MSK Exam 10? Flashcards
3 bones in shoulder
clavicle
scapula
proximal humerus
articular surfaces in shoulder
glenohumeral
sternoclavicular
acrocioclavicular
scapulothoracic
5 main mm of shoulder
deltoid- abduction supra- abduction infra- ext rotation subscap- internal rotation teres minor- external
Rotator cuff
intrinsic injury of shoulder
glenohumeral ligaments- sprain or tear
muscle or tendon inflammation, tear, strain: rotator cuff and deltoid
bones: fracture, inflamed capsule
extrinsic causes shoulder pain
referred
neuro causes shoulder pain
Cervical nerve root compression supraspinatus nerve compression brachial plexus herpes zoster spinal cord lesion cervical spine disease
abdominal cause shoulder pain
hepatobiliary disease
diaphragm irritation
CV causes shoulder pain
MI
axillary vein thrombosis
thoracic outlet syndrome
thoracic causes shoulder pain
upper lobe pneumonia
apical lung tumor
pulmonary embolus
common causes of intrinsic shoulder path
impingement tendinopathy tendon tear AC separation OA adhesive capsulitis (frozen shoulder) bursitis instability SLAP lesion
characterisitic of intrinsic shoulder issue
pain can be positional
more easily localized with palpation and movement
way to test suprascap
empty can
or 90 degree and resist their AB duction
way to test subscap
lift off
or tuck elbow in, 90 degrees and have them push medially against R with their wrist
infraspinatus teres minor test
forearm laterally against R
90 degrees
most intrinsic shoulder pain
supraspinatus
what protects supraspinatus
sub acromial bursa
what space can compress supraspinatus
head of humerus and acromion
night pain in shulder
atrophy sup and post mm
pain crepitus while abducting arm
impingment
tests for impingment
hawkins and near impingement
weakness of rotator cuff can lead to what
superior subluxation humeral head when should abduct beyond 90 degrees
predisposing to impingement
what ligaments can be affected when falling on tip of shoulder
AC and corcaoclavicular
what is Tx for grade 1-3 AC separation
4-5
1-3 conservative
4+ surgical
lost active and passive ROM inshoulder
arthritis!
loss of joint space
arthritis
imaging to distinguish soft tissue path
MRI
risk factor frozen shoulder
DM
limit of steroid injections each year
4
differentiate between bursitis and tendonitis
pain with active vs passive ROM
tendon hurst with active
bursa with passive too
Dx bursitis
clinical exam and inject then test ROM and strength again after
What is SLAP lesion
superior labrum anterior to posterior
where biceps anchors to labrum
acute SLAP lesion
falling and grab something
MRI definition of SLAP lesion
O’Brians
what is new imaging for joint problems instead of MRI
contrast injection into joint with serial XR or fluoroscopy
posterior pain aroun dhip could be
SI
lumbar
unusual true hip pain
lateral hip pain ddx
bursitis
lateral hip pain with paresthesia
meralgia paresthetica
anterior/groin pain ddx
hip pain
osteonecrosis
sepsis, fracture
synovitis
lower anterior thigh pain
referred true hip
upper femur
femoral neck
lumbar radiculopathy
if neither direct P not ROM reproduces “hip pain”
what is ddx
hernia, lower abdominal pathology
referred pain from lumbar area
trochanteric bursitis
exaggerated or abnormal movement of gluteus medius and TFL over greater trochanter
what type of pain with trochanteric bursitis
lateral hip pain, just posterior superior to point of trochanter
important part of PE with hip pain cc
gait analysis
key exam feature in OA hip
restricted abduction and internal rotation
pain
limited flexion and morning stiffness
in OA of hip the groin is aggravated by what
movement more than palpation
when will OA pain hurt the most
morning and end of the day
what is meralgia paresthetica
lateral femoral cutaneous nerve susceptible to impingement
especially when course under inguinal lig
burning of lateral thigh
no weakness of DTR changes
meralgia paresthetica
if burning lateral thigh and with weakness and DTR changes
not! meralgia paresthetica
because involving more than sensory
osteonecrosis
compromised vascular supply to femoral head
joint collapse in 3-5 years
groin pain, weight bearing and motion induced
steroids and excessive alcohol intake can cause what hip path
osteonecrosis
occult fracture imaging
MRI
XR not enough
presentation of referred pain of hip
lumbar ans SI joint
whenever groin pain with back pain
Sx extend beyond knee
paresthesia present
fabere test
hip, psoas or SI problem
flex abduct externally rotate then extend
if painful then +
osgood- schlatter
tibial tuberosity avulsion
osteochondritis of tibial tubercle
apophysitis of tibial tubercle at insertion of patellar tendon
Tx osgood schlatter
pain contro;
continnue activity
leg strengthening with physical therapy
76 u.o L shoulder pain
burning and radiates to back of shoulder low neck area
ddx?
ruptured supraspinatus
cervical n compression/radiculopathy (5, 6)
OA
