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Ortho Exam 2 > RC Pathology - Shoulder Pathologies > Flashcards

RC Pathology - Shoulder Pathologies Flashcards

1
Q

RC pathologies AKA

A

RC dz

RC syndrome

RC tendinopathies

RC tears

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2
Q

RC pathologies are

A

one of most common musculoskeletal disorders in adults

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3
Q

% of all shoulder problems that are caused by RC

A

50-70%

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4
Q

RC pathologies could be –> SXS

A

asymptomatic

minimally or severely symptomatic

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5
Q

acute RC tears

A

5-10% of all tears

20-30 y/o

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6
Q

chronic RC tears

A

about 90-95% of all tears

> 45 y/o

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7
Q

chronic RC tears happen secondary to

A

history of shoulder dysfxn, poor posture and decreased SA space

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8
Q

RC tendinitis (opathy) involves

A

supraspinatus 90% of the time

b/c of its position underneath the anterior acromion

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9
Q

2nd most common RC tendinitis involves

A

infraspinatus

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10
Q

typical presentation of an RC tear

A

weakness of active ABD +/or ER

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11
Q

management of RC tear

A

small rotator cuff tears

full thickness injuries

severe chronic full thickness tears

poor tissue quality

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12
Q

small rotator cuff tears –> management

A

conservative care

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13
Q

full thickness injuries –> management

A

surgical repair

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14
Q

severe chronic full thickness tears –> management

A

conservative

depending on the pt’s fxnal needs

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15
Q

poor tissue quality –> management

A

may need to do a reverse TSR

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16
Q

RC injuries occur d/t–> etiology

A

trauma

attrition

compression

tensile overload

aging

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17
Q

trauma–> etiology

A

macrotrauma

microtrauma

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18
Q

macrotrauma –> etiology

A

FOOSH

fall directly on shoulder

fall downstairs but hold onto hand rail

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19
Q

microtrauma –> etiology

A

recreation

vocational overuse (work)

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20
Q

attrition = –> etiology

A

degenerative

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21
Q

attrition –> etiology

A

fraying of tendon

supraspinatus zone of avascularity near its insertion

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22
Q

fraying of tendon –> attrition –> etiology

A

d/t poor blood supply, poor posture

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23
Q

supraspinatus zone of avascularity near its insertion –> attrition –> etiology

A

makes it very vulnerable to degeneration

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24
Q

compression is similar to –> etiology

A

impingement

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25
Q

compression –> etiology

A

direct trauma to supraspinatus tendon and eventual deterioration

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26
Q

direct trauma to supraspinatus d/t–> compression –> etiology

A

decrease in size of SA space

decrease in joint stability

poor posture

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27
Q

tensile overload –> etiology

A

attempts to resist horizontal adduction, IR, anterior translation and distraction forces

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28
Q

typically occurs –> tensile overload –> etiology

A

during throwing (deceleration phase) and hammering

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29
Q

age –> etiology

A

decreasing blood supply

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30
Q

impingement syndrome

A

most common non-sport related injury to the RC

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31
Q

what does impingement syndrome occur d/t

A

SAIS

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32
Q

what is impingement syndrome

A

supraspinatus tendon passes beneath the acromion

is pinched when arm is raised overhead

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33
Q

where are rotator cuffs more common

A

dominant arm

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34
Q

what does a RC tear in one shoulder indicate

A

increased risk of tear in other shoulder

despite lack of pain or other sxs

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35
Q

biceps tendinopathy –> what happens

A

long head: supraglenoid fossa, interscapular, into superior labrum

can simply get “overload” resulting in tendinopathy

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36
Q

what are biceps tendinopathy sometimes associated w/

A

labral tears

37
Q

biceps tendinopathy –> etiology

A

heavy biceps

too much overhead

repetition or heavy load

38
Q

classifications of RC tears

A

acute v. chronic

location

size/degree

39
Q

location of the tear –> classification

A

bursal side

articular side

40
Q

degree of tears

A

partial or full tear

41
Q

partial tears are classified by –> degree of tears

A

size

may be fraying or the majority of the tendon

with the tendon still remaining substantially to the humeral head

42
Q

can partial tears still function?

