Shoulder 1 Flashcards
What is the capsular pattern of the shoulder?
ER lost first
ABD
IR
Describe the GH capsule
Normal fluid volume?
How is fluid volume effected by different conditions
Capsule is loose, ligaments are discrete capsular thickening
Normal fluid volume: 10-15ml
adhesive capsulitis: 5-10ml
Capsular laxity: 15-30ml
When is the superior GH ligament taut?
When arm is by side in 0 degree abduction
What ligament is the main static stabilizer of the abducted shoulder
Inferior complex of GH
Describe the posterior GH capsule
Thin and useless
Most stability comes from the muscles
What does it mean if you have pain when relaxing later on after doing a fatiguing activity for your shoulder
Instability
Note: scapular squeezes are good exercise for instability
The AC joint is ONLY controlled by:
passive structures
No active structures
If a patient says “I separated my shoulder” what joint are they likely talking about
AC joint
specifically the coracoclavicular ligament
The sternoclavicular joint is only controlled by ______ structures
Passive structures
No active structure
The scapulo-thoracic joint is only controlled by ____ structures
Active
What is reverse scapulo humeral rhythms
Often seen in adhesive capsulitis and RTC
Pt moves twice as much in scapula as GH joint
What is the open packed position of the GH joint
55 abd
30 horizontal add
Decrease grip strength can be a sign of….
Neurological problems
In addition to numbness, tingling, heaviness
What age groups are most effected by humeral epiphysis and osteogenic sarcoma
Children and adolescents
Rotator cuff degeneration typically occurs in _______
40-60 years old
Secondary impingement due to instability (caused by weakness) typically occurs in…
Teens-20s especially in overhead athletes
Calcium deposits in shoulder are most common in what ages
20-40
Adhesive capsulitis is common between what ages
45-60
Also associated with DM and ischemic heart disease
Symptom behavior: pain relieved w arm held in dependent position(gravity NOT pulling on arm)
Thoracic outlet syndrome
Symptom behavior: pain relieved by circumduction of shoulder w accompanying click or clunk
Internal derangement or GH instability
Symptom behavior: Pain relieved w elbow supported
AC joint separation
RC tears
What is the most common pathology in the shoulder, 70% of patients
Impingement/rotator cuff pathology
Rotator cuff tear size classification:
Small:
Medium:
Large:
Massive:
Small: less than 1cm
Medium: 1-3 cm
Large: 3-5cm
Massive: 5+cm
What demographics are associated with adhesive capsulitis
45-60 y/o
Female
Trauma
DM and thyroid disease
T or F: 20-30% of people will subsequently develop adhesive capsulitis in opposite shoulder
T
What are the 4 stages of adhesive capsulitis
Stage 1: pt ignores symptoms. Under 3 months
Stage 2: freezing for 3-9 months
Stage 3: frozen 9-14 months
Stage 4: thawing 14+ months
How does adhesive capsulitis present
Progressing pain w/o mechanism of injury
Progressive loss of ROM in 2+ planes
What does PT do for stage 1 adhesive capsulitis
Not much.. pain control maybe?
If they are even seen by PT
What would PT do for stage 2 adhesive capsulitis
Pain control and manual therapy
What would PT do for stage 3 adhesive capsulitis
Pain has resolved, focus on restoring normal motion
PT goals for stage 4 adhesive capsulitis
Continue to restore normal motion and strength
Glenohumeral instability differential diagnosis (key positive findings)
40+
Hx of dislocation/sublux
Apprehension
Laxity
If a patient has no history of dislocation and no apprehension it is unlikely that they have
Glenohumeral instability
T or F: Gleno-humeral joint instability is a noncontractile problem
T
Non contractile problem that presents with pain w/ overhead activities and at end ROM
Feeling of looseness, slipping of shoulder
GH instability
Most GH dislocations are…
Anterior
90% of all dislocations
What is the MOI of anterior GH dislocation
Abd ER ext
A hill sach’s lesion is more likely to happen with
Repetitive instability
What is the MOI of a SLAP lesion
Trauma, fall, catch a heavy object, repetitive microtrauma
What kind of joint instability can mimic a RTC tear
SLAP lesion
Traumatic OA for the shoulder is common in
45+
What is the MOI of AC joint dysfunction
Trauma or
Chronic secondary to OA, or RA
What is the most common fx in children
Clavicle fractures
What part of the humerus is most commonly fractured
Proximal humerus fractures
Common in children and elderly
