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NMS 3 > Midterm > Flashcards

Midterm Flashcards

1
Q

What is the cause of primary impingement?

A

pathological narrowing of the subacromial space

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2
Q

What is the cause of secondary impingement?

A

anterior GH instability d/t repetitive overuse

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3
Q

What is the most common cause of shoulder pain?

A

impingement

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4
Q

What is the 3rd most frequently seen condition in general medical practice?

A

shoulder impingement

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5
Q

Structural risk factors for impingement? (4)

A
  1. acromial abnormalities 2. AC degeneration 3. altered tendon vascularity 4. calcification
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6
Q

Functional risk factors for impingement? (4)

A
  1. instability 2. muscular imbalance b/t int. rot./adductors and ext rot./abductors 3. tight posterior capsule 4. labral tears
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7
Q

Similarities in presentation of impingement for pts >35 and <35?

A

toothache-like pain, worse at night, worse after provoking activities

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8
Q

Differences in presentation of impingement for pts >35 and <35?

A

> 35 have shoulder weakness (d/t pain), often have crepitus, and can have complete tear of RCT w/ minor trauma

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9
Q

5 shoulder DDx’s?

A
  1. impingement 2. instability 3. bursitis 4. RCT 5. adhesive capsulitis
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10
Q

2 important DDXs to rule out w/ shoulder impingement?

A
  1. Cx sprain/strain d/t CAD 2. RA (look for bilateral Sx)
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11
Q

What is Neer’s pathogenesis?

A

3 stages of shoulder impingement

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12
Q

What is the first stage of Neer’s pathogenesis? Age range?

A

edema and tendinitis. More common in pts under 25

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13
Q

What is the second stage of Neers pathogenesis? Age range?

A

chronic inflammation, fibrosis of impinged tendon. More common in pts 25-40

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14
Q

What is the third stage of Neers pathogenesis? Age range?

A

tendon degeneration, rupture, arthritis. More common in pts over 40

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15
Q

Which stages of Neers pathogenesis are responsive to conservative care?

A

1 and 2

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16
Q

Physical exam: painful arc, painful active int. rot, tenderness, (+) modified Neers, Hawkins-Kennedy, possibly crepitus or instability. Dx?

A

shoulder impingement

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17
Q

T/F: superior translation and/or internal rotation of the humerus along with scapular protraction are considered “good” movements.

A

False

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18
Q

What is the difference between Tx for impingement vs. RTC?

A

for impingement, pt should be especially careful flexing and/or abducting the GH jt over 90 degrees

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19
Q

What other Tx has been shown to be effective for subacromial syndrome?

A

acupuncture

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20
Q

Are steroid injections effective for tx of impingement?

A

mixed results - may improve pain and function but no more effective than NSAIDs or PT

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21
Q

What is more effective for impingement syndrome: surgery or active, non-surgical tx?

A

active non-surgical tx

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22
Q

What is defined as “impingement d/t repetitive flexion, adduction, and internal rotation?”

A

swimmer’s shoulder

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23
Q

What Tx advice should you include for a pt with swimmers shoulder?

A

technique changes (avoid crossover and internal rotation, increase body roll toward pulling side of stroke)

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24
Q

What are the 3 types of instability?

A
  1. traumatic 2. atraumatic 3. acquired
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25
Q

what is the most common cause of dislocation?

A

traumatic P-A force with arm abducted and externally rotated

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26
Q

What is the Tx for a dislocation?

A

sling and refer (return for rehab)

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27
Q

What is the best method for relocating an anterior dislocation?

A

FARES method

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28
Q

What are the three anterior instability tests (performed in a cluster)?

A

anterior apprehension, relocation, release

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29
Q

What are the 2 posterior instability tests?

A

posterior apprehension, Norwoods

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30
Q

How do you interpret instability tests? (What is more predictive?)

A

apprehension is more predictive than pain

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31
Q

What are the conservative tx goals for shoulder instability? (4)

A
  1. improve scapular and clavicular ROM 2. strengthen rotator cuff 3. improve shoulder proprioception 4. activity/lifestyle modifications
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32
Q

5 common causes for poor response to conservative tx for instability?

A
  1. biceps tendinitis 2. rotator cuff tendinitis 3. shoulder impingement syndrome 4. subacromial bursitis 5. labral tears
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33
Q

When is surgery necessary (for shoulder instability)?

