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MSK > Ch 5 MDT Shoulder > Flashcards

Ch 5 MDT Shoulder Flashcards

1
Q

Results from a fall onto the tip of the shoulder resulting in variable degrees of ligamentous disruption

Classified into six types

A

Acromioclavicular (AC) Injury

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2
Q

AC ligaments partially disrupted, and coracoclavicular (CC) ligaments are intact. No superior separation of the clavicle from acromion

A

Type 1

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3
Q

AC ligaments are torn and CC ligaments are intact resulting in partial separation of the clavicle from the acromion

A

Type II

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4
Q

AC and CC Ligaments are completely disrupted resulting in complete separation of the clavicle from acromion

A

Type III

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5
Q

AC and CC ligaments are complete disrupted with superior and prominently posterior displacement

A

Type IV

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6
Q

AC and CC ligaments are completely disrupted with CC interspace more than twice as large as opposite shoulder

A

Type V

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7
Q

Uncommon. Clavicular periosteum and/or deltoid and trapezius muscle are torn resulting in wide displacement. Clavicle lies in either the subacromial space or subcoracoid space

A

Type VI

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8
Q

Pain over AC joint

Pain on lifting affected arm

Type III-VI presents with obvious deformity

A

AC injury

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9
Q

Patient supports arm in adducted position

Distal clavicle prominent

Full range of motion. Abduction especially causes pain.

Decrease in muscle strength due to pain

A

AC injury

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10
Q

Diagnostic tests for AC injury

A

Anterior-posterior (AP) and axillary radiographs

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11
Q

Treatment for I and II AC injuries

A

Sling x 24-48 hours

Ice

Analgesics

Home ROM exercises

Return to full duty in 4 weeks

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12
Q

Treatment for type III AC injury

A

Orthopedic consultation

Sling x 24-48 hours

Ice

Analgesics

Home ROM exercises

Light duty until evaluation by orthopedics

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13
Q

Treatment for type IV-VI AC injuries

A

Orthopedic consultation, will require surgery

Sling until evaluation by ortho

Ice

Analgesics

MEDEVAC

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14
Q

What AC injuries require orthopedic consultation?

A

Type III-VI

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15
Q

Typically results from falling on shoulder or being struck over clavicle

Most common bony injury

A

Clavicle Fracture

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16
Q

Most common location for a clavicle fracture

A

Middle Third

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17
Q

Bony deformity, bump, with shoulder droop

Pain/Tenderness

Decreased ROM due to pain. Grinding when patient moves arm.

Positive Cross-Body

A

Clavicle Fracture

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18
Q

Diagnostic tests for Clavicle fracture

A

AP and 10-degree cephalic tilt radiographic views

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19
Q

Treatment for Clavicle Fracture

A

Ice

Analgesics

Orthopedic Consult

Figure 8 Strap for 6-8 weeks

MEDEVAC

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20
Q

Red flags of Clavicle Fractures

A

Painful nonunion after 4 months of treatment

Widely displacement lateral or mid-shaft fractures or segmental fractures

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21
Q

Provides multiple and extreme degrees of functional motion that greatly depend on the rotator cuff muscles to properly seat the humeral head into the glenoid fossa to provide stability

A

Glenohumeral Joint

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22
Q

Combination of shoulder symptoms, exam findings, radiologic signs attributable to compression of structures around the glenohumeral joint that occur with shoulder elevation

A

Shoulder Impingement Syndrome (SIS)

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23
Q

Common structures impinged in the subacromion space

A

Subacromial bursa

Tendon of the supraspinatus

Tendon of the infraspinatus

Long head of the biceps tendon

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24
Q

Different types of acromion morphology that vary in different individuals

A

Flat

Curved

Hooked (Greatest association with impingement)

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25
Q

Tenderness over greater or lesser tuberosity

Tenderness over bicipital groove

Full Active ROM but possible limited due to pain

Pain worsens between 90-120 degrees of abduction and when lowering arm

A

Shoulder Impingement

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26
Q

Shoulder impingement positive tests

A

Neers and Hawkins

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27
Q

Diagnostic tests for shoulder impingement syndrome

A

AP and axillary X-Rays (usually NORMAL)
-Narrowing of subacromial space suggests long standing rotator cuff tear

MRI with gadolinium

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28
Q

Treatment for Shoulder Impingement Syndrome

A

NSAIDs

Ice

Light duty for offending activities

Home exercise Program

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29
Q

Shoulder Impingement Syndrome

Ortho consult if failed conservative management for ___ months or other pathology is discovered

A

2-3 months

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30
Q

Rotator cuff tears usually originate in what muscle?

