General Concepts, Overview 2

Question 1

what is preemptive analgesia? why does it work?

Answer 1

pre-incisional local anesthesia in addition to general anesthesia

help block pain impulses and sensitization

Question 2

what contributes to dynamic stability of the glenohumeral joint? static stability?

Answer 2

1. dynamic - rotator cuff muscles

2. static - glenoid fossa, labrum, ligaments

Question 3

what ligament in the shoulder joint holds the tendon of the long head of biceps brachii? where does it run?

Answer 3

transverse humeral ligament

between the greater and the lesser trochanter

Question 4

what ligament maintains the integrity of the superior glenohumeral joint?

anterior?

Answer 4

coracohumeral ligament

glenohumeral ligaments (anterior)

Question 5

what are the rotator cuff muscles? (list them)

when do they ALL do?

Answer 5

supraspinatus, infraspinatus, teres minor, subscapularis

pull the humeral head towards the center of the fossa, keeping it centered and keeping the humeral head to hitting the acromion as the humerus is abducted

Question 6

During abduction, the __________ must pivot to rotate the glenoid cavity and acromion upwards. This upward tilt starts at:

around _____ of abduction and continues to approximately _____ of abduction

Answer 6

scapula

30°, 120°

Question 7

what muscles tilt the glenoid (of scapula) up?

Answer 7

trapezius, serratus anterior

Question 8

the humerus must be __________ rotated (beginning at around ____° of abduction)

why?

what muscles do this?

Answer 8

laterally, 90 degrees

to move the greater tubercle out from under the acromion

teres minor and infraspinatus

Question 9

abduction of the arm is initiated by activation of what 2 muscles: (0-30 degrees)

Answer 9

supraspinatus and deltoideus

Question 10

controlled trials demonstrate efficacy of acupuncture in what areas/types of pain?

Answer 10

low back pain
knee osteoarthtitis
migraine headaches
labor

Question 11

what is the chinese medicine rational for how acupuncture works? Western medicine?

Answer 11

chinese medicine: the acupuncture points with needles help relief of stagnation of chi –> relief of pain

western medicine: release of natural opioids

Question 12

compression of subacromial soft tissues between the proximal humerus and acromion: ____________________________

Answer 12

impingement syndrome

Question 13

what muscles are usually affected in impingement syndrome?

Answer 13

long head of biceps brachii

supraspinatus

Question 14

describe the phenomenon of the “painful arc”. what syndrome is this associated with?

Answer 14

impingement syndrome

first part of abduction done without pain, but at about 6-120 degrees, there is pain (where the space under the acromion is smallest).

then from 120-180 degrees, no pain again

Question 15

explain the pathophysiology behind mild, moderate, and secure impingement syndrome:

what are the presentations on physical exam?

Answer 15

Mild: edema, hemorrhage of subacromial soft tissues. Painful arc and NO weakness

Moderate: tendinitis (usually supraspinalis), painful arc and NO weakness but PAIN to resistance

Severe: tendon tear/rupture + inflammation, painful arc and WEAKNESS

Question 16

anterior dislocation can damage what nerve?

Answer 16

axillary nerve

Question 17

what is “dead arm syndrome”? when do you see it most often?

Answer 17

damage to the axillary n.

loss of sensation over deltoid, decreased strength in abduction

anterior dislocation

Question 18

what motions give you pain with anterior shoulder laxity?

Answer 18

abduction and lateral rotation

Question 19

what motions give you pain with posterior shoulder laxity?

Answer 19

adduction and internal rotation

Question 20

describe the apprehension test. what is it for?

Answer 20

it is for anterior shoulder laxity

abduct and laterally rotate shoulder, push femoral head forward. if they have fear or do not let you continue, it is positive

Question 21

what is a “burner”/”stinger”? (specific location)

when do they resolve?

clinical presentation?

Answer 21

result of trauma to the neck/shoulder that affect 5th and 6th cervical nerve roots

usually resolve in hours to weeks

anesthesia, weakness, and dyesthesia

Question 22

define internal validity:

Answer 22

the study design performance at measuring differences between groups, if there is one, that are due only to the hypothesized effect

MEASURE OF STUDY DESIGN

Question 23

why is concealment important for internal validity of an RCT?

Answer 23

decreases placebo effect and bias (patients or investigators minimizing or maximizing symptoms)