DSA 22 Webb Shoulder

Question 1

What muscles attach to the

1. greater tubercle
2. less tubercle
3. deltoid tubercle

Answer 1

1. Suprasinatus inserts here
2. subscapularis inserts here
3. Deltoid inserts here

Question 2

What attached to the coracoid process?

Answer 2

. coracobrachialis and short head of bicep

Question 3

What is the labrum in the GH joint?

Answer 3

fibrocartilaginous rim attached around the margin of the glenoid cavity in the shoulder blade

Question 4

What are the names of the 4 muscles that make up the rotator cuff?

Answer 4

1. Supraspinatus
2. Infraspinatus
3. Teres minor
4. Subscapularis

Question 5

What are the attachments and action of the supraspinatus?

Answer 5

.

Question 6

What are the attachments and action of the infraspinatus?

Answer 6

.

Question 7

What are the attachments and action of the teres minor?

Answer 7

.

Question 8

What are the attachments and action of the subscapularis?

Answer 8

.

Question 9

What 3 main xray views do you order with a shoulder every time?

Answer 9

Axillary, Grashey, and Template of Shoulder

Question 10

A pt with a glenohumeral joint dislocation presents with (3)

Answer 10

1. feeling like popped out of place
2. guarding/won’t move shoulder
3. severe pain

Question 11

How is the arm held with anterior GH dislocation?

Answer 11

held in external rotation

Question 12

How is the arm held with posterior GH dislocation?

Answer 12

held in internal rotation

Question 13

Describe a Bankart lesion.

Answer 13

• an avulsion of the anteroinferior glenoid labrum at its attachment to IGHL complex;
• Result of anterior shoulder dislocation and felt to be d/t recurrent anterior shoulder instability

Question 14

Describe a Hill Sachs lesion.

Answer 14

posterolateral humeral head indentation fracture is created occuring from anterior shoulder dislocation, as soft base of humeral head impacts against relatively hard anterior glenoi

Question 15

Injury to the axillary nerve presents as….

Answer 15

1. defect in sensory to posterior and superior arm

2. detect in deltoid and teres minor

Question 16

When do you perform surgery on a pt with GH dislocation?

Answer 16

1. younger than 25 and 1st time dislocating

2. recurrent dislocation despite non-op tx

Question 17

What is a typical hx for AC separation (3)

Answer 17

1. fall directly onto point of shoulder
2. complaint of lateral shoulder pain at “tip” of shoulder
3. athlete will hold arm at side

Question 18

List 3 findings on PE with AC separation

Answer 18

1. Pain over AC joint
2. Pain with cros arm test
3. Prominent AC joint or distal clavicle elevation

Question 19

How many classification types of AC separation are there?

Answer 19

1-6

Question 20

What classifications of AC separation can be tx non-operatively?

Answer 20

1-3

Question 21

What classification of AC separation are tx with surgery?

Answer 21

4-6

Question 22

What ligament(s) is(are) torn with a Type I?

Answer 22

Sprain of AC ligment

Question 23

What ligament(s) is(are) torn with a Type II?

Answer 23

Tear AC and sprain the coracoclavicular ligament(CC)

Question 24

What ligament(s) is(are) torn with a Type III

Answer 24

tear both the AC and coracoclavicular ligaments

Question 25

What is the typical hx for a proximal humeral fx?

Answer 25

fall onto shoulder or on outstretched hand

Question 26

With a proximal humerus fx what nerve might be damage and what are the results?

Answer 26

axillary with loss of sensation to lateral side of shoulder

Question 27

How are most proximal humeral head fx treated?

Answer 27

nonoperatively if minimal displacement of parts is present | Sling and early passive ROM

Question 28

What is the typical hx for a clavicle fx? (2)

Answer 28

1. fall onto area of shoulder or directly onto clavicle 2. deformity of bump

Question 29

How are MOST clavicle fx tx?

Answer 29

non-operatively wiht sling, immobilize for 3-4wk

Question 30

When are clavicle fx tx surgically? (3)

Answer 30

1. open fx 2. large displacement 3. tenting of skin

Question 31

What is the hx for a Burner/Stinger Injury (5)

Answer 31

1. short duration 2. UE only 3. Unilateral 4. Pain free c-spine motion 5. numbness and shoulder weakness

Question 32

Do you need to get an xray for a Burner/Stringer injury?

Answer 32

no, if you get one, it will be normal

Question 33

What is a typical hx in a pt with a proximal bicep tendon rupture? (4)

Answer 33

1. feel a pop 2. usually lifting something when pop occurs 3. bruising in upper arm 4. May have a bulge (popeye arm)

Question 34

What will a proximal biceps tendon rupture show on MRI?

Answer 34

absent intra-articular biceps tendon

Question 35

A proximal biceps tendon rupture usually involved which head?

Answer 35

long head

Question 36

A distal rupture of the bicep involves which head?

Answer 36

both short and long, more urgent tx

Question 37

What other injury should one be thinking in an older pt with a proximal biceps rupture?

Answer 37

rotator cuff tear

Question 38

What are the 2 types of chronic instability of the shoulder?

Answer 38

1. traumatic | 2. atraumatic

Question 39

What does TUBS stand for

Answer 39

T- traumatic U-unilateral B- Bankart S- Surgery

Question 40

What does AMBRI stand for

Answer 40

``` A- atraumatic M- multi-directional B- bilateral R- recurrent I- inferior capsular shift if surgery needed ```

Question 41

What is a typical hx for shoulder impingement (4)

Answer 41

1. dull ache worse in evening 2. pain generalized or lateral upper shoulder 3. worst with overhead activity 4. hurts to sleep on

Question 42

How do you perform Hawkins test and what is positive?

Answer 42

-pt sits with arm at 90 and elbow flexed at 90, physician stabilizes just distal to elbow joint and just proximal to wrist, then moves pt into internal rotation, positive test is pain in subacromial space

Question 43

Statement: The more curved the acromion the more likely for impingement on rotator cuff tendons below and less space for rotator cuff to run under bone

Answer 43

. just a statement to review

Question 44

What is a typical hx for a pt with biceps tendonitis (2)

Answer 44

1. proximal pain along anterior humerus | 2. hurts with overhead activity and with throwing or pushing

Question 45

What is the name of the test that results in pain with resisted supination of forearm?

Answer 45

Yergasons Test

Question 46

What is the name of the test that results in pain with resisted flexion of the arm?

Answer 46

Speeds test

Question 47

What needs to tear in order for subluxation of the proximal tendon out of the groove on the shoulder to occur? (2)

Answer 47

transverse humeral ligament and usually the subscapularis tendon

Question 48

What action indicates Infraspinatus weakness?

Answer 48

ER weakness

Question 49

What action indicates supraspinatus weakness?

Answer 49

Empty can sign, forward elevation

Question 50

What action indications subscapularis weakness?

Answer 50

Lift off sign, belly press

Question 51

What action indicatons teres minor weakness?

Answer 51

IR weakness

Question 52

When do you treat rotator cuff tears with surgery (4)

Answer 52

1. younger pt 2. full thickness tears 3. acutely retracted tears 4. good tendons and muscles

Question 53

List 4 conditions that are associated with frozen shoulder

Answer 53

trauma to chest, breast surgery, DM, thyroid dz

Question 54

frozen shoulder usually effects what population

Answer 54

women menopausal age

Question 55

What motion is typically lost first with a frozen shoulder?

Answer 55

internal rotation

Question 56

How do you differentiate a frozen shoulder from a rotator cuff tear?

Answer 56

RCT will have PROM