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Upper Test 1 > Lec 3 > Flashcards

Lec 3 Flashcards

1
Q

What kind of joint is the sternoclavicular joint?

A

Saddle

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2
Q

What are the 3 questionnaires for adhesive capsulitites?

A

Disabilities of the arm, shoulder, and hand (DASH)

American shoulder and elbow surgeons score (ASES)

SHoulder pain and disability index (SPADI)

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3
Q

Does musculoskeletal pain typically increase or decrease w/ the stopping of movement / exercise?

A

It stops

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4
Q

Is musculoskeletal activity worse in the day or night?

A

Day - not as much pain at night because the muscles arent moving

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5
Q

Is musckuloskeletal pain continuous or intermittent?

A

Both - all the time or in short bursts

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6
Q

Is systemic pain increased or decreased w/ pressure

A

decreased- if you push on it and it takes away your pain it is often systemic

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7
Q

KNOW: Systemic pain disturbs sleep - however - severe muskuloskeletal pain can also do this

A
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8
Q

Is systemic pain constant or in waves?

A

Both

think throbbing w/ a pulse

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9
Q

KNOW: know facet refferal patterns

A
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10
Q

How is the olecranon-manubrium percussion test performed?

What does it tell us

What 3 bones is it listening for

When it this test typically performed

A

pt seated w/ ARMS CROSSED

place the stethascope on the widest part of pt’s sternum (NO CLOTHING COVERING)

Tap hard on the very bottom of olecranon (the part w/o fat on it)

If you hear a noise w/ stethascope = no fracture (most likely)

Abnormal = no sound = fracture most likely

NOTE: This is listening for fractures along the humerus / clavicle / scapula

Typically performed after traumatic incident, onset of brusing or swelling

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11
Q

How should the stethascope be pointed?

A

angle pointed toward nose

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12
Q

What is the purpose of the bony apperhension test?

A

to rule out/in acute tramatic instability of the shoulder

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13
Q

How is the bony apperhension test performed?

What will the result of a positive test be

Is it passive or active

A

pt is sitting
PT is directly behind the pt

support upper arm /** elbow** w/ one hand and grab forearm/wrist with the other. Abduct the shoulder to 45 degrees, then externally rotate the shoulder

NOTE: This test is completely passive - were doing the entire thing w/ no muscle contraction

Go to pt max w/ NO overperssure (check this)

Positive = pain in the shoulder or it popping out of socket

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14
Q

What are the 4 tests to rule in upper extremity DVT. How many do we need to rule it in?

A

1) The presence of venous material (catheter, venous access, or pacemaker) +1

2) Upper extremity, UNILATERAL pitting edema (push and there isnt fast capillary refill) **+1

3) Localized upper extremity pain +1

4) Another diagnosis is reasonably plausible** -1**

Need 2/4 to have a high risk for DVT

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15
Q

Should we do physical activity w/ someone with DVT? Why?

A

No

Because we don’t want to blood clot to move and become an embolism

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16
Q

What does a brachioradialis reflex look like?

A

Elbow flexion (DOESNT CROSS WRIST) / more like the elbow moves back some

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17
Q

NOTE: Reflexes test the neural conduction down the extremity as well as sensitivity of golgi tendon receptors

Reflexes are a great screening tool for overall neural health

A
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18
Q

Pt presents with poor biceps tendin reflex. What two things could be the issue and where

A

There could be a problem with the golgi tendin receptors in the biceps tendon itself

There could also be a problem w/ C5 myotome (this is a great way to test C5 for that elbow flexion)

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19
Q

Pt presents with impaired C6 dermatome. Whats an appropriate test?

A

C6 = wrist extension

However, testing braichio radialis reflex helps us figure this out (even though brachioradialis does not mess with the wrist)

Check

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20
Q

pt presents w/ a poor tricep reflex. What two things could be an issue

A

The golgi tendon organs in the triceps tendin could be impaired

The C7 dermatome that does that elbow extension could be impaired.

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21
Q

How is a briachioradialis reflex done?

A
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22
Q

How is biceps reflex checked?

A

make sure to tense tendin before taking reflex

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23
Q

where is the conoid tubercle located?

A

3/4 of the way lateral on the clavical - posterior / inferior side

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24
Q

how is the spine of the scapula angled?

A

Goes up as it goes lateral (put them together and you have a smile)

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25
Q

Where is the coronoid fossa?

