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Brad 4th Ed Part 2 > Ch.38 Upper Extremity Shoulder > Flashcards

Ch.38 Upper Extremity Shoulder Flashcards

1
Q

What rehab should be done in the acute stage of injury?

A

RICE, cardio that doesn’t involved affected limb, gental ROM, stablization exercises

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2
Q

What can be done for pain in acute injury?

A

Cryotherapy, E-stim, NSAIDs, tylenol, opiods, oral/injected steroids

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3
Q

When can a patient advance to the recovery phase of rehab?

A

When pain is controlled and tissue healing occured

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4
Q

What is the emphasis of recovery rehab?

A

Restoration of flexibility, strength and proprioception of injured limb

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5
Q

Open kinetic chain exercises should be used for __.

A

Correcting strength imbalances

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6
Q

Closed kinetic chain execises should be used for __.

A

provide joint stabilization throught muscle co-contraction

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7
Q

When can a patient advance to the functional phase of rehab?

A

Injured limbe gained 80% of strength compared to normal limb and not flexibility imbalances

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8
Q

What is addressed in functional rehab?

A

maladaptive movement patterns, muscle subsitution and full strength obtained

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9
Q

2/3 of sternoclavicular joint dislocations are __.

A

Anterior

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10
Q

Grade I Sternoclavicular Sprain

A

Tenderness to palpation w/o joint laxity

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11
Q

Grade II Sternoclavicular Sprain

A

Tenderness to palpation w/ joint laxity w/ a good endpoint

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12
Q

Grade III Sternoclavicular Sprain

A

Tenderness to palpation w/ significant joint laxity and no endpoint

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13
Q

Tx of Grade I & II Sternoclavicular Sprain

A

nonoperative, sling immbolization for comfort in acute phase, rehab

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14
Q

When can patient return to activity with sternoclavicular sprain?

A

Grade I: 1-2 weeks, Grade II: 4-6 weeks

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15
Q

Tx of Grade III Sternoclavicular Sprain

A

Can be nonoperative but recuires surgery if unstable or for mediastinal compression

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16
Q

80% of clavicle fractures occur __.

A

at middle 1/3 of clavicle

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17
Q

Tx of clavicle fx in good alignment

A

immobilization in sling or figure of eigh bandage

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18
Q

When should surgery be considered for clavicle fx?

A

15-20mm shortening, ope fx, neuovascular compromise or tenting of skin

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19
Q

What are teh Rockwood classifications of AC joint sprains?

A

I: sprain AC ligaments
II: tear AC & sprain CC ligaments
III: tear both AC & CC ligaments IV: III plus posterior displacement of distal clavicle into trapezius V: IV plus rupture of deltotrapezial fascia VI: V plus displacement of clavicle below acromion or coracoid process

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20
Q

Tx of type I & II AC joint sprains

A

nonoperative and rehab

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21
Q

Tx of type III AC joint sprains

A

no-op unless persistent pain, comestic or heavy labors and athletes

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22
Q

Tx of type IV-VI AC joint sprains

A

Surgery

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23
Q

How does osteolysis of the distal clavicle develop?

A

repetive overloading: bech press or military press lifts

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24
Q

What is the hx of osteolysis of the distal clavicle?

A

Gradual onset AC joint pain increased with overhead or bench presses, esp when bar lowered to chest

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25
Q

What are the pathologic changes on Xray for oteolysis?

A

distal clavicular subchondral bone loss and cystic changes

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26
Q

Tx of distal clavicle osteolysis

A

avoidance of aggraviting activities, rehab, steroid injection to AC joint, distal clavicle resection

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27
Q

What is does a loud grating scapulothoracic crepitus indicate?

A

Bursitis, fibrotic/atrophic muscle, anomal muscular insertions

28
Q

What is does a loud snapping scapulothoracic crepitus indicate?

A

Boney pathology: osteophyte, rib/scapular osteochondroma/fx

29
Q

What are the Neer classications of rotator cuff injury?

A

I: Inflammation & edema of cuffs II: Fibrosis & tendonitis of cuffs III: partial or complete tear of cuff

30
Q

What are the Bigliani classifications of acromion shapes?

A

I: flat, II: curved, III: hooked

31
Q

What augments rotator cuff contact to posteriorsuperior glenoid rim?

