Ramey UE DSA

Question 1

most common sports injury related to shoulder

Answer 1

rotator cuff injuries

Question 2

mm of the rotator cuff

Answer 2

1. subscapularis
2. supraspinatus
3. infraspinaturs
4. teres minor

Question 3

subscapularis motion

Answer 3

1. internal rotation of the humerus

2. downward rotation of the humeral head into GH joint

Question 4

supraspinatus motion

Answer 4

1. elevation and abduction of the humerus

2. upward traction of the humeral head into the GH joint

Question 5

major rotator cuff affected in impingement syndrome

Answer 5

supraspinatus

Question 6

infraspinatus motion

Answer 6

1. external rotation of the humerus

2. downward traction of the humeral head into GH joint

Question 7

teres minor motion

Answer 7

1. external rotation of the humerus

2. downward traction into the GH joint

Question 8

impingement interval

Answer 8

1. space between the under surface of the acromion and the superior aspect of the humeral head
2. maximally narrowed when arm is abducted

Question 9

pathophysio of impingement syndrome

Answer 9

further narrowing of the impingement interval due to extrinsic compression, loss of competency of the rotator cuff or scapula stasbilizing mm -> impingement of the rotator cuff tendons

Question 10

pathophysio of primary impingement syndrome

Answer 10

anatomical restrictions of the subacromial space -> contents of narrowed space rub against elements of the coracoacromial arch when repetitive shoulder action if performed (especially elevation and internal rotation)

Question 11

pathophysio of secondary impingement syndrome

Answer 11

pain -> reflex inhibition and weakness of rotator cuff mm -> mm fail to center humeral head in the glenoid -> moves superiorly and decrease subacromial space

other factors include poor scapular control, capsular laxity, instability and abnormal biomechanic

Question 12

Hx for impingement syndrome

Answer 12

pain, weakness, and loss of motion are most common complaints

Question 13

PE for impingement syndrome

Answer 13

1. observe scapulothoracic motion while patient abducts the shoulder - pain at 90-120 degrees
2. pos Neer’s and Hawking’s impingement test

Question 14

imaging for impingement syndrome

Answer 14

scapular-Y view - shows subacromial space and can differentiate the 3 types of acromial processes

Question 15

tx for impingement syndrome

Answer 15

conservative - avoid surgery if possible

1. strengthening
2. biomechanical and training changes - look at entire kinetic chain is crucial to returning athletes back to competition w/o reinjury, adequate core strength is a vital part of the kinetic chain
3. ice
4. heat and deep mm massage
5. electrical stimulation
6. NSAID
7. corticosteroid injection
8. relative rest
9. prevention with stretching and strengthening exercise

Question 16

2 mechanisms of biceps tendonitis

Answer 16

1. trauma to the tendon secondary to repetitive use or overuse (throwing or overhead occupational work)
2. sudden violent extension of the elbow, esp in young basketball, bowling, and powerlifting atheletes

Question 17

PE of biceps tendonitis

Answer 17

1. tenderness of tendon when palpated in the grooves
2. crepitation on flexion of elbow
3. Speed’s test
4. Yergason’s test (flex elbow to 90 degrees before examiner extends the elbow while externally rotating the GH joint)

Question 18

tx of biceps tendonitis

Answer 18

1. limiting activity
2. NSAIDs
3. US
4. electromuscular stimulation
5. ROM exercise

Question 19

bicipital tendonitis can be associated with

Answer 19

impingement syndrome

Question 20

use of corticosteroids injection caution in biceps tendonitis because

Answer 20

can contribute to further weakening of the tendon and increase the possibility of subsequent rupture

Question 21

medial epicondylitis (Golfer’s elbow) PE

Answer 21

1. palpable tenderness over epicondyle

2. pain with resisted pronation, wrist flexion, and grip strength testing

Question 22

medial epicondylitis tx

Answer 22

physical therapy

Question 23

medial epicondylitis imaging

Answer 23

imaging is rarely needed

Question 24

mechanisms of nursemaid’s elbow

Answer 24

longitudinal traction on the extended elbow producing a partial slippage of the annular ligament over the radial head and into the radiocapitellar joint (subluxation of the annular ligament)

occurs when child is lifted or swung by the forearm or when the child suddenly steps down from a step or a curb while one of the parents is holding the hand or wrist

Question 25

mean age of children who get nursemaid’s elbow

Answer 25

2-3 y/o (rarely occurs after 7y/o)

Question 26

evaluation of nursemaid’s elbow

Answer 26

neurovascular status must be assessed before manipulation, especially status of the brachial artery and median and ulnar nerves

Question 27

closed reduction for nursemaid’s elbow

Answer 27

1. patient’s forearm is grasped with the elbow semiflexed while the thumb of the physician’s opposite hand is placed over the lateral aspect of the elbow
2. forearm is maximally supinated
3. if no snap is heard, then elbow is flexed maximally until snap occurs

Question 28

3 stages of impingement

Answer 28

I - edema and hemorrhage of supraspinatus tendon and subacromial bursa

II - fibrosis and tendonitis

III - occurs in patients > 50y/o, attrition and culminination of fibrosis and tendinosis that have been present for many years -> full thickness cuff tears

Question 29

surgery for rotator cuff tear is indicated for

Answer 29

chronic rotator cuff tears with GH arthritis

Question 30

lateral epicondylitis (tennis elbow) PE

Answer 30

1. pain and tenderness over the lateral epicondyle and extensor tendon
2. pain with resistance to wrist and 3rd digit extension
3. grip strength can elicit pain

Question 31

lateral epicondylitis tx

Answer 31

1. physical therapy (mainstay tx)

2. addressing athlete’s biomechanics and equipment

Question 32

tendonisis

Answer 32

chronic inflammatory response to tension overload placed on the tendon-bone junction causing angiofibroblastic degeneration