A

moderate to severe cases. Depends on labral damage

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34
Q

What is defined as “a syndrome characterized by shoulder pain and marked restriction of both active and passive GH ROM?”

A

adhesive capsulitis

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35
Q

How is the loss of AROM from adhesive capsulitis characterized?

A

“capsular pattern”

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36
Q

Which gender is more likely to have adhesive capsulitis?

A

females

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37
Q

Age group for adhesive capsulitis?

A

40-60 yrs

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38
Q

Common risk factors for adhesive capsulitis? (9)

A
  1. idiopathic 2. immobilization 3. chronic shoulder/AC Sx 4. shoulder/AC surgery 5. chronic neck Sx 6. diabetes 7. dupuytrens contracture 8. CRPS 9. Autoimmune
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39
Q

What are the 3 stages of adhesive capsulitis pathophysiology?

A

1 = freezing 2 = frozen 3 = thaw

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40
Q

time frame for stage 1 of adhesive capsulitis?

A

2 weeks to 9 mos

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41
Q

time frame for stage 2 of adhesive capsulitis?

A

4-12 mos

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42
Q

time frame for stage 3 of adhesive capsulitis?

A

6 mos - 2yrs

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43
Q

Primary symptom of stage 1 of adh. capsulitis?

A

PAIN (synovitis). AROM is diminished (PROM ok)

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44
Q

Sx of stage 2 of adh. capsulitis?

A

pain, diminished AROM and PROM

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45
Q

Sx of stage 3 of adh capsulitis?

A

pain gradually decreases, AROM slowly returns. marked capsular pattern of movement

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46
Q

What is the time threshold for sling use for adh capsulitis?

A

1 week

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47
Q

What are the 2 PROM exercises recommended for early adh. capsulitis Tx?

A

codmans arm swings, table/wall walking.

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48
Q

what PROM exercises should you add for adhesive capsulitis in late tx?

A

broomstick and towel stretching (NO buddy stretching)

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49
Q

What will contrast MRI show in a pt with adh. capsulitis?

A

diminished jt cavity size

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50
Q

What % of adh. capsulitis cases self-resolve w/in 2 years?

A

60%

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51
Q

How long is some degree of pain and stiffness common in adh. capsulitis (after Dx)?

A

5-10 years

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52
Q

Adhesive capsulitis may be assoc. with an increased risk of what condition?

A

stroke

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53
Q

What is the most commonly affected tendon for calcific tendonitis?

A

supraspinatus

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54
Q

Why is the distal rotator cuff tendon more prone to calcific tendonitis?

A

poorly vascularized

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55
Q

What is calcific tendinitis aka?

A

hydroxyapatite deposition disease (HADD)

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56
Q

Which gender is more likely to have calcific tendinitis?

A

women

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57
Q

What age group is more likely to have calcific tendinitis?

A

40-60 yrs

58
Q

What are the 2 types of calcific tendinitis?

A

type 1 = idiopathic type 2 = metabolic

59
Q

Which type of calcific tendinitis is most common?

A

type 1 - idiopathic

60
Q

Which arm is more likely affected with calcific tendinitis?

A

Non-dominant arm

61
Q

What is the usual mech of injury with calcific tendinitis?

A

unclear - rarely related to a specific event

62
Q

onset of calcific tendinitis - rapid or gradual?

A

acute, rapid onset

63
Q

What condition does the onset of calcific tendinitis resemble?

A

gout

64
Q

Is calcific tendinitis worse in the AM or PM?

A

worse at night - positional night pain

65
Q

How is calcific tendinitis definitively dx’ed?

A

via plain film radiographs comparing int. and ext. rotation

66
Q

when should you perform cross-fiber massage and myofascial release for calcific tendinitis?

A

only in latent phases of condition

67
Q

which PT modalities have been shown to improve pain and function in calcific tendinitis?

A

US and extracorporeal shock wave therapy (ESWT)

68
Q

What are the most likely causes of bicipital tendonitis?

A

impingement and subluxating tendon syndrome

69
Q

What is primary bicipital tendonitis?

A

isolated inflamm. of tendon w/o any assoc. shoulder pathology

70
Q

What is secondary bicipital tendonitis?

