Midterm Flashcards by Beck Forsland

What is the gold standard ancillary study for RCTs?

MRI

How well did you know this?

Not at all

Perfectly

What is the goal for RTW/P (returning to work/play)?

90% strength

100% flexibility

How well did you know this?

Not at all

Perfectly

What is the MC cause of shoulder P?

Shoulder impingement syndrome

How well did you know this?

Not at all

Perfectly

In the PE, what is more predictive than Pain for GH instability (and dislocation)?

Apprehension

How well did you know this?

Not at all

Perfectly

When would you relocate a GH dislocation?

If vascular compromise is present

How well did you know this?

Not at all

Perfectly

What is the MC type of injury to AC joint?

AC Sprain

How well did you know this?

Not at all

Perfectly

What shoulder injury would have an observable step defect?

RCT
Bicipital tendonopathy
Shoulder impingement syndrome
Subscapularis tendonitis
GH instab/dislocation
GH labral tear
Adhesive capsulitis
Calcification tendonosis
AC sprains

AC sprains

How well did you know this?

Not at all

Perfectly

MC RCT muscle?

Supraspinatus

How well did you know this?

Not at all

Perfectly

RTC disorder happens because of 2 things:

Traumatic injury

2. Progressive degeneration

How well did you know this?

Not at all

Perfectly

PE for RTCs

AROM limited in most directions — neutral rotation may be painless. ABD rotation is P.

SITS tenderness on palpation

P w/stretching
P w/resisted mm testing

Or those: Appley’s I &amp; II
Codman’s arm drop
Lift off
Napoleon and hug
Neer’s test w/ resistance
Empty can w/ resistance

How well did you know this?

Not at all

Perfectly

Acute tx for RTC?

POLICE:
Protection
Optimal Loading
Ice
Compression
Elevation

P-free pROM, aROM

IFC, TENS, US, G5
Mob/manip/massage
Isometric mm strength
Acupuncture

How well did you know this?

Not at all

Perfectly

Two types of bicipital tendonitis

Primary - isolated inflam WITHOUT shoulder pathology

Secondary - inflamm WITH pathology

How well did you know this?

Not at all

Perfectly

PE findings for bicipital tendinopathy

Speed’s test
Hyperextension test
Modified yergason/bicipital instab test

How well did you know this?

Not at all

Perfectly

What group of people are most likely to get shoulder impingement syndrome?

Athletes 18-35 yo

How well did you know this?

Not at all

Perfectly

Name the 2 types of shoulder impingement syndrome:

Primary - d/t pathological narrowing

Secondary - caused by GH instab d/t repetitive overuse/hyperelasticity

How well did you know this?

Not at all

Perfectly

Which type of shoulder impingement syndrome is MC?

Secondary - caused by anterior GH instab d/t repetitive overuse

How well did you know this?

Not at all

Perfectly

What are the 2 categories of risk factors for impingement?

Structural (AC degen, calcification, altered tendon vascular ivy)

Functional (instability, muscular imbalance between IR/AD and ER/AB)

How well did you know this?

Not at all

Perfectly

Important ddx from impingement syndrome

Cervical sprain/strain d/t CAD possibly associated with seatbelt contact on GH

Neer’s pathogenesis

How well did you know this?

Not at all

Perfectly

Which stages of Neer’s are responsive to conservative management

1 and 2

3 is less responsive and requires multidisciplinary mgmt

How well did you know this?

Not at all

Perfectly

At what degrees of ABD is there max reduction in GH space

80-120˚

How well did you know this?

Not at all

Perfectly

What is positive on PE for impingement?

Impingement sign w/forward flexion
Painful arc 80-120˚
Painful active internal rotation
Tenderness

Modified Neer’s
Hawkins-Kennedy

How well did you know this?

Not at all

Perfectly

Common mm that are too strong/tight in the shoulder (that may lead to impingement)

Pecs
Lats
Internal rotators
Upper trap
Deltoids

How well did you know this?

Not at all

Perfectly

Common mm that are too weak/tight in the shoulder (that may lead to impingement)

External rotators
Subscap
Serratus ant
Levator scapulae
Middle and lower traps
Rhomboids/abs

How well did you know this?

