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MSS Conditions > Acute & Chronic Shoulder Pain > Flashcards

Acute & Chronic Shoulder Pain Flashcards

1
Q

What attaches to the deltoid tubercle of the humerus?

A

Deltoid

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2
Q

What attaches to the Intertubercle groove of the humerus?

A

Pectoralis major, Teres major & latissiumus dorsi

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3
Q

What attaches to the Greater tubercle of the humerus?

A

Infraspinatus & Teres minor

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4
Q

What attaches to the lesser tubercle of the humerus?

A

Subscapularis

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5
Q

What are the Rotator Cuff mucles & their innervations?

A
  • Supraspinatus (suprascapular n)
  • Infraspinatus (suprascapular n)
  • Teres minor (axillary n)
  • Subscapularis (subscapular n)
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6
Q

What attaches to the Coracoid process?

A
  • Pectoralis minor
  • Biceps bracii
  • Coracobrachialis
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7
Q

What are the 2 clavicular joints?

A

Sternoclavicular & Acromioclavicular

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8
Q

What is the glenoid labrum?

A

Fibrocartilaginous rim attached around the margin of the glenoid cavity in the shoulder blade

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9
Q

Hx of Glenohumeral Joint Dislocation

A
  • Severe pain
  • Does not want to move shoulder
  • Felt like it popped out of place
  • Flaccid UE too painful to move
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10
Q

What causes an Anterior shoulder dislocation?

A

ER or ABDuction force to humerus

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11
Q

How does a pt hold their arm w/ an Anterior shoulder dislocation?

A

Externally rotated & slightly abducted

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12
Q

What causes a Posterior shoulder dislocation?

A

Fall, seizure, electrocution

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13
Q

How does a pt hold their arm w/ a Posterior shoulder dislocation?

A

IR & ADDucted

Exhibiting flattening of the anterior shoulder & a prominent coracoid process.

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14
Q

What 3 X-ray views are needed for a GH dislocation?

A

AP, axillary & scapular-Y

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15
Q

What are CT scans good for?

A

Boney fractures

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16
Q

When should you get an MRI in a GH dislocation?

A

After reduction to check for labral tears

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17
Q

What is a Bankart lesion?

A

Anterior capsule & labrum tear d/t repeated shoulder dislocations

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18
Q

What is a Hill Sachs lesion?

A

Compression fracture of posterolateral humeral head

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19
Q

What causes a Hill Sachs lesion?

A

Forceful impaction of the humeral head against the anteroinferior glenoid rim when the shoulder is dislocated anteriorly

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20
Q

What are the assoc injuries w/ GH dislocation?

A
  • Greater tuberosity fractures
  • Rotator cuff tears (especially over 40 yo)
  • Axillary nerve injury
  • Recurrent dislocations in younger patients
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21
Q

How does an Axillary n injury present?

A

Paralysis of Deltoid→ loss of ABDuction from 18-90°

(0-18° abduction by supraspinatus)

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22
Q

What is the management of a GH dislocation?

A
  • Sling
  • ROM
  • PT
  • Hold out of sports until stabilize & full ROM/ strength
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23
Q

Who should have surgery for GH dislocation?

A
  • <25 yo 1st time dislocation is relative indication
  • Younger the patient the higher risk of recurrence
  • Recurrent dislocation despite nonop tx
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24
Q

Hx of AC Joint Separation

A
  • Fall directly onto POINT of shoulder**
  • Complain of lateral shoulder pain at “TIP” of shoulder**
  • Athlete will hold the arm at side
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25
Q

PE of AC joint separation

A
  • Pain over AC joint & w/ cross arm test
  • Prominent AC joint or distal clavicle elevation
  • Possible increased motion of AC joint
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26
Q

Imaging for AC joint separation?

A

3 X-ray views: AP, axillary & scapular-Y

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27
Q

What is the Classification of AC separations?

A
  • I: sprain AC ligaments
  • II: tear AC & sprain CC ligaments
  • III: tear both AC & CC ligaments
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28
Q

What is the tx of a AC joint separation?

A
  • I, II, III nonop w/ sling & ROM**
  • IV, V, VI surgery
  • Return to sport when nonpainful (management)
  • Reconstruct when greater than 100% displaced or chronic pain**
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29
Q

Proximal Humerus facture hx

A
  • Fall onto shoulder or on outstretched hand
  • Shoulder pain, swelling, bruising, and inability to use shoulder
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30
Q

PE of Humerus fracture

A
  • Swelling
  • Pain to palpation
  • Crepitus with ROM
  • Bruising
  • Loss of normal contour of shoulder
  • Possible loss of sensation to lateral side of shoulder (axillary nerve)**
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31
Q

What imaging is used to dx a Proximal Humerus fracture?

A
  • X-ray: 3 views: AP, axillary & scapular-Y
  • CT scan: preop planning & classification of fracture
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32
Q

How are Proximal Humerus fractures tx?

A
  • Nonop if minimal displacement of parts
  • Sling and early passive ROM
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33
Q

What are the indications for surgery in a Proximal Humerus fracture?

A

Displacement, bone quality, age, activity level, and associated injuries to decide

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34
Q

What % of pts w/ Proximal Humerus fracture need surgery?

A

20%

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35
Q

What is the hx of a Clavicle fracture?

A
  • Fall onto area of shoulder or fall directly onto clavicle
  • Pain over area of fracture
  • May complain of deformity or bump
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36
Q

What will be found on PE of a Clavicle fracture?

A
  • Bump over fracture site from elevation of clavicle
  • Swelling
  • Bruising
  • Motion at fracture site/crepitus
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37
Q

What imaging is dx of a Clavicle fracture?

A

X ray: 3 shoulder views & AP 30° cephalad

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38
Q

What is the tx of a Clavicle fracture?

A
  • Most are nonop
  • Sling
  • Immobilize 3-4 weeks
  • No return to sports until healed and full ROM and strength (management)
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39
Q

What are indications for surgery in a clavicle fracture?

A
  • Large displacement or large bump
  • Open fracture (bone went through skin)
  • Tenting of skin—bone is about to protrude through skin
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40
Q

What is the hx of a Burner/stinger?

A
  • Short duration
  • UE only!
  • Unilateral!
  • Pain free c-spine motion
  • Numbness and shoulder weakness
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41
Q

What will be found on PE of a Burner/stinger?

A
  • Weakness w/ shoulder motion
  • Numbness/paresthesias in arm
  • NO pain to range of motion of c-spine
  • Unilateral UE symptoms
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42
Q

What imaging is needed w/ a burner/stinger?

A

Normally not needed

CT scan of C-spine w/ shoulder pads & helmet if suspect C-spine injury

43
Q

What is the tx of a burner/stinger?

A

Rest & hold out of game

Must be seen by a spine specialist if sx bilateral or in LE!

44
Q

When can a athlete return to play?

A

When pain free full ROM of shoulder, no paresthesias, and normal strength

45
Q

What is the hx of a Proxmial Biceps tendon rupture?

A
  • Patient may feel a pop in the proximal arm or shoulder region usually lifting something
  • Bruising in upper arm
  • “Popeye arm”: bulge in their arm
46
Q

What will be found on PE of Proximal Biceps Tendon rupture?

A
  • Classic bulge of “Popeye” arm
  • Some weakness of elbow flexion or arm supination (us. d/t pain)
47
Q

What imaging is used to dx a Proximal Biceps tendon rupture?

A

MRI: absent intra-articular biceps tendon

48
Q

What is the tx of a Proximal Bicep Tendon rupture?

A

PT, ICE, Anti-inflammatories, rare surgery

49
Q

What is the ddx based on age for chronic shoulder pain?

