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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
Q

Thoracic Outlet Syndrome (TOS): meds

A

acetaminophen for pain

NSAIDs for pain and/or inflammation

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26
Q

Thoracic Outlet Syndrome (TOS): priorities for PT

A
  • 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
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27
Q

AC and SC Joint Disorders: typical MOI

A
  • fall onto shoulder w/ UE abducted

- collision w/ another person during a sporting event

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28
Q

AC and SC Joint Disorders: how is injury graded

A
  • traditionally: 1st to 3rd degree

- Rockwood classification: grades I to IV

29
Q

AC and SC Joint Disorders: UE positioning in acute phase

A
  • UE positioned in neutral w/ use of sling

- avoid shoulder elevation during acute phase of healing

30
Q

AC and SC Joint Disorders: diagnostic and special tests

A
  • x-ray
  • clinical exam
  • Shear test
31
Q

AC and SC Joint Disorders: surgical intervention

A
  • very rare b/c it typically will lead to AC joint degeneration
32
Q

AC and SC Joint Disorders: meds

A

acetaminophen for pain

NSAIDs for pain and/or inflammation

33
Q

AC and SC Joint Disorders: 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
  • manual therapy to AC and SC joints and surrounding connective tissues sch as soft tissue/massage, joint oscillations, and mobs
34
Q

Subacromial/Subdeltoid Bursitis: what is it

A
  • 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
Q

Subacromial/Subdeltoid Bursitis: diagnosis

A

clinical exam: Hx, AROM, PROM, resistive tests

36
Q

Subacromial/Subdeltoid Bursitis: meds

A

acetaminophen for pain

NSAIDs for pain and/or inflammation

37
Q

Subacromial/Subdeltoid Bursitis: PT interventions

A

refer to general interventions for bursitis/tendonitis/tendonosis

38
Q

Rotator Cuff Tendonosis/Tendonopathy: what is it

A
  • 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
Q

Rotator Cuff Tendonosis/Tendonopathy: diagnostic tests and special tests

A
  • possibly MRI, but sometimes not sensitive enough for accurate assessment
  • Supraspinatus test
  • Neer’s impingment test
40
Q

Rotator Cuff Tendonosis/Tendonopathy: meds

A

acetaminophen for pain

NSAIDs for pain and/or inflammation

41
Q

Rotator Cuff Tendonosis/Tendonopathy: PT interventions

A

refer to general interventions for bursitis/tendonitis/tendonosis

42
Q

Impingement Syndrome: what is it

A

characterized by soft tissue inflammation of the shoulder from impingement against the acromion with repetitive overhead AROM

43
Q

Impingement Syndrome: diagnostic tests and special tests

A
  • arthrogram
  • MRI
  • Neer’s impingement test
  • Supraspinatus test
  • Drop arm test
44
Q

Impingement Syndrome: position to avoid if there is a surgical repair

A

avoid shoulder elevation above 90 degrees

45
Q

Impingement Syndrome: meds

A

acetaminophen for pain

NSAIDs for pain and/or inflammation

46
Q

Impingement Syndrome: priorities for PT

A
  • 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
Q

Internal (posterior) Impingement: what is it

A
  • 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
Q

Internal (posterior) Impingement: diagnostic tests

A
  • no specific diagnostic test

- determined through clinical exam

49
Q

Internal (posterior) Impingement: meds

A

acetaminophen for pain

NSAIDs for pain and/or inflammation

50
Q

Internal (posterior) Impingement: priorities for PT

A
  • functional training and restoration of muscle imbalances using ther ex to normalize strength, endurance, coordination, and flexibility
  • correcting biomechanics w/ joint mobs
51
Q

Bicipital Tendonosis/Tendonopathy: what is it

A
  • 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
Q

Bicipital Tendonosis/Tendonopathy: diagnostic tests and special tests

A
  • possibly MRI, not always sensitive enough

- Speed’s test

53
Q

Bicipital Tendonosis/Tendonopathy: meds

A

acetaminophen for pain

NSAIDs for pain and/or inflammation

54
Q

Bicipital Tendonosis/Tendonopathy: priorities for PT

A

refer to general interventions for bursitis/tendonitis/tendonosis

55
Q

Proximal Humeral Fx: what is it

A
  • 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
Q

Proximal Humeral Fx: meds

A

acetaminophen for pain

NSAIDs for pain and/or inflammation

57
Q

Proximal Humeral Fx: priorities for PT

A
  • 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
Q

Adhesive Capsulitis: Common findings in Hx

A
  • Age 45+
  • onset is insidous, post-surgical, or due to trauma -
  • common chronic disease: diabetes
  • typically not painful unless stretched
59
Q

Adhesive Capsulitis: what is it

A
  • 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
Q

Adhesive Capsulitis: meds

A

acetaminophen for pain

NSAIDs for pain and/or inflammation

61
Q

Adhesive Capsulitis: 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
62
Q

Name that Pathology
Symptoms: intermittent pain w/ overhead or strenuous activities, over age 35, could have night pain, scapular or RTC weakness

A

External Primary Impingement (stages 1-3)

63
Q

Name that Pathology

Symptoms: classic night pain, weakness noted predominantly in abduction and lateral rotators, loss of motion

A

RTC tear (full-thickness)

64
Q

Name that Pathology

Symptoms: inability to perform ADLs due to loss of motion, loss of motion may be perceived as weakness

A

Adhesive Capsulitis

65
Q

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

A

Anterior Instability (w/ or w/o external secondary impingement)

66
Q

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

A

Posterior Instability

67
Q

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

A

Multidirectional instability

68
Q

RTC Lesion/Tear: Hx

A
  • typically age 30-50

- pain and weakness after eccentric load

69
Q

RTC Lesion/Tear: Exam

A
  • 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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