Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

5 Ortho > L5 Shoulder Evaluation > Flashcards

L5 Shoulder Evaluation Flashcards

1
Q

What informs your clinical reasoning?

A
  1. Progression and/or stage of S/S
  2. stability of condition
  3. presence of preexisiting conditions
  4. presenting impairments and how they relate to functional limitations
  5. patients current overall level of functioning
  6. patients personal factors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Articular Injuries

A

glenohumeral OA, inflammatory arthritis

instability
labral tear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Periarticular Injuries

A

calcific tendinitis
adhesive capsulitis
biceps tendinitis
AC joint arthritis
AC joint sprains
RC pathology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Osseous Injuries

A

proximal humerus or clavicle fracture
bone cysts
infections
tumors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Referred pain

A

cervical radiculitis and arthritis myofascial neck pain
cardiac, splenic, hepatic, diaphragmatic etiologies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Biomechanical pain

A

scapular dyskinesia w/o structural pathology, repetitive motion resulting in fatigue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Capsular pattern

A

inflammation such as rheumatoid, spetic, gout, traumatic arthritis or capsulitis, OA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Non-capsular pattern

A

present when non-capsular factors cause the decreased range. Bursitis, loose body in the joint, joint sublixation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Capsular pattern of GHJ

A

Capsular pattern of GHJ is ER most limited followed by abduction and IR

determine capsular pattern by performing full PROM at end range

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Subacromial impingement movement pattern

A

abnormal movement patterns in patients w/shoulder pain is substantial

but you cannot prove causation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which special tests provide clinicians with the most value when examining the shoulder?

A

combinations of shoulder physical exam tests provide better accuracy, but marginally so

support for stressing a comprehensive clinical exam including hx and physical examination

combine 2-3 tests of opposing sensitivity and specificity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Diagnosis is

A

the process and end result of information obtained in the exam and eval

you have to exam to arrive at initial hypothesis and then eval to weigh all your data

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Diagnostic gold standard for shoulder conditions

A

SLAP: MRA
GHJ OA: clinical and imaging
Frozen: clinical
RC Tears: MRI and US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Prognosis

A

the process of determining the level of optimal improvement that may be obtained from intervention, and how long to reach that goal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Plan of Care

A

specific interventions to be used and the proposed duration and frequency of interventions taht are required to reach teh anticipated goals and outcomes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

General factors that influence prognosis and outcomes

A

patients health status, risk factors, respose
needs and goals
natural history
complexity, severity, acuity
personal and environmental factors

17
Q

Prognostic Factors for Shoulder Pain

A

longer duration of symptms
gradual onset of symptoms
high pain intensity
45-54 years of age
catastrophizing

18
Q

Shoulder pain and the workplace

A

very common, most likely not caused by work
many cases no cause is found

managing shoulder pain should be a biopsychosocial model, to help them to return to work sooner

19
Q

Natural history of asymptomatic full thickness tears

A
  1. present in individuals in their 60s and 80s
  2. Common, increased incidence with aging
  3. Develop symptoms 2-3 years
  4. Larger tears are more likely to develop symptoms
20
Q

Natural History of RCT Symptomatic

A
  1. Progress in tear size in an avg of 2 years
  2. Size progression is correlated with increasing symptoms
  3. Small full thickness tears have a lower risk of progression
  4. partial thickness progress slower than full thickness tears
21
Q

Re-tears of RC after surgery

A

RC repairs have a 20-90% of re-tears

best predictor of rotator cuff integrity post op was preoperative tear size

tears over 6 cm are less likely to heal completely

22
Q

Predictors for positive outcomes, RCT

A

younger age (younger than 55)
smaller tear size (1-2 cm)
shorter symptom duration
absence of worker comp

worse preop status was associated with greater improvement

23
Q

Low Risk for irreversible change RCT

A

intact RC or small partial thickness tears

24
Q

At Risk for irreversible change RCT

A

<65 yo, symptomatic full thickness, acute tear of any size, tears with loss of function

25
Q

Irreversible changes have occurred group RCT

A

large (3-5 cm), chronic tears or >70

26
Q

Absolute indications for surgical repair of RCT

A

onset of acute, post trauma weakness in younger active individuals

27
Q

Relative indications for RCT surgery

A

pain or weakness that has been refractory to an appropriate course of non-operative management

28
Q

Non-operative treatment for RCT

A

patients w/tendonitis, partial thickness, small full thickness, chronic tears in older, all large irreparable tears

29
Q

Prognosis for GHJ Instability

A

70-100% recurrence rate in pts younger than 20

immobilization is not indicated for younger pops

older pts may have RCT, fracture, neuro deficit

30
Q

Surgery is not indicated in GHJ instability for

A

patients with low physical demands greater than 20
asymptomatic in ADLs

31
Q

RF for Reinjury after Bankart Repair

A

age <22 years old
male
number of preop dislocations
participation in sports
loss of glenoid or humeral bone
presence of anterior avulsion

32
Q

Surgery for GHJ instability

A

young adults engaged in high demand sports who have had their first acute dislocation

no evidence for those not within those categories

33
Q

Patients with dislocation do not need

A

mobilization

34
Q

Secondary impingement and tensile overload due to underlying instability do not need

A

GHJ mobs

35
Q

Grade 2+ posterior translation do not need

A

posterior glides to increase IR

36
Q

Subacromial impingement interventions

A

eccentric exercises for RC and concentric for scapula stabilizers reduces pain and improves function

37
Q

Potential Controversies

A

Will surgery benefit the patient
could surgery make it worse
does the patient believe PT as a viable intervention

5 Ortho (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions