S2_L4: Shoulder Flashcards
TRUE OR FALSE: A patient who has instability will always have laxity.
False
Source: Shoulder Instability (ProProfs Quizzes)
Which of the following is NOT true regarding the articulating surfaces of the GHJ?
A. It has 160° coverage
B. There is 5° retroversion
C. The glenoid inclination angle is 95°
D. Humeral retroversion is 30°
B. There is 5° retroversion
Source: Shoulder Instability (ProProfs Quizzes)
TRUE OR FALSE: SLAP II is the most common type of SLAP lesion and is the only SLAP with the biceps detached.
True
Source: Shoulder Instability (ProProfs Quizzes)
TRUE OR FALSE: A Grade III AC dislocation means that both the AC and CC ligaments are torn. The patient will have slight ecchymosis and will have a large step-off deformity.
True
Source: Shoulder Instability (ProProfs Quizzes)
What is lucatio erecta?
A. When the humeral head becomes stuck under the glenoid
B. A sublabral foramen found in 12% of shoulders
C. Capsulolabral tear of the superiro labrum
D. A cord-like MGHL with a hole in the anterior superior labrum
A. When the humeral head becomes stuck under the glenoid.
Source: Shoulder Instability (ProProfs Quizzes)
All of the following are mechanisms of a dislocation, EXCEPT:
A. FOOSh
B. Forced flexion
C. Traction
D. AbD/Er
C. Traction
Source: Shoulder Instability (ProProfs Quizzes)
The jerk test tests the intergrity of?
Posterior capsule
Source: Shoulder Instability (ProProfs Quizzes)
TRUE OR FALSE: O’Briens is a test for instability.
False
Source: Shoulder Instability (ProProfs Quizzes)
The most frequently broken bone in children and usually the result from a fall on the lateral aspect of the shoulder or FOOSH
Clavicular fracture
Source: Shoulder Injuries Test Review (Quizziz)
Rotator cuff tendonitis involves inflammation of the (1)___, (2)___, (3)____, and (4)____ tendons.
- supraspinatus
- infraspinatus
- teres minor
- subscapularis
Which of the following is the most commonly impinged tendon of the shoulder?
A. Teres minor
B. Supraspinatus
C. Subscapularis
D. Infraspinatus
B. Supraspinatus
Source: Shoulder Injuries Test Review (Quizziz)
TRUE OR FALSE: In the adolescent-aged athlete, a common type of clavicular fracture is known as the “greenstick” fracture.
True
Source: Shoulder Injuries Test Review (Quizziz)
TRUE OR FALSE: It is possible for the biceps tendon to develop tendonitis that can later lead to subluxation of the tendon from the bicipital groove.
True
Source: Shoulder Injuries Test Review (Quizziz)
TRUE OR FALSE: A scapular fracture is an uncommon injury that is normally the result of a direct blow.
True
Source: Shoulder Injuries Test Review (Quizziz)
Which injury is also known as a stinger?
Brachial Plexus Injury
Source: Shoulder Injuries Test Review (Quizziz)
What does SLAP tear stand for?
Superior Labrum Anterior Posterior
The most commonly inflamed bursa in the shoulder is the ___.
Subacromial bursa
An anterior dislocation of the shoulder joint is characterized by (choose multiple):
A. Flattened deltoid
B. Humeral head in the armpit
C. Deformity of the clavicle
D. Inability to touch the opposite shoulder
A,B, & D
Source: Shoulder Injuries Test Review (Quizziz)
Which rotator cuff muscle is responsible for internal rotation?
Subscapularis
Shoulder pain caused by connective tissue rubbing on a shoulder blade. Caused by tendonitis and partial tears in the supraspinatus tendon. Pain will increase with lifting or reaching types of movements. Pain occurs will occur from 60-120 degrees of shoulder Abduction. What is the condition described?
painful arc syndrome
Source: Shoulder Review (Quizziz)
Which two groups of muscles are primarily responsible for retraction?
A. Latissimus dorsi and neck muscles
B. deltoids and coracobrachialis
C. Rhomboids and Trapezius
D. rotator cuff and deltoids
C. Rhomboids and Trapezius
Source: Shoulder Review (Quizziz)
These are disorders that occurs in response to a fall or high force blow to the shoulder
Traumatic arthritis
Adhesive Capsulitis, also known as (1)____, is characterized by the development of dense (2)___, capsular (3)_____ and capsular (4)____.
- Periarthritis
- adhesions
- thickening
- restrictions
A Type 1 classification of the acromion process means that the acromion is ___.
Flat
In hemireplacement arthroplasty, which component is replaced?
Humeral head
In subacromial depression, the “mini-open” approach involves splitting the (1)____ insertion (2)____ rather than detaching it
- deltoid
- vertically
Source: Kisner & Colby 7th ed.
