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F3 E2 Shea > Shoulder 1 > Flashcards

Shoulder 1 Flashcards

1
Q

What are the 2 ligaments that stabilize the acromioclavicular joint?

A
  • AC joint ligament
  • Coracoclavicular ligament complex
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2
Q

T/F

  • AC joint injuries occur in males in their 20’s
A

True

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3
Q

Mechanism of Injury of AC joint injury?

A

Direct Force

  • Falls on AC joint w/ arm at side (collision sport)
  • Force applied to superior aspect of acromion which forces acromion inferior & medial
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4
Q

Type 1, 2, or 3 AC injury?

  • Sprain of AC ligament
  • AC joint intact
  • Coracoclavicular ligaments intact
  • Pain w/o deformity
A

Type 1

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5
Q

Type 1, 2, or 3 AC injury?

  • Sprain of coracoclaviular ligament
  • AC joint disrupted
  • <50% vertical displacement
  • Pain & deformity ++
A

Type 2

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6
Q

Type 1, 2, or 3 AC injury?

  • AC & coracoclavicular ligaments all disrupted
  • AC joint dislocated & shoulder complex displaced inferiorly
  • Coracoclavicular interspace greater than the uninvolved shoulder
  • Pain w/ deformity
A

Type 3

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7
Q

AC joint injury rarely occurs from what mechanism?

A

FOOSH

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8
Q

Inspection/Palpation of AC joint separation

  • Elevated distal clavicle (deformity called what?)
  • Which 3 grades?
  • Swelling
  • Spasm of which muscle?
A
  • “step” deformity
  • 2, 3, 5
  • Trapezius
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9
Q

What 2 tests to eval AC joint separation?

A
  • Cross-arm ADDuction
  • Traction test
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10
Q

Tx for which Type of AC joint injury?

  • Non-operative
  • Ice and protection until pain subsides (7 to 10 days)
  • Return to sports / Activities of Daily Living (ADLs) as pain allows (1-3 weeks)
  • No apparent benefit to the use of specialized braces
A

Types 1 & 2

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11
Q

Tx for which type of AC joint injury?

Non-operative treatment

  • Sling and harness (10-14 days) to approximate alignment
  • Return to sports / ADLs 3-4 weeks

Need for acute surgical treatment remains controversial

  • Conservative treatment recommended except in the throwing athlete or overhead worker
  • Repair generally avoided in contact athletes because of the risk of re-injury
A

Type 3

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12
Q

3 complications of AC joint injuries

A
  • Osteoarthritis (OA) of the AC joint
  • Osetolysis of the distal clavicle
  • Inability to return to optimal functional level
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13
Q

What is the most common direction of dislocation of Shoulder (Glenohumeral) dislocations?

A

Anterior (95%)

Least common = inferior

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14
Q

Which type of shoulder dislocation?

  • Associated with seizures or electrical shock
  • Commonly missed on X-ray
  • High incidence of associated lesser tuberosity fracture
A

Posterior

(relatively uncommon)

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15
Q

Which type of shoulder dislocation?

•ABD/ER (abduction/extended) most common mechanism

Complications

  • Up to 20-40% neurologic injury
  • Hills Sachs lesion
  • Bankart tear
A

Anterior

(most common)

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16
Q

4 PE findings of Shoulder Dislocation

A
  • Flattened deltoid
  • Fullness of anterior chest
  • Prominence of acromion
  • Guarding / protecting
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17
Q

3 x-ray views for Shoulder Dislocation

A
  • AP view (A&B)
  • Axillary view (C&D)
  • “Y” view
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18
Q

What 2 things should be given to patient during Anterior Shoulder Dislocation reduction procedure?

A
  • Apply oxygen by mask or nasal cannula throughout the procedure
  • Fentanyl 100 micrograms IV over 1 minute and then repeated every 3-5 minutes until adequate sedation is achieved
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19
Q

What 2 things should be done prior to reduction of Ant Shoulder Dislocation?

A
  • Prior to reduction, a neurovascular exam should be performed and documented
  • Obtain radiographs to document the dislocation and r/o any fractures
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20
Q

Tx for Shoulder Dislocations?

  • What 3 things?
A

Immediate reduction

  • Hippocratic technique
  • Stimson technique
  • Hennipen Technique
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21
Q
  • Which technique?
  • For what injury?
A
  • Hippocratic Technique
  • Shoulder Dislocation
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22
Q
  • Which technique?
  • Which injury?
A
  • Stimson Technique
  • Shoulder Dislocation
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23
Q
  • Which technique?
  • Which injury?
A
  • Hennepin
  • Shoulder dislocation
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24
Q

What are the 4 provocative tests to eval Shoulder Dislocation?

