Classes of Injury

Question 1

TENDONITIS

Answer 1

1/pain on activity only
2/pain at beginning, disappears during, returns after
3/pain at beginning, during, and after activity; may restrict activity.
4/pain with ADLs, continues to worsen

Question 2

BURSITIS

Question 3

LIGAMENTOUS SPRAIN

Answer 3

1*/mild: minor stretch/tear, no instability with passive relaxed testing. person can continue activity with some discomfort.

2*/moderate: tearing of fibres, snapping sound at time of injury + joint gives way - difficulty continuing activity d/t pain; joint is hypermobile but stable with passive, relaxed testing.

3*/severe: complete rupture or avulsion fracture; snapping sound + joint gives way. significant instability with no end point on passive, relaxed testing. cannot continue activity. in chronic, may be painlessly hypermobile.

Question 4

MUSCLE STRAIN

Answer 4

1*/mild: minor stretch/tear, minimal loss of strength. continues activity with mild discomfort.

2*/moderate: tearing of MT fibres occurs, variable severity. may be snapping sensation/sound.

3*/severe: often a palpable/visible gap, muscle shortens/bunches up. cannot continue activity d/t significant pain and weakness. refer to physician if significant weakness/LoF.

4*/complete rupture or avulsion fracture

Question 5

FROZEN SHOULDER (STAGES)

Answer 5

1/freezing/painful: gradual onset, severe pain at night, cannot lie on affected side.

2/frozen: severe pain diminishing, stiffness is 1* complaint. pain at end ROMs, possible disuse atrophy.

3/thawing: pain local to lateral arm, still diminishing. motion/function gradually returns.

Question 6

SHOULDER IMPINGEMENT (TYPES)

Answer 6

Extrinsic: result of mechanical wear of RC against anteroinferior 1/3 of acromion.

Primary: from anatomical or biomechanical factors. Occurs anteriorly.

Secondary: from increased hypermobility/instability of humeral head. Occurs anteriorly.

Internal: occurs posteriorly; seen in overhead athletes.

Question 7

ACROMIOCLAVICULAR SEPARATION/SPRAIN

Answer 7

Grade 1: damage to AC, no displacement of clavicle. No hypermobility.

Grade 2: Subluc of ACj, disruption of AC ligs + damage to CC ligs. Step deformity.

Grade 3: Rupture of AC + CC ligs. Step deformity, clavicle sits higher. Likely surgery.

Question 8

LABRAL TEARS

Answer 8

Bankart lesion: anteroinferior labrum from 3-7 on the clock.
*usually with traumatic anterior dislocation/instability

SLAP lesion: superior labrum from 10-2 on the clock.
*usually from deceleration when throwing or sudden biceps traction.

Question 9

SHOULDER IMPINGEMENT (STAGES)

Answer 9

1: overuse onset, anterior shoulder pain, improves with rest + reversible with conservative tx.

2: pain at night, painful arc. not alleviated by rest. bursal thickening, fibrosis, degeneration, partial tear of RC.

3: possible RC tears. painful arc, tendon degeneration and bony changes. almost exclusively after age 40.

4: complete RC tears with atrophy. surgical candidates.