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PCM_MIDTERM 01 > Lecture 8: Shoulder Complaint > Flashcards

Lecture 8: Shoulder Complaint Flashcards

1
Q

What makes the shoulder joint special?

A

Rotator cuff tendons pass between bones (acromion and humerus)

  • Pros: great flexibility
  • more susceptible to injury
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2
Q

What bones make up shoulder?

A

Clavicle
Scapula (Acromion)
Humerus

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3
Q

What are the steps of a shoulder joint exam?

A
  1. Inspection
  2. Palpation
  3. Range of Motion
  4. Speciality Testing
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4
Q

What is Painful Arc Test?

A

Test for subacromial impingement and rotator cuff tendon injury
-Positive if there is pain from 60-120 degrees

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5
Q

What is the first step in order to diagnose shoulder pain?

A

Check if it is traumatic or atraumatic

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6
Q

What can be possibly injured in traumatic shoulder pain?

A

Bones: fractures (clavicle or proximal humerus) or dislocation (glenohumeral)
Soft Tissue: Myofascial, Rotator Cuff (tendon injuries), Acromial clavicular ligament injury
Joints: cartilage, hemarthrosis, joint capsule

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7
Q

What can can cause atraumatic shoulder pain?

A

Extrinsic: referred pain (e.g. heart attack)
Intrinsic: Overuse injuries, shoulder instability, septic arthritis, etc

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8
Q

Where are possible fractures or dislocations in shoulder?

A
  • Fractures: clavicle (mostly in kids), proximal humerus (mostly in old people), scapula (blunt trauma)
  • Dislocations: Glenohumeral (most often anterior)
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9
Q

Where are possible soft tissue injuries in shoulder?

A
  • Ligamentous injuries (ex Acromial Clavicular ligament)

- Tendon injuries (rotator cuff)

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10
Q

What is most common cause for acromioclavicular joint injuries?

A

Direct blow or falling onto shoulder

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11
Q

What muscles make up Rotator Cuff?

A

Supraspinatus (Tendon of Supraspinatus M. most injured)
Infraspinatus
Teres Minor M.
Subscapularis M.

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12
Q

What are common ways to injure Rotator Cuff muscle?

A

Repetitive overhead activity (work or sports)

  • Impingement syndrome: compression of Rotator cuff tendons
  • Tendon Injury: sprain or tear
  • Tendinopathy: chronic injury to tendons
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13
Q

What are some extrinsic causes of shoulder pain?

A

Neurologic: cervical radiculopathy, brachial plexus, herpes zoster, thoracic outlet syndrome, etc

Abdominal: Hepatobiliary disease, diaphragmatic irritation

Cardiovascular: Acute MI, thrombosis

Pulmonary: Pneumonia, lung tumor, pulmonary embolism

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14
Q

What are intrinsic causes of shoulder pain?

A
  • Overuse
  • Shoulder instability
  • Rotator Cuff issues
  • Bursitis
  • Synovitis
  • many more
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15
Q

What are most common acute reasons for shoulder pain?

A
  • Rotator Cuff Injuries
  • Clavicle and Proximal Humerus Fractions
  • Glenohumeral Joint Dislocations
  • Acromioclavicular joint injuries
  • Myofascial injury
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16
Q

What are most common life threatening reasons for shoulder pain?

A
  • Septic Arthritis

- Referred pain from MI, Lung Pathology, Intraperitoneal Hemorrhage

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17
Q

Joint vs extremity exam

A

joint: inspection: palpation, rom, speciality testing

exremity: palpation, rom, speciality testing, nerovascular status
- neuro: reflex and motor/sensory
- vascular: pulses and cap refill

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18
Q

Glenohumeal dislocation is ___ of all major joint dislocations?

A

50%

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19
Q

What are the three types of glenohumeral dislocation

A
  • anterior (most common)
  • posterior (2-4 percent)
  • inferior: luaxio erecta: hand is placed upwards looks like ur raisng your hand (.5%)
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20
Q

AC sepearation called what

A

step off

21
Q

What tendon is most commonly injured in the rotator cuff?