Not at all

Perfectly

What is the acute Tx for impingement

Same as RTC

Except pt should be careful in flexion/ABD >90˚

How well did you know this?

Not at all

Perfectly

What types of GH instability are there?

- Traumatic d/t dislocation - Atraumatic (multidirectional) which is congenital - Acquired d/t repetitive overhead motion, mm imbalance, etc.

Which way do dislocations commonly occur? And why?

Anterior D/t traumatic P-A force w/ ABD and external rotation

When do you relocate a dislocation?

If vascular compromise is present. Otherwise you sling and refer to ER

What method of relocation is better?

FARES is better than Hippocratic & Kocher

What orthos could be positive in PE?

``` Sulcus sign Sulcus test Faegin’s test Anterior apprehension Relocation & release Posterior apprehension Norwood’s stress test ```

Interpreting the results of instab tests are difficult. What is a better prediction pattern in a PE than pain?

Apprehensino

What are conservative Tx goals for instab/dislocation?

Improve scapular and clavicular arom/srom Strengthen rotator cuff mm Improve shoulder proprioception Activity/lifestyle mods

What are the 2 types of labral tears?

SLAP d/t repetitive use (Superior Labrum Anterior-Posterior) Bankart d/t dislocation (A-I MC)

What is the MC labral tear and what causes it?

SLAP lesion | D/t repetitive stress

Who is more likely to get labral tears?

M>F 3:1

If there is a painful audible, DDX:

RCT Impingement Labral tear

If there is a painless audible, DDX:

GH joint dysfxn

What injury may include neuropraxic injury to NR and/or cervicobrachial plexus implicating distal radiation beyond the elbow?

Labral tear

What is commonly associated with PAINFUL clicking/audibles at onset?

Labral tears

What is the history of a labral tear?

Trauma or repetitive overuse

Orthos for slap lesions

Anterior load and shift Biceps prov Biceps load

General orthos for labral tears

Click Crank O’Brien’s test

When do you suspect labral tears?

When conservative Tx fAils Recurring painful clicking/crepitus When there is overt GH instab

painless GH clicking DDX

* GH Joint dysfunction * Mild GH Instability * Mild Osteoarthritis (OA) * Subacute/Chronic Partial Thickness RCT * Subacute/Chronic Impingement * Subacute/Chronic Tendonitis * Mild Grade I Labral Tear

Painful GH clicking DDX

* Grade II-IV Labral Tear * Moderate to Severe GH Instability * Moderate to Severe Osteoarthritis (OA) * Stage II/III Calcific Tendonitis * Acute Impingement * Acute Subacromial Bursitis * Full Thickness RCT * Acute Tendonitis

DDx Painless GH clicking from Painful (aka list the things from history that make you think painless)

``` Gradual onset (or mild trauma) Full GH aROM and pROM Responds well to conservative care Lower risk with regards to surgery Amenable to manipulation Can lead to painful clicking if untreated ```

A syndrome characterized by shoulder pain and marked restriction of both active and passive glenohumeral (GH) range of motion.

Adhesive capsulitis

Who gets adhesive capsulitis?

F>M | 40-60yo

What is the onset/quality of adhesive capsulitis?

• Most commonly sudden, non-traumatic • Sudden onset of severe symptoms without a clear mechanism of injury (Calcific tendinopathy must also be considered) • Also has freezing-frozen-thawing phases • Acute onset and very painful shoulder pain (“like a boil”) • Commonly occurs in the supraspinatus of the dominant arm • Vague history of glenohumeral “stiffness” may be an early indicator

What is the schedule of loss of ROM in adhesive capsulitis?

External rotation ABD Internal rotation

What is the quality of adhesive capsulitis?

Stiffness (freezing phase) Sharp, severe (frozen) Stiffness (thawing)

adhesive capsulitis looks like what when it is in the freezing phase?

RCT Impingement Labral tears Instab

adhesive capsulitis looks like what when it is in the frozne phase?

Marked loss of AROM

adhesive capsulitis looks like what when it is in the thawing phase?

Gradual return of AROM

How long does the freezing stage of adhesive capsulitis last?

2 weeks - 9 months

How long does the frozen stage of adhesive capsulitis last?

