Lec 3 Flashcards
1
Q
What kind of joint is the sternoclavicular joint?
A
Saddle
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)
3
Q
Does musculoskeletal pain typically increase or decrease w/ the stopping of movement / exercise?
A
It stops
4
Q
Is musculoskeletal activity worse in the day or night?
A
Day - not as much pain at night because the muscles arent moving
5
Q
Is musckuloskeletal pain continuous or intermittent?
A
Both - all the time or in short bursts
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
7
Q
KNOW: Systemic pain disturbs sleep - however - severe muskuloskeletal pain can also do this
A
8
Q
Is systemic pain constant or in waves?
A
Both
think throbbing w/ a pulse
9
Q
KNOW: know facet refferal patterns
A
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
11
Q
How should the stethascope be pointed?
A
angle pointed toward nose
12
Q
What is the purpose of the bony apperhension test?
A
to rule out/in acute tramatic instability of the shoulder
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
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
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
16
Q
What does a brachioradialis reflex look like?
A
Elbow flexion (DOESNT CROSS WRIST) / more like the elbow moves back some
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
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)
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
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.
21
Q
How is a briachioradialis reflex done?
A
22
Q
How is biceps reflex checked?
A
make sure to tense tendin before taking reflex
23
Q
where is the conoid tubercle located?
A
3/4 of the way lateral on the clavical - posterior / inferior side
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)
25
Where is the coronoid fossa?
anterior distal medial humerus
26
where is the radial fossa?
Anterior distal lateral humerus
27
whats more medial the trochlea or the capitiulum?
Troachlea
28
Where is the olecranon fossa?
Posterior distal humerus
29
what does the capitulum articulate w/
radial head
30
What does the trochlea articulate w/
ulna
31
KNOW: On the back of the humerus you only have the trochlea (no captilum)
32
where is the scapular notch?
just medial to the coarcoid process
33
Where is the coracoacromial ligament
between the coracoid process and the acromium
34
Where is the coraco clavicular ligament?
between the coracoid process and the clavicle - note this ligament has two heads
35
What bones does the shoulder complex include?
Scapula / humerus / clavicle
36
What 4 joints make up the shoulder complex
Glenohumeral
Acromioclavicular
Sternoclavicular
Scapulothoracic
37
What does the transverse humeral ligament do?
Holds the biceps long head tendin down
38
What kind of joint is the sternoclavicular joint?
Saddle joint
39
What is the pattern of ristriction for a frozen shoulder?
External rotation --> Abduction --> Internal Rotation
(these are the 3 lost with external rotation being the most lost)
40
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?
Limited internal rotation (lots of other shoulder pathologies have external rotation issues but few have internal rotation problems)
41
What motion is most limited with adhesive capsulitits?
External rotation
42
patient comes in with internal rotation issues. What am I thinking they have
adhesive capsulitits
43
Why are external and internal rotation so affected by adhesive capsulitits
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
44
What does an AROM test test for
contractive tissue issues
45
What does PROM test for?
ligamentous / capsular problems
46
Shoulder flexion ROM
180 degrees
47
Shoulder extension ROM
60 degrees
48
Shoulder abduction degrees
180
49
External rotation degrees
90
50
Internal rotation degrees
70
51
Horizontal abduction degrees
90-100
52
Horizontal adduction degrees
40-50
53
What vertebra is the top of the scapla at
Around T2
54
What vertebra is the spine of the scapula at?
T4
55
What vertebra is the bottom of the scapula at?
T7
56
What vertebra is the bottom of the ribs at
T12
57
What vertebra are the hips at
L4
58
What vertebra is the PSIS at
S2
59
What plane do elevation and depression of the clavical move within?
Frontal
60
What two movements go along w/ clavicular elevation?
Abduction / flexion (things where you move your arm overhead
61
What two motions go along w/ clavicular depression
Shoulder adduction / extension to neutral (bring arm back down from flexion)
62
Sternoclavicular elevation arthrokinematics
What about the movement(s) it produces
superior roll inferior slide
Adduction / Flexion
63
Sternoclavicular depression arthrokinematics
What motions does it produce
Inferior roll superior slide
Adduction, Extension (to neutral)
64
What plane of motion is protraction / retraction at the sternoclavicular joint?
Transverse plane (think scapula going in a circle when you reach out)
65
Give the arthrokinematics of protraction at the sternoclavicular joint
what motions go along with this
Anterior roll / Anterior slide
Horizontal adduction / scapular protraction
66
Sternoclavicular retraction arthrokinematics
What motion(s) go with it
Posterior roll / posterior slide
horizontal abduction / scapular retraction
67
What are the arthrokinematics of sternoclavicular anterior rotation?
