing the joint space to open up.
  • (Note: it is important to be visualizing this during the practical)
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25
Q

-Is this the move of choice for a G-H fixation?

G-H Traction supine

A

-Yes, because you can palpate the joint space rather than just visualize it.

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26
Q

Give at least “3” diagnoses that G-H traction, supine would work for?

A
  • Frozen shoulder,
  • inferior humerus,
  • posterior humerus,
  • osteoarthritis with fixation,
  • G-H dislocation.
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27
Q

How do you bring this joint to tension before the thrust? + Describe the thrust

St-Cl Superior

A
  • Bring the arm into abduction & extension.
  • Straight S-I, maybe a little torque, fingers point toward the axilla
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28
Q

What are we doing with our opposite arm?

St-Cl traction seated

A

-Holding the opposite shoulder back

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29
Q

Why do we hold the shoulder back?

St-Cl traction seated

A

-Isolating the st-cl joint, not rotating the thoracics

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30
Q

What direction does the clavicle most commonly subluxate

St-Cl traction supine

A

Superipr

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31
Q

Is this traction move a post-check for St-cl Superior?

St-Cl Traction supine

A

-NO, this is actually a procedure & should be done before St-Cl S

32
Q

Which part of this takes care of superiority?

A-C PS

A

-Pushing down on the distal end of the clavicle

33
Q

Which part takes care of the posteriority?

A-C PS

A

-Pushing slightly forward and externally rotating the arm.

34
Q

Most common muscle involved with Hyperabduction Syndrome or a positive Wright’s?

A

-Pectoralis minor

35
Q

What causes the pectoralis minor to be shortened or go into contracture?

A

(1.) Cervical subluxation,

(2.) subacromial bursitis,

(3.) rolled shoulder posture

(4.) other types of TOS

36
Q

Scalenus anticus syndrome is caused by what?

A

-subluxation usually

37
Q

What to do for scalenus anticus syndrome?

A

-Adjust subluxation,…. then use moist heat to relax the muscles,….finally stretch

38
Q

Positive Eden’s indicates?

A
  • Decreased pulse volume or amplitude (not rate),
  • TOS,….Costoclavicular syndrome
39
Q

How to treat for positive Eden’s?

A
  • Find out if it’s muscle guarding often indicating a hypertonic pectoralis major involvement, which needs to be stretched out.
  • It may also be a cervical, thoracic or rib subluxation, often helped by adjusting.
40
Q

What questions might you ask if a patient has a positive Eden’s?

A

-Do they carry a backpack?….Do they carry heavy objects in front of them at work?

-Ever had accident with the seatbelt on?…Ever had a fractured or dislocated clavicle,…or shoulder problem?

-Have they ever _f_allen _o_n their shoulder or with an _o_ut stretched arm/hand (FOOSH) ?

41
Q

How far up and back do we go with the patient’s shoulder?

St-Co traction seated

A

-To patient tolerance or until you feel the joint open up

42
Q

How far up and back would you go for rib 2 compared to rib 5?

St-Co traction seated

A

-Not as far, it won’t take as much rotation/extension for rib 2

43
Q

Where is the pain point for this?

St-Co traction seated

A

? -Pain right over the joint space.

-(Superior rib) located over the top of rib head. –(Inferior rib) located over bottom of rib head

44
Q

What is the best way to post check?

St-Co traction seated

A

-Have the patient take a very deep breath in while bringing shoulders up, then blow it all the way out while feeling the excursion of the ribs involved.

45
Q

St-Co S*** or ***St-Co I

Which rib levels may commonly need St-Co thrusting type adjusting procedures?

A

-Ribs 2 – 5.

46
Q

What’s patient placement?

St-Co S*** or ***St-Co I

A

-Supine, on the center of the table

47
Q

Doctor’s stance?

St-Co S*** or ***St-Co I

A

-Straightaway so that you don’t have body drop

48
Q

What type of breathing would show aberrant motion with a St-Co S?

A

-On expiration, the rib doesn’t come down

49
Q

Where is the pain point?

St-Co S

A

-Right over the sternocostal joint of the involved rib

50
Q

What if the pain is running along the rib all the way around?

