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OCS > Clinical Shoulder > Flashcards

Clinical Shoulder Flashcards

1
Q

What is Scapulohumeral Rhythym

A
  • Refers to the motion that occurs at the scapaulothoracic joint during elevation of the arm
  • Normal Ratio is 2:1
  • 2 deg of Glenohumeral motion for every 1 degree of Scapulothoracic
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2
Q

What Gliding Movement changes occur with surgical tightening of the Shoulder Joint Capsule?

A
  • Obligate movement is said to occur whereby tightening of the posterior capsule or Rotator Interval increase Anterior Translation during forward elevation
  • Excessive Anterior stability after repair can cause humeral head and joint contact posteriorly and can possibly lead to degenerative changes in the shoulder
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3
Q

What is the normal strength ratio of the shoulder in ER and IR?

A

External Rotators typically are about 66% as strong as the internal rotators
- Some (Davies, etc) have proposed during rehabilitation we should shoot for 75% to create a “Posterior Dominant” Shoulder

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4
Q

What ligament is typically contracted in shoulders with adhesive capsulitis?

A
  • The Coracohumeral ligament

- This ligament prevents ER with arm at side and often needs to be released to regain full ER ROM

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5
Q

What is the rotator cuff interval?

A
  • The capsular tissue in the interval between the Subscapularis and Supraspinaus Tendons
  • It is composed of parts of the Subscapularis and Supraspinatus tendons as well as the Coracohumeral and Superior Glenohumeral ligaments
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6
Q

How can pathologic change to the rotator cuff interval affect the shoulder?

A
  • If too tight, can limit ER and play a role in Adhesive Capsulitis
  • If too lax, can play a role in Multidirectional Instability and Anteroinferior instability
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7
Q

What are the biomechanical effects of the Rotator Cuff?

A
  • Depress the humeral head and counteract the Superior pull of the deltoid
  • Maintain proper positioning of the humeral head within the glenoid
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8
Q

What is the Quadrangular Space, What Structures pass through it?

A
  • Anatomic interval formed by shaft of the humerus laterally, long head of the biceps medially, teres minor superiorly and teres major inferiorly.
  • It contains Axillary Nerve, Posterior Humeral Circumflex artery
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9
Q

What is the Triangular Space, What structures pass through it?

A
  • Anatomic interval bordered by long head of biceps laterally, teres minor superiorly, and teres major inferiorly
  • It contains the circumflex scapular artery and a branch of the scapular artery
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10
Q

Which ligaments provide static prevention of anterior translation of the humeral head, and in which positions do they perform this action?

A
  • Anterior Band of the Inferior Glenohumeral ligament in the ER9090 position
  • Middle Glenohumeral ligament in midrange shoulder elevation
  • Superior Glenohumeral ligament prevents ER and Inferior Translation with arm at side
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11
Q

What is a Bankart Lesion?

A
  • Detachment of the anchor point of the Anterior Band of Inferior Glenohumeral and middle Glenohumeral ligaments
  • Often occurs as a result of traumatic Anterior Dislocation of the shoulder
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12
Q

What is a Hill Sachs Lesion?

A
  • Impression fracture to the posterolateral margin of the humeral head
  • Caused by impaction on the rim of the glenoid during Anterior Dislocation
  • If lesion involves >30% of the articular surface of the humerus, can lead to recurrent instability
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13
Q

Where does the Suprascapular nerve sometimes become compressed and what deficits would be present?

A
  • Suprascapular Notch and Spinoglenoid notch
  • If at Suprascapular, Supraspinatus and Infraspinatus would be affected
  • If at Spinoglenoid, Infraspinatus would be affected
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14
Q

Which nerve is at greatest risk during Anterior Shoulder Surgery?

A
  • Axillary nerve
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15
Q

Which Nerve Superficial to the Posterior Cervical Triangle and is susceptible to injury?

A
  • Cranial Nerve XI (Spinal Accessory Nerve)
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16
Q

Injury to which nerve causes Classic Medial Scapular Winging?

A
  • Long Thoracic Nerve
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17
Q

What is Os Acromiale?