A

supraspinatus

22
Q

Always document what?

A

Patient is neurovacularly intact

23
Q

If the patient is atruamatic what should you order first?

A

an ekg

24
Q

After a fall what should you ask?

A

did you loose consciousness? What did you fall on?

25
Q

Arm flextion

A

180 degrees

choracobrachialis and anterior deltoids

26
Q

arm extension

A

60 degrees

latissimus dorsi and teres major

27
Q

Arm abduction

A

180 degrees

deltoids and supraspinatus

28
Q

arm horiziontal adduction

A

pectoralis major and latssimus dorsi (40-50 or 130-140)

29
Q

arm horiztional abduction

A

suprspinatus and mid delts 130-145 or 40-55

30
Q

arm external rotation

A

infraspinatus and teres minor 90

31
Q

arm internal rotation

A

subscaupularis and pec minor 90

32
Q

Apprehension test

A
  • patient is seated
  • shoulder abducted to 90 and elbow is flexed to 90
  • block linkage and then force arm into extenral rotation

+ test: patient apprehensive of repeat dislocation

indecates glenohumearl instability

33
Q

Empty can test

A
  • flex patient shoulders to 90, while horiztonally abducting them to 45.
  • internally rotate both arms so tumbs are pointing down
  • press down on forearms while patient resisits

+ test: pain/ weakness

indicates rotator cuff pathology (supraspinatus)

34
Q

drop arm test

A
  • abduct arm to 90 and tell them to slowly drop arm
  • positive test: arm will drop or gentle wrist tap will cause arm to drop
  • indicates full thickness tear of suprapinatus
35
Q

Painful arc test

A
  • patient abducts arm starting at their side
  • positive test: pain is present within 60-120 degress of shoulder abduction
  • indicates subacromial impigment / rotator cuff injury
36
Q

neer impingment

A

-stabalize the patients shoulder with forearm pronated. Passivley flex the shoulder to fully flexed position.

+ test is pain

indicates subacromial bursa or rotator cuff impingment

37
Q

Hawkins test

A

flex shoulder to 90 degrees, flex elbow to 90 degrees and passivley rotate the humeurs into internal rotation.

+ test: pain

indicates rotator cuff or sub acromial bursa impingment

38
Q

cross arm test

A

adducts patients arm across their chest and rest it on oppsite shoulder

+ test: pain in ac joint with end range adduction

-indicates: ac joint pathology

39
Q

What causes rotator cuff injuries

A

repated overhaed activity in sports or work

40
Q

What is impigment syndrome?

A

compression of the rotator cuff tendons and subacromial bursa between greater tubercle of humeral head and lateral edge of accromion process

41
Q

List 2 most common causes of shoulder pain

A

rotator cuff injuries and myofacscial injury

42
Q

what does vindicate stand for?

A

vascular, infectious, neoplastic, degenerative, Iatrogenic, congenital, autoimmune, traumatic, and endocrine/metabolic

43
Q

What does the apprehension test test for and what is a positive test?

A

-gleno humeral instability, patient apprehenive of repeated dislocation

44
Q

What does the empty can test test for and what is a positive test?

A

rotator cuff pathology (supraspinatus specifically), pain or weakness is a positive test

45
Q

What does the drop-arm test test for and what is a positive test?

A

Full thickness tear of the supraspinatus, arm will drop or gentle tap on the wrist will cause the arm to drop

46
Q

What does the painful arc test test for and what is a positive test?

A

indicates subacromial impingement and/or rotator cuff injury, pain is elicited within 60-120 degrees of shoulder abduction

47
Q

What does neer impingement test for and what is a positive test?

A

subacromial bursa or rotator cuff impingement, pain during passive flexion

48
Q

What does the hawkin’s test test for and what is a positive test?

A

rotator cuff or subacromial bursa impingement, pain with internal rotation

49
Q

What does the cross arm test test for and what is a positive test?

A

AC joint pathology, pain in AC joint with end range adduction

PCM_MIDTERM 01 (13 decks)

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