A

inflamm. assoc. w/ shoulder pathology such as impingement syndrome or RCT

71
Q

What population most commonly gets bicipital tendinopathy?

A

athletes aged 18-35

72
Q

bicipital tendon rupture is most common in what age group?

A

over 50

73
Q

Bicipital tendonitis etiology? (3)

A
  1. repetitive overuse 2. assoc. shoulder pathology 3. inflamm. conditions affecting the GH jt
74
Q

risk factors for complete rupture of biceps tendon? (6)

A
  1. history of RCT 2. recurrent tendonitis 3. contralateral biceps tendon rupture 4. RA 5. age >40 6. poor conditioning
75
Q

Usual presentation of biciptal tendinopathy?

A

deep throbbing ache in anterior shoulder (usually in bicipital groove), with radiation to deltoid tubercle and/or anterior elbow

76
Q

Is bicipital tendinopathy worse in AM or PM?

A

night pain

77
Q

What is “popeye sign”?

A

bulge above elbow d/t distal msl retraction

78
Q

Which tests have been established to clearly diagnose or r/o specific shoulder pathologies?

A

no individual physical exam test. (trick question!)

79
Q

Which ortho tests are used to test for bicipital tendinopathy?

A

speeds test, hyperextension test, modified yergason

80
Q

What are plain film radiographs used for regarding bicipital tendinopathy?

A

to rule out DJD and bony causes of impingement

81
Q

What is imaging US used for regarding bicipital tendinopathy?

A

assess for biceps rupture, subluxation, or dislocation

82
Q

what are MRI/CT used for regarding bicipital tendinopathy?

A

help ID rotator cuff or labral tears

83
Q

What is injection of local anesthetic used for regarding bicipital tendinopathy?

A

to isolate bicipital tendinitis from rotator cuff tendinitis

84
Q

What is the best first line approach to Tx for bicipital tendinitis?

A

conservative tx approach (POLICE, US, indirect light massage, activity modification)

85
Q

When is surgery indicated for bicipital tendinopathy? (3)

A
  1. Sx persist after 3 mos of Tx 2. other shoulder conditions (instability, labral tears) develop 3. rupture is intolerable d/t interference w/ ADLs
86
Q

Where is pain from the subscap tendon usually?

A

typically anterolateral w/ potential referral to wrist

87
Q

what is the typical MOI for acute supscap tendonitis?

A

same as GH dislocation - P-A force

88
Q

which ortho tests will be positive for subscap tendonitis?

A

(+) Napoleon and Hug tests

Maybe (+) Lift Off and Int. Rot. lag tests

89
Q

What is the key to improving Sx of subscap tendinopathy?

A

trigger pt therapy (myofascial release also effective)

90
Q

Which joints should you adjust for subscap tendinopathy?

A

scapulocostal, GH, AC (in addition to spine)

91
Q

Which msls should be rehabbed for subscap tendinopathy?

A

all rotator cuff msls, in addition to biceps

92
Q

What indicates a good prognosis for subscap tendinopathy?

A

No comorbidities

93
Q

What indicates a poor prognosis for subscap tendinopathy?

A

impingement, instability, and/or labral tears present and not managed

94
Q

What are the static AC stabilizers?

A

AC ligaments, coracoclavicular ligs

95
Q

What are the dynamic AC stabilizers?

A

deltoid, trapezius, serratus anterior

96
Q

What % of shoulder girdle injuries are AC sprains?

A

10%

97
Q

Etiology of AC sprains? (4)

A
  1. direct trauma to posterolateral shoulder 2. FOOSH 3. distraction loading 4. insidious
98
Q

Which grade of AC sprain will you see a step defect?

A

Grade 2 and above

99
Q

What grade of AC sprain should be referred?

A

Grades 4-6

100
Q

What condition may occur with repetitive heavy GH use (without trauma)?

A

AC osteolysis

101
Q

Why should you refer a pt with AC osteolysis?

A

to rule out and monitor for other osteolytic processes

102
Q

What three test bundle should you perform for AC sprain? (higher PPV)

A

Obriens, horizontal passive adduction, resisted horizontal abduction

103
Q

Which condition are Paxino’s pinch and Dugas test used for?

A

AC sprain

104
Q

conservative Tx for AC sprain?