Match the following descriptions to the condition it describes.
- Irreversible structural damage to cartilage & bone
- Involvement of the elbow
- Osteophyte formation
- Involvement of the shoulder
- Age of onset is after 40
A. OA
B. RA
- B
- B
- A
- B
- A
Match the following descriptions to the stage it describes.
- Gradual onset of pain, increased with movement
- Pain only with movement
- Persistent and more intense pain even at rest
- Has significant adhesions
- No synovitis but has evident capsular restrictions
A. stage 1
B. frozen stage
C. freezing stage
D. thawing stage
E. none
- A
- B
- C
- B
- D
When there is about (1)____% LOM compared to the normal ROM, PTs cannot proceed with (2)___ exercises.
- 50
- strengthening
Match the following descriptions to the condition it describes.
- May result from repeated stressful joint movements
with the arm at waist level - may contribute to TOS by compromising space available for the neuromuscular bundle that courses between the clavicle and 1st rib
- Usually caused by falling on shoulder or on an
outstretched arm (FOOSH) - Lesion is usually near the musculotendinous junction,
resulting in a painful arc during overhead reaching - Lesion is usually near the musculotendinous junction,
resulting in a painful arc during overhead, forward, or cross body motions.
A. Subluxation or dislocation
B. Hypomobility
C. Infraspinatus Tendonitis
D. Supraspinatus Tendonitis
E. Overuse syndromes
- E
- B
- A
- D
- C
This is when stability is compromising more than 1 direction
Multidirectional Instability
(1)____ tilting of the scapula occurs in conjunction with internal rotation and extension of the humerus when reaching the hand behind the back, while (2)____ tilting occurs during humeral elevation
- Anterior
- posterior
Source: Kisner & Colby 7th ed., page 549
The weight of the arm creates a (1)____ rotation, protraction, and (2)____ tilting moment on the scapula
- downward
- forward
Source: Kisner & Colby 7th ed., page 549
Sitting or standing with increased thoracic kyphosis decreases (1)____ tilting and (2)____ rotation of the scapula during elevation of the arm.
- posterior
- external / upward
Source: Kisner & Colby 7th ed., page 550
When the space of the coracoacromial arch is compromised, ______ occurs.
impingement syndrome
Source: Kisner & Colby 7th ed., page 550
Motion of the scapula, synchronous with motions of the humerus, allows for ____° of shoulder ROM into flexion or abduction with elevation
150-180
Source: Kisner & Colby 7th ed., page 550
Weak (1)____ and (2)____ muscles or inadequate external rotation may result in impingement of the soft tissues in the suprahumeral space, causing pain, inflammation, and eventually loss of function.
- infraspinatus
- teres minor
Source: Kisner & Colby 7th ed., page 550
What is the ratio of GH motion and scapular rotation?
2° of GH motion to 1° of scapular rotation
Source: Kisner & Colby 7th ed., page 550
Determine the site of referred pain from related tissues.
- pain perceived at the tip of shoulder and scapular region
- pain perceived in the upper trapezius region
- pain perceived in the left axilla and pectoral region
- pain perceived in the deltoid region and lateral arm
- pain perceived in the trapezius to the tip of the shoulder
A. Diaphragm
B. Heart
C. Dermatome C4
D. Dermatome C5
E. Gallbladder
- E
- A
- B
- D
- C
Source: Kisner & Colby 7th ed., page 552
A common source of referred pain for the shoulder regions is nerve roots ___ or ____.
C4 or C5
Source: Kisner & Colby 7th ed., page 552
Common compression sites in the shoulder region are seen in (1)____ in the thoracic outlet, (2)____ in the suprascapular notch, (3)____ in the axilla
- Brachial plexus
- Suprascapular nerve
- Radial nerve
Source: Kisner & Colby 7th ed., page 552
TURE OR FALSE: Patients with diabetes mellitus and thyroid disease are at increased risk for developing frozen shoulder
True
Source: Kisner & Colby 7th ed., page 552
TRUE OR FALSE: In stage 1 of an idiopathic frozen shoulder, rotator cuff strength is intact.
True
Source: Kisner & Colby 7th ed., page 553
TRUE OR FALSE: In stage 2 of an idiopathic frozen shoulder, atrophy of the deltoid, rotator cuff, biceps, and triceps brachii muscles may be noted.
False.
This is seen in stage 3.
Source: Kisner & Colby 7th ed., page 553
When the frozen shoulder is in stage two, what is its chronicity?
Acute
Source: Kisner & Colby 7th ed., page 553
_____ uses the effects of gravity to distract the humerus from the glenoid fossa. The technique must be taught as small, gentle motions initiated with body swaying while keeping the shoulder muscles relaxed.