A
  • Apprehension
  • Jobe Relocation (Differentiate pain versus instability)
  • Surprise (aka Release test)
  • Sulcus sign
25
Q

Shoulder Dislocation Aftercare

A
  • Confirm reduction w/ radiographs
  • Immobilize arm in sling
  • Remove sling & extend elbow several times daily to prevent elbow stiffness
  • Consult ortho
26
Q

3 complications of Ant Shoulder Dislocation

A

•Bankart lesion (Glenoid labral avulsion (anterior/inferior))

•Hill-Sachs lesion (Impression fracture to posterolateral portion of the humeral head)

•Capsular laxity

27
Q

What is this? / Which injury?

  • Detachment of the anterior-inferior portion of the labrum from the glenoid.
  • The most common cause of recurrent instability after an injury.
A

Bankart Lesion

  • Anterior Shoulder Dislocation
28
Q

What is this?

  • A posterolateral compression fracture of the humeral head
  • Caused by collision of the humeral head with the anterior ring of the glenoid.
  • May destabilize glenohumeral joint & may predispose to further dislocation
A

Hill-Sachs Lesion

29
Q
  • Recurrence of shoulder dislocation after traumatic anterior dislocation is high in patients of what age?
  • Recurrence is less common in what age?
  • First time dislocation in pts older than 40 yrs may be associated w/ what?
A
  • Traumatic, high recurrence: <30 y/o
  • Less common recurrence: >45 y/o
  • rotator cuff tear
30
Q

2 complications of shoulder dislocations

A

Brachial Plexus Injury

•Carefully document pre- and post-reduction neuro exam in all patients!!

Recurrent dislocation

  • Common in more active patients
  • Treated with anterior shoulder reconstruction and Bankart repair
31
Q

What is the most freq cause of shoulder pain??

A

Subacromial Impingement Syndrome (SAIS)

32
Q

SAIS

  • What is root of problem?
  • What are the 2 types?
A
  • Decreased subacromial space
  • Primary / Secondary
33
Q

Which type of SAIS?

  • Driven by degenerative changes
  • > 35 y/o
  • Bone spurs &/or calcific deposits
  • “true” or “classic” impingement
A

Primary

34
Q

Which type of SAIS?

•Hooked acromion = increased subacromial pressure

  • Decrease subacromial space
  • More contact with RC tendons
  • Increased risk of SAIS → increased risk of RC tear
A

Primary

35
Q

Degenerative Calcification is seen with what?

A

Primary Impingement (SAIS)

36
Q

Which type of SAIS?

  • Due to repetitive overhead movement (ABDuction and ER)
  • <35 y/o
  • Overhead athlete (volleyball)
  • Faulty scapular posture
A

Secondary Impingement

37
Q
  • 2 contributing factors to Secondary Impingement?
  • Leads to adaptive muscle imbalances such as?
A
  • Forward head / Increased thoracic kyphosis
  • Tight pec minor –> anterior tilting & protraction
    • ↓ subacromial space → impingement → inflammation and gradual degeneration of subacromial structures
38
Q

SAIS is due to inflammation affecting volume in subacromial space –> increased compression.

  • Repetitive microtrauma occurs in what 3 structures?
A
  • Supraspinatus tendon
  • Subacromial bursa
  • Long Head of Biceps
39
Q

SAIS

  • Gradual or sudden onset of pain?
  • Where is pain located (2 places)
  • Night pain / diff sleeping on affected side
  • TTP over what 3 areas?
A
  • Gradual
  • Anterior & Lateral shoulder = deltoid tuberosity, exacerbated by overhead activity
  • greater tuberosity / subacromial bursa / biceps tendon (long head)
40
Q

3 strength tests for SAIS?

A
  • External rotation/Infraspinatus Strength Test
  • Empty can Supraspinatus Test
  • Lift-off Subscapularis Test
41
Q

3 components of conservative care for SAIS?

A
  • NSAIDS
  • Avoid offending activities / Sleep position modified
  • Therapy program for postural correction (PT or home therapy)
42
Q

SAIS

  • If no improvement in how many weeks of conservative care can you progress to corticosteroid injection in combo w/ conservative?
A

6 weeks

43
Q

Under what circumstances with SAIS would you do surgery (subacromial decompression)?