A
  • An unfused acromial epiphysis. Failure of the distal end of the acromion to ossify
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18
Q

What are the Three Types of Acromion Shape?

A
  • Type 1: Flat
  • Type 2: curved downward
  • Type 3: Hooked
  • Much higher incidence of RTC tears in type 3 and 2 than type 1
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19
Q

What are the Four Stages of Neers Rotator Cuff Pathology Classification?

A
  • Stage I: Edema and Hemmorhage
  • Stage 2: Fibrosis and Tendinitis
  • Stage 3: Bone Spur and Tendon Rupture
  • Stage 4: Cuf Tear Arthropathy
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20
Q

What is the Coracoacromial Arch?

A
  • The Coracoacromial Ligament. It acts as the roof of the Glenohumeral joint and can compress tissue when humeral elevation and internal rotation occurs.
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21
Q

What are the two types of Subacromial Decompression?

A
  • Open and Arthroscopic
  • Some doctors prefer one or the other, but if a massive RTC tear is found during the procedure it is more easily repaired when open.
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22
Q

What is a Mumford Procedure?

A
  • Distal Clavicular Excision/ Removal

- Removal of distal 2cm

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23
Q

Describe Primary vs. Secondary Shoulder impingement

A
  • Primary is mechanical and caused by joint space overcrowding
  • Secondary is typically due to instability
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24
Q

What is Posterior (Internal) Impingement?

A
  • Pinching of the Infraspinatus and Supraspinatus between the posterior superior aspect of the glenoid
  • Typically seen in throwers, symptomatic when in the cocking position or phase of throwing
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25
Q

Describe how the size of a rotator cuff tear is classified

A
  • Small < 1 cm
  • Medium is 1-3 cm
  • Large is 3-5 cm
  • Massive > 5 cm
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26
Q

What Special Tests are most predictive of Rotator Cuff Tear?

A
  • Supraspinatus Weakness
  • External Rotation Weakness
  • Impingement sign
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27
Q

What is the most common direction and mechanism of injury for Dislocation of the Shoulder?

A
  • Subcoracoid Anterior Dislocation

- Typically occurs with indirect force with arm Abducted, Extended, and Externally Rotated.

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28
Q

What is the most common nerve injury after Anterior Dislocation of the Shoulder?

A
  • Axillary Nerve (30%)
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29
Q

What is the most common Mechanism of Injury for Posterior Shoulder Dislocations?

A
  • Axial Loading of the arm in and Adducted, Flexed, and Internally Rotated Position.
  • Blow to front of the shoulder, FOOSH
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30
Q

Describe the Acronym TUBS

A 
Shoulder Instability
T - Traumatic Onset
U- Unidirectional (anterior)
B - Bankart Lesion (usually present)
S - Surgery (success rate higher with surgery)
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31
Q

Describe the Acronym AMBRI

A

Shoulder Instability
A - Atraumatic Onset
M - Multidirectional
B - Bilateral (usually)
R - Rehabilitation (success rate is high with conservative management)
I - Inferior Capsular Shift (procedure of choice if conservative treatment fails)

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32
Q

What is an ALPSA Lesion?

A

ALPSA stands for Anterior Labroligamentous Periosteal Sleeve Avulsion. Often accompanies an anterior dislocation, the labrum and periosteal sleeve of the anterior glenoid are avulsed and displaced medially.

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33
Q

What is a HAGL Lesion?

A

HAGL stands for Humeral Avulsion of the Glenohumeral Ligament. Occurs with traumatic dislocation when the arm is forced into a hyperabducted position.

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34
Q

What are common special tests for Shoulder Impingement?

A
  • Neers
  • Hawkins Kennedy
  • Jobes
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35
Q

What are common special tests for Rotator Cuff Tear?

A
  • Drop Arm Test (ER)
  • Lift Off Sign
  • IR and ER Lag Test
  • Hornblowers Sign
  • Belly Press
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36
Q

What are common special tests for Shoulder Instability?