A

POLICE, taping, mobilize if possible, GH exercises to tolerance

105
Q

When should you sling an AC sprain?

A

both waking and non-waking hours, with “rest” periods - allow for as much AROM as possible

106
Q

What are the 2 types of labral tears?

A

SLAP lesion, Bankart lesion

107
Q

What is a SLAP lesion?

A

superior (A-P) detachment

108
Q

What is a Bankart lesion?

A

anterior-inferior detachment

109
Q

Which type of labral tear is more common?

A

SLAP lesion

110
Q

What is the main cause of SLAP lesion?

A

repetitive use

111
Q

What is the main cause of Bankart lesion?

A

dislocation

112
Q

Which gender is more likely to have a labral tear?

A

male

113
Q

Which arm is more likely to have a labral tear?

A

dominant arm

114
Q

S/Sx of labral tear?

A

shoulder pain, popping/catching, positive labral tests, instability, Rot cuff weakness/tenderness

115
Q

DDX for labral tear? (4)

A

RCT, impingement, biceps tendinopathy, instability

116
Q

3 general labral tear ortho tests?

A

obriens, crank, clunk

117
Q

3 ortho tests for SLAP lesions?

A

anterior shift, provocation, biceps load

118
Q

What grade of labral tear should be referred for surgical consult?

A

grade 2 and above

119
Q

When should you suspect a labral tear? (3)

A
  1. conservative Tx fails 2. recurring PAINFUL snapping/crepitus 3. overt instability
120
Q

MFTPs in which msls can refer to the lateral shoulder/arm? (7)

A

SITS, scalenes, coracobrachialis, deltoid

121
Q

MFTPs in which msls can refer to the anterior shoulder/arm? (8)

A

Supraspinatus, infraspinatus, biceps, scalenes, pecs, subclavius, coracobrachialis, deltoid

122
Q

MFTPs in which msls can refer to the posterior shoulder/arm? (12)

A

SITS, levator, scalenes, serratus posterior, latissimus, teres major, coracobrachialis, triceps, deltoid

123
Q

MFTPs in which msls can refer to the medial arm/elbow? (5)

A

subscap, lats, pecs, serratus anterior and posterior

124
Q

MFTPs in which msls can refer to the lateral elbow? (8)

A

SITS, scalenes, subclavius, triceps, deltoid

125
Q

MFTPs in which msls can refer to the wrist/hand? (11)

A

Supraspinatus, infraspinatus, subscap, scalenes, serratus anterior and posterior, Pecs, lats, coracobrachialis, brachialis, triceps

126
Q

What is the age group at higher risk for RCTs?

A

over 50 yrs

127
Q

Risk factors for RCTs? (4)

A
  1. previous steroid inj. 2. overweight/obesity 3. CVD 4. smokers
128
Q

Where is pain usually localized to in RCTs?

A

anterolateral aspect of shoulder

129
Q

Are all RCTs painful?

A

No - can be painless

130
Q

What is the more common onset of RCT?

A

progressive Sx from repetitive overuse

131
Q

What ortho tests are used to test for RCTs?

A

Apleys 1&2 (screening), Codmans arm drop, Lift Off, Trumpeters, Napoleon, Hug Test, Empty can

132
Q

Which ortho test has a high PPV for RCT in pts over 60?

A

Codmans arm drop

133
Q

Should pts with an RCT be given a sling?

A

systematic review showed complications from immobilization

134
Q

What mobilization positions should be avoided with RCTs?

A

any that stretch the posterior cuff

135
Q

On x-ray of an RCT, what is a diminished acromial-humeral interval (AHI) indicative of?

A

large tear

136
Q

What is considered the gold standard for Dx of RCTs?

A

MRI

137
Q

How quickly do mild RCTs heal?

A

1-4 weeks

138
Q

How quickly do moderate RCTs heal?

A

2wks-1 year

139
Q

How quickly do severe RCTs heal (without referral)?

A

2months - over 1 year

140
Q

Are steroid injections beneficial for RCTs?

A

some benefit in ACUTE RCT, ineffective for CHRONIC

141
Q

Is platelet rich plasma (PRP) effective for RCTs?

A

may be

142
Q

Is surgery or PT more effective for improving pain and function at 1 year in small and medium RCTs?

A

Surgery

NMS 3 (2 decks)

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