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Ortho/Rheumatology > D/Os of Shoulder & Neck > Flashcards

D/Os of Shoulder & Neck Flashcards

1
Q

Diagnostics of acute muscle spasm or strain of the neck?

A

XR = lateral cervical spine to include C7

  • -r/o Fx (acute).
  • -Loss of cervical lordosis (chronic).
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2
Q

Injury to the muscles and/or ligaments surrounding the cervical spine?

A

Acute muscle spasm or strain.

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3
Q

HPI of acute muscle spasm or strain?

A

*Hyperextension injury, “WHIPLASH.”
“Delayed” onset of Sx:
–Stiffness, Pain, Difficulty w/ROM, HAs, Muscle tightness.

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4
Q

What should always be included in a physical exam of neck injuries or all orthopedic injuries?

A
  1. Inspection.
  2. Palpation.
  3. ACTIVE ROM (AROM) before Passive.
  4. Strength.
  5. Special tests.
  6. Neurovascular exam.
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5
Q

Characteristics of the PE in acute muscle spasm or strain?

A
  1. Inspection = ridged appearance.
  2. Palpation = tenderness over musculature, esp. SCM/upper trapezius.
  3. AROM = “painful extension,” limited flexion, extension, lateral bending or rotation.
  4. Strength = pain against resistance.
  5. Special tests = none.
  6. Neurovascular = normal.
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6
Q

Where do 90% of disc lesions occur?

A

At C5-C6 levels

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7
Q

“Compression” test for cervical disc disease?

A

Push down on the skull of the seated patient. If pain from neural foramen stenosis exists, then this movement will cause neck or extremity pain.

**This should be a gentle maneuver and does not come completely w/o risk of liability.

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8
Q

Diagnostic tests for Cervical Disc Disease?

A
  1. XR – AP, Lateral Cervical spine (will not always show anything but indicated for insurance purposes to get and MRI).
    - -loss of disc height w/spinal stenosis.
    - -osteophyte formation.
    - -narrowing of the intervertebral foramen.
  2. **MRI - Gold Standard.
    - -Disc herniation, nerve root compression.
  3. EMG/Nerve Conduction Study:
    - -evaluates peripheral nerves.
    - -may need to refer before completing this test.
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9
Q

Treatment for cervical disc disease?

A
  • NSAIDs (check pt history - CV, GI).
  • Analgesics (Tylenol).
  • PT.
  • Chiropractic therapy.
  • Referral to neurology or neurosurgery.
  • Most will improve with time.
  • Approx. 5% will need surgery*
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10
Q

Name all the rotator cuff muscles:

A

“SITS”

  • Supraspinatus.
  • Infraspinatus.
  • Teres Minor.
  • Subscapularis.
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11
Q

“Chronic Inflammation” of the rotator cuff at the musculotendinous junction, which creates scarring and thickening of the rotator cuff?

A

Tendinitis of the shoulder.

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12
Q

Inflammation of the “Subacromial Bursa?”

A

Bursitis of the subacromial bursa.

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13
Q

Soft tissues structures “pinched” between the humerus and the arch of the “acromion?”

A

Impingement of the shoulder rotator cuff muscles.

–poor functioning rotator cuff causes humoral head elevation toward the arch of the acromion.

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14
Q

Diagnostics of Tendinitis - Bursitis - Impingement?

A
  1. XR – AP, Lateral/Scapular Y, Axillary.
    - -Scapular Y view assists w/evaluating the angle of the acromion.
    - -Axillary view provides visualization of the glenoid and glenohumeral joint.
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15
Q

A partial or complete tear of the rotator cuff?

A

Rotator Cuff Tears.

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16
Q

Which “SITS” muscle is most commonly involved in a rotator cuff tear?

A

Supraspinatus.

  • Rare to see teres minor involved.
  • May occur suddenly w/trauma or gradually.
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17
Q

Possible HPI of a rotator cuff tear?

A
  • Fall.
  • Traction injury.
  • Lifting a heavy object.
  • Proximal lateral arm pain.
  • “Weakness” w/flexion, abduction.
  • Throwing athletes, intensive laborers.
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18
Q

Treatment for Rotator Cuff Tears?

A
  • NSAIDs.
  • Analgesics.
  • ICE.
  • Local steroid injection.
  • PT (esp, if surgery.)
  • Consultation to “Orthopedic Surgeon.”
  • –esp, if traumatic MOI.
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19
Q

What is Adhesive Capsulitis also known as?

A

“Frozen Shoulder Syndrome.”

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20
Q

Diagnostics for Adhesive Capsulitis?

A

**Diagnosis is Clinical!

-XR: AP, Lateral/Scapular Y, Axillary
(pt may not be able to perform an axillary view due to decreased ROM).