A
  • Ant Load and Shift
  • Sulcus Sign
  • Apprehension Test
  • Relocation and Anterior Release
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37
Q

What grading scheme is used to describe glenohumeral translation?

A

Grade 1 - Humeral head to rim of glenoid but not past, 50% translation
Grade 2 - Humeral head subluxes beyond the glenoid rim but self reduces upon release
Grade 3 - Head remains dislocated on release, clinical dislocation

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38
Q

What are Hill Sachs and Reverse Hill Sachs Lesions?

A

Hill Sachs - Compression fracture of the posterolateral humeral head, occurs with Anterior dislocation.
Reverse Hill Sachs - Compression fracture of Anteromedial humeral head, Occurs with Posterior Dislocation

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39
Q

What is a Bankart Lesion?

A
  • An Avulsion of the Anterior Portion of the Inferior Glenohumeral Ligament and Glenoid Labrum off the Anterior Rim of the Glenoid
  • Often contributes to recurrent instability of the shoulder
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40
Q

What are common complications when managing a traumatic anterior dislocation

A
  • Recurrent Dislocations

- Can also include fractures of the Humerus, Vascular Injuries, Neural Injuries, and Rotator Cuff Tears

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41
Q

With Anterior Dislocation, is an associated Rotator Cuff Tear Common?

A
  • In young populations, no

- Age > 40 it ranges from 35-86%

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42
Q

What are some common surgical Procedures to correct Shoulder Instability?

A
  • Bankart Repair - Suturing of the Anterior Capsule and Labrum to the Glenoid Rim
  • Capsular Shift - Tightening of the joint capsule
  • Staple or Thermal Capsulorrhaphy - Shrinking the capsule either by stapling it down or thermally shrinking it
  • Putti-Platt Procedure- Subscapularis and Capsular Shortening
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43
Q

What are SLAP Lesions?

A
  • Superior Labrum Anterior to Posterior Lesion

- Usually occurs from downward force on a supinated outstretched arm or a fall on the lateral shoulder

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44
Q

What are the 4 types of SLAP Lesions?

A

Type 1- Degenerative Fraying of the Labrum
Type 2- Avulsion of the superior labrum and biceps tendon
Type 3- Bucket Handle tears of the Superior Labrum
Type 4- Same as 2 or 3 with extension into the Biceps Tendon

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45
Q

What are some common special tests to evaluate SLAP Lesions?

A
  • Obriens (Active Compression)
  • Crank
  • Biceps Load at 90 and 110
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46
Q

Define Primary and Secondary Adhesive Capsulitis

A
  • Primary- Stiff shoulder with insidious onset

- Secondary- Stiff Shoulder with onset after some type of trauma

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47
Q

What MRI findings are assocaiated with Adhesive Capsulitis?

A
  • Thickening of the Coracohumeral Ligament > 4 mm

- Thickening of the capsule in the Rotator Interval > 7 mm

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48
Q

What are some predisposing factors of adhesive capsulitis?

A
  • Cervical Spine Disorders
  • Autoimmune Disorders
  • Tendonitis
  • Hypothyroidism
  • Diabetes
  • Hormonal Disorders
  • Poor Posture
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49
Q

What are some surgical options to increase ROM in Adhesive Capsulitis?

A
  • Manipulation under Anasthesia
  • Arthroscopic capsular release
  • Manipulation is preferred and usually has better outcomes, but release can be performed if pnt has not responded to conservative management or MUA
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50
Q

What is the difference between unconstrained, constrained and reverse Total Shoulder Arthroplasty?

A

Unconstrained- Shallow ball and socket much like the original
Constrained- Deeper ball and socket more similar to the hip, Slight decrease in ROM with this
Reverse- Ball is on the glenoid side and socket on humerus, good for people with deficient cuff

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51
Q

What is a Hemiarthoplasty of the Shoulder?

A
  • Replacement of humeral head but not glenoid

- Good option when humeral head necrosed or damaged, but glenoid intact

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52
Q

How long will a TSA Last?

