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A: MSK UQ > Lecture 7B: Shoudler Complex Examination And Evluation > Flashcards

Lecture 7B: Shoudler Complex Examination And Evluation Flashcards

1
Q

What are 3 casues of shoulder complex dysfucntion

A

Compromise of passive restraint
components

Compromise of NM control

Compromise of >1 neighboring
joints that contribute to motion

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2
Q

If someone has a shoulder tendinopathy when will they have pain and a hx of what

A

Pain w activities and hx of receptive motions

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3
Q

If someone has shoulder instability when will they have pain

A

Pain w prolonged static positions and pain after activities

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4
Q

Children and adolescence may present w what in the shoulder

A

humeral epiphysitis or osteogenic sarcoma

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5
Q

when does RC degeneration typically occur

A

40-60 y/o

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6
Q

Secondary impinment d/t instability typically seen in who

A

Teens - 20’s = especially w over head athletes

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7
Q

Who is calcium deposits in shoulder most common in

A

20-40 y/o

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8
Q

Insidious capsulitis typically seen in what age group

A

45-60 y/o

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9
Q

Insidious onset of adhesive capsulitis is often associated w what

A

DM and ischemic heart disease

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10
Q

If someone has a MOI of overhead exertion w repetitive motions what injuries may they have

A

Sub-acromial bursitis/impingement
RC tendinopathy/tear
Biceps tendinopathy

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11
Q

If someone has a MOI of fall on outstretch hand (FOOSH) what injuries may they have

A

Shoulder/elbow/wrist sprain or strain
Elbow/wrist fx’s
AC joint separations
Clavicle fx’s
GH joint fx’s
GH dislocations

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12
Q

If someone has a MOI of fall on tip of shoulder what injuries could they have

A

AC joint separations
Bone contusion
C-spine injury

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13
Q

If someone has a MOI of forced horixtonal extension of abducted , ER arm what injury may they have

A

Anterior GH dislocation

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14
Q

Should pain in swimmers are likely to fatigue what mm

A

Upper back , RC and pecs

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15
Q

If pain is relieved w arm elevated over head what do u think

A

Cervicogenic cause

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16
Q

If pain is relieaved w elbow supported what do u think

A
  • ac joint separation
    -RC tears
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17
Q

If pain is relieved by circumduction of shoulder w accompanying click or clunk what do u think

A
  • internal derangement
    -GH instability
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18
Q

If pain is relieved w arm distraction what do u think

A

Bursitis
RC tendinopathy

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19
Q

If pain is relieved w arm held in dependent position wht do u think

A
  • TOS
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20
Q

If someone has a hx of trauma in the shoulder what may it suggest even if it occurred a while ago

A

Instability

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21
Q

What is the three levle staged algorithm for rehabilitation (STAR) classification for shoulder pain

A
  • screen ( are thy appropriate for PT or no)
  • medical dx (shoulder origin or not)
  • if shoulder then is it RRC/impingment or frozen shoulder or GH instability or post op
  • then determine rehab classification ( high , moderate or low irritatbility)
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22
Q

What are thee KEY POSITIVE finding for RC impingment (5)

A

Impingement signs
Painful arc
Pain w/ isom resist
Weakness
Atrophy

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23
Q

When someone come in shoulder pain , what is the % that it is RC impingment

A

50-70%

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24
Q

What is the key negative findings for RC/impingement

A
  • significant los of motin
  • instability signs
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25
Q

What is the key positive finding for frozen shoulder (3)

A

Spontaneous progressive pain

Loss of motion in multiple planes

Pain at end-range

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26
Q

What are the key negative finding that it is not frozen shoulder

A
  • normal ROM
  • younger then 40
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27
Q

Does frozen shoulder have a MOI

A

No

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28
Q

What is the key postive finding that would make u think GH instability (4)

A

Age < 40
Hx disloc / sublux
Apprehension
Generalized laxity

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29
Q

What are the key negative finding that would make u think it is not GH instability

A
  • no hx of dislocation
  • no apprehension (scared that it is gonna dx)
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30
Q

How do u end up tearing ur RC

A

Start w impingement —> RC tendinopathy —> RC year

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31
Q

50-70% of all shoulder pain seen in PT related to ___ ___

A

RC dysfunction

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32
Q

What’s the MOI for impingement/ RC path

A

Compression
Tensile over load
Macrotrauma

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33
Q

Impingement/ RC path is a ___ problems anf there is pain w what

A

Contractile

Pain w resisted testing , weakness/atrophy

34
Q

Is impingement a problem or stymptoms

35
Q

How are RC tears described by

A

Size , location , direction and depth

36
Q

The amount of weakness of RC is directly related to what

A

Size of tear

37
Q

What is the treatment for RC tear

A

It is conservative - restore joint mobility and as needed and strengthen surrounding mm

  • sx for SA depression or RC repair w or w/o biceps tendonesis
38
Q

What is considered a small , medium , large or massive RC tear

A

Small= < 1 cm
Med= 1-3 cm
Large = 3-5 cm
Massive = > 5 cm

39
Q

What age , gender and disease is common w adhesive capsulitis (frozen shoulder)