4 months - 12 months

How long does the thawing stage of adhesive capsulitis last?

6 months - 2 years

what to do in acute Tx adhesive capsulitis

``` Avoid prolonged rest Ice and NSAID All the PT mods Codman’s arm swings Wand/broomstick Table/wall walking Mob ```

What do you want to avoid in subacute/chronic TX of adhesive capsulitis?

“Buddy” stretching

When would you need plain films for adhesive capsulitis?

To r/o osseous pathology in GH or AC joints

When would you need plain film for calcific tendinitis?

To determine degree of calcification in the tendon

In what pathology will contrast arthrogram/MRI should thickened axillary fold?

adhesive capsulitis

What is the prognosis for adhesive capsulitis

Overall good 60% of cases self-resolve in 2 years Some P and stiffness common 5-10 years after Dx

adhesive capsulitis may be associated with increased risk of

Stroke

Where do calcific deposits end up?

In / around the RCT near greater tubercle

Which RTC is MC affected by calcific deposits?

Supraspinatus

Who is most likely to get calcific deposits

Sedentary W>M

What are the 2 types of calcific deposits and which one is MC?

Type I - idiopathic ** MC Type II - metabolic

Type I calcific deposits is related to?

Chronic impingement syndrome

What are Uhthoff’s stages?

Stage I pre-calcific - NO P Stage II calcific +/- P Stage III post-calcific +/- P

What is US useful for? What is it NOT useful for?

Calcific tendinopathy! NOT adhesive capsulitis

What is extracorporeal shock wave therapy for?

May improve P and fxn in chronic calcific tendonitis

What is: Injury to the AC joint capsule and/or coracoclavicular ligaments, acromioclavicular ligament, coracoacromial ligament, and deltotrapezial fascia.

AC sprain

Who is most likely to get AC sprains?

18-35 yo | M>F

AC sprains account for _____% of all shoulder girdle injuries?

10%

What is the MC type of injury to the AC joint?

Grade I AC sprains

In which grade of AC sprain do you see observable step defect?

Grade II AC sprains Grade III Is complete separation of joint and has a marked step defect

What grades of AC sprains are d/t high-energy injury?

Grades IV-VI

How do you treat Grade IV-VI AC sprains?

Surgically

What are 3 bundled tests for AC sprains it’s a higher PPV?

O’Briens Horizontal (cross body) ADD Resisted Horizontal ABD

How do you Tx Grades I-III AC sprains?

Conservatively

Prognosis for Grade I-III AC sprains?

Responds well w/i 4-6 weeks

What Tp refers to lateral shoulder/arm? (4)

SITS Delt Scalene Coracobrachialis

What Tp refers to anterior shoulder/arm? (6)

``` Biceps Scalenes Pecs Subclavius Coracobrachialis Delts ```

Where does biceps Tp refer to? (1)

Anterior shoulder/arm

Where does Tp in levator scapula refer to? (1)

Posterior shoulder/arm

Where does Serratus anterior and posterior refer to? (2) Where does Serratus posterior (ONLY) refer to? (1)

BOTH: Medial arm/elbow and to wrist/hand Posterior ONLY: posterior shoulder/arm

Where does subscapularis refer to? (1)

Medial arm/elbow

Where does teres major refer to? (1)

Posterior shoulder/arm

Where does brachialis refer to? (1)

Wrist/hand

Pain referral to posterior shoulder/arm (9)

``` S.I.T.S Levator Scapula Scalene’s Serratus posterior Latissimus dorsi Teres Major Coracobrachialis Triceps Deltoid ```

Pain referral to medial arm/elbow (4)

Subscapularis Latissimus dorsi Pec ’s Serratus anterior and posterior

Pain referral to lateral arm/elbow (5)

``` S.I.T.S Scalene’s Subclavius Triceps Deltoid’s ```

Pain referral to wrist/hand (8)

``` S.I.T.S Scalene’s Serratus anterior and posterior Pec ’s Latissimus dorsi Coracobrachialis Brachialis Triceps ```

Describe Travell and Simons MFTP work

1-2 min ischemic compression

Describe Nimmo MFTP work

5-7 sec specific pressure