A
  • Typically > 20 years
53
Q

Describe the Neer Phased Rehab phases for Total Shoulder Arthroplasty

A
  • Phase 1- Passive ROM
  • Phase 2- AROM
  • Phase 3- Resistive Exercise
54
Q

What are typical mechanisms of injury to AC Joint?

A
  • Direct force to tip oc shoulder with arm adducted at side

- Indirect force such as a FOOSH

55
Q

What are the main ligaments of the AC Joint and what are their primary roles?

A
  • Superior and Inferior AC Ligaments- Prevent horizontal movement
  • Coracoclavicular Ligament (Trapezoid and Conoid)- Give Vertical Stability
56
Q

Describe the classification system for AC joint injuries

A

Type 1- Sprain of AC ligament
Type 2- Complete Disruption of AC, sprain of CC
Type 3- Complete Disruption of AC and CC

57
Q

Do Type 1 or Type 2 AC injuries require a sling?

A
  • Not for Type 1, early return to function with several days of RICE and relative rest
  • Type 2 injuries usually require a sling, RICE and Return to ROM as tolerated
58
Q

What is the surgical procedure to correct Arthritic AC Disability?

A
  • Distal Clavicular Resection or Mumford

- Removes approx .5-2.0 cm

59
Q

What is the typical MOI for Sternoclavicular Injuries?

A
  • Someone lying on their side and rolls over their shoulder (wrestling)
  • Blow to the Anterior Shoulder
60
Q

What Ligaments support the SC Joint?

A
  • Anterior and Posterior Sternoclavicular Ligaments
  • Costoclavicular Ligament
  • Interclavicular Ligament
61
Q

What are grades of SC Joint sprains?

A
  • Similar to that of the AC
  • Type 1- Ligaments intact
  • Type 2- Ligaments partially disrupted
  • Type 3- Total Disruption of ligaments
  • Anterior dislocation of SC joint more common than Posterior, 9:1
62
Q

What is Sprengels Deformity?

A
  • Failure of the scapula to descend during normal development
  • Seen in Infancy,usually along with other musculoskeletal deformities
63
Q

What is SICK Scapula?

A
  • Scapular Malposition
  • Inferior medial border prominence
  • Coracoid Pain
  • Dyskinesis
  • Often found in overhead athletes and noted by a unilateral drop in the affected shoulder
64
Q

Describe the Lateral Scapular Slide Test

A
  • Measure the distance from the T8 Vertebrae to the inferior angle of the scapula in 3 positions
    1. Arm at Side
    2. Hands on Waist
    3. Arms Abducted to 90 deg with max internal rotation
  • Difference > 1.5 cm between sides indicates scapular muscle dysfunction
65
Q

What is typical MOI of Long Thoracic Nerve Palsy?

A
  • Idiopathic without history of Macrotrauma
  • Surgical Complications
  • Viral Illness
  • Trauma
66
Q

What nerve is commonly affected after a cervical lymph node or benign tumor resection?

A
  • Spinal Accessory Nerve

- Usually affects Trapezius but spares the Sternocleidomastoid

67
Q

Define Snapping Scapula

A
  • Friction between mobilie scapula and thoracic wall

- If pathologically painful can be caused by thickened bursa, bone spur, or Osteochondroma

68
Q

Describe locations of Suprascapular Nerve Entrapment and clinical findings

A
  • Suprascapular Notch and Ligament - Supraspinatus and Infraspinatus weakness
  • Spinoglenoid Ligament- Sparing of the Supraspinatus with weakness of the Infraspinatus
69
Q

What nerve is most frequently injured with a fracture of the Clavicle?

A
  • Ulnar Nerve as it passes between the first rib and the fracture clavicle
70
Q

What nerves are commonly affected after a Proximal Humerus Fracture?

A
  • Axillary Nerve
  • Suprascapular Nerve
  • Often temporary and resolves as tissue healing of fracture takes place
71
Q

What Nerve is most commonly affected after Humeral Shaft Fracture?

A
  • Radial Nerve

- Rare Brachial Plexus Injury

72
Q

What treatment is required for radial nerve injury after humeral shaft fracture?