A

anterior distal medial humerus

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26
Q

where is the radial fossa?

A

Anterior distal lateral humerus

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27
Q

whats more medial the trochlea or the capitiulum?

A

Troachlea

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28
Q

Where is the olecranon fossa?

A

Posterior distal humerus

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29
Q

what does the capitulum articulate w/

A

radial head

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30
Q

What does the trochlea articulate w/

A

ulna

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31
Q

KNOW: On the back of the humerus you only have the trochlea (no captilum)

A
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32
Q

where is the scapular notch?

A

just medial to the coarcoid process

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33
Q

Where is the coracoacromial ligament

A

between the coracoid process and the acromium

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34
Q

Where is the coraco clavicular ligament?

A

between the coracoid process and the clavicle - note this ligament has two heads

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35
Q

What bones does the shoulder complex include?

A

Scapula / humerus / clavicle

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36
Q

What 4 joints make up the shoulder complex

A

Glenohumeral
Acromioclavicular
Sternoclavicular
Scapulothoracic

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37
Q

What does the transverse humeral ligament do?

A

Holds the biceps long head tendin down

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38
Q

What kind of joint is the sternoclavicular joint?

A

Saddle joint

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39
Q

What is the pattern of ristriction for a frozen shoulder?

A

External rotation –> Abduction –> Internal Rotation

(these are the 3 lost with external rotation being the most lost)

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40
Q

Patient walks in and you are trying to figure out what pathology they have going on. What would be something that would lead you to think they have adhesive capsulitits?

A

Limited internal rotation (lots of other shoulder pathologies have external rotation issues but few have internal rotation problems)

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41
Q

What motion is most limited with adhesive capsulitits?

A

External rotation

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42
Q

patient comes in with internal rotation issues. What am I thinking they have

A

adhesive capsulitits

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43
Q

Why are external and internal rotation so affected by adhesive capsulitits

A

Because the ligaments are all swollen and taught

With internal rotation we have an anterior roll posterior slide. this front and back movement is limited by the joint capsule. Vice versa w/ external rotation

NOTE: abduction is also limited

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44
Q

What does an AROM test test for

A

contractive tissue issues

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45
Q

What does PROM test for?

A

ligamentous / capsular problems

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46
Q

Shoulder flexion ROM

A

180 degrees

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47
Q

Shoulder extension ROM

A

60 degrees

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48
Q

Shoulder abduction degrees

A

180

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49
Q

External rotation degrees

A

90

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50
Q

Internal rotation degrees

A

70

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51
Q

Horizontal abduction degrees

A

90-100

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52
Q

Horizontal adduction degrees

A

40-50

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53
Q

What vertebra is the top of the scapla at

A

Around T2

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54
Q

What vertebra is the spine of the scapula at?

A

T4

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55
Q

What vertebra is the bottom of the scapula at?

A

T7

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56
Q

What vertebra is the bottom of the ribs at

A

T12

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57
Q

What vertebra are the hips at

A

L4

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58
Q

What vertebra is the PSIS at

A

S2

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59
Q

What plane do elevation and depression of the clavical move within?

A

Frontal

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60
Q

What two movements go along w/ clavicular elevation?

A

Abduction / flexion (things where you move your arm overhead

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61
Q

What two motions go along w/ clavicular depression

A

Shoulder adduction / extension to neutral (bring arm back down from flexion)

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62
Q

Sternoclavicular elevation arthrokinematics

What about the movement(s) it produces

A

superior roll inferior slide

Adduction / Flexion

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63
Q

Sternoclavicular depression arthrokinematics

What motions does it produce

A

Inferior roll superior slide

Adduction, Extension (to neutral)

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64
Q

What plane of motion is protraction / retraction at the sternoclavicular joint?

A

Transverse plane (think scapula going in a circle when you reach out)

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65
Q

Give the arthrokinematics of protraction at the sternoclavicular joint

what motions go along with this

A

Anterior roll / Anterior slide

Horizontal adduction / scapular protraction

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66
Q

Sternoclavicular retraction arthrokinematics

What motion(s) go with it

A

Posterior roll / posterior slide

horizontal abduction / scapular retraction

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67
Q

What are the arthrokinematics of sternoclavicular anterior rotation?

What movement(s) go along with it

A

Anterior spin

Goes with extension (back to neutral) and adduction

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68
Q

What are the arthrokinematics of posterior rotation of the clavicle (sternoclavicular)

What movement’s go along with it?

