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Sharlene and MB's PT party > MSK #12- Shoulder conditions > Flashcards

MSK #12- Shoulder conditions Flashcards

1
Q

GH Subluxation and Dislocation: What direction do they typically occur in

A
  • 95% anterior- inferior
  • occurs when abducted UE is forcefully externally rotated causing tearing of inferior GH ligament, anterior capsule, and occasional glenoid labrum
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2
Q

GH Subluxation and Dislocation: Tell me about posterior dislocations

A
  • rare
  • occur w/ multi-directional laxity of GH joint
  • occurs w/ horizontal adduction and IR of GH joint
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3
Q

GH Subluxation and Dislocation: possible complications

A
  • compression Fx of posterior humeral head (Hill-Sachs lesion)
  • superior labrum tear (SLAP lesion)
  • avulsion of anteroinferior capsule and ligaments associated w/ glenoid rim (Bankart’s lesion)
  • bruising of axillary nerve
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4
Q

GH Subluxation and Dislocation: what position should pt.s avoid after surgical repair for chronic dislocation/subluxation

A

the apprehension position- flexion 90 degrees or more, horizontal abduction 90 degrees or more, and ER to 80 degrees

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5
Q

GH Subluxation and Dislocation: diagnostic and special tests

A
  • Apprehension test
  • X-ray
  • CT scan
  • MRI
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6
Q

GH Subluxation and Dislocation: med

A

acetaminophen for pain

NSAIDs for pain and/or inflammation

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7
Q

GH Subluxation and Dislocation: priorities for PT

A
  • may varying depending on pt. problems and if there was a surgical intervention
  • biomechanical faults caused by joint restrictions should be corrected w/ joint mobs to the specific restrictions identified during exam
  • restoration of normal shoulder mechanics: strengthening, endurance, coordination
  • ther ex should focus on regaining dynamic scap/thoracic , GH stabilization, and muscle re-ed
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8
Q

Instability: 2 categories

A

Traumatic- common in young throwing athletes

Atraumatic- pt.s w/ congenitally loose connective tissue around the shoulder, Typically ages 10-35. No Hx of trauma.

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9
Q

Instability: characterized by ____

A
  • popping/clicking
  • repeated dislocation/subluxation
  • anterior or posterior pain
  • pain and instability w/ activity
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10
Q

Instability: when is surgery indicated

A
  • labrum repair

- Bankart lesions

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11
Q

Instability: how is it diagnosed

A
  • clinical exam of Hx, AROM, PROM, resistive tests, palpation
  • Will have full or excessive ROM
  • palpation and muscles tests likely to be normal
  • Special tests: Load and shift test, apprehension test, relocation test, augmentation test
  • MRIs identify labral tears
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12
Q

Instability: meds

A

acetaminophen for pain

NSAIDs for pain and/or inflammation

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13
Q

Instability: priorities for PT

A
  • emphasize return of function w/o pain
  • functional training and restoration of muscle imbalances using ther ex to normalize strength, endurance, coordination, and flexibility
  • correcting biomechanics w/ joint mobs
  • For pt.s requiring surgery, shoulder is kept in sling for 3-4 weeks. After 6 weeks more sports-specific training can be done. Full return may take 3-4 months
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14
Q

Labral Tears: two major types

A

SLAP- tear on top half and may involve biceps tendon

Bankart- tear on bottom half and commonly involve the inferior glenohumeral ligament. Often occurs w/ other shoulder injuries such as dislocations

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15
Q

Labral Tears: s/s

A
  • shoulder pain that cannot be localized to a specific point
  • pain worse w/ overhead activities or when arm is held behind back
  • weakness
  • instability in shoulder
  • pain w/ resisted biceps flexion
  • tenderness over front of shoulder
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16
Q

Labral Tears: when is surgery required

A
  • unstable injuries required to reattach labrum to glenoid

- Bankart lesion

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17
Q

Labral Tears: diagnostic tests

A
  • clinical exam: Hx, AROM, PROM, resistive tests, palpation
  • MRI
  • arthroscopic surgery (gold standard)
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18
Q

Labral Tears: meds

A

acetaminophen for pain

NSAIDs for pain and/or inflammation

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19
Q

Labral Tears: priorities for PT

A
  • emphasize return of function w/o pain
  • functional training and restoration of muscle imbalances using ther ex to normalize strength, endurance, coordination, and flexibility
  • correcting biomechanics w/ joint mobs
  • For pt.s requiring surgery, shoulder is kept in sling for 3-4 weeks. After 6 weeks more sports-specific training can be done. Full return may take 3-4 months
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20
Q

