Ortho Block 2 Cram Flashcards
Define the 6 types of AC joint sprains
1- ligament sprain
2- joint widening w/ less than 100% elevation of AC joint
3- 100% superior displacement clavicle w/ inc CC interspace
4- superior and posterior clavicle displacement
5- 100-300% superior displacement clavicle w/ increased CC interspace
6- distal clavicle is in subacromial/subcoracoid space from arm abduction during injury causing clavicle to get stuck under short head of bicep
What images are ordered for AC joint injuries?
What are the adverse outcomes of this injury?
Bilateral AP to confirm Type 2-6
Weighted bilateral for Type 1-2
Deformity
Weakness
Pain
Numbness
What are the 4 types of shoulder arthritis?
Primary- age w/out trauma/Fx
Secondary- Hx of trauma/Fx
Rhematoid- bilateral, multiple joints across midline
Crystaloid- unicorn of shoulder
Define Shoulder arthritis
What type of ostephyte is associated w/ shoulder arthritis?
Destruction of joint cartilage w/ pain, loss of space and function
Goats beard- inferior spur in glenoidhumeral ligament
What will be seen on x-rays of shoulder arthritis?
Superior migration of the humeral head develops in associated w/ ? which leads to ?
Flattened humeral head
Inferior osteophyte
Posterior glenoid erosion
Superior migration
Rotator cuff tears
Causes loading of glenoid leading to rotator arthropathy
What would be seen on x-ray of RA in the shoulder?
How are shoulder arthritis cases Tx non-surgically?
Periarticular lesions
Osteopenia
Central glenoid wear
RICE, NSAID, Heat/Ice
CCS injection w/ posterior approach, max of 3
What are adverse outcomes of shoulder arthritis surgical Tx?
When are they referred to Ortho?
Thrombophlebitis
Emoblus
Intolerable pain
Dec functional range of motion after 3mon of non-surg Tx
What is the most common MOIs of transient brachial plexy?
Upper/middle trunks (C5-7): Traction force on shoulder w/ head tilted to opposite direction
Post-ganglionic
Lower trunks (C8-T1):
Nerves stretched w/ arm abducted/ hanging
Pre-ganglionic, poor prognosis
What is a unique finding of pre-ganglionic brachial plexy?
What is the cornerstone of an accurate diagnosis of Burners/Stingers?
Horners- ipsilateral myosis, anhidrosis, enophthalmos
Neuro exam
What type of images are ordered for burners/stingers?
What unique presenting Sxs can post-ganglionic burner PTs present w/ ?
X-rays of C-spine and shoulder girdle
Painful rhomboids and anterior serratus muscles
What is the first step to management of PTs w/ burners presenting with bilateral upper/lower extremity radicular Sxs?
What are 4 things required prior to a person returning to sports/duty after having a burner?
Treat as spinal cord injury until proven otherwise
Resolution of pain/neuro Sxs
Normal neuro exam
Full cervical ROM
How are brachial plexus burners Tx non-surgical
What additional study could be ordered to assess nerve function?
Strength/stretch
Splint to maintain PROM
Nerve conduction study:
Electromyogram- motor function
Velocity- tests speed of signals
What do recurrent episodes of burners/stingers suggest?
What are the adverse outcomes of this condition?
Cervical stenosis
Inc risk for spinal cord injury
Pain
Sensation loss
Weakness
Amputation
What is an indication to refer a PT w/ a burner/stinger to Ortho?
Frozen shoulder is AKA ? and defined as ?
Worsening neuro Sxs
Adhesive capsulitis
Idiopathic (non-traumatic) loss of A/PROM
What is the are most common risks of adhesive capsulitis?
Where is the pain located for these PTs?
Type 1 DM
Hypothyroid
Dupuytren Dz
At deltoid insertion
How is Frozen Shoulder movement limitations different than arthritis limitations?
What term is pathognomonic of this condition?
Worse w/ external rotation
Contracture of coracohumeral ligament which limits external rotation
What findings would be see on MRI of a frozen shoulder?
How are these cases Tx nonsurgically?
Contracted capsule
Loss of inferior pouch
NSAID, heat, stretching
How are frozen shoulders Tx w/ surgery?
How long does it take for a shoulder to freeze and release?
Arthroscopic capsule release
Freeze in 48hrs
Thaw in 6-24mon
What happens to frozen shoulder PTs who take therapy too aggressively?
When do these PTs need to be referred?
Fx of humerus
No pain/movement improvement after 3mon
What muscle is the primary raiser of the arm?
This muscle is pulled under what structure during movement?
Supraspinatus
Under coracoacromial arch
What are the two causes impingement?
Where do these PTs have their pain localized to?
Loss of blood supply and mechanical damage
Lateral shoulder under acromium
Worse w/ abduction between 90-120* and lowering arm
PTs with impingement usually have what 3 positive tests during PE?
These 3 tests only indicated there’s an issue where?
Neers, Hawkins, Jobes
Supraspinatus
What tests are done during PE to differentiate between impingement, rotator cuff or AC joint origin?
What is the goal of PT for these PTs?
Drop arm- r/o rotator
Cross arm- r/o AC joint
Perform overhead movements w/out pain
What is the non-traumatic trifecta leading to rotator cuff tears?
What type of motion changes will be seen?
Degeneration, impingement, dec blood supply
Normal PROM, dec AROM