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Physical Exam Course > Shoulder > Flashcards

Shoulder Flashcards

1
Q

History: Pain over lateral deltoid

A

Rotator cuff

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2
Q

History: Peri-scapular pain

A

Radiculopathy
Myofascial pain

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3
Q

History: “1-finger sign”

A

AC joint

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4
Q

History: Burning Pain

A

Nerve injury

  • Radiculopathy
  • Parsonage turner/brachial neuritis
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5
Q

History: Clicking

A

Instability
Labral involvement

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6
Q

Shoulder Inspection: Step-off deformity

A

AC joint separation

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7
Q

Inspection: ER + Abduction

A

Anterior dislocation

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8
Q

Inspection: Adduction + IR

A

Posterior Dislocation

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9
Q

Inspection: Dropped shoulder

A

Spinal accessory neuropathy

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10
Q

Inspection: Elevated shoulder

A

Levator spasticity
Cervical dystonia

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11
Q

ROM: Preliminary screen

A

Touchdown sign (if normal move on)

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12
Q

ROM: Apley Scratch Superior

A 
Abduction + ER
Normal T4 (Scapular spine)
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13
Q

ROM: Apley Scratch Inferior

A

Adduction + IR
Normal: T8 (inferior angle of scapula)

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14
Q

GIRD Definition

A

Glenohumeral Internal Rotation Deficit
> 20-25 degree side-to-side difference in IR in dominant vs non-dominant arms

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15
Q

GIRD population

A

Throwing Athletes
Swimmers

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16
Q

GIRD causes

A

Tight posterior capsule
Humeral retroversion (young patients)
Muscle Thixotropy

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17
Q

GIRD Complications

A

Rotator cuff impingement
Rotator cuff tears
SLAP tears
> 25% more likely to have SLAP lesion

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18
Q

GIRD treatments

A

Posterior capsule stretching

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19
Q

Scapulothoracic Motion: GH vs Scapula

A

2: 1 ratio of glenohumeral to scapular motion for abduction
- GH motion: 120 degrees
- Scapular motion: 60 degrees

> Scapular Substitution: Scapulothoracic motion can provide 90 degrees of abduction if necessary

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20
Q

Scapular Winging: Muscles

A

Medial: Serratus anterior
Lateral: Trapezius, Rhomboid

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21
Q

Scapular Winging: Trapezius innervation

A

Spinal accessory

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22
Q

Scapular Winging: Rhomboid innervation

A

Dorsal scapular

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23
Q

Scapular Winging: Serratus anterior innervation

A

Long thoracic

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24
Q

Scapular Winging: Lateral winging

A

Rhomboid/Trapezius
- Inferior angle of scapula rotated laterally

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25
Q

Scapular Winging: Lateral Winging testing

A

Abduct arm to 90/180 degrees

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26
Q

Scapular Winging: Medial winging cause

A

Serratus anterior

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27
Q

Scapular Winging: Medial winging testing

A

Forward flex arms to 90 degrees

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28
Q

Neurologic Exam: Sensation C4

A

Distal Clavicle

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29
Q

Neurologic Exam: Sensation C5

A

Lateral epicondyle

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30
Q

Neurologic Exam: Sensation C6

A

Thumb

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31
Q

Neurologic Exam: Sensation C7

A

Middle finger

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32
Q

Neurologic Exam: Sensation C8

A

Little finger

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33
Q

Neurologic Exam: Sensation C5

A

Biceps

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34
Q

Neurologic Exam: Sensation C6

A

Pronator

35
Q

Neurologic Exam: Sensation C7

A

Triceps

36
Q

Painless weakness in overhead athlete

A

Suprascapular neuropathy

37
Q

Refractory pain + weakness in young overhead athlete

A

Suprascapular neuropathy

38
Q

Volleyball shoulder

A

Suprascapular nerve palsy

39
Q

Suprascapular nerve function

A

Motor: Supraspinatus + Infraspinatus
Sensory: Deep sensation/proprioception of joint

40
Q

Suprascapular neuropathy: Compression sites

A

Suprascapular notch: Supraspinatus + Infraspinatus
Spinoglenoid notch: Infraspinatus only

41
Q

Suprascapular neuropathy at suprascapular notch

A

Supraspinatus + Infraspinatus

42
Q

Suprascapular neuropathy at spinoglenoid notch

A

Infraspinatus notch

43
Q

Suprascapular neuropathy: Diagnosis

A

EMG
- Significant difference in distal motor latency (Supraspinatus/Infraspinatus)
- Spontaneous activity, abnormal MUAPs, recruitment on needle (Supraspinatus/infraspinatus)
MRI
- Evaluate for space occupying lesions (peri-labral cyst)
- Evaluate for atrophy of muscles

44
Q

Suprascapular neuropathy: Treatment

A
  • Activity modification
  • PT: RC strengthening, scapular stabilization
  • Suprascapular nerve block/ablation
  • Surgery (if space occupying lesion)
45
Q

Special Tests: Rotator Cuff Impingement

A

Neers
Hawkins

46
Q

Special Tests: Rotator Cuff Pathology

A
  • *Impingement**
  • Neer’s
  • Hawkins
  • *Supraspinatus**
  • Empty Can
  • Drop arm tear (complete supraspinatus tear)
  • *Infraspinatus/Teres Minor**
  • Resisted ER
  • Hornblower’s (Teres Minor)
  • *Subscapularis**
  • Lift off test
  • Belly press test
47
Q

