MSK Re-Up #4 (Shoulder) Flashcards
MC type of shoulder dislocation?
How will the patient be holding their arm with this type of dislocation?
-Anterior
-Arm held in abduction and external rotation (elbow pointing outward)
-Squared off shoulder, humeral head palpable inferiorly
Shoulder radiographs are usually the initial test of choice for a suspected shoulder dislocation. What views distinguish the different types of dislocations?
What are two unique findings in an anterior dislocation that can be seen on X-rays (they have specific names)
-Axillary and scapular “Y” views
-Hill Sach Lesion: groove fracture of the humerus
-Bankart Lesion: glenoid rim fracture
Management for an anterior shoulder dislocation includes reduction and immobilization. However, what should you also do (it is a common complication).
Check deltoid pinprick sensation for axillary nerve injury!
On the other hand, posterior shoulder dislocations are MC associated with what events?
How is the patient usually holding their arm with this type of dislocation?
Seizures, electric shock, trauma
-Arm adducted and internally rotated
-Anterior shoulder appears flat
Explain how a posterior shoulder dislocation looks on shoulder radiographs (AP and scapular Y views).
-Humeral head looks like a light bulb or ice cream cone (light bulb sign)
Rotator Cuff Impingement Syndrome is entrapment of what muscle/tendon?
What motions exacerbate this condition?
What are some symptoms?
-Supraspinatus entrapment
-Overhead motions exacerbate
-Anterolateral (front) shoulder pain
-Decreased or painful abduction
-Night pain
What are three tests that can diagnose impingement syndrome (name and describe them)?
-Hawkins: arm in front, IR (move down)
-Neer: IR and raise arm (gymnast arm in air)
-Empty Can: arm out, thumb down (IR), push down
Treatment for Impingement syndrome
-Rest, PT, NSAIDs, steroid injections, surgery?
What are the four muscles of the rotator cuff? Which one is MC injured?
What are some symptoms of a rotator cuff tear?
-SITS
–Supraspinatus (MC), Infraspinatus, Teres Minor, Subscapularis
-Anterolateral (deltoid) shoulder pain
-Decreased ROM especially with overhead activities, ER or abduction (combing hair, reaching for wallet)
-Can’t sleep on affected side
-Passive ROM > Active ROM
-Weakness, atrophy, continuous pain
List and explain the rotator cuff muscles and their associated actions
-Supraspinatus: Abduction
-Infraspinatus: External Rotation
-Teres Minor: ER and Adduction
-Subscapularis: IR and Adduction
Which physical exam test has a 90% specificity for evaluating the supraspinatus?
Empty Can Test
You perform some of the same exam tests for a rotator cuff tear as you do for impingement. What are the main three?
-Hawkins Test, Neer Test, Drop Arm Test (pain with lifting arm above shoulder level or slowly lowering it)
Rotator Cuff Tendinitis, is MC in what population?
Adolescents and < 40 years old
For a rotator cuff TEAR, what is the management?
-Conservative: PT, NSAIDs, Corticosteroid injections
-Surgery: fail conservative treatment within 6 months or if a complete tear
What is the best diagnostic study to get for a rotator cuff tear?
MRI
Management for rotator cuff tendinitis
-Shoulder pendulum or wall climbing exercises, ICE, NSAIDs, stop offending activity
How does an acromioclavicular joint dislocation (shoulder separation) occur?
The acromioclavicular ligament provides ______ stability whereas the coracoclavicular ligament provides______ stability.
Direct blow to an adducted shoulder
-AC: horizontal stability
-CC: vertical stability
How does an acromioclavicular joint dislocation (shoulder separation) occur?
The acromioclavicular ligament provides ______ stability whereas the coracoclavicular ligament provides______ stability.
Direct blow to an adducted shoulder
-AC: horizontal stability
-CC: vertical stability
Symptoms of an AC joint separation
-Pain with lifting arm
-Unable to lift arm at the shoulder
-Step-off at AC joint
Explain the four grades of an AC dislocation (shoulder separation)
Grade I: Normal XR (ligamental sprain)
Grade II: AC ruptured, CC sprained
Grade III: Both ruptured/torn
Grade IV: AC and CC rupture, displacement of clavicle through trapezius
Nonoperative and Surgical Treatment for an AC dislocation
-Nonoperative: ice, sling ,rest, early PT to keep ROM
-Surgical: Grade IV or more with < 2 cm clavicular displacement
Adhesive Capsulitis (Frozen Shoulder) is shoulder stiffness due to inflammation. What are two common conditions associated with it?
Symptoms of adhesive capsulitis?
-DM and Hypothyroidism
-Shoulder pain/stiffness
-Decreased ROM (especially ER)
-Pain worse at night
-Resistance to passive ROM on affected side
-Insidious onset over months - years
Treatment for adhesive capsulitis
-Rehab ROM (mainstay)
-Do NOT immobilize
-Codman Exercises: dangle arms –> circumduction
-NSAIDs, PT, Steroid injections, manipulation under anesthesia
What is the MC fractured bone in children, adolescents, and newborns during birth?
There are three “Groups” or classifications of this fracture. Explain them.
-Clavicle fracture
-Group 1 (Midshaft): Middle 1/3 MC
-Group 2 (Lateral): Distal 1/3
-Group 3: (Proximal): Medial 1/3
If no history of high energy impact to the area or a FOOSH, what should you suspect with a clavicle fracture?
Malignancy, rickets, child abuse (if <2 years old)
Symptoms of a clavicle fracture
What are the treatments based on the different types of clavicle features?
-pain with ROM, deformity (tenting of skin), crepitus. May hold arm against chest to protect it.
-Mid 1/3: Nonoperative (sling immobilization) in adults. Figure of 8 splint in children. Operative (open fractures, displaced with tenting of skin, shortening)
-Proximal 1/3: Ortho consult
A proximal humerus/humeral head fracture occurs due to a FOOSH or direct blow. However it is a common site for pathologic fractures due to _________
What is the treatment for this type of humerus fracture?
-metastatic breast cancer
-Sling immobilization, analgesics, PT for rehab
On the other hand, a humeral shaft fracture also occurs from a FOOSH or direct trauma. What must you do first here?
Rule out radial nerve injury (may develop wrist drop)!
Treatment for humeral shaft fracture
-Nonoperative: coaptation splint or sling and swathe with prompt ortho follow up
-Operative: ORIF for open fractures or brachial plexus injury
Thoracic Outlet Syndrome is what?
Compression of the brachial plexus (MC), subclavian vein, or subclavian artery as they exit shoulder girdle to the 1st rib
Symptoms of Thoracic Outlet Syndrome (think nerve and vascular compression both)
-Nerve compression: ulnar neuropathy, pain and paresthesia to forearm and arm
-Vascular Compression: swelling of arm especially with abduction of arm, decreased pulses
What is one unique exam test you can do to diagnose Thoracic Outlet Syndrome (it has a specific name)?
Adson Test: loss of radial pulse with head tilted toward affected side
How to confirm Thoracic Outlet Syndrome?
What is the treatment?
-MRI confirms
Joint protection, PT, ortho consult
