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Foundations 3 > Disorders and Injuries of the Shoulder part 2 > Flashcards

Disorders and Injuries of the Shoulder part 2 Flashcards

1
Q

Clinical presentation of Humeral fractures

A

Severe pain
Limited ROM
Swelling
Ecchymosis (bruising)

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2
Q

What classification tool is used to assess humeral fractures?

A

Neers classification

Location, fracture parts and displacement

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3
Q

Most frequent cause of shoulder pain

A

Subacromial Impingement Syndrome (SAIS)

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4
Q

What is the pathology that creates a Subacromial impingement syndrome?

What structures are typically involved

A

Decreased subacromial space causes repetitive mircrotruama

  1. Supraspinatus tendon
  2. Subacromial bursa
  3. Long head tendon of bicep
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5
Q

What are the three types of Acromion morphology?

A

Type 1: Flat
Type 2: Curved
Type 3: Hooked

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6
Q

What affect does a Type 3 “Hooked” acromion have?

A

Decrease subacromial space

More contact with RC tendons

Increased risk of SAIS → increased risk of RC tear

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7
Q

What causes a Primary Impingement?

What age is this most common in and WHY?

A

Considered degenerative changes

> 35 y/o
Bone spurs &/or calcific deposits
“true” or “classic” impingement

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8
Q

What causes Secondary impingement?

A

Due to repetitive overhead movement

Abduction and ER

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9
Q

Who is a secondary impingement most common in and at what age?

A

<35 y/o
Overhead athlete
Faulty scapular posture

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10
Q

What contributary factors can cause secondary impingement?

A

Faulty scapular posture

  • Forward head
  • Increased thoracic kyphosis
  • Leads to adaptive muscle imbalances
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11
Q

How does muscle imbalance cause secondary impingement?

A

Tight pec minor can cause anterior tilting & protraction

↓ subacromial space → impingement → inflammation and gradual degeneration of subacromial structures

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12
Q

What findings do you see during physical exam when assessing Secondary impingement?

A

Gradual onset of anterior and lateral shoulder pain (deltoid tuberosity) exacerbated by overhead activity

Night pain and difficulty sleeping on affected side

Tenderness to palpation over greater tuberosity, subacromial bursa and biceps tendon (long head)

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13
Q

What special diagnostic test can you perform during physical exam if you suspect subacromial impingement

A

Neers impingement

Hawkins impingement test

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14
Q

What strength test are used to assess subacromial impingement?

A

External rotation strength testing
Empty can testing
Lift off Subscapularis test

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15
Q

Which imaging test would you order order for someone with subacromial impingement?

Why and for what benefit

A

X-ray

Always in cases of traumatic injury to r/o fracture
Eval for calcifications / bone spurs
Evaluation of acromial morphology

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16
Q

What are initial treatments for subacromial impingement

A

NSAIDs and avoidance of offending activities
Modify sleeping position
Therapy program focusing on postural correction
-Physical therapy
-Home therapy

17
Q

If initial treatment does not help someone with subacromial impingment what other treatment is next?

A

subacromial corticosteroid injection

18
Q

What is subacromial decompression surgery recommended?

A

Failure of conservative care (NSAIDS,injection,physical thearpy

Evidence of calcification and bone spurs

19
Q

What is the MC etiology for a Rotator Cuff injury

A

Overuse MC

Others:
Age-related degeneration
Chronic mechanical impingement
Traumatic

20
Q

Which tendon do rotator cuff injuries MC originate from?

A

Supraspinatus tendon (90%)

21
Q

Clinical Presentation of a Rotator Cuff injury?

A

Recurrent shoulder pain for several months (overuse)

Specific injury that triggered the onset of the pain (traumatic)

Subacromial pain and pain localized to deltoid tuberosity

Night pain and difficulty sleeping on affected side

Weakness, catching, and grating especially when lifting the arm overhead

22
Q

slide 29

A

slide 29

23
Q

slide 29

A

slide 29

24
Q

Gold Standard imaging to diagnose Rotator cuff tear?

What must be ordered alongside with a partial tear?

A

MRI

If chronic injury and concern is for partial tear order arthrogram

25
Q

What imaging usually has to get order prior to ordering MRI?

What does it look for?

A

X-ray

Traumatic injuries to r/o fracture
Eval for calcifications / bone spurs

26
Q

What are non-surgical treatment options for rotator cuff injuries?

What kind of tear are these best used for?

A 
NSAIDs, PT, and avoidance of overhead activities
Steroid injection (should never receive > 3 subacromial injections/year)
27
Q

When is surgery warranted for a rotator cuff injury

A

Patient with significant symptoms and failed rehab > 3-6 months

28
Q

Patient with acute TRAUMATIC cuff tear can receive what kind of treatment? How soon?

A

Surgery

Best done acutely or no later than within 6 weeks of injury

29
Q

What is Adhesive Capsulitis? (Frozen shoulder)

What age group is this found in?

What is the most common risk factor?

A

Idiopathic loss of both active and passive motion

Most commonly affects patients 40-60 years of age

DM (esp. type 1) is most common risk factor

30
Q

How does Adhesive Capsulitis occur?

A

Inflammatory process involving the glenohumeral capsule

31
Q

What is the most pronounced range of motion loss with Adhesive Capsulitis?

What are other losses

A

External rotation –> MC

Abduction
Flexion

32
Q

What kind of pain is seen with Adhesive Capsulitis?

A

Dull / achy at rest (deltoid tuberosity)

Sharp at end range of restricted movements (GH joint)

33
Q

What imaging is used to confirm suspicion of Adhesive Capsulitis?

A

MRI

Radiographs help rule out other pathologies though

34
Q

What is the “Freezing” phase seen in Adhesive Capsulitis?

A

Freezing” phase - pain and progressive loss of motion

35
Q

What is the Thawing phase?

A

“Thawing” phase - decreasing discomfort associated with a slow but steady improvement in ROM

36
Q

What are initial treatment options for Adhesive capsulitis?

A

Intra-articular injection of steroid may be considered

Physical Therapy

37
Q

What is recommended when treating Adhesive capsulitis with PHysical therapy?

A

Pain prescriptions prior to therapy

38
Q

When is surgery warranted for adhesive capsulitis?

A

after 9-12 months of failed initial treatment

Foundations 3 (25 decks)

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