Thoracic Outlet Syndrome (TOS): what is it

A
  • compression of neurovascular bundle (brachial plexus, subclavian artery and vein, vagus and phrenic nerves, and sympathetic trunk) in thoracic outlet between bony and soft tissue structures
  • occurs when size or shape of thoracic outlet is altered
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21
Q

Thoracic Outlet Syndrome (TOS): common areas of compression

A
  • superior thoracic outlet
  • scalene triangle
  • between clavicle and first rib
  • between pec minor and thoracic wall
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22
Q

Thoracic Outlet Syndrome (TOS): what type of surgical intervention may be used

A

removal of cervical rib or a release of anterior and/or middle scalene muscle

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23
Q

Thoracic Outlet Syndrome (TOS): Diagnostic tests

A
  • x-ray: identify abnormal bony anatomy
  • MRI: identify abnormal soft tissue anatomy
  • electrodiagnostic test: assess nerve dysfunction
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24
Q

Thoracic Outlet Syndrome (TOS): Special Tests

A
  • Adson’s test
  • Roos test
  • Wright test
  • Costoclavicular test
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25
Thoracic Outlet Syndrome (TOS): meds
acetaminophen for pain | NSAIDs for pain and/or inflammation
26
Thoracic Outlet Syndrome (TOS): priorities for PT
- interventions will vary depending on exact cause - postural re-education - functional training and restoration of muscle imbalances using ther ex to normalize strength, endurance, coordination, and flexibility - correcting biomechanics w/ joint mobs - manip (typically 1st rib articulation) to diminish pain and soft tissue guarding
27
AC and SC Joint Disorders: typical MOI
- fall onto shoulder w/ UE abducted | - collision w/ another person during a sporting event
28
AC and SC Joint Disorders: how is injury graded
- traditionally: 1st to 3rd degree | - Rockwood classification: grades I to IV
29
AC and SC Joint Disorders: UE positioning in acute phase
- UE positioned in neutral w/ use of sling | - avoid shoulder elevation during acute phase of healing
30
AC and SC Joint Disorders: diagnostic and special tests
- x-ray - clinical exam - Shear test
31
AC and SC Joint Disorders: surgical intervention
- very rare b/c it typically will lead to AC joint degeneration
32
AC and SC Joint Disorders: meds
acetaminophen for pain | NSAIDs for pain and/or inflammation
33
AC and SC Joint Disorders: priorities for PT
- emphasize return of function w/o pain - functional training and restoration of muscle imbalances using ther ex to normalize strength, endurance, coordination, and flexibility - manual therapy to AC and SC joints and surrounding connective tissues sch as soft tissue/massage, joint oscillations, and mobs
34
Subacromial/Subdeltoid Bursitis: what is it
- subacromial and subdeltoid bursae (which may be continuous) have a close relationship to rotator cuff tendons, making them susceptible to overuse - can also become impinged beneath the acromial arch
35
Subacromial/Subdeltoid Bursitis: diagnosis
clinical exam: Hx, AROM, PROM, resistive tests
36
Subacromial/Subdeltoid Bursitis: meds
acetaminophen for pain | NSAIDs for pain and/or inflammation
37
Subacromial/Subdeltoid Bursitis: PT interventions
refer to general interventions for bursitis/tendonitis/tendonosis
38
Rotator Cuff Tendonosis/Tendonopathy: what is it
- tendons of RTC are susceptible to tendonitis, due to relatively poor blood supply near insertion of muscles - results from mechanical impingement of the distal attachment of the RTC on the anterior acromion and/or coracoacromial ligament with repetitive overhead activities
39
Rotator Cuff Tendonosis/Tendonopathy: diagnostic tests and special tests
- possibly MRI, but sometimes not sensitive enough for accurate assessment - Supraspinatus test - Neer's impingment test
40
Rotator Cuff Tendonosis/Tendonopathy: meds
acetaminophen for pain | NSAIDs for pain and/or inflammation
41
Rotator Cuff Tendonosis/Tendonopathy: PT interventions
refer to general interventions for bursitis/tendonitis/tendonosis
42
Impingement Syndrome: what is it
characterized by soft tissue inflammation of the shoulder from impingement against the acromion with repetitive overhead AROM
43
Impingement Syndrome: diagnostic tests and special tests
- arthrogram - MRI - Neer's impingement test - Supraspinatus test - Drop arm test
44
Impingement Syndrome: position to avoid if there is a surgical repair
avoid shoulder elevation above 90 degrees
45
Impingement Syndrome: meds
acetaminophen for pain | NSAIDs for pain and/or inflammation
46
Impingement Syndrome: priorities for PT