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21
Q

Treatment for Adhesive Capsulitis?

A
  1. NSAIDs, analgesics, ICE/Heat alternation.
  2. Local Steroid injection.
  3. **PT – aggressive range of motion.
  4. Consult to Ortho Surgeon for possibly manipulation under anesthesia.
  5. CPM chair (Continuous Passive Motion).
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22
Q

What is the approx. time for recovery from adhesive capsulitis?

A

Approx. 6 months or more to recover.

**Early recognition and prevention is key!”

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23
Q

An accumulation of scar tissue in the joint capsule?

A

Adhesive Capsulitis

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24
Q

What are the 3 stages of Adhesive Capsulitis?

A
  1. Painful – freezing.
  2. Adhesive – frozen.
  3. Recovery – thawed.
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25
Q

Adhesive capsulitis causes?

A

Primarily “Idiopathic;” 2dry can be from injury or shoulder surgery.

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26
Q

Who is adhesive capsulitis more common in?

A

MC in women, DM pt’s, Thyroid disease.

5th decade of life most common.

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27
Q

HPI of Adhesive Capsulitis?

A
  • -Gradual onset of pain.
  • -Proximal lateral arm pain.
  • *Stiffness and decreased ROM.**
  • -Trouble laying on arm.
  • -Locking of the arm.

Most will complain that their are is frozen and they can’t move it.

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28
Q

PE of Adhesive Capsulitis?

A
  1. Inspection: holding arm at side.
  2. Palpation: generalized tenderness.
  3. AROM:
    - -Decreased flexion, abduction and external rotation; most will still be able to internally rotate.
    * *Passive ROM decreased.**
  4. Strength: can be difficult to test due to stiffness.
  5. Special Tests: can be difficult to test due to stiffness.
  6. Neurovascular: normal.
29
Q

Disruption of the glenohumeral joint where the humerus translates anteriorly or posteriorly in relationship to the glenoid?

A

Shoulder dislocation

**90% are anterior. Posterior is rare.

30
Q

HPI of shoulder dislocation?

A

Anterior: “Forceful abduction and external rotation”.

Posterior: occur w/seizures, or a force applied to an internally rotated arm.

31
Q

Anterior dislocation mnemonic?

A

TUBS:

  • Traumatic injury.
  • Unilateral injury.
  • Bankart labral tear or Hill-Sachs Glenohumeral Fx.
  • Surgical mgmt, often necessary.
32
Q

Posterior Dislocation mnemonic?

A

AMBR:

  • Atraumatic.
  • Multidirectional instability present prior.
  • Bilateral or Hx of bilateral instability.
  • Rehab recommended for treatment.
33
Q

PE of Anterior Dislocation?

A
  1. Inspection = arm adducted and in external rotation.
  2. Palpation = prominent acromion, “palpable divot” where humeral head should be.
  3. AROM = minimal and painful, “internal rotation is painful.”
  4. Strength = decreased.
  5. Special tests:
    “Apprehension,” Sulcus, Dugas.
    –special tests are not for acute dislocations; mostly to eval for return to play or recovery.
  6. Neurovascular:
    “eval and document NV status pre- and post-reduction.
34
Q

PE of Posterior Dislocation?

A
  1. Inspection = “arm is in internal rotation” w/forearm on abdomen.
  2. Palpation = prominent acromion.
  3. AROM = minimal and painful, “external rotation is painful.”
  4. Strength = decreased.
  5. Special tests = Sulcus.
  6. Neurovascular:
    “Eval and document NV status pre- and post-reduction.”
35
Q

Diagnostics for Shoulder dislocation?

A
  1. XR – AP, Lateral/Scapular Y, Axillary, Posterior Oblique.

“Post reduction XR is a must!”
-Posterior Oblique = good for posterior dislocation as it gives view of glenohumeral joint.

36
Q

When is an MRI indicated in shoulder dislocation?

A

If the pt has not fully healed in 4-6 weeks and cont’d pain.

37
Q

Treatment of Shoulder dislocation?

A
  1. Reduction:
    –good muscle relaxation is a must (IV sedation).
    “Gentle Straight Traction”
    “Stimson Traction Method”
    “Risk of causing further damage incl. humeral head Fx.”
  2. NSAIDs, Analgesic, ICE, Sling for 1-2 wks.
  3. Begin gentle ROM as Sx improve.
  4. PT.
  5. “Avoid positions that might cause a dislocation.”
  6. Pt’s under 30 yrs old have a 50% chance of 2nd dislocation.
  7. Multiple dislocations = surgery.
38
Q

The cartilage that lines the glenoid providing stability to the shoulder joint?

