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Musculo > Shoulder > Flashcards

Shoulder Flashcards

1
Q

What is the DASH questionnaire?

A

patient asked about 30 functional tasks, scored 0-4 on the tasks. max score is 80
LOWER score= greater disability

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2
Q

what is the shoulder pain and disability index (SPADI)?

A

measurement of 13 items scored on VAS, 8 items physical function, 5 items pain related
Max score=100
HIGHER score= greater disability

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3
Q

What is the ASES questionare?

A

10 items scored on VAS
Max score=100
LOWER score= greater disability

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4
Q

What should you look at when observing a patient with shoulder pathology?

A

irritability of the condition
(Are they holding their arm close to them?)
posture
head position
scapular dumping?

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5
Q

Order of shoulder screen assessments?

A

AROM/PROM
repeated movement testing
joint play
muscle performance
functional testing
Provacation palpation

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6
Q

How do you assess movement patters of an individual with shoulder pathology?

A

observe if they are using their shoulder for movement.
Are they substituting with scapula, trunk, or head?

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7
Q

potential causes for Traumatic onset of shoulder pain?

A

fall onto lateral shoulder
forced external rotation
dislocation (dashboard/steering wheel during MVA)
FOOSH (posterior dilocation

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8
Q

Potential causes for insidious onset of shoulder pain?

A

overhead use
lifting and carrying
seated work life
Change in athletics, occupation, ADL’s
Change in health status

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9
Q

Complaints of popping/shifting can indicate potential injury to what?

A

general instability
weakness of RC/capsule

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10
Q

Complaints of clicking, snapping, grinding can indicate?

A

Clicking: labral issue
grinding: arthritic issue
Snapping: tendon/ bone issue

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11
Q

C/O aching can indicate?

A

muscle issue

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12
Q

C/O sharp pain, numbness, dead arm can indiciate?

A

nerve issue

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13
Q

C/O of shoulder stiffness can indicate?

A

arthritis issue

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14
Q

what degree range is the glenohumeral painful arc?

A

60-120*

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15
Q

what degree range is the acromioclavicular painful arc?

A

170-180*

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16
Q

Source of neuromuscular shoulder pain?

A

cervical radiculopathy
Brachial plexopathy
neurologic amytrophy
Focal mononeuropathy
Muscular dystrophy

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17
Q

Source of cardiovascular shoulder pain?

A

Cardiac ischemia, thoracic outlet syndrome, aortic disease, axillary thrombosis

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18
Q

Source of pulmonary shoulder pain?

A

pneumonia, pulmonary embolism, pneumothorax, pneumoperitoneum

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19
Q

Source of malignant shoulder pain?

A

metastatic cancer

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20
Q

source of abdominal shoulder pain?

A

billary disease, hepatic disease, pancreatitis, splenic injury, perforated viscuss

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21
Q

What is Ehlers-Danlos disorder?

A

defect in collagen synthesis, higher rates of hypermobility
higher incidence of dislocation

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22
Q

what is marfan’s syndrome?

A

Genetic disorder of connective tissue, disproportionately long limbs, fingers, statue, predisposal to CV disorders
Hyper mobile—> higher incidence of dislocation

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23
Q

Beighton index hypermobility score ranges?

A

0-3: normal
4-9: hypermobile
5 positions: 8 total components (tested on both sides)

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24
Q

What are some warning signs that shoulder pain may be visceral?

A

constant pain, no relief with rest
insidious onset
pain in throbbing
Fever, nausea, weight loss, dizziness
pain changes with eating, sneezing, breathing, walking

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25
Q

Warning signs that shoulder pathology may be a fracture?

A

traumatic onset
pain worse during sleep

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26
Q

Why is age >50 a red flag complaint?

A

they have increased risk of RC tear or other serious patholgies

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27
Q

why is night pain and weight loss a red flag complaint?

A

Sign of cancer

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28
Q

Where does an MI refer pain to?

A

left shoulder

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29
Q

why is pleurtic pain a red flag complaint?

A

increased risk for pancoast tumor

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30
Q

List the red flag complaints?

A

age>50
night pain, weight loss
fever
pain unrelated to activity, not relieved with rest
history of smoking
History of cancer
Pleuritic pain

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31
Q

What are you looking for in regards to skin characteristics?

A

vasculature
incisions/lesions

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32
Q

What are some potential defects you may see in the arm?

A

Popeyes sign
suprascapular atrophy
subscapular atrophy
axillary atrophy
Accessory
long thoracic

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33
Q

Signs that the shoulder complex has impaired smoothness?

A

clicking, popping, grating

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34
Q

What are you looking for during inspection of the shoulder?

A

Skeletal abnormalities (posture, prominence)
Skin characteristics
Defects (popeye or ludington sign)
Hypertrophy (upper trap)

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35
Q

Axillary n. issue would result in atrophy of which muscles?

A

delt and teres minor

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36
Q

accessory n issue would result in atrophy of which muscles?

A

trapezius, SCM

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37
Q

Suprascapular n. issue would result in atrophy of which muscles?

A

infraspinatus, supraspinatus

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38
Q

subscap nerve issue would result in atrophy to which muscles?

A

subscapularis (upper+ lower), teres major (lower)

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39
Q

Long thoracic n issue would result in atrophy to which muscles?

A

serratus ant. (scapular winging)

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40
Q

what does it mean if mid range AROM is unstable?

A

pathology not related to capsule

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41
Q

what does it mean if end range AROM is unstable?

A

pathology most likely related to joint capsule

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42
Q

Normal range of shoulder…
Flexion?
Abduction?
Extension
ER?
IR?

A

180
180
60
90
70

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43
Q

ER 90* scaption and abduction is associated with which capsular instability?

A

anterior dislocation

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44
Q

Horizontal Adduction and IR are associated with which capsular instability?

A

posterior dislocation

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45
Q

how do you assess movement patters of an individual with shoulder pathology?

A

observe if they are using their shoulder for movement.
Are they substituting with scapula, trunk, or head?

46
Q

how do you assess glenohumeral active range of motion?

A

you dont its only done passively

47
Q

what is a derangement in the shoulder?

A

internal distrubance in normal resting position of joint resulting in pain

48
Q

How does shoulder derangement present?

A

rapid changes in symptoms
pain most likely intermittent
limitations depend on the day
Usually insidious onset

49
Q

How does shoulder articular dysfunction present?

A

intermittent pain
pain at end range when structures are stretches
no rapid change in symptoms

50
Q

How does shoulder contractile dysfunction present?

A

intermittent pain
pain with active contraction
no rapid changes of symptoms

51
Q

How does postural syndrome present?

A

Normal tissues under sustained loads
Resolves with position changes

52
Q

which joint play movements can be do in glenohumeral joint?

A

anterior, posterior, inferior glides

53
Q

what joint play movements can be done at scapula?

A

elevation
depression
upward/downward rotation
protraction
retraction

54
Q

what joint play movements can be done at AC joint?

A

anterior
posterior glide

55
Q

What joint play movements can be done at sternoclavicular joint?

A

superior, inferior
anterior, posterior

56
Q

What joint play movements can be done at thoracic spine?

A

CVP
IVP

57
Q

what glides occur during flexion?

A

posterior and inferior glide

58
Q

what glides occur during extension?

A

anterior

59
Q

what glides occur during abduction?

A

inferior glide @ humerus
Inferior glide @ clavicle

60
Q

What glides occur during IR?

A

posterior glide

61
Q

What glides occur during ER?

A

technically anterior glide but since many people have bad posture (posterior glide)

62
Q

Should u do shoulder or scapular MMT first?

A

scapula
will affect where you place support during shoulder assessment

63
Q

Rule IN rotator cuff syndrome if?

A

symptoms worsen with overhead activity
midrange catching sensation
MMT to RC flexion and abduction= pain
RC weakness

64
Q

Rule OUT RC syndrome if?

A

MMT is pain free
RC and biceps have normal strength
Loss of passive ROM

65
Q

Diagnostic cluster for RC tear?

A

Age>65
Night pain
ER weakness
also
Age>60
painful arc
drop arm
infraspinatus

66
Q

> _____* loss of force at 10*abduction is indicative of?

A

50%
RC tear

67
Q

What tests help to confirm full thickness supraspinatus tear?

A

empty/full can
External rotation lag sign

68
Q

what tests help to confirm full thickness infraspinatus tear?

A

external rotation lag sign

69
Q

what tests help to confirm full thickness subscap tear?

A

lift off + belly press or
bear hug + belly press

70
Q

What tests help to confirm rotator cuff partial tear?

A

painful arc

71
Q

What does speeds test help to diagnose?

A

long head of biceps tendinopathy

72
Q

What does ludingtons test help to diagnose?

A

long head of biceps tendon rupture

73
Q

What test cluster should you use for impingement syndrome?

A

painful arc
infraspinatus test
hawkins Kennedy

74
Q

what is the scapular assistance test?

A

assisting upward rotation
Should decrease pain

75
Q

what is scapular resistance test?

A

stabilization of medial border of scap
improves painful arc

76
Q

What does the internal rotation resisted strength test help differentiate between?

A

RC tendinopathy v.s intra-articular pathology

77
Q

Internal rotation resisted strength test…
if IR>ER strength then what is the pathology?
If ER> IR what is the pathology?

A

RC tendinopathy
intra-articular pathology

78
Q

What is a hill sachs lesion?

A

anterior labral tear and posterior humeral head fracture

79
Q

What is a bankart lesion?

A

anterior inferior labrum tear
Issue with instability

80
Q

what is a reverse hill sachs fracture?

A

anterior medial humeral head fracture

81
Q

What two special tests assess for superior labral tear?

A

Active compression test
biceps tendon II test

82
Q

What two special tests assess for posterior dislocation?

A

jerk test
kims test

83
Q

what two special tests assess for AC pathology?

A

AC resisted extension
active compression test
cross body adduction test

84
Q

Rule IN adhesive capsulitis if?

A

patient is 40-65
gradual onset of worsening stiffness/pain
pain + stiffness limit sleeping
PROM limited in multiple directions

85
Q

Rule OUT adhesive capsulitis if?

A

PROM is normal
radiographic arthritis is present
ER and IR PROM increases with 45* abduction

86
Q

what tendons can you palpate in the shoulder?

A

supraspinatus
infraspinatus
teres minor
subscap
LHB

87
Q

High irritability is characterized by?

A

high pain levels (7/10)
consistent night/resting pain
high levels of disability
pain before end range
AROM < PROM

88
Q

Moderate irritability is characterized by?

A

moderate pain (4-6/10)
intermittent night/resting pain
moderate disability
pain at end range
AROM=PROM

89
Q

Low irritability is characterized by?

A

pain 3/10
no night/resting pain
minimal disability
pain with overpressure
AROM =PROM

90
Q

Pain control interventions

A

Pt education
PROM in pain free range
AROM in pain free range
Submax isometrics
manual scap stabilization
non-thrust
Soft tissue techniques
Modalites

91
Q

how are submax isometrics prescribed?

A

5 second hold, no pain, 10 reps, throughout day
5-50% MVIC

92
Q

What are types of soft tissue techniques?

A

Strain counter strain, AR, PNF, tooling

93
Q

Priority impairments for someone in the mobility group?

A

pain with motion
decreased joint play
decreased ROM
poor posture
Decreased MMT
substitution of GH motion with scapulohumeral

94
Q

Intervention strategies for mobility group?

A

PROM/AAROM/AROM
Stretching: PNF, contract relax
Non-thrust: III, IV
MWM
Motor control (sequencing of scap movement)

95
Q

How do you decreased capsule, ligament, fascia extensibility?

A

creep, stress relaxation

96
Q

how do you stretch a tight muscle?

A

3-5 sets of 30-60s hold

97
Q

how do you stretch a spasming muscle?

A

PNF, active release

98
Q

What does the cross-body stretch help?

A

posterior capsule movement

99
Q

What is a grade V non-thrust?

A

trust manipulation

100
Q

which direction joint mob increases ER?

A

posterior glid

101
Q

How do you perform repeated movements for the shoulder joint?

A

extension with cane
sets of 10

102
Q

What exercises can be used for scapula?

A

I,Y,T

103
Q

what are rhythmic stabilization exercises good for?

A

multidirectional instability, dislocation, RC tear

104
Q

Give an example of a rhythmic stabilization exercise?

A

ball on the wall RC and scap exercise with pertubation
Bosu ball plank

105
Q

what percent stronger is dominant arm compared to non-dominant?

A

15-30%

106
Q

Training of what movement will improve all other shoulder movements?

A

IR/ER training

107
Q

Is training ER /IR in side lying vs standing easier Or harder

A

harder, adding gravity

108
Q

How do you program RC strength exercises?

A

starts with 3-5 sets light weight
15-20 reps

109
Q

at what point of rehab do you want to include speed training?

A

at the end
speed increases injury risk

110
Q

Your doing great! Keep up the good work

A

💕💕💕💕

Musculo (5 decks)

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