A

45-60
Females
DM and thyroid disease

40
Q

What are the 4 stages for frozen shoulder

A

Stage I (pt typically ignores) for <3
months
Stage II (freezing) for 3-9 months
Stage III (frozen) for 9-14 months
Stage IV (thawing) for 14+ months

41
Q

There is progressive ___ w no MOI in frozen shoulder

42
Q

In frozen shoulder there is progressive loss of ROM in how many planes

43
Q

What is the treatment for stage 1 and 2( freezing) of adhesive capsulitis

A

Stage I – pain control (if seen by PT)
Stage II – pain control + manual therapy
(as tolerated) + mobility ex’s
Emphasize self care here

44
Q

What is the treatment for stage 3( frozen) and 4 (thaw) of adhesive capsulitis

A

Stage III – pain typically has resolved;
focus on restoring normal motion and
strength where possible
Stretching as tolerated

Stage IV – continue to restore normal
motion & strength as able
Stretching + strengthening + NM re-
education

45
Q

What is Abnormal symptomatic motion of the
GH joint that affects normal joint
kinematics

A

GH joint instability

46
Q

What is the underlying causes of GH instability

A

Genetic
Collagen
Biomechanical factors

47
Q

What is the S&S of gh instability

A
  • feelings of looseness or slipping , pain , subluxation or dislocation
48
Q

What is the MOI for GH instability

A

Traumatic vs atraumatic
TUBS vs AMBRI

49
Q

What is the difference between
TUBS vs AMBRI

A

TUBS = Trauma , Unidirectional , Bankart , SX

AMBRI= Atraumatic , Multidirectional , Bilateral , Rehab , Inferior

50
Q

What is the most common direction of instability in the GH joint

51
Q

What direction is >90% of all shoulder dislocation

52
Q

What is the MOI for anterior GH instability

A

Abduction , ER and ext

Sports like football ,swimming , baseball

53
Q

What is the conservation tx for anterior GH instability

A

Gradual return to full AROM , strengthen scapular and RC mm , NM re ed

54
Q

What is the sx tx for anterior GH instability

A

Labral repair, salvage

55
Q

What is the MOI of the superior labrum anterior and postieror instability ( SLAP)

A

Trauma , fall , catching a heavy object

Repetitive microtrauma - throwing

56
Q

why is DDx difficult for a SLAP instability

A

SYMTOMS similar to RC disease and GH instability

57
Q

Where does a SLAP lesion usually occur in the labrum

A

10- 2on a clock

58
Q

What is the MOI for a postieor GH instability

A

Flexion , add , IR

Associated w seizures , electric shock , diving into shallow pool and MVAs

59
Q

What is the MOI for inferior GH instability (very uncommon)

A

Carry heavy object s, hyper abduction

60
Q

What is the treatment for inferior GH instability

A

Immobilization

61
Q

What is classified as mult directional instability

A

Instability in > 1 direction

More common in males

62
Q

What is the MOI of multi directional GH instability

A

Typically insidious

63
Q

What is common with multi directional GH instability

A

RC pain and scap dyskinesia

64
Q

What is the sx treatment for multi directional GH instability

A

Capsular shift , capsulorrhaphy

65
Q

What is the conservative tx for multi directional GH instability

A

Strengthen scapular and RC ,, , nm re ed

66
Q

What is scapular dyskinesis

A

Alterations in normal position or
motion of the scapula during coupled
scapulo-humeral movements

67
Q

What is conservative treatment for scapular dyskinesis

A

gradual return to full
AROM, strengthen scapular and RC
muscles, NM re-education, correct
deficits in surrounding joints`

68
Q

What occur in people > 45 adn their MOI is bony morphology changes following trauma

A

Traumatic OA

69
Q

What is the SX treatment for traumatic OA

A

TSA - intact RC

RTSA- torn RC

70
Q

What is present in 31% of pt w shoulder pain

71
Q

What is the MOI for AC joint dysfunction

A

Trauma - fall onto tip of shoulder

Or chronic - secondary to OA , RA or mechanical dysfunction

72
Q

What are the treatments for the different sprains for AC joint *+(6 kind)

A

Types I-II – conservative management
Type III – controversial
Types IV-VI – surgical reduction

73
Q

Is AC or SC joint dysfunction more common

74
Q

What kind of dislocations in the SC joint can be life threatening

75
Q

What s the MOI for SC joint dysfucntion

A

Sprain vs dislocation 2/2 fall on flex/add or ext/ add arm

76
Q

What is the most common fx bone in childhood

77
Q

What is the sx treatment from clavicle fx

A

ORIF if fx displaced

78
Q

What is the most common humeral fx in children and elderly

79
Q

What are outcome measures for the shoulder

A
  • DASH (Disability of Arm, Shoulder and Hand)
  • QuickDASH
  • Penn Shoulder Score
  • SPADI (Shoulder Pain and Disability Index)
  • K-JOC Score (

A: MSK UQ (20 decks)

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