A

Labrum

39
Q

SLAP Tears?

A

Injury to the labrum.

SLAP = Superior labrum anterior and posterior.

40
Q

HPI of a Labral Tears?

A
  • Sudden trauma (MVA, traction injury).
  • Overhead throwers.
  • Wrestlers.
  • Aging.
  • *Instability, clicking, poppin, boring pain.
41
Q

PE of a Labral Tears?

A
  1. Inspection = may notice elevation at SC joint.
  2. Palpation = crepitation w/ROM, tenderness along anterior joint line.
  3. AROM = full.
  4. Strength = full or loss.
  5. Special tests = Obrien’s, Speeds, Clunk.
  6. NV = normal.
42
Q

Diagnostics for a Labral Tear?

A
  1. XR - AP, Lateral/Scapular Y, Axillary.

2. MRI w/Arthrogram.

43
Q

Treatment for a Labral Tear?

A
  1. NSAIDs, analgesics, ICE.
  2. Glenohumeral steroid injections (fluoroscopy guidance).
  3. PT.
  4. Surgery:
    - -Labral repair.
    - -Younger pt’s.
    - -Instability.
44
Q

Labral Repair recovery and risks?

A
  1. Repair – sutures and anchors.
  2. Recovery:
    - -sling use for 6 wks.
    - -Formal PT.
    - -Return to activity = 6 months.
  3. Risks = infections, failure of sutures or anchors, limited ROM, damage to cartilage.
45
Q

What disorder causes disruption of the glenohumeral joint articular cartilage?

A

Glenohumeral Osteoarthritis

  • progressive vs. post-traumatic.
  • mild, moderate, severe.
46
Q

HPI of Glenohumeral Osteoarthritis?

A
  • -Chronic shoulder instability.
  • -Handedness.
  • -Repetitive activity.
  • -Pain, crepitation, decreased ROM.
47
Q

PE of Glenohumeral Osteoarthritis?

A
  1. Inspection = possible joint effusion.
  2. Palpation = crepitation w/ROM.
  3. AROM = decreased.
  4. Strength = decreased w/rotator cuff disease.
  5. Special tests = none.
  6. Neurovascular = normal.
48
Q

Diagnostics for Glenohumeral Osteoarthritis?

A
  1. XR – AP, Lateral/Scapular Y, Axillary.

- osteophytes, joint space narrowing, etc.

49
Q

Treatment of Glenohumeral Osteoarthritis?

A
  1. NSAIDs, analgesics, ICE.
  2. Glenohumeral steroid injection (fluoroscopy guidance).
  3. PT.
  4. Surgery
    - -Total Shoulder Arthroplasty (intact rotator cuff).
    - -Reverse Total Shoulder Arthroplasty (torn rotator cuff that is irreparable).
50
Q

Shoulder repair, recovery and risks?

A
  1. Total or Reverse Total Shoulder Arthroplasty using metal and plastic implants w/cement.
  2. Recovery:
    - -Sling use for 6 wks, w/home exercises as tolerated.
    - -Formal PT after 4-6 wks.
    - -Return to activity = 3 months.
  3. Risks:
    - -infection, failure of hardware, failure of subscapularis repair w/total shoulder, limited ROM/strength.
51
Q

Treatment for an acute muscle spasm or strain?

A
  1. Rest, NSAIDs, analgesics.
  2. Soft cervical collar, 1-2 wks.
  3. Ice (acute). Heat (chronic).
  4. PT.
  5. Chiropractic Treatment.
52
Q

What two disorders are within the cervical disc disease category?

A
  1. Cervical Disc Protrusion.
  2. Spinal Stenosis.

**presentation, diagnosis and treatment are very similar.

53
Q

“Herniation” of the nucleus pulposus outward?

A

Cervical Disc Protrusion.

54
Q

“Narrowing” and collapse of the disc space?

A

Spinal Stenosis.

55
Q

Characteristics of Cervical Disc Protrusion vs Spinal Stenosis?

A

Cervical disc protrusion:
“younger” pt’s.
“immediate (acute)” or gradual compression of the nerve root.

Spinal Stenosis:
“older” pt’s.
“gradual” compression of the nerve root.
–vertebrae become closer, bone spurs form, decreased size of the intervertebral foramen.

56
Q

Important to remember about nerve roots…

A

In the cervical spine, the nerve roots exit ABOVE the vertebrae they are numbered for.

Thoracic and down exit below.

57
Q

HPI of cervical disc disease?

