Acute Shoulder

Question 1

Which structures could be damaged when you have an AC joint sprain (aside from clavicle)?

Answer 1

-coracoclavicular ligaments (conoid and trapezoid)
-AC ligament
-joint capsule
-origin of deltoid
-insertion of trapezius

Question 2

Which ROM tests are least likely to be painful for an AC joint sprain?

Answer 2

Lateral and medial rotation in an atomic neutral

Question 3

Which ROM tests are most likely to be painful for an AC joint sprain?

Answer 3

-active and passive flexion, abduction, cross-extension, cross-flexion

Question 4

Which structures could be damaged when you dislocate your GH joint anteriorly?

Answer 4

SGHL, MGHL, IGHL complex, GH joint capsule, glenoid labrum, any rotator cuff tendons especially subscapularis, humeral head

Question 5

Which ROM tests are most likely to be painful following an anterior GH dislocation?

Answer 5

-Active and passive abduction, lateral rotation, cross-extension.
-resisted abduction, cross-flexion and cross-extension

Question 6

Which clinical tests are used to diagnose subscapularis injury?

Answer 6

Lift off test, bear hug test, belly press test

Question 7

Explain the difference between sensitivity and specificity in clinical tests

Answer 7

Sensitivity: how easy it is for the test to correctly identify the presence of an injury

Specificity: how easy it is for the test to identify when a person doesn’t have an injury

Question 8

How long should an AC joint injury be supported by a sling?

Answer 8

Up to 10 days, or when comfortable without

Question 9

Rockwood classification of AC joint sprains

Answer 9

I: minor damage to AC joint ligament and capsules. Integrity of the joint remains.
II: AC joint ligament and capsule are completely torn. Some damage to CC ligaments. Step deformity present.
III: all structures fully torn, including CC ligaments. Step deformity is prominent.

Question 10

MOI for AC joint sprain

Answer 10

-fall onto outstretched hand
-landing on lateral aspect of shoulder

Question 11

What increases pain for AC joint sprains?

Answer 11

-raising the arm up overhead (flexion/abduction)
-elevation of SG and rotation of scapula
-pushing/pulling (protraction and retraction)
-weight bearing
-daily activities like getting dressed, showering, etc

Question 12

Clinical presentation for clavicle fracture

Answer 12

-hearing or feeling a crack/snap/pop
-tenderness at point of fracture
-aggregated by cross-flexion
-painful to hang at side, relieved by tensor support
-X-ray is gold standard for diagnosis

Question 13

Fracture healing process

Answer 13

Step 1: hematoma formation (first 72 hours). Blood forms around the bone and periosteum to fill in fracture site.
Step 2: soft callous formation (2 weeks). Fibrocartilagenous network forms. Angiogenesis forms new blood vessels.
Step 3: hard callous (6-12) weeks. Osteoblast activity builds up the bone.
Step 4: remodelling (several months). correct overgrowth from step 3.

Question 14

Levels of stability in GH injuries

Answer 14

Typical function = zero displacement
Sublaxation = partial displacement
Dislocation = full displacement

Question 15

When the GH joint is dislocated anteriorly, which ligament is most likely to be damaged?

Answer 15

IGHL

Question 16

Name the 4 rotator cuff muscles

Answer 16

Spraspinatus, infraspinatus, terres minor, subscapularis

Question 17

MOI for GH joint dislocation

Answer 17

-force at distal arm
-force at proximal humerus
-fall backward onto outstretch hand (less common)

Question 18

Clinical presentation for GH dislocation

Answer 18

-apprehensive about rotating, abduction and flexion
-typical signs of tissue damage like bruising and swelling
-deep shoulder pain, not point specific
-upper trapezius feels tight

Question 19

Recurrence rates of GH dislocation in the first year

Answer 19

About 39%, as high as 60%
Patients under the age of 40 have 13 times the chance of recurrent instability