A

spin

Flexion / abduction

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69
Q

Patient lifts arm overhead (in flexion). What is happening at the sternoclavicular joint? (arthokinematics

A

Clavicular elevation: Superior roll / inferior slide

Posterior rotation: Spin

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70
Q

Patient goes from full flexion into extension (to neutral). What is happening at the sternoclavicular joint (arthrokinematics / movements)

A

Depression of the clavicle: Inferior roll superior slide

Anterior roll: spin

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71
Q

Patient adducts arm. what is happening at the sternoclavicular joint? (arthrokinematics / movements)

A

Depression of clavicle: inferior roll, superior slide

Anterior roll of clavicle: spin

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72
Q

Patient reaches out infront of them to grab a ball sitting on a shelf at eye level. What is happening at the sternoclavicular joint? (movement / arthrokinematics)

A

Protraction

Horizontal adduction / scapular protraction

anterior roll, anterior slide

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73
Q

Patient is on a rower and pulls both of their elbows back. What position is their sternoclavicular joint in? Arthrokinematics?

A

Retraction

Horizontal abduction / scapular retraction

Posterior roll / posterior slide

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74
Q

What motions are at the acromioclavicular joint?

A

Downward / Upward rotation
External / Internal rotation
Anterior / Posterior Tilting

All considered spin movements because its a disc joint

75
Q

What movements go with upward rotation of the scapula at the Acromioclavicular joint. Arthrokinematics?

A

Raising arm (flexion / abduction)

Considered a spin because the AC joint is a disc joint

76
Q

Downward rotation at the acromioclavicular (scapula) joint encompasses what movements? Arthrokinematics?

A

lowering arm to neutral movements
Adduction / Extension (to neutral)

Spin

77
Q

What movements cause external rotation of the scapula at the AC joint? Arthrokinematics?

A

Just imagine taking that glenoid cavity externally

Glenohumeral external rotation / retraction

Spin

Almost imagine that medially border pressing hard against the spine while the glenoid cavity tries to move posterior (glenoid always reference point)

78
Q

What movements go with scapular interal rotation at the acromioclavicular joint?

A

glenohumeral internal rotation / protraction

Spin

Just imagine that glenoid cavity being shifted anterior and the medially border of the scapula is being ripped away from the back (everything from the reference point of the glenoid)

79
Q

KNOW: Think of the AC joint almost like two convex surfaces. Whenever you move any direction you will have that spin

A
80
Q

What movements go with scapular anterior tilt?

A

Elevation of the scapula / arm (ribs moves up and over the ribs) / protraction. Essentally were talking about the glenoid cavity being shifted anterior which causes the whole top of the scapula to move anterior and the inferior portion to move posterior
* Associated w/ excessive thoracic kyphosis (think the posterior portion of scapula sticking out the back)

81
Q

What movements go with scapular posterior tilt?

A

Posterior tilt is the entire top of the scapula shifting back which shifts the entire bottom half anterior

end range shoulder flexion / retraction / depression

82
Q

What acromioclavicular joint movement is associated w/ kyphosis?

A

anterior tilting (puts you in that protracted / pulled forward position

(makes since you’re hunched forward)

83
Q

What scapulo throacic joint motions do we have? (no arthrokinematics just scapula on thoracic ribs)

A

Elvation / depression

Protractoin / retraction

Upward / Downward rotation

NOTE: we do not have interal / external rotation here. We also don’t have anterior / posterior tilt - all of these are taking the scapula off the ribs

84
Q

What motions at all the joints we talked about do we have w/ scapular upward rotation (entire complex)

A

Scapularthroacic joint = upward rotation

Acromioclavicular joint = upward rotation (spin)

Sternoclavicular joint = elevation
*Superior roll & inferior slide

85
Q

What movements do we have scapular elevation? (entire complex)

A

Acromioclavicular joint = downward rotation (spin) (keeps scapular angle from changing to much (keeps scapular vertical position)

Sternoclavicular joint = elevation
* Superior roll / inferior slide

86
Q

What movements do we have w/ scapular protraction (entire complex)

A

Sternoclavicular joint: Protraction
* anterior roll / anterior slide

Acromioclavicular joint: Internal rotation
* Spin

Makes sense - scapula is essentially going lateral moving around the rib cage

87
Q

Wasting of what muscle causes scapular winging

A

serratus anterior (long thoracic)

88
Q

Every every __ degrees of motion at the humerus __ degree of motion happens at the scapula

A

2,1

89
Q

For full 180 degrees of abduction the humeral head moves in the glenoid cavity 120 degrees. How many degrees does the scapula rotate?

