Shoulder Flashcards
Describe how the inferior glenohumeral ligament supports the shoulder
Support shoulder like like a hammock when the arm is abducted
Describe some characteristics of shoulder laxity
Unilateral or bilateral Identified with PROM A Common May not result in instability No dysfunction or complaint May be present but compensated for May be congenital or secondary to poor movement
Describe some characteristics of shoulder instability
Mostly unilateral but not always
Likely to have MOI
Disfunction and complaint
Body has a hard time compensating for these
Define the term SLAP lesion
Superior labral injuries that are both anterior and posterior
Describe the MOI of SLAP lesions
Traumatic or chronic FOOSH MVA Sudden deceleration or traction forces Chronic anterior and posterior instability
Describe the pathophysiology of SLAP lesions
Superior labrum is mobile and connected to biceps making it more vulnerable
Biceps tendon is in tact with slap lesions
Describe a type 1 SLAP lesion
fraying of edge of labrum
Pain with horizontal ABD and ER of shoulder
Describe a type 2 SLAP lesion
Detachment of labrum and biceps tendon anchor
Loss of stabilizing effect of the labrum and biceps
Most common type
Describe a type 3 SLAP lesion
Vertical tear in the labrum
Remaining labrum and biceps intact
Describe a type 4 SLAP lesion
Bucket handle tear in bicep tendon
Labral flap and biceps displaceable into GH joint
Describe a type 5 SLAP lesion
Bankart lesion of anterior capsule extending into the anterior superior labrum
Describe a type 6 SLAP lesion
Disruption of biceps tendon anchor with anterior or posterior superior labral flap tear
Describe a type 7 SLAP lesion
Extension of a SLAP lesion anteriorly to involve the area inferior to the middle GH ligament
Describe how a slap lesion presents
No specific symptoms
Pain with overhead activities
Catching or locking
What are some special tests to test for SLAP lesions
O"brien active compression test Clunk Crank Speed's Jobe relocation Biceps load Anterior slide
How do you manage SLAP lesions
Exercises for dynamic stabilization
Surgery has good prognosis
What is the most common type of GH instability
Anterior
Describe some general presentation and MOI info on GH instability
Complains of slipping or popping out with overhead activities
May be traumatic, repetitive or genetic
Describe the presentation of anterior GH instability
Impingement like symptoms
Ill defined global shoulder pain, activity specific
Describe the MOI of GH anterior instability
ABD, ER, hori ABD
What do you check for in GH anterior instability
Posterior tightness as it may cause anterior translation
Describe some MOIs for GH Posterior instability
Rare
Seizure, electrick shock, diving into shallow pool, MVA
Describe the presentation of GH posterior instability
Severe pain, limited ER, less than 90 ABD
Vague pain with arm in flexed and adducted position
Clunk with shoulder movement from Flexion to ABD and ER
Posterior prominence of shoulders when observed from above
What are the 4 special tests to confirm GH posterior instability
Kim
Jerk
O’Brian
Posterior impingement sign
Describe GH inferior instability
Very uncommon
From carrying heavy things or extreme hyperabduction
Sulcus sign used to asses inferior stability
Describe Multidirectional GH instability
Instability present in one or more direction
Usually present with scapulothoracic dyskinesia
Describe GH instability management
Strengthen dynamic stabilizers
Follow specific instructions bases on method of repair
Immobilize briefly for comfort
What types of exercises should be done for GH instability
ROM - emphasize posterior capsule with anterior instability
Scapular stability - Scapular pinch, shoulder shrug, taping
Closed chain - all movements of the scapula
Open chain - PNF, diagonals upright rows, ER scapular retraction
What populations is shoulder replacement saved for
Elders
Those with unremitting pain
What Muscles should be examined preoperatively to total shoulder replacement
All muscles that attach to the scapula
What limb position is to be avoided after shoulder replacement
Active IR
Passive or active ER beyond 35-40
Describe unconstrained shoulder replacement
Most common
Inert humeral component with high density glenoid component
Describe constrained shoulder replacement
Parts are coupled and fixed to bone
Rarely used
Describe reversed ball and socket shoulder replacement
Humerus is socket, glenoid shaped to a ball
used when rotator cuff is compromised
Describe semi constrained shoulder replacement
Increased ROM
Smaller humeral head
head neck angle of 60
What are the risk factors for adhesive capsulitis
Thyroid disease Diabetes 40-65 Previous trauma Female having in one arm increases the likelihood of the other
How do you diagnose adhesive capsulitis
Shoulder pain for longer than 1 month
Pain sleeping on shoulder
Cannot lay on shoulder
ROM restricted in all directions
What is ASES
OM for adhesive capsulitis
0-100 (best)
MDC - 9.4 (use this)
MCID 6.4
What is DASH
Disabilities of the arm shoulder and hand
0-100 (best)
MCID - 10.2
MDC 10.5
What is SPADI
Shoulder pain and disability index
0-100 100 best
MDC 18.1
MCID 8
Where is the dorsal scapular nerve impinged and what is the presentation
Middle scalene
scapular pain radiating to lateral shoulder and arm
Where is the supra scapular nerve impinged and what is the presentation
Suprascapular notch, underneath the transverse scapular ligament
Posterior border of SCM
Limited shoulder flexion and abduction
pain with contralateral cervical rotation
Describe type 1-3 AC joint rehab
Recovery with conservative management Modalities sling 1-2 weeks Gentle ROM - isometric for clavicular attachments full activity in 12 weeks
Describe interventions for AC injuries grades 4-6
Surgical intervention
Pain free ROM - Normalize arthro - functional training
What is the most common direction for SC joint dislocations and some MOIs
anterior
MVA, sports
Describe the types of SA injuries
1 - sprain of SC ligament
2 - Subluxation
- A - anterior
- B - posterior
3 - A - anterior dislocation
- B posterior dislocation
4 - habitual dislocationHow long is the shoulder immobilized for after SC joint injury
3-4 days
Describe this test
Biceps load test
Deep pain indicates SLAP lesion
Describe this test
IRRST test
weak ER - external impingement
Weak IR - weak internal impingement
Describe this test
Kim test
Posterior inferior labral lesion
posterior shoulder pain
Describe this test
Jerk test
Posteroinferior labral lesion
Sharp shoulder pain
Describe this test
Compression rotation
Labral tear
Catching or snapping
Describe this test
Crank test
SLAP lesion
Describe the fulcrum test
Arm over head
Instabilities
Describe this test
O’Brian test
labral tear
Pain with internal rotation bit not external rotation
Describe this test
Speed test
pain at bicipital groove
Bicipital tendinopathy and SLAP tear
Describe this test
Jobe relocation
Pain
SLAP lesion
Describe this test
Anterior slide test
Pain
SLAP lesions
