Shoulder Flashcards
AC Ligament -sprain
Coracoclavicular ligaments - intact and stable
Type 1
AC Ligament - rupture
Coracoclavicular ligaments -sprain
distal clavicle - not stable
Type 2
AC Ligament - rupture
Coracoclavicular ligaments - rupture
Joint instability - step off deformity
Type 3
AC Ligament -rupture
Coracoclavicular ligaments -rupture
clavicle displaced posteriorly
Type 4
AC Ligament - rupture
Coracoclavicular ligaments -rupture
superior displacement of the clavicle
Type 5
AC Ligament - rupture
Coracoclavicular ligaments - rupture
subcoracoid or subacromial displacement of distal clavicle
Type 6
TUBS
Traumatic, Unilateral, Bankart, Surgery
AMBRI
Atrauamtic multidirectional bilateral rehab inferior capsular shift
Special Test used to assess for elevated first rib
Cervical rotation lateral flexion test - kappa .84
CPR for Thoracic Manipulation for shoulder pain
89% success with 3
4 or more = 100%
Pain free shoulder flexion < 127 degrees
IR < 52 at 90 of abduction
negative neer
not taking pain meds
sx < 90 days
Adhesive Capsulitis with a MOI is defined as
Secondary AC
Adhesive capsulitis without a MOI / insidious onset is defined as
Primary AC
This ligament restrains inferior humeral movement at 0 degrees of shoulder elevation
Superior GH
This ligament restrains the GH joint when the shoulder is abducted
Inferior GH
This ligament restrains anterior translation / ER of the GH joint
Middle GH
Painful arc of 60-120
subacromial impingement
painful arc of 120-160
AC joint issue
Best position to strengthen the supraspinatus
Full can - minimizes contribution from the deltoid
Cluster for RTC Tear
Drop arm
Painful arc
Infraspinatus muscle test / ER weakness
Age > 60
There is pain reduction and/or a gain in ROM by assisting the scapula into upward rotation with shoulder flexion, this is an example of a (+) what special test?
Scapular assistance test
a (+) Flip sign is what?
The medial border of the scapula will protrude/”flip” up when resisting shoulder ER. This indicates a loss of scapular stability and you need to strengthen the scapula with serratus anterior and trap force couple
Whats the test position for Champagne Test? What Muscle is this testing?
Supraspinatus
30degree of abduction, slight ER, 30 degree of flexion
Whats the difference between the MMT for Infrspinatus and teres minor testing?
Both ER - Teres Minor at 90 degrees of abd, Infraspinatus ER at neutral
Hill Sach Lesion
Compression fix of posterior lateral humeral head when it hits the glenoid rim upon dislocation
Bankart Leison
Anterior labral detachment. IGHLC disrupted
How would you grade the following GH joint assessment? The humeral head translates over the glenoid rim with spontaneous return on removal of stress
Grade 2 - Also, presence of translation without pain indicates laxity not instability
Grade 1 - translation within the glenoid
Grade 3 - dislocation
What are the 3 views for radiography for the shoulder?
AP
Scapular Y
Axillary
What is primary impingement?
compression of the rotator cuff tendons between the humeral head and the overlying anterior third of the acromion, coracoacromial ligament, coracoid, or acromioclavicular joint
What is posterior impingement?
Shoulder at 90-90 position causes the supraspinatus and infraspinatus tendons to rotate posteriorly
This more posterior orientation of the tendons aligns them such that the undersurfaces of the tendons rub on the posterior-superior glenoid lip and become pinched or compressed between the humeral head and the posterior-superior glenoid rim
Late cocking phase of throwing makes this all worse
What is an optimal ER/IR ratio for strength?
66% - 1:2
Sizes and grades of RTC tears
small - < 1 cm
Medium 1-3cm
large 3-5cm
massive >5cm
full thickness - actual measurment
risk factors for post op stiffness following RTC repair
calcific tendinitis, partial articular supraspinatus tendon avulsion lesions, concomitant superior labrum anterior to posterior repairs, preoperative adhesive capsulitis, and single-tendon rotator cuff repairs
What is the reasoning for early motion in the rehab process following surgery?
is intended to promote healing, enhance collagen organization, stimulate joint mechanoreceptors, and aid in decreasing the patient’s pain through neuromuscular modulation
Types of SLAP Tears
Type I: Debridement
Typer 2: Repair Biceps anchor attachment
Type 3: Debridement of bucket handle type tear
Type 4: same as 3; repair biceps tenodesis or tenotomy
Stages of Adhesive Capsulitis
- Pre Adhesive Stage
Demonstrates mild erythematous synovitis and may last up to 3 months while the patient experience sharp pain at end ranges of motion, achy pain at rest, sleep disturbance
May be diagnosed with RTC impingement (incorrectly). To avoid this, know that ER is lost with an intact RTC
Stage 2: Acute Adhesive or Freezing Stage
Thickened red synovitis during a 3-9 month period
Patients have acute discomfort and very painful end ranges of all motions. Mild rom loss
Stage 3: Fibortic Stage or Frozen
Less synovitis. More mature capsuloligamentous fibrosis results in significant stiffness with less pain. Limited motion under anesthesia
Stage 4: Thawing
No synovitis
Painless stiffness and motion improves by remodeling from 15-24 months