A

can still maintain fxn

43
Q

full thickness tears –> classification

A

tears involving complete detachment of the tendon(s) from the humeral head

44
Q

will a full thickness tear impair the shoulder

A

yes

will impair shoulder motion and fxn significantly

45
Q

size of tear

A

small

medium

large

massive

46
Q

small tear –> classification

A

< 3 mm

47
Q

medium tear –> classification

A

3-6 mm

48
Q

large tear –> classification

A

> 6 mm

49
Q

grade of RC tears

A

1-3

50
Q

tendinopathy/tear sxs

A

variable

pain +/or weakness and possibly decreased shoulder active mobility

impingement window pain

51
Q

variable –> sxs of tendionopathy/tears

A

does not always correspond to the size of the tear

52
Q

impingement window pain –> sxs

A

painful arc

53
Q

sxs are initially

A

dull ache w/ referral into upper arm

54
Q

when are sxs worse

A

at night

w/ activity

when laying on that shoulder

reaching overhead

putting on a coat

55
Q

older pt sxs

A

insidious

could go to bed fine at night and wake up w/ full RC tear

56
Q

objective exam

A

observation

palpation

UQ screen

57
Q

observation –> objective exam

A

posture

postural protection signs

compensatory shoulder shrug w/ movement

58
Q

posture –> observation –> objective

A

cervical

thoracic

scapula

shoulder

59
Q

postural protective signs –> observation –> objective

A

use of opposite UE to support shoulder

if not use sling

60
Q

palpation –> objective

A

atrophy in supraspinous and maybe infraspinous fossa

pain in supraspinatus

61
Q

UQ screens –> objective

A

r/o C/S, elbow, wrist/hand

62
Q

STT –> ROM

A

AROM < PROM

63
Q

STT –> AROM

A

maybe painful arc of movement

decreased AROM usually w/ pain at end range

64
Q

STT –> PROM

A

could be decreased d/t pain/muscle guarding

PROM > scaption versus cardinal plane

scaption usually get greater range and less pain

65
Q

STT –> contractile tissue

A

pain w/ isometric resistance of one or more rotator cuff tendons

if full tear –> might be pain free and weak

66
Q

special tests

A

positive

possibly

negative

67
Q

positive special tests–> tendinopathy/impingement

A

hawkins/kennedy

painful arc

ER weakness

68
Q

possible special tests –> tendinopathy/impingement

A

neurodynamics

69
Q

negative special tests –> tendinopathy/impingement

A

sulcus sign

apprehension

relocation

clunk

posterior drawer

70
Q

positive –> RC tear

A

painful arc

drop arm

weakness ER (lag)

71
Q

possible –> RC tear

A

neurodynamics

72
Q

negative –> RC tear

A

sulcus signs

apprehension

relocation

clunk

posterior drawer

73
Q

differential dx for shoulder pain

A

referred C/S pain

cardiac origin

visceral origin

somatic

pathology

74
Q

sources of shoulder pain

A

radiating pain from cervical spine

cervical facet referral pain

75
Q

radiating pain from C spine –> sources

A

C5/C6 dermatome

DTRs

weakness of distal myotomes

76
Q

cervical facet referral pain –> sources

A

somatic source of referred shoulder pain

77
Q

dx tests

A

MRI (gold standard)

diagnostic ultrasound

78
Q

rotator cuff management

A

conservative management and then surgery

surgery –> after conservative tx has failed

79
Q

conservative management

A

acute

acute and on-going

80
Q

acute

A

PRICE or RICE

modalities

gentle ROM to surrounding structures

anti-inflammatory meds –> only if necessary

81
Q

acute and ongoing

A

PEACE & LOVE

education

maintain PROM and AROM

progressive strengthening

stretch/mobilization

postural training

82
Q

candidates for surgery

A

full thickness tears

83
Q

full thickness tears w/ –> candidates for surgery

A

pain at night and at rest

severe loss of fxn

+ MRI

no changes w/ conservative care

84
Q

when do we do a repair –> pain

A

if pain doesnt improve w/ non-surgical methods

continued pain is the main indication for surgery

85
Q

when do we do a repair –> sxs

A

have lasted 6-12 months

86
Q

when do we do a repair –> tear

A

more than 3 mm

87
Q

when do we do a repair –> weakness and loss of fxn

A

significant loss of strength and loss of fxn

88
Q

when do we do a repair –> MOI

A

recent, acute injury

Ortho Exam 2 (17 decks)

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