A
  • Most heal on their own, but splinting and ROM is recommended to prevent contractures
73
Q

How is the Spinal Accessory Nerve Usually Injured?

A
  • Tumor
  • Surgical Procedures to the posterior triangle
  • Stretch and Whiplash Injuries
74
Q

What is typical presentation of Spinal Accessory Nerve Palsy?

A
  • Dropping shoulder or Flat Upper Trap
  • Winging of scapula with ABduction of the arm
  • If SCM is affected, rotation of the head toward opposite shoulder
75
Q

What is the most commonly injured nerve after Anterior Shoulder Dislocation?

A
  • Axillary Nerve
76
Q

What clinical signs would be seen with Musculocutaneous nerve injury?

A
  • Weakness in Elbow Flexion and Supination

- Numbness or Parasthesia to lateral forearm

77
Q

What is Ruck Sack Palsy?

A
  • Weight of a Ruck Sack compromises the upper trunk of the Brachial Plexus or Long Thoracic Nerve
78
Q

What are signs and symptoms of an Upper Trunk Brachial Plexus injury?

A
  • Affect the Suprascapular, Musculocutaneous, and Axillary nerves and parts of the Median and Radial Nerves
  • Weakness in shoulder flexion, abduction, Extension
  • Weakness in Elbow Flexion, Supination, Pronation and wrist flexion
  • Parasthesias in lateral forearm, hands, thumb and index finger
79
Q

What are signs and symptoms of a Lower Trunk Brachial Plexus Injury?

A
  • Affect Ulnar, C8 part of Radial, Distal Median Nerve
  • Weakness of hand intrinsics including thenar muscles and lumbricals
  • Parasthesias to medial forearm, medial hand, entire ring and little fingers
80
Q

Differentiate Lateral Cord and Upper Trunk Brachial Plexus Injuries

A
  • Lateral Cord - Less Severe - Sparing of the Suprascapular Nerve and Upper Trunk parts of the Axillary and Radial Nerves
  • Lateral Cord will have normal Shoulder Flexion, External Rotation, Abduction
  • Lateral Forearm parasthesias but not into hand
81
Q

Differentiate Medial Cord and Lower Trunk Brachial Plexus Injuries

A
  • Medial Cord Similar to Lower Trunk - In Medial cored there will be Sparing of C8 Contribution of Radial Nerve
  • Normal Strength to finger extension
82
Q

Differentiate C5-6 root injury and Upper Trunk Injury

A
  • Upper Trunk Spares the Dorsal Scapular Nerve to rhomboids and Long Thoracic nerve to Serratus Anterior
  • C5-6 Lesion does not
83
Q

Differentiate C5-6 root injury and Lateral Cord Injury

A
  • Lateral Cord Lesion spares the suprascapular nerve to supraspinatus and infraspinatus
  • C5-6 Lesion does not
84
Q

What are some clinical tests used to evaluate Thoracic Outlet Syndrome?

A
  • Adsons Maneuver
  • Allen Test
  • Roos Test
  • Wright Test
  • Costoclavicular Syndrome Test
  • Halstead Maneuver
  • To decrease False Positive Rate, Perform at least 3
85
Q

What are signs and symptoms of a Middle Trunk Brachial Plexus Injury?

A
  • Rarely injured in isolation

- Weakness in radial distribution involving Triceps and sparing the Brachioradialis

86
Q

What Nerves/Roots does a Burner or Stinger affect?

A
  • C5-6 Roots

- Upper Trunk Brachial Plexus

87
Q

Describe Clinical Findings of Pancoast Tumor

A
  • Sensory changes to medial hand
  • Horners Syndrome
  • Intrinsic Hand Muscle wasting
  • Night Pain
88
Q

What is Quadrangular Space Syndrome?

A
  • Compression of the Axillary Nerve as it passes through the quadrangular space
  • Sx include weakness of the Deltoid and Teres Minor
89
Q

What is a Sprengels Deformity?

A
  • The failure of the Scapula to caudally descend during fetal development
  • Results in Small and Undescended Scapula and Scapular Winging in children
  • If Surgery indicated (most cases), best to perform between 3 and 8 years. At 8 years, chance of nerve damage is greater.
90
Q

What are Erbs and Klumpkes Palsy?