A

60

90
Q

Can PT’s look at scapular movement and decide if its typical or atypical?

A

No - its not easy

91
Q

What glenohumeral joint assessments do we do?

A

Inferior glide
Lateral distraction
Anterior glide
Posterior glide

92
Q

What sternoclavicular joint assessments do we do?

A

Inferior glide
Superior glide
Posterior glide

93
Q

KNOW: When the pt first comes in the clinic we do lots of sensitivity tests (negative = rule out). Its like getting the dirt off the problem. Then we can determine if they are appropriate for PT

Then we try to see if the shoulder is the true origin or if its reffering from somewhere else

If we determine that it is coming from the shoulder we can start to rule in things like subacromial pain syndrome / adhesive capsulitits / glenohumeral instability etc…

Then we would try and figure out what kind of tissue is involved. Is it nerve, muscle, labrum etc… and we want to figure out their irritability

This irritability will affect how we treat them

A
94
Q

How do you do an internal rotation resisted strength test?

A

pt in 90 degrees abduction and 80 degrees external rotation. then compare that to internal rotation strength. based on this ratio we can tell if its intra articular or extra articular

If interal rotation strength < external rotation the test is positive ofr intra articular pathology (aka internal rotation less than external = something is happening within the capsule or intraarticular)

If internal rotation strength is > than external strength than that would indicate a rotator cuff pathology

If they’re realtively equal but still having pain we would proably still lean to extra articular issues (outlined below)

If internal rotation strength is&raquo_space; external rotation strength the test is positive for a rotator cuff pathology

Rotator Cuff pathology: Rotator cuff tears, rotator cuff tendinopathy and impingement syndrome (this would be if internal rotation strength > than external rotation strength)

Extra-articular pathologies: AC joint lesions, LHB tendinopathy, and/pr referred pain from any part of the body (this would be if they’re both weak but realtively equal)

Intra-articular pathology: Glenohumeral capsulolabral instability and/or lesions and itneral impingement syndrome (this would be if internal rotation strength was less than external rotation strength)

95
Q

What kind of tests would I do if I found that shoulder external rotation was weaker than shoulder internal rotation (int > ext)

A

Rotator cuff tests

96
Q

I have found that the pt has stronger IR than ER at the shoulder. What two issues am I looking for

A

IR > ER = Rotator cuff pathology

Tests:
* Rotator cuff impingement syndrome
* Rotator cuff Tears

97
Q

Therapist does an internal rotation rested strength tests and finds that both internal rotation and external rotation are both equal but realively weak. What should the therapist be thinking?

A

Extra articular pathology

98
Q

What are some examples of extra articular pathologies? (3)

A

AC Joint lesions
Long head Bicep (LHB) Lesions
Shoulder pain referred from another body region

99
Q

pt presents w/ a stronger ER than IR on internal rotation resisted strength test what does that tell us?

A

Weaker IR = Intra articular pathology

100
Q

What are some examples of intra-articular apthologies?

A

Anterior capsulolabral insability

Posterior Capsulolabral instability and / or lesions

Bankart lesions

SLAP lesions

Articular internal impingement syndrome

101
Q

What age group typically gets rotator cuff tears?

A

Older (65+)
* Think weak musles tear easier

102
Q

What kind of rotator cuff tears are more prominant:
* partal thickness
* Full thickness

A

Full thickness tears more common

103
Q

Who normally gets subacromial impingement syndrome?

A

This is the acromium pinching down
* typically 35+ (think middle aged)

104
Q

Why would crepitus be present w/ rotator cuff pathologies?

A

The primary function of the SITS muscles are to pull the head of the humerus into the glenoid cavity. When one of these muscles tears it is unable to pull the head in as effiecntly - meaning that when you move you are going to have some form of clicking

105
Q

What motions hurt w/ rotator cuff pathologies

A

Limitation lifting arm over head (causing shoulder pain)

So they would have trouble lifting, carrying, dressing and bathing

106
Q

Is a RTC injury a sudden onset or a gradual onset

A

Both

Rotator cuff pathology = more gradual (I think this is the wasting away of the muscles)

Tracumatic event = sudden

107
Q

What typically causes subacromial impingement syndrome?