A

Young (<30-40 years of age): Instability

Older (>40 years of age)

  • Impingement
  • Biceps tendonitis
  • Rotator Cuff Tear
  • Frozen Shoulder (Adhesive Capsulitis)
  • Arthritis
  • Glenohumeral Joint
  • AC Joint
50
Q

What is the MC dislocated joint?

A

Shoulder Joint

51
Q

What is shoulder instability?

A

Pathological cond manifesting as pain or feeling of slipping due to excessive translation of humeral head on glenoid during active motion

52
Q

What is the hx of Shoulder instability?

A
  • Assoc w/ gen laxity of ligamentous structures
  • Often following shoulder dislocation(s)
  • Could be just from repeated subluxations
  • Often feel shoulder slipping
  • Often will have pain or weakness
53
Q

Who gets Shoulder instability?

A

Swimmers, gymnasts
Female more commonly

54
Q

What are the special tests for Shoulder instability?

A 
Apprehension sign (anterior and posterior)
 Relocation test
55
Q

Imaging for Shoulder Instability

A
  • X-ray: 3 views
  • MRI: labral tears
56
Q

What does TUBS stand for?

A
  • Traumatic
  • Unilateral
  • Bankart fracture
  • Surgery
57
Q

What does AMBRI stand for?

A
  • Atraumatic
  • Multidirectional instability
  • Bilateral
  • Rehab
  • Inferior capsular shift if surgery necessary
58
Q

Tx for Shoulder instability?

A

Rehab–Especially AMBRI

Surgery

  • Failed rehab
  • Contact sports
  • Large Bankart
  • Open or arthroscopic
59
Q

What should surgery for shoulder instability focus on?

A

Labral tear—reattach
Capsule laxity—tightening the capsule

60
Q

Impingement hx

A
  • Dull ache worse in evenings
  • Pain location generalized or lateral upper arm/shoulder or at deltoid insertion
  • Worst with overhead activity
  • Hurts to sleep on
  • Hurts to get things out of cabinet—reach above head or behind back
61
Q

What are the special tests for Shoulder Impingement?

A
  • Hawkings
  • Neer sign
  • Neer test
  • Empty can test
62
Q

What is shoulder impingement?

A

Anterior 1/3 of acromion undersurface causes irritation to the underlying cuff tendons causing sx

63
Q

What acromion shape inc risk of impingement?

A

Curved or hooked

64
Q

Tx of Shoulder Impingement

A
  • Rest
  • Analgesics
  • Exercises
  • Stretching
  • Strengthen
  • Injection (cortisone may weaken tendon and lead to rupture so counsel patient and slow rehab)**
  • Surgery: Persistent, Excise and/or smooth acromion
65
Q

Hx of Biceps tendonitis?

A
  • Proximal pain along anterior humerus
  • Hurts with overhead activity and with throwing or pushing
66
Q

Where will the pain be on PE of Biceps Tendonits?

A

Along the proximal biceps in the intertubercular groove

67
Q

What special tests are used for Bicep tendonits?

A
  • Yergason test–resist supination of forearm
  • Speed test–resisted forward F of arm
68
Q

Imaging for Biceps Tendonits

A

X-ray: normal

MRI: shows inflam

69
Q

Tx of Biceps tendonits?

A

NSAIDs, PT, Rest
Must be careful with injections because intra-tendon injection can cause rupture

Surgery with tenotomy (cutting the tendon) or tenodesis (bury the tendon in the bone) when nonop fails

70
Q

Hx of Rotator Cuff Tear

A
  • Pain in area under acromion
  • Inability to raise arm above head
  • Weakness of motion
71
Q

Which Rotator Cuff muscle is affected if weak forward elevation/Empty can sign?

A

Supraspinatus

72
Q

Which rotator cuff muscle is affected w/ weak ER?

A

Infraspinatus

73
Q

What muscles is tested w/ Lift off sign or Belly press?

A

Subscapularis

74
Q

Imaging for Rotator Cuff

A

X-ray: normal

MRI: confirmatory

75
Q

What is the Nonop tx for Rotator cuff tear?