Pendulum Exercise
Source: Kisner & Colby 7th ed., page 554
What must be the PTs glide in performing shoulder MWM for painful restriction of shoulder ER and IR?
Posterolateral for ER, inferior for IR
Source: Kisner & Colby 7th ed., page 556
TRUE OR FALSE: A PT must sustain the movement during MWM for ER for 10 seconds and repeat in sets of 5 to 10.
True
Source: Kisner & Colby 7th ed., page 556
TRUE OR FALSE: After trauma and associated overstretching of the capsules and ligaments of either the SC & AC joint, hypermobility is usually permanent because there are almost no muscles that provide direct stability to these joints.
True
Source: Kisner & Colby 7th ed., page 558
The most common surgical procedure used to treat advanced shoulder joint pathology is referred to as _____.
shoulder arthroplasty
Source: Kisner & Colby 7th ed., page 558
______ is often used when the articular surface and underlying bone of the humeral head have deteriorated but the glenoid fossa is reasonably intact.
Hemiarthroplasty
Source: Kisner & Colby 7th ed., page 559-560
For the patient with severe, chronic pain and loss of function as the result of a massive, irreparable cuff tear and subsequent cuff tear arthropathy, ______ is usually indicated.
rTSA
Source: Kisner & Colby 7th ed., page 560
When the rotator cuff is intact prior to surgery, the emphasis of postoperative rehabilitation is to (1)____ shoulder mobility and functional use of the arm as soon as possible while protecting soft tissues as they heal. In contrast, with a tenuous repair or preoperative history of recurrent GH dislocation, rehabilitation will emphasize (2)_____ joint stability rather than mobility.
- restore
- improving or maintaining
Source: Kisner & Colby 7th ed., page 561
What should be the position of the shoulder after shoulder arthroplasty when sitting?
Arm supported in sling or resting on a pillow in the patient’s lap or on the armrest of a chair
Source: Kisner & Colby 7th ed., page 562
Regardless of implant design, (1)____ is the primary goal of shoulder arthroplasty, with (2)____ in functional mobility a secondary goal.
- pain relief
- improvement
Source: Kisner & Colby 7th ed., page 563
The maximum protection phase of rehabilitation following TSA begins on the first postoperative day and extends for ____ weeks
4-6
Source: Kisner & Colby 7th ed., page 564
TRUE OR FALSE: Rotator cuff pathology may be associated with types I and III
False.
It is associated with types II and III.
Source: Kisner & Colby 7th ed., page 565
Internal impingement is associated with a combination of (1)____ GH capsule (2)____ and (3)____ kinematic alterations.
- posterior
- tightness
- scapula
Source: Kisner & Colby 7th ed., page 568
Tendonitis/bursitis are categorized as a stage (1)____ impingement syndrome, while rotator cuff tears are categorized as a stage (2)____ impingement syndrome.
- II
- III
Source: Kisner & Colby 7th ed., page 569
This condition presents as a deceleration (eccentric) injury due to overload during repetitive or forceful throwing activities.
Infraspinatus tendonitis
Source: Kisner & Colby 7th ed., page 569
This conditions presents with pain that occurs with Speed’s test and on palpation of the bicipital groove.
Bicipital tendonitis
Source: Kisner & Colby 7th ed., page 570
TRUE OR FALSE: Pendulum exercises without weights can be used to cause pain-inhibiting grade II joint distraction and oscillation motions.
True
Source: Kisner & Colby 7th ed., page 571
Active shoulder motions may be possible by ____ weeks postoperatively.
2
Source: Kisner & Colby 7th ed., page 575
What are 2 important directions of glide when performing joint mobilization on a patient with painful shoulder syndromes?
Posterior and caudal glides
Source: Kisner & Colby 7th ed., page 575
TRUE OR FALSE: Regardless of the approach, subacromial decompression is performed (particularly for cuff tears associated with chronic impingement) before repair of the rotator cuff is undertaken.
True
Source: Kisner & Colby 7th ed., page 577
Why is the shoulder immobilized in abduction after a rotator cuff repair?
In the abducted position, the shoulder is in a more relaxed, neutral position, reducing the possibility of reflexive muscle contractions that could disrupt the repairs. In addition, supporting the arm in abduction reduces tension on the repaired tendons and may also improve blood flow to the repair site.
Source: Kisner & Colby 7th ed., page 579
Because weakness and atrophy of the rotator cuff often are present prior to injury, strengthen and increase (1)_____ of the cuff muscles before dynamically (2)____ the shoulder abductors and flexors.
- endurance
- strengthening
Source: Kisner & Colby 7th ed., page 582
Inferior instability of the shoulder is evident in a positive ___.
Sulcus sign
Source: Kisner & Colby 7th ed., page 583
With anterior instability, the (1)____ capsule may become tight; with posterior instability, the (2)____ capsule may become tight.