A

Changes in loads the shoulder

AKA someone working out for this first time in forever, participating in a new sport or performing any new movements that htey havent done before

108
Q

KNOW: RTC causes night pain, weakness, loss of motion, pain with “certain movements”

A
109
Q

Where does most rotator cuff pain occur?

Where can it radiate down to?

A

Most occurs at the shoulder but can radiate down to the deltoid tuberosity

110
Q

NOTE: with rotator cuff issues we have 4 tendons here so any of them could be the issue (we can do individual muscle tests to figure that out)

A
111
Q

Why does rotator cuff pain limit “certain movements” that can be different for different people?

A

Because a rotator cuff tear can be any of the 4 muscles and depending on which one has been injuried will tell us what symptoms will be limited

112
Q

What activities cause pain w/ subacromial impingement?

A

Patients that report pain w/ raising arm (note: roator cuff also has pain w/ doing this)

Think primarily abduction but flexion as well

thats because things are litteraly getting pinched under the acromium

NOTE: This pain can be constant or intermittent

113
Q

Where is pain noted w/ subacromial impingement syndrome?

A

Just under the acromium or just posterior to acromium

NOTE: When abducting / flexing that subacromial space gets pinched

You can get pinching of the bursa / inflammation

You can also get pinching of supraspinatus tendon

114
Q

KNOW: sometimes impingement syndrome can cause a rotator cuff tear (because the supraspinatus tendon is constantly being pinched)

A
115
Q

Where would a partial thickness articular side tear be?

A

Supraspinatus tendon side closer to the bone (the articulation)

116
Q

Where would a partial thickness bursal side tear be?

A

RTC tear on the bursa side (so top) of the supraspinatus tendon

117
Q

What is a intramuscular cyst of the RTC

A

Cyst that spread inside the muscles of the rotator cuff and can cause RTC tears

118
Q

What is a partal thickness avulsion of supraspinatus tendon?

A

Rotator cuff tear that involves the spiraspinatus tendon pulling away the humeral head

119
Q

What subgroup of people typically get partial thickness avulsion of supraspiantus tendon (RTC tear)?

What action are they normally doing?

A

Older (65+)

Straining injuries (trying to lift something or doing something vigrous)

120
Q

What is an interstital RTC tear?

A

Tear in the middle of the tendon

121
Q

what is a full thinkness tear of a rotator cuff muscle?

A

Tear that goes all the way through

122
Q

NOTE: For special tests just note if they’re good at diagnosing or ruling out

A
123
Q

Special test item cluster for full thickness rotator cuff tear

How many do we want to be posititve

A

1) Pain with dropping arm (pt brings arm up and can he hold it without pain or dropping)
* Positive = dropping arm / pain

2) Painful Arc for GH dysfunction: pt has pain between 45 degrees and 120 degree but painless in other parts (note if it hurts right near 1700 degrees were thinking more acromioclavicular injuries)

3) Infraspinatus (ER) weakness/pain compared w/ to IR (IR stronger than ER)

We want all 3 to be posititve = 91% sure they have a full thicknes stear

124
Q

What 4 things are common w/ an intraarticular pathology

A

NOTE: This is when ER strength > IR strength

1) Instability
2) Bankart Lesion
3) Hill-Sachs lEsion
4) SLAP lesion

(These are the 4 things were thinking when pt presents with that ER > IR) - intracapsular

125
Q

What are the three kinds of shoulder instability?

A

TUBS: Traumatic Unidirectional instability with Bankart lesion requiring Surgery

AMBRII: Atraumatic onset of Multidirectional instability that is accompanied by Bilateral laxity or hypermobility. Rehabiliation indicated, however if operation is necessary, a procedure such as a capsulorraphy is performed to tighten the Inferior capsule and the rotator Interval

rraphy = surgerical repair

SLAP Lesion: Superior Labrail Anterior Posterior lesion

126
Q

What is the MOI for a slap lesion?

A

Fall / overhead Athletes forcefully using the bicep (causing the tendin to have issues)

I think like doing a handstand where you’re causing an eccentric contraction of that bicep long head tendin which conntects to the labrum

127
Q

What normally causes SLAP lesions? Why?

(Not MOI But what breaking causes it)

A

Bicep long head tendinopathy

This happens because 50% of the bicep long head tendin acctches the labrum and 50% go to the supraglenoid tubercle

128
Q

KNOW: Normally there is some MOI for TUBS (could be MVA / sporting event / other traumatic incident)

NOTE: shoulder is normally somewhat over the head when the accident happens (in some smount of abd)

A
129
Q

Do dislocations normally happen w/ TUBS injuries? What nerve pathology is typically linked to TUBS syle injuries

A

Yes - (bankart must dislocate)

axillary n

130
Q

what is the pain like w/ TUBS injuries?

A

Sharp (they just popped their shoulder out of place_

131
Q

Do TUBS pts have a history of instability?

A

Not typically - its traumatic and one direction

132
Q

Do we normally have surgery w/ TUBS injuries?

A

Yes TUBS

133
Q

Do people w/ AMBRI’s have a hx of dislocation?

A

Yes, its multidirectional which means its proably a genetic thing)

134
Q

Does a traumatic event cause AMBRII’s?

A

Atraumatic AMBRI

135
Q

NOTE: W/ TUBs we typically see a lack of trust in shoulder

In AMBRI’s they might have a lack of trust OR the y might not even care if they have subluxations anymore because its happened so many times

A
136
Q

What age group typically gets AMBRIs?

What kind of people (physical charcteristics)

What disorders do they typically have?

A

10-35 (younger population)

Thinner - less muscle mass around shoulder (teenagers / young adults typically thinner individuals)

Connective tissue disorders (Ehler-Danlos syndrome / downsyndrome / marfan)

Think soccer field

137
Q

Do people w/ AMBRI’s have rigid or lax ROM?

A

Rull / excessive ROM (makes sense their connective tissue is lax)

138
Q

A chronic AMBRI pt has anterior instability. Which direction are the most likely to sublux

A

Extension

139
Q

An AMBRI pt has anterior / inferior instability what movements does this make weak

A

abduction (inferior slide) / extenrional rotation (anterior roll)

This would be more swinging / OH athletes

140
Q

An AMBRI pt has posterior instability. What movment is affected?

A

Weight bearing in 90 degrees of shoulder flexion (pop out through the back)

141
Q

Where does a bankart lesion occur

A

Anterior inferior aspect of the labrum

142
Q

What kind of shoulder instability goes along w/ a bankart lesion (AMBRI)

A

Anterior instability (it breaks and the shoulder pops anteriorly then moves medially causing that bankart lesion)

143
Q

Where is a Hill-Sachs lesion? What causes it?

A

Posterior superior lateral humeral head

Typically AMBRI anterior instability of the humerus poping into the scapula

144
Q

What is a boney bankart lesion?

A

When the slipping of the humerus actually breaks the bone under the labrum

145
Q

What is the most common kind of shoulder dislocation?

A

Anterior

146
Q

Who gets more Bankart lesions?

A

Younger thinner

This was mentioned as a instability thing (AMBRI)

147
Q

Why would it be worse to have a hill-sachs lesion as a kid?

A

Because you’re still growing so it might cause growth plate issues

148
Q

Of the glenohumeral ligaments, which one is the strongest?

what about weakest?

A

Middle glenohumeral

Inferior glenohumeral

149
Q

What is the most common kind of shoulder dislocation? Why?

A

Anterior inferior

Anterior is the most common, however, the middle glenohumeral ligament is really strong and the inferior glenohumerla ligament is really weak - so it tends to slide through inferior glenohumeral ligament

150
Q

pt comes in after an inferior humeral dislocation and complains of a “dead arm” what muscle would I check and why?

A

Deltoid

Because the axillary n innervates the delts and is often inpacted by inferior dislocations of the humerus

151
Q

What space does the axillary n run through?

A

quadangular space (quad = 4 rotator cuff muscles angular = 4 angles)

152
Q

What dislocations of the humerus affect the axillary n?

A

Anterior / inferior dislocations

153
Q

The shoulder dislocates in an anterior / inferior fashion. The patient would present in weakness in what two muscles? Why? what other symptoms where?

A

Axillary n
Teres minor / Deltoids
Numbness / tingling of lateral arm and posterior shoulder (think about hwere it comes out)

154
Q

Memorize taht numbness w/ axillary n issues happens basically in the deltoid area (poster / lateral)

A
155
Q

Grade 1 acromial clavicular ligament sprain:
* Coracoclavicular ligament?
* AC joint?
* Muscular structures?