What movement(s) go along with it
Anterior spin
Goes with extension (back to neutral) and adduction
68
What are the arthrokinematics of posterior rotation of the clavicle (sternoclavicular)
What movement's go along with it?
spin
Flexion / abduction
69
Patient lifts arm overhead (in flexion). What is happening at the sternoclavicular joint? (arthokinematics
Clavicular elevation: Superior roll / inferior slide
Posterior rotation: Spin
70
Patient goes from full flexion into extension (to neutral). What is happening at the sternoclavicular joint (arthrokinematics / movements)
Depression of the clavicle: Inferior roll superior slide
Anterior roll: spin
71
Patient adducts arm. what is happening at the sternoclavicular joint? (arthrokinematics / movements)
Depression of clavicle: inferior roll, superior slide
Anterior roll of clavicle: spin
72
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)
Protraction
Horizontal adduction / scapular protraction
anterior roll, anterior slide
73
Patient is on a rower and pulls both of their elbows back. What position is their sternoclavicular joint in? Arthrokinematics?
Retraction
Horizontal abduction / scapular retraction
Posterior roll / posterior slide
74
What motions are at the acromioclavicular joint?
Downward / Upward rotation
External / Internal rotation
Anterior / Posterior Tilting
All considered spin movements because its a disc joint
75
What movements go with upward rotation of the scapula at the Acromioclavicular joint. Arthrokinematics?
Raising arm (flexion / abduction)
Considered a spin because the AC joint is a disc joint
76
Downward rotation at the acromioclavicular (scapula) joint encompasses what movements? Arthrokinematics?
lowering arm to neutral movements
Adduction / Extension (to neutral)
Spin
77
What movements cause external rotation of the scapula at the AC joint? Arthrokinematics?
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
What movements go with scapular interal rotation at the acromioclavicular joint?
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
KNOW: Think of the AC joint almost like two convex surfaces. Whenever you move any direction you will have that spin
80
What movements go with scapular anterior tilt?
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
What movements go with scapular posterior tilt?
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
**What acromioclavicular joint movement is associated w/ kyphosis?**
anterior tilting (puts you in that protracted / pulled forward position
(makes since you're hunched forward)
83
What scapulo throacic joint motions do we have? (no arthrokinematics just scapula on thoracic ribs)
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
What motions at all the joints we talked about do we have w/ scapular upward rotation (entire complex)
Scapularthroacic joint = upward rotation
Acromioclavicular joint = upward rotation (spin)
Sternoclavicular joint = elevation
*Superior roll & inferior slide
85
What movements do we have scapular elevation? (entire complex)
Acromioclavicular joint = **downward rotation (spin) (keeps scapular angle from changing to much (keeps scapular vertical position)**
Sternoclavicular joint = elevation
* Superior roll / inferior slide
86
What movements do we have w/ scapular protraction (entire complex)
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
Wasting of what muscle causes scapular winging
serratus anterior (long thoracic)
88
Every every __ degrees of motion at the humerus __ degree of motion happens at the scapula
2,1
89
For full 180 degrees of abduction the humeral head moves in the glenoid cavity 120 degrees. How many degrees does the scapula rotate?
60
90
Can PT's look at scapular movement and decide if its typical or atypical?
No - its not easy
91
What glenohumeral joint assessments do we do?
Inferior glide
Lateral distraction
Anterior glide
Posterior glide
92
What sternoclavicular joint assessments do we do?
Inferior glide
Superior glide
Posterior glide
93
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
94
**How do you do an internal rotation resisted strength test?**
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 articula**r issues (outlined below)
**If internal rotation strength is >> 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
What kind of tests would I do if I found that shoulder external rotation was weaker than shoulder internal rotation (int > ext)
Rotator cuff tests
96
I have found that the pt has stronger IR than ER at the shoulder. What two issues am I looking for
IR > ER = Rotator cuff pathology
Tests:
* Rotator cuff impingement syndrome
* Rotator cuff Tears
97
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?
Extra articular pathology
98
What are some examples of extra articular pathologies? (3)
AC Joint lesions
Long head Bicep (LHB) Lesions
Shoulder pain referred from another body region
99
pt presents w/ a stronger ER than IR on internal rotation resisted strength test what does that tell us?
Weaker IR = Intra articular pathology
100
What are some examples of intra-articular apthologies?
Anterior capsulolabral insability
Posterior Capsulolabral instability and / or lesions
Bankart lesions
SLAP lesions
Articular internal impingement syndrome
101
What age group typically gets rotator cuff tears?
Older (65+)
* Think weak musles tear easier
102
What kind of rotator cuff tears are more prominant:
* partal thickness
* Full thickness
Full thickness tears more common
103
Who normally gets subacromial impingement syndrome?