A
  • Brachial Plexus Lesions that typically occur during birth
  • Erbs - C5-6- Weakness in Axillary, Musculocutaneous, Radial, Suprascapular Nerve Patterns
  • Klumpkes- C8-T1- Weakness of Median and Ulanar Nerves, Claw Hand
  • Worse prognosis with Klumpkes
91
Q

What are the normal strength ratios of the shoulder?

A
  • IR > ER by 3:2
  • ADD > ABD by 2:1
  • Ext > Flex by 5:4
92
Q

What is the role of the biceps in stabilizing the glenomumeral joint?

A
  • Increases compression across the Glenohumeral joint and dynamically maintains coaptation of the humeral head within the glenoid
93
Q

The shoulder girdle is primarily supplied by what cervical roots and Trunk of Brachial Plexus?

A
  • C5-6

- Upper Trunk

94
Q

Describe the differences in the Three grades of AC joint injury

A
  • Grade 1- AC liagments partially disrupted but Coracoclavicular intact
  • Grade 2- AC ligaments torn, Coracoclavicular partially disrupted
  • Grade 3- AC and Coracoclavicular ligaments torn
95
Q

What is the difference between primary and secondary adhesive capsulitis?

A
  • Primary- Idiopathic progression

- Secondary- Traumatic in origin or related to disease process

96
Q

Describe the pattern of motion loss most typically associated with Adhesive Capsulitis

A

ER more limited than ABduction which is more limited than IR

97
Q

What are possible mechanisms of Glenohumeral Labral Tear?

A
  • FOOSH
  • Traction injury
  • Peel Back Injury: arm abducted and maximally ER and twisting of biceps results in “peeling back” of labrum
98
Q

In baseball pitchers reporting a “dead arm” what is a possible diagnosis?

A
  • SLAP Tear

- Also RTC Tear or both

99
Q

What is Subscapular Bursitis?

A
  • Focal Inflammation caused by mechanical pressure and friction between superomedial angle of scapula and the second and third ribs
100
Q

What are characteristic electrodiagnostic changes in Thoracic Outlet Syndrome?

A
  • Prolonged latency of F Wave

- Reduced Amplitude of Ulnar Sensory Evoked Amplitude

101
Q

What motion does the Superior Glenohumeral Ligament Restrain and in what position?

A
  • Restrains Inferior translation of the humeral head when the arm is adducted at the side
102
Q

What motion does the Middle Glenohumeral Ligament Restrain and in what position?

A
  • Restrains Anterior Humeral Translation with arm in mid range of abduction up to 45 deg
  • Also restrains ER with arm at side
103
Q

What is the most important Ligament for the Stability of the Sternoclavicular Joint?

A
  • Posterior Sternoclavicular Ligament
104
Q

What are some Muscular Imbalances found in individuals with Impingement Syndrome?

A
  • Decreased Serratus Anterior Activity
  • Delay in Firing of the Middle and Lower Trapezius
  • Dominance of Upper Trapezius and Levator Scapulae
105
Q

What are the three categories of the Kibler Scapular Dysfunction classification system?

A
  • Inferior Angle Scapular Dysfunction
  • Medial Border Scapular Dysfunction
  • Superior Scapular Dysfunction
106
Q

What conditions do you commonly see Scapular Dysfunction with and what types of Scapular Dysfunction?

A
  • Inferior Angle- Rotator Cuff Impingement
  • Medial Border- GH Joint Instability
  • Superior - Rotator Cuff weakness and force couple imbalances
107
Q

What are some special tests used to assess Scapular Dysfunction?

A
  • Lateral Scapular Slide Test
  • Scapular Assistance Test
  • Scapular Retraction Test
  • Flip Sign
108
Q

With a Limitation in IR and Post Capsule Tightness, how will this affect the Humeral Head in Movement of the Shoulder?

A
  • Anterior Superior Translation
109
Q

What is the Optimal Testing Position for the Supraspinatus?