A

Coracoclavicular ligament = intact
AC joint = intact/tender
Muscular tructures = intact

156
Q

Grade 2 acromial clavicular ligament disruption:
* Coracoclavicular ligament?
* AC joint?
* Muscular structures?

A

Coarcoclavicular ligament = sprain
AC joint = joint space slightly wider (can palpate)
Muscular structures = intact

157
Q

Grade 3 acromial claviclar ligament disruption
* Coracoclavicular ligament?
* AC joint?
* Muscular structures?

A

Coacroclavicular ligament = disruption

AC joint = dislocation shoulder displaced inferiorly (like a pinao key - little drop off)

Muscular structures = deltoid / trapezius detached from calvicle

158
Q

Grade 4 acromial claviclar ligament disruption
* Coracoclavicular ligament?
* AC joint?
* Muscular structures?

A

Coracoclavicular ligament = disruption

AC joint = dislocation / clavicle displaced posteriorly

Muscular structures = deltoid / trapeizus detached from the clavicle

159
Q

Grade 5 acromial claviclar ligament disruption
* Coracoclavicular ligament?
* AC joint?
* Muscular structures?

A

CC ligament = disruption
AC joint = dislocation
Muscle = deltoid/trap detached from clavicle

160
Q

Grade 6 acromial claviclar ligament disruption
* Coracoclavicular ligament?
* AC joint?
* Muscular structures?

A

CC ligament = disruption
AC joint = dislocation, clavicle or upper rib fracture, possible brachial plexus injury
Muscle = deltoid/trap detached from clavicle

normally a very truamatic injury

161
Q

What treatment do we do for grades 1-3 acromiclavicular joint injuries?

A

immobilization / PT

162
Q

What treatment do we do for grade 3-6 AC joint injury?

A

Surgery

163
Q

what grade AC joint injury is this?

A

grade 4 or 5 (significant amount of movement)

164
Q

What is the MOI for AC joint injuries?

A

Fall onto the shoulder joint itself

165
Q

KNOW: Approximating an AC joint lesion makes them feel better (sling)

A
166
Q

KNOW: Pain is typically localized to the AC joint w/ AC joint lesions

A
167
Q

What movement hurts the most w/ AC joint lesions?

A

Horozontal adduction

Its anything moving the joint apart (think ER/IR / Abd/flex

mostly hurts at end ranges

168
Q

Do resistive motions hurt AC joint lesions (think MMTs). Why?

A

No, because theres not really much muscular tissue (active tissue) at that joint

169
Q

KNOW: Partial or full thickness long head of the bicep tears are possible along w/ tendinitis (inflammation of the tendin) (cytokines / inflammatory makers presents)

tendinosis is also possible (thinking of the tendin = more chronic)

Tenosynovitis = inflammation of the sheath around the tendin

TEndin rupture

A
170
Q

What would happen with a distal rupture of the long head of the biceps tendin

A

superior buldge

171
Q

What are the 3 causes of long head biceps tendin pathology?

A

Increased load (leads to inflammation)

Instability of the shoulder (tendon crosses shoulder)

SLAP lesion = tendin attaches to labrum

172
Q

What 3 things cause SLAP lesions?

A

FOOSH
Traction injury (pulling)
Peel-back inury (max ER)

173
Q

pain with resiting what motions shows us we have bicep long head issues?

A

Pain w/ shouler flexion / elbow flexion / abduction

174
Q

where would pain be w/ bicep long head tendin pathology

A

bicipital groove

175
Q

what age group and sex typically gets glenohumeral osteoarthritits?

A

Older females

176
Q

is OA fast or slow onset?

A

Slow

177
Q

How does OA present in the mornings?

A

stiff

178
Q

what motion is the stiffest w/ glenohumeral osteoarthritits?

A

ER

179
Q

KNOW: someone w/ OA will have reduced pain and stiffness w/ movement

They will also have increased crepitits / difficulty sleeping

A
180
Q

What is the pain like w/ OA

A

Deep ache

181
Q

What is the best imaging for OA?

A

X-ray

182
Q

Does distraction help OA?

A

Yes

183
Q

KNOW: w/ imaging the bones look really close to eachother because the articular cartilage is breaking down

we do surgery when theres tons of weakness / pain / loss of motion

A

Upper Test 1 (14 decks)

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