This is the acromium pinching down
* typically 35+ (think middle aged)
104
Why would crepitus be present w/ rotator cuff pathologies?
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
What motions hurt w/ rotator cuff pathologies
Limitation lifting arm over head (causing shoulder pain)
So they would have trouble lifting, carrying, dressing and bathing
106
Is a RTC injury a sudden onset or a gradual onset
Both
Rotator cuff pathology = more gradual (I think this is the wasting away of the muscles)
Tracumatic event = sudden
107
What typically causes subacromial impingement syndrome?
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
KNOW: RTC causes night pain, weakness, loss of motion, pain with "certain movements"
109
Where does most rotator cuff pain occur?
Where can it radiate down to?
Most occurs at the shoulder but can radiate down to the deltoid tuberosity
110
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)
111
Why does rotator cuff pain limit "certain movements" that can be different for different people?
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
What activities cause pain w/ subacromial impingement?
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
Where is pain noted w/ subacromial impingement syndrome?
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
KNOW: sometimes impingement syndrome can cause a rotator cuff tear (because the supraspinatus tendon is constantly being pinched)
115
Where would a partial thickness articular side tear be?
Supraspinatus tendon side closer to the bone (the articulation)
116
Where would a partial thickness bursal side tear be?
RTC tear on the bursa side (so top) of the supraspinatus tendon
117
What is a intramuscular cyst of the RTC
Cyst that spread inside the muscles of the rotator cuff and can cause RTC tears
118
What is a partal thickness avulsion of supraspinatus tendon?
Rotator cuff tear that involves the spiraspinatus tendon pulling away the humeral head
119
What subgroup of people typically get partial thickness avulsion of supraspiantus tendon (RTC tear)?
What action are they normally doing?
Older (65+)
Straining injuries (trying to lift something or doing something vigrous)
120
What is an interstital RTC tear?
Tear in the middle of the tendon
121
what is a full thinkness tear of a rotator cuff muscle?
Tear that goes all the way through
122
NOTE: For special tests just note if they're good at diagnosing or ruling out
123
Special test item cluster for full thickness rotator cuff tear
How many do we want to be posititve
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
What 4 things are common w/ an intraarticular pathology
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
What are the three kinds of shoulder instability?
TUBS: **T**raumatic **U**nidirectional instability with **B**ankart **l**esion requiring Surgery
AMBRII: **A**traumatic onset of **M**ultidirectional instability that is accompanied by **B**ilateral laxity or hypermobility. **R**ehabiliation indicated, however if operation is necessary, a procedure such as a capsulorraphy is performed to tighten the **I**nferior capsule and the rotator **I**nterval
rraphy = surgerical repair
SLAP Lesion: Superior Labrail Anterior Posterior lesion
126
What is the MOI for a slap lesion?
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
**What normally causes SLAP lesions? Why?**
(Not MOI But what breaking causes it)
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
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)
129
Do dislocations normally happen w/ TUBS injuries? What nerve pathology is typically linked to TUBS syle injuries
Yes - (bankart must dislocate)
axillary n
130
what is the pain like w/ TUBS injuries?
Sharp (they just popped their shoulder out of place_
131
Do TUBS pts have a history of instability?
Not typically - its traumatic and one direction
132
Do we normally have surgery w/ TUBS injuries?
Yes TUB**S**
133
Do people w/ AMBRI's have a hx of dislocation?
Yes, its multidirectional which means its proably a genetic thing)
134
Does a traumatic event cause AMBRII's?
Atraumatic **A**MBRI
135
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
136
What age group typically gets AMBRIs?
What kind of people (physical charcteristics)
What disorders do they typically have?
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
Do people w/ AMBRI's have rigid or lax ROM?
Rull / excessive ROM (makes sense their connective tissue is lax)
138
A chronic AMBRI pt has anterior instability. Which direction are the most likely to sublux
Extension
139
An AMBRI pt has anterior / inferior instability what movements does this make weak
abduction (inferior slide) / extenrional rotation (anterior roll)
This would be more swinging / OH athletes
140
An AMBRI pt has posterior instability. What movment is affected?
Weight bearing in 90 degrees of shoulder flexion (pop out through the back)
141
Where does a bankart lesion occur
Anterior inferior aspect of the labrum
142
What kind of shoulder instability goes along w/ a bankart lesion (AMBRI)
Anterior instability (it breaks and the shoulder pops anteriorly then moves medially causing that bankart lesion)
143
Where is a Hill-Sachs lesion? What causes it?
Posterior superior lateral humeral head
Typically AMBRI anterior instability of the humerus poping into the scapula
144
What is a boney bankart lesion?