A

anterior glenohumeral head instability and posterior glenohumeral head capsular tightness

32
Q

Rotator cuff impingement can be caused by:

A

hooked acromion, thick coracoacromial ligament, glenohumeral joint instability, scapulothoracic dyskinesis and instability

33
Q

What stage of throwing can cause microtrauma to rotator cuffs due to eccentric overload?

A

External rotators during decceleration phase

34
Q

Rotator cuff muscle strengthening should begin with:

A

closed chain exercises to promote stability and proprioception

35
Q

Open chain exercises should be used rotator cuff disorders to __.

A

Correct strength imbalance of shoulder ER relative to IR

36
Q

Hx of long head biceps tendon ruputure

A

> 40yo, hx of rotator cuff dz, “pop” at injury, during lifting or pulling

37
Q

Best imaging for biceps tendon rupture

A

MRI or US

38
Q

Tx of biceps tendon rupture in >40yo or sedentary pt

A

Sling for compfort, strengthen shoudler girdle and rotator cuff muscles

39
Q

Tx of biceps tendon rupture in young active pt

A

Surgery

40
Q

MCC of pectoralis major strain

A

forceful shoulder adduction & IR (weight lifters & football players)

41
Q

What muscle is important for anterior and posterior glenohumeral joint stability?

A

Subscapularis

42
Q

What is the most frequent type of unidirectional glenohumeral joint instability?

A

Traumatic anterior instability

43
Q

What is multidirectional glenohumeral joint instability due to?

A

Congenital capsular laxity (Marfans or EDS) or chronic repetitive microtrauma

44
Q

What is a Bankhart lesion?

A

avulsion of anterior-inferior glenoid labrum w/ or w/o bone from glenoid rim

45
Q

What’s a SLAP lesion?

A

Superior labral anterior to posterior lesion

46
Q

What is a Hill-Sachs defect?

A

compression fx of posterolateral aspec of humeral head from anterior humeral dislocation

47
Q

What is a reverse Bankhart lesion?

A

Tear of the posterior inferior glenoid labrum causing separation from the glenoid fossa rim

48
Q

What are common sx of shoulder subluxation?

A

Burning or dead feeling in arm

49
Q

How can an Hill-Sachs defect bee seen on X-ray?

A

AP view with shoulder IR and Stryker Notch view

50
Q

What does the scapular Y view on xray show?

A

Assess glenohumeral joint alignment

51
Q

What does the axillary lateral view show on xray?

A

Anterior or posterior subulxation or dislocation and fx of glenoid rim

52
Q

What are the best views for Bankhar lesion on xray?

A

Garth view and West Point view

53
Q

What patient has a high rate of redislocation after first time shoulder dislocation?

A

Young active patient, require surgery

54
Q

When should shoulder immbolization be done after dislocation?

A

First 24 hrs, then 3 weeks with humer ER 30 deg. if not done in the first day benefits not significant

55
Q

What conditions are associated with adhesive capsulitis?

A

DM, inflam arthritis, trauma, prolonged immobilization, thydroid dz, CVA, MI, autoimmune dz

56
Q

Sx of adhesive capsulitis in Stage I

A

Painful and restricted ROM in first 1-3 mo

57
Q

Sx of adhesive capsulitis in Stage II

A

Painful ROM, progressive loss of glenohumeral motion (3-9 mo)

58
Q

Sx of adhesive capsulitis in Stage III

A

“Frozen stage”: Reduced pain w/ shoulder movement, severely restricted glenohumeral ROM (9-15 mo)

59
Q

Sx of adhesive capsulitis in Stage IV

A

“Thawing stage”: Minimal pain, progressive normalization of ROM (15-24 mo)

60
Q

Type 1 SLAP lesion

A

fraying of superior labrum w/o detached biceps tendon

61
Q

Type 2 SLAP lesion

A

Bicep tendon detached from supraglenoid tubercle

62
Q

Type 3 SLAP lesion

A

Bucket handle tear of superior labrum w/o detachment of biceps tendon

63
Q

Type 4 SLAP lesion

A

Tear of superior labrum extends to biceps tendon

64
Q

What exam finding can indicate SLAP lesion?

A

Postive O’Brien test

65
Q

What is the gold standard for dx of SLAP lesion?

A

Arthroscopy

66
Q

What imaging is used to dx SLAP lesion?

A

Gadolinium-enhanced MRI

Brad 4th Ed Part 2 (28 decks)

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