A

(1.) Probably subluxation of the thoracic spine;

(2.) shingles,

(3.) intercostal neuralgia,

(4.) fracture,

(5.) Tumor,

(6.) Heart Attack if on the left

51
Q

What do you do for patient safety on St-Co S?

A

-Turn their face away so you don’t put your elbow in it,

52
Q

What do you do to get an S-I, LOC?

A

-Drop your elbow down close to the chest wall

53
Q

What breathing instructions do you give the patient on a St-Co S

A

-Blow air all the way out and hold

54
Q

Why do you give the breathing instructions?

St-Co S

A
  • “blow out” air so that musculature is pulling down on rib & opens up the joint space underneath the rib
  • “hold” to keep from forcing out residual air
55
Q

Breathing instructions?

St-Co I

A

-Take a deep breath in and hold

56
Q

What’s the best post-check?

St-Co I

A

-Fluid motion

57
Q

How would you do fluid motion on St – Co I .

A

-Put fingers above and below rib you’re testing, breath in and out

58
Q

Which should you see improvement on, inspiration or expiration?

St-Co I

A

-Inspiration

59
Q

When not to use mentholated rubs?

A
  • Allergies,
  • Pneumonia,
  • they are oil-based & will leave residue in lungs.
60
Q

Patient placement

St-Co Traction supine

A

-Supine, shoulder way off the table, especially for lower ribs

61
Q

Which way should Dr.’s fingers point?

St-Co traction supine

A

-M-L, some (S-I) or ribs 2-3rd or (I-S) 4-5th to follow the involved rib attitude depending on how low in the rib cage you are.

62
Q

What is the limiting factor for bringing arm up and back?

St-Co traction supine

A

-Patient tolerance or until you feel the joint open

63
Q

Visualization Steroclavicular joint

A

-superior clavicle: compare proximal ends of the clavicles to see if one sits higher than the other

64
Q

Visualization AC

A
  • posterior superior clavicle: one distal end of clavicle sits higher than the other.
  • Compare trapezius muscles on each side to see if there is a smooth transition over the distal clavicle. (Step sign.)
65
Q

Visualization GH

A

-inferior humerus: roundness of one shoulder is sitting lower in relation to the acromion process (dimpling) (Sulcus sign).

66
Q

Visualization: Scapulothoracic

A

-lateral/medial scapula: vertebral border of scapula has flared laterally/medially w/ respect to midline (spine)

67
Q

Most common shoulder misalignment?

A

-G-H I (Inferior, due to gravity)

68
Q

Most common shoulder dislocation? Why?

A
  • Anterior-inferior;
  • gravity pulls it down & forward,
  • carrying things pulls it down & forward
  • the anterior glenoid labrum is shallow
69
Q

What tests will help differentially diagnosis (ddx) an inferior & posterior humerus?

A
  • Yergason’s,
  • Dawburn’s,
  • Supraspinatus

Extra information use: (Appley’s Scratch & Teres Major for internal / external ROM )

70
Q

Kocher’s Maneuver:

A

-Traction,.…external rotation,…adduction,…internal rotation,.…finalize support as in Dugas

71
Q

What three systems do you want to check on your post check?

Kocher’s Maneuver

A

Neuro

Vascular

Musculoskeletal

72
Q

Why do a 3-part procedure vs. surgery for frozen shoulder (Adhesive Capsulitis)

A

-Less risk of fractured humerus, dislocated glenohumeral joint

73
Q

Most important component of frozen shoulder treatment?

A

-Find out what caused them to stop using their shoulder allowing it to “freeze”, then address the problem. Could be due to scar tissue buildup, or DJD / Arthritis.

74
Q

Most common _AC misalignmen_t

A

-posterior superior.

75
Q

What is “shoulder separation”?

A

-dislocation (vs. subluxation) of AC joint

76
Q

ROM vs. immobilization for AC joint?

A
  • Subluxation w/fixation……-do ROM, not immobilize
  • Dislocation ……-immobilize with brace or “reminder” tether
77
Q

*“Move of choice” for G-H joint?

A

-traction with patient supine because you can palpate the joint during this procedure.

Extremities 2 (7 decks)

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