Lecture 6: The Shoulder Flashcards
Why are supraspinatus injuries so difficult to rehabilitate?
The supraspinatus tendon sits under the anterior acromion and inserts onto the greater tubercle of the humerus, which is a very avascular area (The “watershed area”), and so the low blood supply to the tissue makes it difficult for the tissue to heal (doesn’t have a supply of O2, nutrients, etc.).
List the 2 causes of adhesive capsulitis.
- Inflammatory response (extrinsic to the GH joint)
- Prolonged immobilization (intrinsic to the GH joint)
What is the capsular pattern of adhesive capsulitis?
- External rotation
- Abduction
- Internal rotation
A 50 year old woman has pain moving her shoulder in all directions, says her shoulder feels hot, and that she is having trouble taking off her bra. What condition does she have?
Adhesive capsulitis
Briefly outline the stages of symptomology of adhesive capsulitis as well as what the treatment looks like in each stage.
Freezing stage: Rapid onset of severe shoulder pain and ROM of the shoulder becomes very limited (2-9 months). Treatment is just pain management (NSAIDs and hot/cold compresses).
Frozen stage: Possibly less pain, but shoulder becomes stiffer (4-12 months). Use aggressive mobilization.
Thawing stage: The shoulder’s ability to move begins to improve as you try to regain previous function (5 to 24 months). Trying to restore previous function.
Explain the rationale for the treatment used for adhesive capsulitis during the “frozen stage”. What procedure must be done if the person does not use the proper treatment during the frozen stage?
- Aggressive mobilization is used because if you don’t use these aggressive techniques to improve ROM, then the prognosis during the thawing stage will be much worse due to deconditioning and malnourishment of the joint capsule.
- Manipulation under anesthetic
A swimmer experiences pain in the range of 60 to 120 degrees shoulder flexion and is having pain while lifting. What condition do they likely have? What exercises would you recommend for this person?
- Subacromial impingement
- Side raises with dumbbell to make space using distraction
Explain why increased age is a risk factor for subacromial impingement.
Arthritis takes up space in the subacromial space
A type II SLAP tear is also known as a “_________________”
Bankart lesion
1.Which SLAP tears involve the biceps tendon?
2.What is the difference between these two types of SLAP tears?
- What symptom is specific to these two types of SLAP tear?
- Which one is more common?
- Type II and IV
- With type II the biceps tendon anchor is detaching, whereas in type IV the biceps tendon is tearing due to the bucket handle tear tearing past into the biceps tendon.
- Loss of shoulder stability
- Type II
A patient reports falling onto their outstretched hand, after which they experienced shoulder pain with overhead activities and notice a catching feeling in their shoulder that comes and goes. What injury do they likely have (be specific)?
Type III SLAP tear - inconsistent catching and locking occurs with type III SLAP tears because the bucket handle folds in on itself and fold back.
Which type of SLAP tear is due to repetitive trauma?
Type II
A patient has pain with overhead activities and can’t horizontally abduct or externally rotate their shoulder with the forearm pronated without pain. What injury do they likely have (be specific)?
Type I SLAP tear
How do you treat each type of SLAP tear?
Type I: Physical therapy (strengthen the shoulder muscles)
Type II: Operation followed by physical therapy
Type III: Operation followed by physical therapy
Type IV: Operation followed by physical therapy
A tennis player comes into the clinic with a dull ache in their right shoulder that radiates into their upper arm, are experiencing weakness in that shoulder and have lost some of their normal ROM compared to their left side. They note that they are having trouble sleeping on their right side due to the discomfort. What injury do they have?
Rotator cuff tear
What is the most common cause of an acromioclavicular joint sprain?
Fall on superior-lateral aspect of shoulder with arm in adducted position
List and explain the grades of injury of an acromioclavicular joint sprain.
Grade 1
- Partial AC ligament tear
- Can still use shoulder
Grade 2
- Partial/full AC ligament tear + partial CC ligament tear
- Movement limited by pain
Grade 3
- Full AC ligament tear + Full CC ligament tear
- Severe loss of function (no strength or stability)
- A bump in shoulder
List 3 risk factors for swimming-related injuries
- Previous injury
- High competition level
- Scapular dyskinesia
In terms of ultrasound, the ____________ is the device that sends and receives the ultrasound waves, and is composed of an array of ____________ that generate these waves.
- Transducer
- Quartz crystals
List the advantages of diagnostic ultrasound.
- Less expensive than most other imaging modalities (with the exception of plain films)
- Does not involve ionizing radiation
- Non-invasive
- Allows for real time imaging
- Readily available technique
List the disadvantages of diagnostic ultrasound.
- Small field of view
- Presence of artifacts
What is the difference between the SPADI (shoulder pain and disability index) and the DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire?
The SPADI only evaluates the shoulder, whereas the DASH evaluates the arm and hand in addition to the shoulder.
The SPADI is more pain-focused.
How is the SPADI scored, and what is the MCID?
- 0-100 (100 is the worst)
- 20 points
What trade-off does the integrated support team need to be aware of while an athlete is recovering?
How much rehab they do vs how much training (of their sport) that they do (injury rehab vs fitness)
