MSK exam Flashcards
bones of shoulder girdle
clavicle
scapula
proximal humerus
4 articulations of shoulder
glenohumeral
sternoclavicualr
acromioclavicular
scapulothoracic
mm of shoulder
deltoid supraspinatus infraspinatus subscapularis teres minor
mm of rotator cuff
supraspinatus
infraspinatus
subscapularis
teres minor
deltoid action
abduction
supraspinatus action
abduction
infraspinatus action
external rotation
subscaupularis action
internal rotation
teres minor action
external rotation
intrinsic causes of shoulder pain
glenohumeral ligaments sprain or tear
mm or tendon inflammation, tear, strain
bones- fracutres, inflamed capsule
neurological external causes of shoulder pain
cercial nn root compression supraspinatus nn compression brachial plexus lesions herpes zoster spinal cord lesion cervical spine disease
abdominal causes of shoulder pain
hepatobiliary diseases diaphragm irritation (spleen, ectopic, perforated)
CV causes of shoulder pain
MI
axiallary vv thrombosis
thoracic outlet syndrome
thoracic causes of shoulder pain
upper lobe pneumonia
apical lung tumor
PE
intrinsic pathologies
impingment tendinopathy tendon tear AC separation osteoarthritis adhesive capsulitis bursitis instability SLAP lesion
testing infraspinatus and teres minor
pt rotates forearm laterally against resistance
supraspinatus
most common cause of tendon or mm source pain
susceptible to repetitive motion injuries: baseball, house painters
only protected by subacromial bursa
supraspinatus attachments
sup scapular
greater tubercle of humerus
passes thru narrow area btwn acromion and head of humerus
tendinitis
weakness of cuff mm allow upward migration of humeral head -> irritates supraspinatus tendon and/or mm from impingment on acromion
can lead to tear
drop arm test
supraspinatus tear
impingement
weakness of rotator cuff can lead to superior subluxation of humeral head when shoulder is abducted beyond 90 degrees, predisposing to impingment syndromes
Sx may be necessary
AC seperation
fall on tip of shoulder typical
involves both AC and coracoclavicular ligs
5 grades
tender over AC joint, visual inspection at 3+
usually conservative Tx
osteoarthritis
atrophy, significant loss of both active and passive ROM, tender, crepitus
x-ray loss of joint space
adhesive capsulitis
aka frozen shoulder
any reason there is long standing loss of ROM
mm atrophy, significant loss of both active and passive ROM, tender, but major complaint is stiffness
DM SIGNIFICANT risk factor
MRI to Dx
bursistis
trauma, repetitive motion , tender
pain with both active and passive ROM
inject with lidocaine to Dx
rotator cuff tear
persistent weakness despite pain relief w/injection
rotator cuff tendonpathy
normal strength with pain relief
SLAP lesion
superior labrum anterior to posterior
most common in throwing athletes and those who do lots of work overhead
acutely can be d/t grabbing onto something while falling or lifting something heavy suddenly
signs of SLAP
clicking
ant pain, especially on abduction and external rotation
shoulder workup
x-ray
US
MRI
trochanteric bursitis
exaggerated or abnormal movement of gluteus medius and TFL over greater trochanter
lat hip apin
chronic trochanteric bursitis
bursa fibrose and lose its ability to provide frictionless surface of movement
what do you want to know if trochanteric bursitis is suspected
lumbar mm tightness leg length discrepancy knee or ankle arthritis varus/vlagus stance or gait orthotics? gait symmetry
osteoarthritis
activity pain, occuring at night or fist thing in am
groin pain aggrevated by movement
restricted abduction and internal rotation
meralgia pareshetica
lat femoral cuteanoue nn impinged as it courses underneath inguinal lig
sensory only
osteonecrosis
aka aseptic necorsis
avascular necrosis or osteochrondritis dissecans
joint collapse in 3-5yrs
occult fracture
severe pain on light weight bearing
intolerable hip roation
MRI needed, plan xray not sensitive enough
referred pain
from lumber and SI joint common suspect when:
-whenever groin pain accompanied by back pain
- symptoms extend beyond knee
pareshesia present
direct exam of hip is
osgood-schlatter
aka tibial tuberosity avulsion
osteochondritis of tibial tubercle
apophystitis of tibial tubercle at insertion of patellar tendon
do not limit kids activity