A

Supraspinatus

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31
Q

Rotator cuff full thickness tears are uncommon in patients younger than 40, but are present in ___% of patients older than 60

A

25%

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32
Q

Chronic shoulder pain for several months

Specific injury that triggered pain

Night pain and difficulty sleeping on the affected side

Complaints of weakness, catching and grating especially overhead activities

A

Rotator Cuff Tear

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33
Q

Shoulder may appear sunken, indicating atrophy

Tenderness over greater tuberosity

Grating sensation felt at tip of shoulder

Usually, Full ROM

A

Rotator Cuff Tear

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34
Q

Tests that may be positive for Rotator Cuff Tear

A

Abduction, forward flexion, and external rotation may be limited

Positive Drop Arm Test

Positive Empty Can Test

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35
Q

Tests needed to evaluate subacromial space for spurring and malalignment for Rotator Cuff Tears

A

Radiographs

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36
Q

Diagnostic testing that confirms Rotator Cuff Tears

A

MRI

37
Q

Treatment for Rotator Cuff Tear

A

NSAIDs

Ice

Light duty with no overhead activity

Home exercises/Physical Therapy

38
Q

Rotator Cuff Tear

Orthopedic consult if failed rehabilitation over ___ months

A

3-6 months

39
Q

Rotator Cuff Tears

Acute traumatic tears should be surgically repaired immediately or no later than __ weeks post-injury

A

6 weeks

40
Q

Rotator Cuff Tear

Patients younger than __ years old should be considered for surgical repair as tears could enlarge with time

A

55 years old

41
Q

Bicep tendon injury occur most commonly along which part of the bicep tendon?

A

Long Head

42
Q

More common in people who pull, lift, reach, or throw for work/recreation
-Rock climbers, weight lifters

A

Bicep tendon injury

43
Q

Clinical presentation with anterior shoulder pain that radiates distally down the arm over bicep muscle

Aggravated by lifting, pulling, overhead activity

A

Bicep tendon injury

44
Q

What is suspected if there was a single injury (“pop”) with ecchymosis and swelling?

A

Bicep Tendon Rupture

45
Q

Positive test in Bicep Tendon injury

A

Speeds test

46
Q

Treatment for bicep tendon injury

A

NSAIDs

Ice

Duty/activity modification

Physical therapy/Home Exercises

47
Q

Treatment for Bicep tendon rupture

A

Ortho Consult

NSAIDs, Ice, Activity Modification, Home exercises/Physical Therapy

48
Q

Synonyms for Shoulder Instability

A

Dislocation

Multidirectional instability

Recurrent dislocation

Subluxation

49
Q

Anterior, posterior, inferior or multidirectional glenohumeral laxity due to traumatic or atraumatic pathology

A

Instability

50
Q

Humeral head partially slips out of socket with spontaneous reduction

A

Subluxation

51
Q

Humeral head completely slips out of glenoid fossa with spontaneous reduction or sometimes requiring manual manipulation

A

Dislocation

52
Q

Shoulder Instability

Two specific instability patterns

A

TUBS - Traumatic Unilateral dislocations with a Bankart lesion that can be successfully treated with Surgery

AMBRI - Atraumatic Multidirectional instability, Bilateral, successfully treated with Rehab and occasionally Inferior capsular surgery

53
Q

Patient with ______ instability will describe that sensation of the shoulder slipping out of joint when arm is abducted and externally rotated

A

Anterior instability

54
Q

Initial anterior dislocation is associated with trauma from:

A

Fall

Forceful throwing motion

55
Q

Recurrent dislocations may occur simply by:

A

Overhead positioning

56
Q

Patient with _______ dislocation will describe a force that is posteriorly directed

A

Posterior dislocation

57
Q

Ability to voluntarily dislocate shoulder is frequently associated with:

A

Multidirectional instability

58
Q

Most common direction of a shoulder dislocation

A

Anterior

59
Q

Joint disfigurement

Patient supports arm in neutral position

A

Anterior dislocation

60
Q

Joint disfigurement

Patient holds arm in adduction and internal rotation

A

Posterior dislocation

61
Q

Full ROM with humeral “clucking” with flexion and abduction/adduction

Should be checked for generalized ligamentous laxity

A

Multidirectional instability

62
Q

Special tests that are positive for inferior laxity

A

Sulcus test

63
Q

Special tests that are positive for anterior instability

A

Apprehension test

64
Q

Special tests that are positive for anterior/posterior laxity

A

Anterior/Posterior Drawer test

65
Q

Special tests that are positive for posterior instability

A

Jerk test

66
Q

Diagnostic tests for Shoulder Dislocation

A

AP and Axillary radiographs

MRI

67
Q

Treatment for shoulder dislocation

A

Reduce

Sling in neutral position

Light Duty, No active use of arm for 2-3 weeks

Rotator cuff strengthening 2-3 weeks post reduction

Physical Therapy

Ortho Consult

68
Q

Gravity assisted reduction with patient lying on stomach

A

Stimson technique

69
Q

Reduction of dislocation

Elbow at 90 degrees flexion while longitudinal traction is applied to the humerus. Gently rotate arm

A

Longitudinal Traction technique

70
Q

What drug maybe required to relax muscle structures to allow for reduction?

A

Valium

71
Q

What needs to be re-evaluated after a reduction?

A

Axillary nerve function

72
Q

What dislocations require orthopedic evaluation for possible surgery and MEDEVAC?

A

First time dislocations

Evidence of neurovascular compromise

73
Q

Fibrocartilaginous ring attached to outer surface of glenoid

Gives depth to shoulder joint

Increases area of contact between the humeral head and glenoid

Point of contact for several ligaments and tendons

A

Labrum

74
Q

Lesions involve injury to the superior glenoid labrum and the biceps anchor complex

A

Superior Labrum Anterior Posterior (SLAP)

75
Q

SLAP lesions are usually confirmed during:

A

Surgery

76
Q

MOI:

Falling back onto an outstretched arm

Tries to prevent falling by grabbing hold of an object

Suddenly lifts heavy object

Forceful throwing, excessive overhead activity

A

SLAP lesion (Labrum tear)

77
Q

Anterior shoulder pain from overuse

Clicking/clunking of the shoulder in certain positions

Swelling, paresthesia, severe night pain is UNCOMMON

A

SLAP Lesion (labrum tear)

78
Q

What special tests are recommended for SLAP lesions?

A

O’briens and Speeds

79
Q

A condition of varying severity characterized by the gradual development of global limitation of active and passive shoulder motion where radiographic findings other than osteopenia are absent

A

Adhesive Capsulitis

80
Q

Referred to as “Frozen Shoulder”

More common in older populations (50’s-60’s)

Often associated with other diseases
-Diabetes, thyroid disease, autoimmune, stroke, Parkinsons, HIV Medication use

VERY common after shoulder injuries

A

Adhesive Capsulitis

81
Q

Adhesive Capsulitis

Diffuse, severe, and disabling shoulder pain
-Increasing stiffness

Lasts __ months

A

2-9 months

82
Q

Adhesive Capsulitis

Stiffness and severe loss of shoulder motion with pain less pronounced

Lasts ___ months

A

4-12 months

83
Q

Adhesive Capsulitis

Recovery phase with stiffness and gradual return of shoulder motion that takes about ____ months to complete

A

5-24 months

84
Q

Concern for adhesive capsulitis is raised when a patient with history of shoulder injury complains of:

A

Severe pain that is worse at night

“Nagging pain”

85
Q

Most significant finding during physical exam of Adhesive Capsulitis

A

ROM reduction

86
Q

What is most affected in Adhesive Capsulitis?

A

External rotation and abduction

87
Q

Diagnostic tests for Adhesive Capsulitis

A

Plain films (Usually Normal)

MRI

U/S

88
Q

Treatment for Adhesive Capsulitis

A

Early Mobilization

Shoulder motion exercises, Physical Therapy consult

NSAIDs/Tylenol

89
Q

When to refer Adhesive Capsulitis?

A

Patients who do not respond to conservative management

  • Sports medicine for steroid injection
  • Ortho for surgery (likely does not improve outcome)

MSK (14 decks)

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