Msk- Shoulder Flashcards
What are the 4 joints in the shoulder?
Sternoclavicular joint
Acromioclavicular joint
Glenohumeral joint
Scapulothoracic joint ( not a true joint)
What is Thoracic outlet syndrome?
Entrapment syndrome caused by pressure on brachial plexus
What are the 4 types of Thoracic outlet syndrome?
Neurogenic
Non specific symptomatic neurogenic
Vascular arterial
Vascular venous
How is the thoracic outlet syndrome “neurogenic” type?
What are some signs and symptoms?
Anomaly of the bone that’s compressing the nerve.
Pt will have weak grip strength
Signs and symptoms: paresthesia,numbness, weak grip strength, loss of manual dexterity and precision mov in hands.
How is the thoracic outlet syndrome “non specific symptomatic neurogenic” type?
What are some sign and symptoms?
Signs and symptoms similar to true TOS but there is no evidence of anatomical anomalies,muscle atrophy.
Typically due to maladaptive posture. Related to shortening of scalenes muscles and pec minor.
Signs and symptoms: paresthesia,numbness, weak grip strength, loss of manual dexterity and precision mov in hands.
How is the thoracic outlet syndrome “vascular arterial” type?
What are some signs and symptoms?
Compression of subclavian artery. Typically due to anatomical anomaly (cervical rib)
Aggravated by arm motion, especially overhead activities.
Signs and symptoms: cool skin,pale extremity, diminished or absent pulse, rapid fatigued of limb, lower bp on the affected side
How is the thoracic outlet syndrome “vascular venous” type
What are some signs and symptoms?
Compression of subclavian vein. Does not typically result in TOS c/o
Sings and symptoms: painfull swelling in arm,bluish discoloration
What are some interventions for TOS?
Regain normal muscle length (scalenes and pec major/minor)
Improve endurance in postural muscles
Nerve mobility
Nerve gliding and flossing
What is shoulder separation?
Trauma to the ligs holding the acromion and clavicle together.
What is the main sign for shoulder separation?
Step deformity ( seen on grade 3 sprain)
What is shoulder dislocation?
Separation of the humerus from the scapula
What is a possible sign for shoulder dislocation?
Sulcus sign
What is the difference between Bankart and SLAP glenohumeral labral tear?
Bankart: anterior and inferior 3-7o clock
SLAP: posterior and superior 2-10o clock
What is the treatment for Glenohumeral labral tear?
Surgery
What is the movs that are restricted on Adhesive capsulitis?
ROM restrictions follows the capsular pattern of the shoulder:
External rotation
Abduction
Internal rotation
What is adhesive capsulitis(
An idiopathic condition which is characterized by sh pain followed by progressive loss of glenohumeral joint
How many stages there is for Adhesive capsulitis?
4
How is characterized the stage 1 of Adhesive capsulitis?
Gradual onset of pain
Pain increases w mov and present at night
Loss of ER ROM
Duration ~3months
How is characterized the stage 2 (freezing) of Adhesive capsulitis?
Persistent and more intense pain, even at rest
Restricted ROM in the capsular pattern
Ext rotation-abd-internal rotation
Duration:3-9 months
How is characterized the stage 3 ( Frozen) of Adhesive capsulitis?
Pain only w mov. Less night pain
Significant adhesions. Hard capsular end feel in most directions
Restricted ROM in all directions w increased scapula compensation movs
May present w atrophy of deltoid,rotator cuff, biceps and triceps
Duration:9-15 months
How is characterized the stage 4 (thawing) of Adhesive capsulitis?
Minimal pain
Gradual improvement of ROM
Some pts may never regain full ROM
Duration: 15-24 months or longer
What is a common sign for subacromial impingement syndrome?
Glenohumeral painful arc (60-120 degrees ) of abduction
What is scapular dyskinesia?
An alteration in the normal position or mov of the scapula.
What is scapular winging ?
Occurs when the muscles of the scapula are too weak or paralyzed, resulting in a limited ability to stabilize the scapula.
How is the direction of the winging determined ?
It’s determined by the medial border of the scapula
What is the most common muscle that gets weak on the Scapular winging?
Serratil anterior
Origin: na parte da frente das costelas
Inserção: borda medial da escapula
What is the scapulohumeral rhythm?
2:1
2 degrees of mov on the glenohumeral joint
For 1 degree of mov on the scapulothoracic joint
For abduction
What muscles are affected on Erb duchene Paralysis?
Deltoid, teres minir, supra and infraspinatus, biceps brachi and brachialis
What muscles are affected ( tight) in the upper cross syndrome?
Upper trapezius and elevator os scapula
Pectoralis
What muscles are affected ( weak) in the upper cross syndrome?
Cervical flexors
Lower trapezius, serratus ant and romboides
What is the rest position for the shoulder?
50 abd
35 horizontal add
What is the capsular pattern for the glenohumeral joint?
Loss of ER,ABD and IR
Shoulder dystocia
Complication of vaginal delivery i which the sh are caught above the mothers pubic bone after the head has already passed through the birth canal
Plagiocephaly
Commom condition in infants characterized by flattening of one side of the skull ( also known as flat head syndrome)
Will occur on the opposite side of the torcicolo
What sleeping position increases the risk of sudden infant death syndrome (sids)
Prone or on side
Herpes zoster is also know as
Shingles
Most common cause of klumpke s paralysis?
