Common Causes of Shoulder Pain II

Question 1

Partial ac seperation vs full ligs severed

Answer 1

Partia- Sup/inf acromioclavicular ligs

Full- coracoclavicular (conoid/trapezoid) due to downward force

Question 2

Diagnosis of complete seperation (what will you observe)

Answer 2

step defect at AC jt, acromion lies in front and below clavicle

Question 3

Diagnosis of incomplete seperation

Answer 3

Injury only to ac ligs- prominent clavicle (outer edge of clavicle steps down to acromion)

Question 4

mc causes of atraumatic instability of the GH jt.

Answer 4

1. Chronic micro repetitive injuries (ex throwing)

2. Generalized soft tissue laxity that allows abnormal excursion in multiple planes

Question 5

Where is pain usually felt in atraumatic instability

Answer 5

Athletes may have no recognition or sensation of joint instability but complain of: pain, sensation of weakness, arm occasionally goes “dead” during the act of throwing.

-pain in post shoulder

Question 6

Symptoms associated with ant subluxation

Answer 6

Pain during overhead phase of throwing

Question 7

Symptoms associated with post subluxation

Answer 7

Occurs when a posteriorly directed force is applied (ex. when performing a bench press, push-up, or when the arm is in front as with a football lineman).

Question 8

What are the 2 tests used to test for atraumatic shoulder instability

Answer 8

1. apprehension sign

2. Relocation test

Question 9

What are the 4 steps to rehab recurrent subluxations /instability

Answer 9

Rest- to allow stretched/imflamed capsule to heal

Strengthening

Endurance- isokinetic ex

Sport specific activity

Question 10

What should be strengthened for post instability

Answer 10

Empahsize internal rotator and serrates (avoid flex)

Question 11

What should be strengthened for ant instability

Answer 11

Emphasize ext rotators and post delt (avoid extension)

Question 12

What is adhesive capsulitis generally due to

Answer 12

synovial inflammation with subsequent reactive capsular fibrosis

-Lack of movement leads to lack of circulation of the synovial fluid which in turn brings walls of axillary fold to begin to adhere to one another, which brings full intra articular adhesions which manifest itself in less movement of the humeral head.

Question 13

4 stages of adhesive capsulitis

Answer 13

1. (<3m) Pain, progressive loss of aROM (some passive loss0
2. (3-6m) Progressive loss of ROM (especially passive now)
3. (9-14m) Pain free now but still stiff shoulder
4. slow stead recover of ROM

Question 14

Diagnostic features of adhesive capsulitis (what is restricted, when is there pain)

Answer 14

1. Both active and passive movements are restricted at GH jt.

Acutly painful when brought to the limits of active ROM (should be no pain when not moving)

Question 15

Who does adhesive capsulitis usually affect

Answer 15

7:1 Females:Males
usually older pop (especially diabetics)
ppl with periarthritic personality

Question 16

tx of adhesive capsulitis

Answer 16

Work within pain passively stretching the capsule in its most restricted directions

Question 17

Hills sachs defect presentation and how does it occur

Answer 17

Compression fx of postlat aspect of the humeral head when dislocating anteriorly

Question 18

Bankart lesion and how does it occur

Answer 18

It is an avulsion of ant/inf glenoid labrum due to ant shoulder dislocation

-primary lesion in recurrent ant instability

Question 19

What is a SLAP lesion and which type also involves the biceps tendon + causes instability

Answer 19

In SLAP lesions, the labrum detaches from its usual location along the top margin of the shoulder cavity.

-With Type 2 SLAP lesions the biceps tendon is pulled away from the glenoid attachement; this result in instability. In Type 1 and 3, the biceps tendon is intact and has not pulled away from the labrum, there is no instability.