Common MSK Shoulder Problems Flashcards
Shoulder Impingement Syndrome - Characteristics
Most common.
RC muscle impingement between bony structures.
Pain in abduction, flexion and side lying.
Shoulder Impingement Syndrome - Classification (2)
Internal Impingement. Posterosuperior glenoid.
External Impingement (subacromial, supraspinatus tendon): primary vs secondary.
Shoulder Impingement Syndrome - External Impingement Classification (2)
Primary: structural obstruction
Secondary: Functional problem:
- Rotator cuff weakness
- Instability
- Scapular dyskinesia
- Biceps pathology
Internal Impingement (Glenoid) - MOI, Structures Involved, Pain.
Overhead throwing athletes, repetitive large shoulder ER.
Between Suprasp. and IS tendons and greater tubercle - posterosuperior rim of glenoid.
Posterosuperior pain. Pain at night.
Rotator Cuff Pathology - Tendinopathy : Intrinsic vs Extrinsic Mechanisms
Intrinsic mechanism: Secondary, external impingement. Over-use, age, weakness. Degeneration.
Extrinsic mechanism: anatomical variable (acromial shape). Over-use. Internal and external impingement.
Rotator Cuff Pathology - Tendinopathy : Clinical Presentation (4)
Pain during overhead activity (throwing). <90° usually pain free.
SS and IS (if involved) tender on palpation.
Painful arc may be present.
Impingement test and apprehension may be present.
Rotator Cuff Pathology - Tear : Common Factors
> 60 y, weak external rotators, weak suprasp. and signs of impingement: very likely tear.
Supraspinatus common.
Degenerative or acute.
Rotator Cuff Pathology - Tear : Clinical Presentation
Pain radiating to lateral-mid humerus or anterolateral acromion.
Pain in side-lying on shoulder or sleeping with hand overhead.
Pain occurs when reaching above head.
Scapular Dyskinesia - Causes (3)
Altered scapular motion and position.
Cause: bone, articular (AC or GH instability), soft tissue (muscle tightness/weakness, post. GH capsule stiffness).
Scapular Dyskinesis - Tightness of Soft Tissue
tightness of posterior capsule and pec minor causes increases anterior tilt and protraction.
Scapular Dyskinesia - Altered Muscle Performance
Decreased SA strength.
Hyper/early activity of upper trap.
Late activation of mid and lower traps.
Scapular Dyskinesis - Clinical Presentation (resting, arm elevation/lowering) (4)
Resting position: excessive protraction, elevation, anterior tilt.
Winging of scapula, inferior medial border prominence.
During arm elevation: early scapula elevation (shrug).
Arm lowering: rapid downward rot.
Scapular-humeral rhythm may be affected.
Glenohumeral Instability - Classification regarding Nature (3)
Traumatic
Acquired
Atraumatic
Glenohumeral Instability - Traumatic: MOI and Observation
Direct contact (P-A) leading to anterior dislocation of humerus.
Observation: prominent humeral head and space below acromion.
MOI: ER and 90° abd.
Bankart and Hill-Sachs lesions.
Glenohumeral Instability - Acquired Instability - Characteristics (4)
Over-use.
Due to hyperangulation, over-head movement.
Subluxation of humeral head (sometimes).
Frequently results in int. or ext. impingement -> RC pathology.
Glenohumeral Instability - Acquired Instability - SLAP Injury MOI
Superior labral anterior to posterior injury.
MOI: Excessive traction of biceps tendon:
- Eccentric follow through of of long head after throwing (abd., ER.)
- Peel back mechanism during extreme ER.
4 Types.
Glenohumeral Instability - Atraumatic - Cause and Pain
Multidirectional instability.
Result of ligament hyperlaxity or repetitive microtrauma (over-head).
Pain in mid-range and altered muscle activity.
Glenohumeral Internal Rotation Deficit (GIRD) - Mechanism
Overhead athletes, repetitive throwing.
Tightening of posterior capsule, leads to increased anterior translation of humeral head.
Decreased subacromial space (related to int. and ext. impingement).
Acromioclavicular Sprain - Tyoes (6)
Traumatic, affecting capsule, ligaments, muscles, skin and fascia.
Type 1: sprain of AC ligament
Type 2: torn AC
Type 3: Torn AC and CC
Type 4: Tears + clavicular displacement
Type 5: affecting fascia complex
Type 6: Large displacement of clavicle towards sub-coracoid region.
Biceps Tendinopathy - Cause (4) and Pain
Primarily long head.
Result of shoulder instability, impingement, RC pathology or overuse.
Tenderness on bicipital groove, night pain, pain at rest.
Adhesive Capsulitis (Frozen Shoulder) - Types (2) and ROM
Joint capsule thickening. Arthrofibrosis.
Idiopathic: spontaneous, >35 y. women.
Secondary: after surgery, immobilization, prolonged inflammation of tendon.
Decreased active and passive ROM: ER > ABD > FLEX > IR.
Special Tests - External Subacromial Impingement (5)
Jobe: positive
Neer: poitive anterior
Hawkins: positive
Apprehension: positive anterior
Relocation:
- positive if pain disappears -> secondary impingement.
- Negative if pain stays -> primary impingement.
Internal Posterosuperior Glenoid Impingement - Special Tests (5)
Jobe: negative
Neer: positive posterior pain
Hawkins: negative
Apprehension: positive posterior
Relocation: positive if pain eases -> secondary impingement
Rotator Cuff Pathology - Special test (1)
Full can test: positive
Primary or secondary impingement
Scapular Dyskinesis - Special Tests (2)
Secondary impingement.
Scapula assisted test (SAT): positive
Scapula retraction test (SRT): positive
Instability - Special Tests (3)
Secondary impingement
Anterior instability: load+shift test
Posterior instability: post. laxity test
Inferior instability: sulcus sign
Biceps SLAP Pathology - Special Tests (3)
O’Brians: positive
Speed’s: positive
Biceps’s load II: positive