A
  • Failure with conservative care
  • Evidence of calcifications &/or bone spur
44
Q

Rotator Cuff Tear

  • MC etiology? 2nd MC?
  • Originate where?
  • Full thickness tears uncommon < __ yrs
  • Incidence of full thickness tears increases >___ yrs
  • Incidence ESP. increases > ___ yrs
A
  • # 1: overuse
  • # 2: traumatic
  • uncommon <40 yrs
  • common >40 yrs
  • very common >60 yrs
45
Q

Clinical Px of which injury?

  • Recurrent shoulder pain for several months (overuse)
  • Specific injury that triggered the onset of the pain (traumatic)
  • Subacromial pain and pain localized to deltoid tuberosity
  • Night pain and difficulty sleeping on affected side
  • Weakness, catching, and grating especially when lifting the arm overhead
A

Rotator Cuff Tear

46
Q

PE of Rotator Cuff Tear

  • TTP of subacromial space
  • What ROM is decreased?
  • What ROM is normal?
  • What test is positive?
A
  • Dec: Active (shoulder shrug w/ abduction)
  • Normal: Passive
  • “drop arm” test is positive
47
Q

4 muscles of the rotator cuff

A
  • Supraspinatus
  • Infraspinatus
  • Teres minor
  • Subscapularis
48
Q

What is the gold standard imaging of Rotator Cuff tear

A

MRI

  • If chronic injury and concern is for partial tear order arthrogram
  • If traumatic injury and pt most likely has full thickness tear arthrogram is optional
49
Q

Nonsurgical Tx for Rotator Cuff Tear

  • <__% thickness tears
  • PT
  • Avoidance of overhead activities
  • 2 meds?
A
  • <50%
  • NSAIDs
  • Steroid Injection
    • •May decrease inflammation of an associated subacromial bursitis and provide short-term pain relief
  • May also weaken tendon/accelerate propagation of tear
  • Patients should never receive > 3 subacromial injections/year
50
Q

Surgery for Chronic Injury of RC tear

  • Significant sxs and failed ____ for > how many months?
A
  • rehab
  • > 3-6 months
51
Q

Surgery for Acute Traumatic RC tear

  • Best done acutely or no later than within ___ weeks of injury
A

6 weeks

52
Q

Condition?

  • Idiopathic loss of BOTH active & passive motion***
  • Most commonly affects pts 40-60 y/o
  • MC risk factor?
  • Other related condiitons:
    • hypothyroidism
    • dupuytren contracture
    • cervical disk herniation
    • Parkinson’s disease
A

Adhesive Capsulitis (Frozen Shoulder)

  • MC RF: DM type 1
53
Q

Adhesive Capsulitis (Frozen Shoulder)

  • Inflammatory process involving what structure?
  • Gradual ROM loss
    • mechanical restriction
    • pt commonly unaware
    • What are the 3 common primary motions involved?
A
  • Glenohumeral capsule (idiopathic)
  1. External rotation (most pronounced)
  2. Abduction
  3. Flexion
54
Q

Adhesive Capsulitis - Evaluation

  • Significant (at least __%) reduction in BOTH active & passive ROM
    • What motion is most pronounced?
  • Pain
    • Dull/achy pain over what structure w/ what motion?
    • Sharp pain when?
  • Diffuse shoulder tenderness may be present
A
  • 50%
  • Most pronounced: external rotation
  • Dull at rest: deltoid tuberosity
  • Sharp: at end range of restricte movements (GH joint)
55
Q

An MRI in a pt w/ Adhesive Capsulitis will reveal what 2 things?

A
  • Contracted capsule
  • Loss of inferior pouch
56
Q

Which phase of adhesive capsulitis?

  • Pain and progressive loss of motion
A

“Freezing” phase

57
Q

Which phase of adhesive capsulitis?

  • Decreasing discomfort associated w/ slow but steady improvement in ROM
A

“Thawing” phase

58
Q
  • How long does it take for Adhesive Capsulitis to resolve?
  • Most pts experience what?
A
  • 6 months - 2 years
  • minimal long term pain or functional deficit
59
Q

Tx of Adhesive Capsulitis

  • What “may” be considered?
  • PT will perform what? Consider what tx prior to PT visit?
  • If no improvement in how long will surgery be considered?
A
  • Intra-articular injection of steroid
  • PT: aggressive ROM, consider pain control prior to PT therapy
  • 9 - 12 months

F3 E2 Shea (14 decks)

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