- restoration of posture - functional training and restoration of muscle imbalances using ther ex to normalize strength, endurance, coordination, and flexibility - correcting biomechanics w/ joint mobs
47
Internal (posterior) Impingement: what is it
- characterized by an irritation between the RTC and greater tuberosity or posterior glenoid and labrum - often seen in athletes performing overhead activities - pain commonly noted on posterior shoulder
48
Internal (posterior) Impingement: diagnostic tests
- no specific diagnostic test | - determined through clinical exam
49
Internal (posterior) Impingement: meds
acetaminophen for pain | NSAIDs for pain and/or inflammation
50
Internal (posterior) Impingement: priorities for PT
- functional training and restoration of muscle imbalances using ther ex to normalize strength, endurance, coordination, and flexibility - correcting biomechanics w/ joint mobs
51
Bicipital Tendonosis/Tendonopathy: what is it
- most commonly an inflammation of the long head of the biceps - results from mechanical impingement of the proximal tendon between the anterior acromion and the bicipital groove of the humerus
52
Bicipital Tendonosis/Tendonopathy: diagnostic tests and special tests
- possibly MRI, not always sensitive enough | - Speed's test
53
Bicipital Tendonosis/Tendonopathy: meds
acetaminophen for pain | NSAIDs for pain and/or inflammation
54
Bicipital Tendonosis/Tendonopathy: priorities for PT
refer to general interventions for bursitis/tendonitis/tendonosis
55
Proximal Humeral Fx: what is it
- humeral neck Fx frequently occur w/ a FOOSh among older osteoporotic women - generally does not require immobilization or surgical repair since it is a fairly stable Fx - greater tuberosity fx are more common in middle-age and elder adults, usually related to a fall onto the shoulder, and does not require immobilization for healing
56
Proximal Humeral Fx: meds
acetaminophen for pain | NSAIDs for pain and/or inflammation
57
Proximal Humeral Fx: priorities for PT
- early PROM is important in preventing capsular adhesions - emphasize return of function w/o pain - functional training and restoration of muscle imbalances using ther ex to normalize strength, endurance, coordination, and flexibility - correcting biomechanics w/ joint mobs
58
Adhesive Capsulitis: Common findings in Hx
- Age 45+ - onset is insidous, post-surgical, or due to trauma - - common chronic disease: diabetes - typically not painful unless stretched
59
Adhesive Capsulitis: what is it
- characterized by a restriction in shoulder motion as a result of inflammation and fibrosis of the shoulder capsule, usually due to disuse following injury or repetitive microtrauma - may be insidious onset - Restriction follows capsular pattern: ER>abduction/flexion>IR - may demonstrate shoulder hiking
60
Adhesive Capsulitis: meds
acetaminophen for pain | NSAIDs for pain and/or inflammation
61
Adhesive Capsulitis: priorities for PT
- emphasize return of function w/o pain - functional training and restoration of muscle imbalances using ther ex to normalize strength, endurance, coordination, and flexibility - correcting biomechanics w/ joint mobs
62
Name that Pathology Symptoms: intermittent pain w/ overhead or strenuous activities, over age 35, could have night pain, scapular or RTC weakness
External Primary Impingement (stages 1-3)
63
Name that Pathology | Symptoms: classic night pain, weakness noted predominantly in abduction and lateral rotators, loss of motion
RTC tear (full-thickness)
64
Name that Pathology | Symptoms: inability to perform ADLs due to loss of motion, loss of motion may be perceived as weakness
Adhesive Capsulitis
65
Name that Pathology Symptoms: apprehension to mechanical shifting limits activities, slipping, popping, sliding, apprehension w/ horizontal abduction and lateral rotation , may have anterior or posterior pain, weak scapular stabilizers
Anterior Instability (w/ or w/o external secondary impingement)
66
Name that Pathology Symptoms: slipping or popping of humerus out the back- may be associated w/ forward flexion and medial rotation while shoulder is under a compressive load
Posterior Instability
67
Name that Pathology Symptoms: looseness of shoulder in all directions- may be most pronounced while carrying luggage or turning over in sleep, may or may not have pain
Multidirectional instability
68
RTC Lesion/Tear: Hx
- typically age 30-50 | - pain and weakness after eccentric load
69
RTC Lesion/Tear: Exam
- may observe shoulder hike - weakness and pain with abduction and ER - pain w/ PROM if there is also impingement - Special Tests: drop arm test, empty can test - tenderness around RTC - may use xray - MRI

Sharlene and MB's PT party (35 decks)

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