- posterior
- anterior
Source: Kisner & Colby 7th ed., page 584
TRUE OR FALSE: In anterior shoulder dislocation, shorter duration of activity restriction is required for younger patients than older patients.
False.
Younger patients need longer duration as they exhibit higher demands of functional activities therefore increasing the risk of recurrent dislocation. Moreover, an elderly is more likely to have post-operative stiffness.
Source: Kisner & Colby 7th ed., page 585
In a closed reduction of anterior shoulder dislocation, mobilization techniques are initiated using all appropriate glides except the (1)____ glide. Conversely, when mobilization is allowed after a closed reduction of posterior shoulder dislocation, begin joint mobilization techniques using all appropriate glides except the (2)____ glide.
- anterior
- posterior
For anterior dislocation, anterior glide is contraindicated even though external rotation is necessary for functional elevation of the humerus if posterior dislocation. For posterior dislocation, posterior glide is contraindicated.
Source: Kisner & Colby 7th ed., page 585-586
After surgical reconstruction for recurrent anterior or anterior inferior instability, the shoulder is immobilized in a (1)_____ with the arm at the side or in some amount of abduction and internal rotation, with the arm slightly anterior to the frontal plane of the body. After surgery for posterior or posteroinferior instability, the upper extremity is supported in an (2)____ with the shoulder immobilized in the (3)____ position.
- sling or splint
- orthosis
- “handshake”
The handshake position is described as neutral rotation to 10° to 20° of external rotation, 20° to 30° of abduction, elbow flexed, and neutral flexion or slight extension.
Source: Kisner & Colby 7th ed., page 588
After surgical stabilization of either the AC or SC joint, the shoulder is immobilized for up to ____ weeks.
6
Source: Kisner & Colby 7th ed., page 594
What is the consistent with capsular pattern of the shoulder?
ER > Abduction > IR & flexion
This kind of impingement occurs as a result of mechanical compression of tissues of rotator cuff against the anteroinferior 1/3 of acromion in the suprahumeral space during arm elevation.
Extrinsic impingement
In AC & SC joints condition, (1)____ occurs if trauma or overuse is involved, while (2)____ occurs if sustained posture, arthritis or immobility is involved.
- Hypermobility
- Hypomobility
TRUE OR FALSE: Atraumatic posterior instability is more common that atraumatic anterior instability.
False.
What modality is often given during maximum control protection phase?
Cryotherapy
In which stage of shoulder hypomobility can PTs observe capsular tightness?
Subacute
In this stage of frozen shoulder, there may be an excessive scapulothoracic movement as a compensation.
Frozen stage / Stage 3
Case: Frozen Shoudler in Controlled Motion Phase
TRUE OR FALSE: If a joint is irritable and gliding in the direction of restriction is not tolerated, glide in the opposite direction.
True
Source: Kisner & Colby 7th ed.
When there is subluxation of dislocation of the AC & SC joints, the distal end of the clavical often displaces ____ and ____ on the acromion.
Posteriorly and superiorly
TRUE OR FALSE: Hypermobility is NOT permanent after trauma or overstretching of the AC or SC joint.
False.
It is usually permanent as there are almost no muscles that provide direct stability.
Case: Tendonitis/ Bursitis
When using friction massages, a PT must remember that an extremity must be in a (1) ___ position when targeting a tendon and in a (2)____ position when targeting a muscle belly.
- Stretched
- Shortened
TRUE OR FALSE: Anterior glide is contraindicated in cases of shoulder instability or dislocation
True
What must be the muscle strength of the rotator cuff and deltoid muscles to progress from moderate to minimum protection phase in TSA?
4/5
What kind of approach is usually done in subacromial depression?
Arthroscopic
TRUE OR FALSE: When treating a painful shoulder syndrome (primary or secondary), grasping the wand with the forearm supinated when performing shoulder flexion and abduction may help encourage humeral external rotation.
True
Source: Kisner & Colby 7th ed., page 595
A forward tilt of the scapula observed with a forward head posture and increased thoracic kyphosis is associated with (1)___ in the pectoralis minor, levator scapulae, and scalenus muscles and (2)___ in the serratus anterior or trapezius muscles
- decreased flexibility
- weakness
Source: Kisner & Colby 7th ed., page 550
Overuse syndromes of the AC joint may result from repeated stressful joint movements with the arm at ___, such as with grinding, packing assembly, and construction work, or repeated diagonal extension, adduction, and internal rotation motions, as when spiking a volleyball or serving in tennis.
Waist level
Source: Kisner & Colby 7th ed., page 558
In rotator cuff tears, if the supraspinatus or infraspinatus was repaired, a PT must remember to proceed cautiously when resisting GH joint _____.
external rotation
In anterior shoulder dislocation, what muscles will test weak?
SITS muscles/ rotator cuff muscles