A
  • Full Can
110
Q

What is the Optimal Testing Position for the Teres Minor?

A
  • Patte Test
111
Q

What is the Optimal Testing Position for the Subscapularis?

A
  • Gerber Lift Off
112
Q

What is the Optimal Testing Position for the Infraspinatus?

A
  • Patient Seated, Arm at side with 45 deg IR
113
Q

Describe the Tests of the Beighton Hypermobility Scale?

A
  • 9 Individual Tests, Assessed Bilaterally
  • Passive Hyperextension of 5th MCP Joint
  • Passive Thumb Opposition to Forearm
  • Elbow Hyperextension
  • Knee Hyperextension
  • Standing Trunk Flexion (not bilaterally assessed)
114
Q

What is the Typical ER/IR Strength Ratio?

A
  • 66%
115
Q

What are the 3 Stages of Neers Impingement?

A
  • Edema and Hemmhorage
  • Fibrosis and Tendonitis
  • Spurs and Tendon Rupture
116
Q

What are the 3 types of Acromion?

A
  • Type 1- Flat
  • Type 2- Curved
  • Type 3- Hooked
117
Q

What are the two types of Partial Thickness Tears?

A
  • Bursal Side- Superior Surface Tears

- Articular Side- Under Surface Tears

118
Q

What types of Shoulder Dysfunction are Bursal and Articular Side Tears Associated With?

A
  • Bursal Side- Subacromial Impingement

- Articular Side- Increased Tensile Loads and Instability (capsular, labral, and muscular insufficiency)

119
Q

How do you classify the size of a Rotator Cuff Tear?

A
  • Small < 1 cm
  • Medium 1-3 cm
  • Large 3-5 cm
  • Massive >5 cm
120
Q

What are some Postoperative Milestones after RTC Repair?

A
  • 4-6 weeks- Early PROM, Submaximal Isometric
  • 5-6 weeks- Initiate Isotonics
  • 8 weeks- Closed Chain Exercise
  • 10 weeks- 90 deg Abducted ER and IR
  • 12 weeks- Maximal Isokinetics
  • 16 weeks- Return to Sport
121
Q

What are some Postoperative Milestones after Bankart Repair?

A
  • 4-6 weeks- Light Tubing Isotonics
  • 6-8 weeks- Higher Level Strengthening
  • 12-16 weeks- Sports Specific Activities
122
Q

How many weeks after SLAP Repair should you wait until you begin ER ROM?

A
  • Should wait 4 weeks until beginning ER ROM past 0 deg
123
Q

What are some Postoperative Milestones after SLAP Repair?

A
  • 5-6 weeks- GH ROM increased in all planes
  • 10 weeks- Submaximal Isometrics in Elbow Flexion
  • 12 weeks- Full Shoulder ROM should be achieved
124
Q

Describe the Modified Weaver-Dunn Procedure

A
  • Coracoclavicular Ligament Reconstruction at the AC Joint
125
Q

Contracture of what structure is very common in patients with Frozen Shoulder?

A
  • Rotator Cuff Interval

- RCI release can lead to dramatic improvement in ROM into ER

126
Q

What Surgical Options are available in patients with Glenohumeral Osteoarthritis?

A
  • Hemiarthroplasty (HA)
  • Total Shoulder Arthroplasty (TSA)
  • Reverse TSA (RSA)
127
Q

How common is nerve injury with Proximal Humeral Fracture?

A
  • 67% of patients with PHF had nerve injury

- Most common is Axillary Nerve

128
Q

What are some Postoperative Milestones after TSA?

A
  • Variable recommendations

- Perform AAROM for first 3 weeks, Begin Isometric at 3-5 weeks, Tubing at 10 weeks, Return to work 16 weeks

129
Q

When is a Reverse TSA warranted?

A
  • 3 Situations related to GH Joint Damage
  • Massive or Irreparable RTC Tear
  • Proximal Humeral Fracture Resulting in RTC Deficiency
  • Revision of previous arthroplasty that has concurrent RTC Deficiency

OCS (13 decks)

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