Approach to Shoulder Final Exam Flashcards
PMH must asks for shoulder complaint?
Htn, DM, CAD complaint specific: prior injury, systemic illness that causes joint pain
PSH for shoulder complaint.
General surgeries such as appendix gallbladder Complaint specific such as prior ortho surgery or procedure
Medication asks for shoulder complaint
General: blood thinner, Diabetic meds, Cardiac meds, Htn meds Complaint: NBarcotics, NSAIDS, Tylenol, Steroids
Social history needed with shoulder complaint?
General: smoking etoh, drugs Complaint: what how how often how recent
Joint objective exam necessities?
Inspection, Palpation, ROM, Specialty tests, Neurovascular exam
What is the painful arc test?
Tests for subacromial impingement and rotator cuff tendon injury **test has the highest + LR and -LR of all rotator cuff maneuvers Patient will abduct their arm and a positive test will show shoulder pain from 60 to 120
What roots are tested with tricep reflex?
C6-7
What roots are tested with Biceps and rachioradialis reflexes?
C5-6
What dermatome is thumb, pinky, nipples and umbalicas?
C6 thumb C8 Pinky T4 Nipples T10 belly button
Clavicle fractures?
Most common in kids and young adults
Proximal humerus fractures?
Most common in elderly
Scapular fracture?
Associated with blunt trauma
Glenohumeral anterior dislocation
Most common type of shoulder dislocation. 95-97% of cases
Acromioclavicular Joint Injury
- Usually from direct trauma or lateral aspect of acromion with arm adducted
- Can be AC sprain or rupture
Rotator Cuff Components?
- Subscapularis
- Supraspinatus
- Infraspinatus
- Teres Minor
Rotator cuff risk factors and symmptoms.
- Rotator cuff impingement or older age
- Symptoms are pain over lateral deltoid and more prominent with overhead activity and at night, also weakness
What speciality test do you perform for a suspected Rotator Cuff injury?
- Painful Arc*** best one
- Neer impingement
- Hawkins impingement
- empty can
- Drop arm
Diagnostics:
- X ray is NOT helpful
- Ultrasound and MRI are standard
Treatment:
- Rest, Ice, NSAIDS, PT
Atraumatic cases of shoulder pain?
- Extrinsic: Can be referred pain with no pathology of shoulder, shoulder exam looks normal, examples are MI, free blood retroperitoneum
- Intrinsic: intra and extra articular
What are the most common causes of shoulder pain?
Acute:
- Rotator cuff injuries most common
- Fracture dislocation
- AC joint injuries
- Myofascial injury
Chronic: >6months
- rotator cuff disorders
- adhesive capsulitis
- shoulder instability
- arthritis
- Life Threatening:
- Septic Arthris
When the scapula depresses what happens to the clavicle?
scapula depresses and the distal clavicle at the AC joint will inferiorly glide and proiximal clavicle at the SC joint will superiorly glide.
Scapula elevates the distall clavicle will supereiorly gilde at AC joint and Prosimal clavicle will inferiorly glide at SC joint
With abduction what happens to Scapular motion and clavicular motion at AC and SC joint?
Depress scapula, inferior glide of AC and superior glide at SC
Abduction what happens with scapula and clavicle?
- Scapula will elevate
- Clavicle at the AC joint will superiorly glide
- Clavicle at the SC joint will inferirly glide
What happens to the scapula and clavicle with flexion of the shoulder?
- Protract scap
- Anterior glide of clavicle at the AC joint
- Posterior glide of clavicle at the SC joint
What happens to the scapula and clavicle with shoyulder extension?
- Retraction scap
- Posterior glide of clavicle at AC
- Anterior glide of clavicle at SC joint
What happens with internal and external rotation of the shoulder at the scapula and clavicle?
- N/A for scapula and clavicle at SC joint
- Clavicle at AC joint will internally rotate with internal rotation and externally rotate with external rotation
Patient with an inferior glide SC joint dysfunction, how do you treat?
ADduct the shoulder
Patient with a superior glide SC joint SD, how do you treat
Resist shoulder ABduction
Patient with an Anterior glide SC joint SD, how do you treat?
Resist shoulder flexion
Patient with a posterior glide SC joint SD, how to treat?
Resist shoulder extension
AC joint SD of superior, how do you treat?
Resist inferior pressure to distal clavicle
Patient with an internal rotation AC joint SD, how do you treat?
Resist shoulder external rotation
Patient with an external rotation AC joint somatic dysfunction, how do you treatt?
Resist internal rotation