A
  • Chronic tears
  • Older patients
  • PT: ROM/pendulum
  • Strengthening muscles around shoulder
  • NSAIDS
  • Steroid shots
76
Q

What are the indications for sugery in a Rotator cuff tear?

A
  • Younger patients
  • Full thickness tears
  • Acutely retracted tears
  • Good tendons & muscles
77
Q

Hx of Adhesive Capulitis (Frozen shoulder)

A

Pain & restricted GH joint motion

Pt in tears on exam

78
Q

What can Frozen shoulder be assoc w/?

A
  • Trauma to chest
  • Breast surgery
  • DM
  • Thyroid dz
79
Q

Imaging for Frozen shoulder

A

X-ray: normal (diff from OA)

MRI arthrogram: dec joint filling & thickening of inferior capsule

80
Q

Tx of Frozen Shoulder

A
  • NSAIDs
  • Pain meds to sleep
  • PO or Injection Cortisone
  • PT
  • Usually burns out on own
81
Q

What is done during surgery of Frozen shoulder?

A

Lysis of adhesions with arthroscope if fail nonop for several months

82
Q

Who does the worst w/ all tx for Frozen shoulder?

A

Diabetics

83
Q

Hx of DJD of Shoulder

A
  • Progressive pain
  • Progressive dec active & passive ROM
  • Night pain
  • Motion makes pain worse
  • Crepitus*
84
Q

What will be found on the 3 X-ray views of DJD?

A
  • Loss of joint space
  • Osteophytes/spurs
  • Subchondral sclerosis and cysts
85
Q

What is the tx of DJD?

A
  • NSAIDs
  • Avoid activities that hurt shoulder
  • Steroid shots
86
Q

When should a pt w/ DJD get a joint replacement?

A
  • Failed nonop
  • Severe pain affecting ADL
  • Quite limited activities after—good pain relief for ADLs but limited ROM often
87
Q

What is the hx of AC joint DJD?

A
  • Pain on top of shoulder or reaching across body
  • Complain of bump on top of shoulder
88
Q

What will be found on PE in AC joint DJD?

A
  • Pain to palpation over AC joint
  • Bump over AC joint from hypertrophy
  • Positive cross arm compression test
89
Q

What % of pt have recurring GH dislocations in <20yo?

A

90%

50% have major problems & do surgery

90
Q

What % of pts 20-40yo have recurring GH dislocations?

A

60%

91
Q

What % of pts >40yo have recurring GH dislocations?

A

<10%

92
Q

In pts >40yo what other assoc injury should one worry about after a shoulder dislocation?

A

Rotator Cuff tear

93
Q

What will be shown on X-ray in a posterior dislocation?

A

Light bulb sign!!

94
Q

What will a normal lateral X-ray of the GH joint show?

A

Golf ball on tee!!

95
Q

What are the risks of surgery w/ a clavicle fx?

A

Large incision & risk of artery injury

96
Q

Were is the Conoid lig located?

A

Medial

97
Q

Where is the Trapezoid lig located?

A

Lateral

98
Q

Where does the Long head of the biceps attach?

A

Supraglenoid tubercle

99
Q

Where does the short head of the biceps attach?

A

Coracoid process

100
Q

What is commonly assoc w/ proximal biceps tendon ruptures?

A

Subscapularis (MC) or supraspinatus tears

101
Q

Besides impingement, what else can cause biceps tendonitis?

A

Subluxation of tendon when transverse humeral ligament or subscap tendon is torn

102
Q

What can intra-tendon injections cause?

A

Rupture

103
Q

What is the tx for AC joint DJD?

A
  • Rest
  • NSAIDs
  • Cortisone shot in AC joint
104
Q

When is surgery indicated in AC joint DJD?

A
  • Failure of nonop treatment
  • Distal clavicle excision
  • Arthroscopic or open

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