A
  1. “Radicular Symptoms,” following a dermatome pattern.
  2. Neck stiffness.
  3. Painful extension.
  4. Worse w/coughing, sneezing, valsalva.
  5. “Numbness and Tingling” (ants crawling, pins/needles).
  6. “Unilateral” Sx.
  7. Referred pain along the medial border of the scapula.
58
Q

PE of Cervical disc disease?

A
  1. Inspection = neck guarding.
  2. Palpation:
    - -tenderness over cervical spinous processes.
    - -trigger points along rhomboids.
  3. AROM = decreased, pain w/extension.
  4. Strength = weakness upper extremities.
  5. Special tests:
    - - “Compression (Spurling),” Jackson’s compression, valsalva maneuver.
  6. Neurovascular = “decreased sensation” in dermatomes; reflex changes.
59
Q

Compression of the cervical spinal cord will produce PE findings where?

A

Lower extremities.

60
Q

Symptoms of a disc lesion at C5-C6?

A
  1. Pain location = neck, medial scapula, lateral arm, shoulder, dorsal forearm.
  2. Sensory Deficit = lateral forearm, thumb and index finger.
  3. Motor weakness = biceps and wrist extension.
  4. Reflex deficit = biceps, brachioradialis.

**see slide 11 on ppt.

61
Q

What to keep in mind when evaluating the shoulder?

A
  1. Repetitive motions.
  2. Age and integrity of the rotator cuff tendons.
  3. Shoulder instability overloads the rotator cuff.
  4. Downward sloping acromion.
62
Q

HPI of Tendinitis - Bursitis - Impingement?

A
  1. Pain:
    - -at night.
    - -with “overhead activity,” esp. with “abduction.”
    - -reaching behind the back.
  2. Proximal lateral arm pain (referred pain to the deltoid).
  3. Trouble laying on the shoulder.
63
Q

PE of Tendinitis - Bursitis - Impingement?

A
  1. Inspection = pt grasping lateral arm.
  2. Palpation:
    - -tenderness lateral to the acromion at the greater tuberosity, upper traps, posterior musculature.
    - -crepitation w/ROM.
  3. AROM:
    - - “pain w/ABDuction,” esp. from 60-120 degrees.
    - -pain w/forward elevation, internal rotation.
    - -passive ROM painful.
  4. Strength = minimal loss.
  5. Special Tests = “impingement, Hawkin’s”
  6. Neurovascular = normal.
64
Q

What are the Impingement and Hawkins Tests?

A

To test for AC impingement.

Impingement = AC joint impingement of the supraspinatus tendon. Involves passive forward flexion of greater than 90 degrees; + test is AC joint pain.

Hawkin’s = AC joint impingement and supraspinatus tendon weakness/tear. Same as impingement but thumb is pronated.

65
Q

Treatment for Tendinitis - Bursistis - Impingement?

A
  1. AVOID overhead activity.
  2. NSAIDs, analgesics, ICE.
  3. “Local Steroid Injection”
    - -into subacromial space.
    - -1-2cc of steroid combined w/2-4cc of local anesthetic.
    - -Safe to give every 3-4 months.
  4. PT.
66
Q

PE for rotator cuff tears?

A
  1. Inspection = pt grasping lateral arm, “deltoid assistance.”
  2. Palpation = tenderness to acromion at greater tuberosity, upper traps and post. musculature; crepitation w/ROM.
  3. AROM = may be full, “usually decreased” w/abduction, flexion. PROM usually pain free.
  4. Strength = “loss of strength” w/abduction, flexion, internal rotation.
  5. Special tests = impingement, hawkin’s, “Jobe’s (empty beer can) and Drop arm,” lift-off.
  6. Neurovascular = normal.
67
Q

What is the Jobe’s Test, Drop Arm test, Lift-off test?

A

Jobe’s Test aka “Empty Beer Can Test”
–a test for relative isolation of the supraspinatus.

Drop Arm test:

  • -fully abduct arm and then slowly lower it. A positive test is sudden drop of the arm to the side.
  • -Pain or weakness indicates painful arc syndrome (bursitis, rotator cuff strain, tendonitis, impingement).
  • -Inability to maintain a 90 degree abduction position against gravity (less than +3/5 muscle strength) indicates severe injury (grade 3 cuff tear).

Lift-off test:
–the pt reaches behind the back for the scapula (indicates anterior capsule ROM). Ability to lift the hand off the back indicates an intact subscapularis.

68
Q

Diagnostics for Rotator Cuff Tears?

A
  1. XR – AP, Lateral/Scapular Y, Axillary.
    - -may notice “humeral head elevation” towards the acromion.
    - -calcific deposits.
    - -cystic changes in the humeral head.
  2. “MRI prefered w/Arthrogram.”
  3. Ultrasound.

Ortho/Rheumatology (15 decks)

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