7) Shoulder Flashcards
Fxn of superior GH & coracohumeral ligaments
Limits ER of the adducted shoulder
Fxn of middle glenohumeral ligament
Limits anterior translation of the abducted shoulder
Fxn of inferior glenohumeral complex
Gives multidirectional stability
Fxn of glenoid labrum
- Increases depth of the glenoid
* Attachment site for GH ligaments
Fxn of subacromial Burma
Water balloon for the shoulder
Things that are important when taking a hx for shoulder:
- Age
- MOI (Trauma, overuse, etc)
- Stage of healing
- OLDCARTS
- Night pain
- Meds
- Hx of spinal patho
- Pain vs weakness vs ROM
- Parasthesia
- Difficulty w/motor tasks
- Hand Dominance
- ADL limitations
- Catching
- Constitutional Sx’s
Things to consider when doing a shoulder exam
- Inspect skin for bruising
- Look for anatomical deformity
- Muscle atrophy
- Scapular Winging
- Contours & creases
- Asymmetry
- Palpation
- ROM
- MMT
- Sensation
- Ligament Laxity
Purpose of differential subAC injection
Helps to differentiate a tear from inhibition causing 2 weakness
What causes anterior traumatic GH instability & why?
Hyperabduction & ER–>Causes capsulolabral avulsion between 3-6 o’clock on the glenoid
True or False: Anterior traumatic instability often requires surgery.
True
Classic Bankart Lesion
Labrum & capsule get avulsed from the glenoid
Anterior Labroligamentous Periosteal Sleeve Avulsion (ALPSA)
Labrum is torn but periosteum remained intact
Does ALPSA have healing potential?
Yes
Bony Bankart Lesion
Associated w/dislocation
Hill-Sachs Lesion
Dent/chip in the humeral head
HAGL
Capsular avulsion on the inferior aspect of the glenoid
Multi-Directional Instability
Symptomatic subluxation/dislocation in 2 or more directions
Type 1 Multidirectional Instability
Multidirectional laxity & global instability
Type 2 Multidirectional Instability
Multidirectional laxity & anteroinferior instability
Type 3 Multidirectional Instability
Multidirectional laxity & posteroinferior instability
Type 4 Multidirectional Instability
Multidirectional laxity & anteroposterior instability
Typical profile of pt w/shoulder pathologies
Young adults who are often athletic & reporting generalized pain
Common shoulder pathologies:
- Loose/torn capsule
- Weak/overwhelmed dynamic stabilizers
- Generalized laxity
Non-operative management of shoulder pathologies is effective in up to what percent of cases?
90%
What things should non-operative management of shoulder pathologies focus on?
- Adductor ER, & IR strengthening
- Progressive ROM
- Periscapular Re-ed
When is surgical management of shoulder pathologies indicated?
When 6-12 months of rehab has failed
Contraindications to surgical management of shoulder pathologies
- Voluntary dislocators w/emotional problems
* Behaviorally immature teens
Post-op protocols
- Protect the subscap & labrum repair
- Limit passive ER & active IR
- Wait 6wks to progress ROM
- Wait 10-12wks to progress strengthening
- Ok to start periscapular program
ACLR
Tx of shoulder pain in throwing athletes focused on excessive anterior laxity
What is the benefit to an ACLR?
Don’t have to protect the subscap so you can start early strengthening & periscapular program
After an ACLR, when can you begin to progress ROM?
After 6wks
180 Rule in Throwers
IR loss < ER gain
What is the peel-back mechanism responsible for?
Causing type 2 SLAP tears in throwers
Grade 0 GH Instability
No translation
Grade 1 GH Instability
Humeral head moves slightly up the face of the glenoid (0-1cm translation)
Grade 2 GH Instability
Humeral head rides up the face to, but not over the rim of the glenoid (1-2cm translation)
Grade 3 GH Instability
Humeral head rides up & over the glenoid rim (>2cm translation)
*Usually reduces when stress is removed, but not always
Principles of tx for
- Avoid repetitive stress
- Restore strength & flexibility
- Activity modification
- General conditioning
Rehab implications for
- Must decr pain before attaining motion
- Need motion for strength
- Can take wks to months
Rehab implications for
- Must decr pain before attaining motion
- Need motion for strength
- Can take wks to months
Benefits of scope vs open repair
- Avoids deltoid morbidity
- Surgeon can better asses tear geometry
- More precise
- Faster rehab & earlier return to ADL’s
Principles of tx for impingement
- Avoid repetitive stress
- Restore strength & flexibility
- Activity modification
- General conditioning
Tx for adhesive capsulitis
- Tx should be conservative for 6 months
- NSAID’s & articular injections
- Aggressive ROM
- Strengthening when motion returns
Surgical tx for adhesive capsulitis
Surgical release w/manipulation
What condition is surgical release w/manipulation done for?
Adhesive capsulitis
Why are pain pumps not used anymore & what is used instead?
Pain pumps kill cartilage so scalene blocks are now used
Tx after surgical manipulation
- Aggressive ROM
- Nerve Block
- CPM
- Motion, motion, motion!
Tx after surgical manipulation
- Aggressive ROM
- Nerve Block
- CPM
- Motion, motion, motion!
What is a SLAP tear associated w/?
Biceps tendon rupture
Neer Test
Tests for subacromial impingement
Hawkins-Kennedy Impingement Test
Tests for subacromial impingement
O’Brien’s Compression Test
Tests for SLAP tear
What does the acronym TUBS stand for?
Traumatic
Unidirectional
Bankart
Surgery
What does the acronym AMBRII stand for?
Atraumatic Multidirectional Bilateral Rehabilitation Inferior capsular shift Interval
What pathologies are under the umbrella of RTC disease?
- RTC tendinitis/osis/opathy
- Calcific tendinitis
- RTC tear
- Subacromial bursitis
- Impingement Syndrome
What pathologies are under the umbrella of RTC disease?
- RTC tendinitis/osis/opathy
- Calcific tendinitis
- RTC tear
- Subacromial bursitis
- Impingement Syndrome
Grade 1 AC jt dislocation
Partial tear of AC ligament caused by a mild blow
Grade 2 AC jt dislocation
Subluxation bc of a full AC ligament tear
Grade 3 AC jt dislocation
AC ligament, coracoclavicular ligament, & capsule are torn
Grade 4 AC jt dislocation
Clavicle is posteriorly displaced & pushed through the fascia of the traps
Grade 5 AC jt dislocation
Severe displacement of the GH jt w/the clavicle 300% to the acromion
True or false: In a grade 2 AC jt separation, the coracoclavicular ligament is intact.
True
Grade 6 AC jt dislocation
Acromial end of the clavicle is locked inferior to the coracoid