Rotator Cuff: Pain w/ preserved strenght

A

Tendonitis/Tendinopathy

48
Q

Rotator Cuff: Pain w/ weakness

A

Rotator Cuff Tear

49
Q

Special Tests: Bicipital Tendonitis

A

Speeds test

Yergason’s test

50
Q

Special Tests: arm flexed 30 degrees, elbow extended, hand supinated, resisted downward force

A

Speed’s Test

51
Q

Special Tests: Arm adducted, elbow flexed 90 degrees, patient supinates hand against resistance w/ passive ER of shoulder

A

Yergason’s

52
Q

Special Tests: AC Joint

A
  1. Cross Arm/Scarf Test
  2. Dugas Test: Actively touches opposite shoulder
  3. AC Distraction (Bad Cop): Passive touches opposite shoulder
    1.
53
Q

Special Tests: Pt touches opposite shoulder w/ affected arm

A

Dugas Test

54
Q

Acromion Types

A

Type 1: Smooth

Type 2: Curved

Type 3: Hooked

55
Q

AC Joint Separation Grades

A

Severity of ligament tear

Type I

Type II

Type III

Direction/degree of clavicle displacement

Type IV

Type V

Type VI

56
Q

Special Tests: Labral Pathology

A
  1. Obrien Test
  2. Anterior Slide
  3. Crank test
57
Q

Special test: arm flexed to 90 degrees, elbow extended, internal rotation, adduct past neutral, resist downward force

A

Obrien Test

Positive Test: Pain w/ clicking

58
Q

SLAP definition

A

Superior Labral Tear in Anterior to Posterior Direction

59
Q

SLAP Tear: 4 types

A

Type I: Degenerative fraying

Type II: Detachment of biceps

Type III: Bucket handle tear of superior labrum w/ intact anchor

Type IV: Bucket handle tear w/ involvement of biceps tendon

60
Q

Special Tests: Instability (4)

A
  1. Sulcus sign
  2. Apprehension/Relocation
  3. Release
  4. Load and shift
61
Q

Special Tests: (+) Sulcus sign

A

>½ inch movement= Hypermobility

62
Q

Special Tests: Release Test (shoulder instability)

A

At end of relocation test abruptly stop applying force

(85% sensitivity, 87% specificity)

63
Q

Shoulder Instability: Most common direction of instability

A

Anterior + Inferior

64
Q

Shoulder Instability: TUBS

A

Anterior Dislocation

  • Traumatic
  • Unidirectional instability
  • Bankart lesion
    • Surgery= treatment of choice
65
Q

Shoulder Instability: AMBRII

A

Posterior Dislocation

  • Atraumatic
  • Multidirectional
  • Bilateral involvement
  • Rehab= treatment of choice
  • Inferior capsule shift if surgery required
  • Interval lesion
66
Q

Shoulder Instability: Bankart lesion

A

Anterior labral tear associated w/ anterior dislocation

67
Q

Shoulder Instability: Hills-Sachs lesion

A

Compression fracture of posterior lateral humeral head related to repeated subluxation/instability

68
Q

Impingement of subscapularis tendon associated w/ soft tissue/bursa between the coracoid process and lesser tuberosity of humerus

A

Subcoracoid impingement

69
Q

Subcoracoid Impingement:

A

Impingement of subscapularis tendon associated w/ soft tissue/bursa between the coracoid process and lesser tuberosity of humerus

70
Q

Subcoracoid Impingement: Position of maximal impingment

A

Flexion

Adduction

Internal rotation

71
Q

Subcoracoid Impingement: Risk Factors

A

Long/excessively lateral coracoid process

Posterior capsule tightness

72
Q
  • Anterior shoulder pain worse w/ flexion/adduction/IR
    • Driving
    • Drawing on blackboard
    • Throwing follow through
  • Tender over coracoid process
A

Subcoracoid impingment

73
Q

Special Tests: Subcoracoid impingement

A

Subcoracoid impingement test

  • Flex arm to 90, passively adduct and internally rotate w/ elbow extended
74
Q

Subcoracoid impingment: Imaging

A
  • CT: Measure coracohumeral distance
  • US: Measure coracohumeral distance
  • MRI: Assess for rotator cuff/subcapularis integrity
75
Q

Impingement of superior/bursal aspect of supraspinatus

A

External impingment

76
Q

Impingement of articular side of supraspinatus/undersurface of rotator cuff

A

Internal impingment

77
Q

Internal Impingment: Cause

A

Excessive external rotation: Throwing athletes, GIRD

  • Fraying of posterior cuff
  • Articular sided cuff tears
  • Posterior superior labral tears
  • Damage to posterior capsul/glenoid
78
Q
  • Poorly localized posterior shoulder pain
  • Worse w/ throwing during late cocking/early acceleration phase
  • Increased external rotation
  • Decreased internal rotation
A

Internal Impingement

79
Q

Shoulder Imaging: AP + Axilar lateral/trans scapular

A

Dislocation

80
Q

Shoulder Imaging: West Point View

A

Bankart lesion

81
Q

Shoulder Imaging: Stryker notch view

A

Hill’s Sach’s Lesions

82
Q

Shoulder Imaging: Serendipity View

A

Sternoclavicular joint

Medial ⅓ of clavicle

83
Q

Shoulder Imaging: MRI

A

Rotator cuff pathology

Soft Tissue Abnormalities

84
Q

Shoulder Imaging: MR Arthrogram

A

Labral injuries

Undersurface cuff tears

Physical Exam Course (7 decks)

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