Traction on an abd arm as the child is being pulled out during birthing
Brachial plexus injury of c8-t1
Waiters tip position
Position seen inpt w erb duchene paralysis:
Arm hanging by the side, sh internal rot
Elbow ext and forearm pronation
What muscles are involved on TOS- above clavicle?
Scalenus anterior amd medius
What muscles are involved on TOS- hyperabd syndrome?
Behind pec minor
What muscles are involved on TOS- coracoid syndrome?
Subscapular muscle
Where the costoclavicular syndrome TOS occur?
Behind the clavicle. Between the 1rib and the clavicle
Which of the following special tests is used to help diagnose scapular dyskinesia?
a) Scapular assist test
b) Wall/floor pushup
c) Horizontal adduction test
d) Speed’s test
B
Scapular assist test: sh impigment or GH impingement
Horizontal adduction test: AC SPRAIN
SPEED test: biceps tendinopathy
Which of the following exercises would be most beneficial for a client w scapular winging?
a) Resisted scapular retractions using a resistance band
b) Scapular elevation while holding dumbbell in hand
c) Push-up plus exercise
d) Scapular depression active range of motion
C
Pq fortalece o serratus anterior
patient is being examined by a physical therapist for shoulder pain. The individual reports that the pain is located in an area around the acromion and has been gradually increasing over the last 3 months.
The patient has limited passive motion in external rotation, internal rotation, and flexion, and complains of severe pain with all three motions. Which of the following disorders is MOST likely present?
- Subacromial bursitis
- Acromioclavicular joint lesion
- Scapulothoracic hypomobility
- Adhesive capsulitis
4
- This would have pain with extreme flexion and internal rotation, but would not limit passive range of motion.
- This would more commonly have pain with cross-body movements and is not the MOST
likely disorder. - This would not necessarily limit passive motion of the glenohumeral joint.
- This is the correct answer. The scenario describes a capsular pattern that generally progresses over the course of several months. The lack of passive motion is also a key factor.
A 65 year old patient reports developing shoulder pain over the last 3 months that is exacerbated by overhead activities. The patient displays poor posture and has rotator cuff musculature that is 25% weaker on the involved upper extremity. Which of the following is MOST likely the source of the pain?
- Primary impingement
- Secondary impingement
- Biceps tendinopathy
- Anterior capsule instability
2
- This would be likely due to the patient’s age (bone spurs forming under the acromion process). However, the information given indicates otherwise.
- This is the most correct answer. Worsening with overhead activity and rotator cuff weakness are both important signs of secondary impingement.
- Biceps tendinopathy is indicated by pain with active elbow and shoulder flexion.
- This could be present. but is not the MOST correct answer.
A physical therapist is mobilizing a patient’s glenohumeral joint to improve passive range of motion. The therapist provides a large amplitude oscillation to the limits of available motion.
Which of the following grades of mobilization is being provided?
- Grade II
- Grade III
- Grade IV
- Grade V
2
- Large amplitude oscillations, but not to end of range
- This is the correct answer.
- Small amplitude oscillations at the end of range.
- High velocity, low amplitude thrust past the end of range.
A patient is asked to flex their shoulder to go degrees with the forearm in full supination. The examiner places resistance downward against the flexed arm. Which structure BEST represents what the examiner testing?
- Acromioclavicular joint pathology
- Rotator cuff pathology
- Anterior deltoid pathology
- Biceps tendon pathology
4
- This is tested with the crossover test.
- This is tested with external rotation lag sign or resisted external/internal rotation/supraspinatus.
- This could be involved. but is not the best answer.
- This is the correct answer.
A patient is having difficulty raising her arm over her head. The physical therapist hypothesizes that the scapulohumeral rhythm is impaired. Which of the following BEST represents the normal combination of movements that will result in full shoulder flexion?
- Glenohumeral flexion 80°; scapulothoracic upward rotation 80°.
- Glenohumeral flexion 100°; scapulothoracic upward rotation 60°.
- Glenohumeral flexion 100°; scapulothoracie upward rotation 80°.
- Glenohumeral flexion 120°; scapulothoracic upward rotation 60°.
- This is the correct answer. There is typically a 2:1 glenohumeral:scapulothoracic ratio of movement that will achieve full shoulder flexion.
Your patient presents with biceps tendinosis of his non-operative side.
Which of the following correctly defines tendinosis?
a. Inflammation with thickening of a tendon sheath.
b. Inflammation of a tendon, often associated with scarring or calcium deposits.
c. Degeneration of the tendon due to repetitive micro trauma.
d. Inflammation of the synovial membrane covering a tendon.
C
• Inflammation with thickening of a tendon sheath - Tenovaginitis
• Inflammation of a tendon, often associated with scarring or calcium deposits - Tendinitis
• Degeneration of the tendon due to repetitive microtrauma - tendinosis
• Inflammation of the synovial membrane covering a tendon - Tenosynovitis
The patient is referred to a surgeon for a bankart repair. Which of the following positions do not need to be limited postoperatively?
a. External rotation
b. Horizontal abduction
C. Extension
d. Internal rotation
D
- Which of the following statements is true regarding bicipital tendinosis?
a. The lesion involves the short head of the biceps.
b. Pain may occur with resisted testing, with the elbow extended and the forearm in a pronated position while the shoulder is flexing.
c. Rupture or dislocation of this humeral depressor muscle may escalate impingement of tissues in the suprahumeral space.
d. Pain occurs with palpation of the tendon just inferior to the posterior corner of the acromion when the patient horizontally adducts and laterally rotates the humerus.
C