When the slipping of the humerus actually breaks the bone under the labrum
145
What is the most common kind of shoulder dislocation?
Anterior
146
Who gets more Bankart lesions?
Younger thinner
This was mentioned as a instability thing (AMBRI)
147
Why would it be worse to have a hill-sachs lesion as a kid?
Because you're still growing so it might cause growth plate issues
148
Of the glenohumeral ligaments, which one is the strongest?
what about weakest?
Middle glenohumeral
Inferior glenohumeral
149
What is the most common kind of shoulder dislocation? Why?
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
pt comes in after an inferior humeral dislocation and complains of a "dead arm" what muscle would I check and why?
Deltoid
Because the axillary n innervates the delts and is often inpacted by inferior dislocations of the humerus
151
What space does the axillary n run through?
quadangular space (quad = 4 rotator cuff muscles angular = 4 angles)
152
What dislocations of the humerus affect the axillary n?
Anterior / inferior dislocations
153
The shoulder dislocates in an anterior / inferior fashion. The patient would present in weakness in what two muscles? Why? what other symptoms where?
Axillary n
Teres minor / Deltoids
Numbness / tingling of lateral arm and posterior shoulder (think about hwere it comes out)
154
Memorize taht numbness w/ axillary n issues happens basically in the deltoid area (poster / lateral)
155
Grade 1 acromial clavicular ligament sprain:
* Coracoclavicular ligament?
* AC joint?
* Muscular structures?
Coracoclavicular ligament = intact
AC joint = intact/tender
Muscular tructures = intact
156
Grade 2 acromial clavicular ligament disruption:
* Coracoclavicular ligament?
* AC joint?
* Muscular structures?
Coarcoclavicular ligament = sprain
AC joint = joint space slightly wider (can palpate)
Muscular structures = intact
157
Grade 3 acromial claviclar ligament disruption
* Coracoclavicular ligament?
* AC joint?
* Muscular structures?
Coacroclavicular ligament = disruption
AC joint = dislocation shoulder displaced inferiorly (like a pinao key - little drop off)
Muscular structures = deltoid / trapezius detached from calvicle
158
Grade 4 acromial claviclar ligament disruption
* Coracoclavicular ligament?
* AC joint?
* Muscular structures?
Coracoclavicular ligament = disruption
AC joint = dislocation / clavicle displaced posteriorly
Muscular structures = deltoid / trapeizus detached from the clavicle
159
Grade 5 acromial claviclar ligament disruption
* Coracoclavicular ligament?
* AC joint?
* Muscular structures?
CC ligament = disruption
AC joint = dislocation
Muscle = deltoid/trap detached from clavicle
160
Grade 6 acromial claviclar ligament disruption
* Coracoclavicular ligament?
* AC joint?
* Muscular structures?
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
What treatment do we do for grades 1-3 acromiclavicular joint injuries?
immobilization / PT
162
What treatment do we do for grade 3-6 AC joint injury?
Surgery
163
what grade AC joint injury is this?
grade 4 or 5 (significant amount of movement)
164
What is the MOI for AC joint injuries?
Fall onto the shoulder joint itself
165
KNOW: Approximating an AC joint lesion makes them feel better (sling)
166
KNOW: Pain is typically localized to the AC joint w/ AC joint lesions
167
What movement hurts the most w/ AC joint lesions?
Horozontal adduction
Its anything moving the joint apart (think ER/IR / Abd/flex
mostly hurts at end ranges
168
Do resistive motions hurt AC joint lesions (think MMTs). Why?
No, because theres not really much muscular tissue (active tissue) at that joint
169
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
170
What would happen with a distal rupture of the long head of the biceps tendin
superior buldge
171
What are the 3 causes of long head biceps tendin pathology?
Increased load (leads to inflammation)
Instability of the shoulder (tendon crosses shoulder)
SLAP lesion = tendin attaches to labrum
172
What 3 things cause SLAP lesions?
FOOSH
Traction injury (pulling)
Peel-back inury (max ER)
173
pain with resiting what motions shows us we have bicep long head issues?
Pain w/ shouler flexion / elbow flexion / abduction
174
where would pain be w/ bicep long head tendin pathology
bicipital groove
175
what age group and sex typically gets glenohumeral osteoarthritits?
Older females
176
is OA fast or slow onset?
Slow
177
How does OA present in the mornings?
stiff
178
what motion is the stiffest w/ glenohumeral osteoarthritits?
ER
179
KNOW: someone w/ OA will have reduced pain and stiffness w/ movement
They will also have increased crepitits / difficulty sleeping
180
What is the pain like w/ OA
Deep ache
181
What is the best imaging for OA?
X-ray
182
Does distraction help OA?
Yes
183
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
