Shoulder Flashcards
What kind of xray view do you use for AC jt and bony bankart fractures?
Westpoint-
- view
-patient must be prone, arm out to side hanging over table
-modified axial projection
-can see the anterior glenoid
Best Treatment for faster Return to play for mid shaft clavicle fractures
Open reduction and plate fixation
can return 10-12 weeks
What is a possible complication of clavicle injury and what are the signs?
Subclavian artery injury
-N/T in ipsilateral hand
-no motor weakness in UE’s
Which ligaments are primary restraints of posterrior and inferior instability
-Superior glenohumeral ligament
-Coracohumeral ligament have been shown to provide resistance to posterior and inferior instability. This occurs best in humeral ADD and ER
Which ligaments restrains anterior instability When shoulder at 45°,
the middle glenohumeral ligament
What happens in the shoulder joint ligaments When abduction increases to 90°,
the anterior band of the inferior glenohumeral ligament restrains against anterior instability
4 Types of SLAP TEARS
- Type 1: labral fraying
Type 2: biceps torn off- peel back
Type 3: bucket handle tear
Type 4: biceps split
Describe Type 2 SLAP tear
-detached biceps tendon
- during late cocking
- biceps tendon gets twisted and peels labrum and bicep from glenoid,
-can cause ant or post dislocation
Describe type 3 SLAP
Bucket handle tear
- labrum hangs into joint causing locking and popping
Describe Type 4 SLAP
-Bucket handle tear that SPLITS BICEPS TENDON
-can also cause locking and popping
The Lateral Scapular Slide Test (LSST)
to determine scapular position with the arm abducted 0, 45, and 90 degrees in the coronal plane. Assessment of scapular position is based on the derived difference measurement of bilateral scapular distances.” Patients with suspected scapular weakness have increased measurement values on the involved side. Now, that being said, it isn’t a stellar test. Furthermore, the results suggest that sensitivity and specificity of the LSST measurements are poor and that the LSST should not be used to identify people with and without shoulder dysfunction.” However, you may still see it on your exam.
Secondary shoulder impingement
relative impingement occurring in the presence of rotator cuff weakness or instability of the capsule
describe injury to Suprascapular Nerve
innervates supraspinatus and infraspinatus, will see infraspintaus atrophy, can be compressed in the suprascapular notch or spinoglenoid notch
What is most commonly injuried nerve after shoulder dislocation
Axillary
-innervates deltoid, teres minor and long head of triceps
sensory distribution covers shoulder joint- regimental badge
What does a (-) negative LR of 0.92 show?
is weak and is not enough information to definitively rule out the condition.
a neg LR (-) of .92 is weak and is not enough information to definitively rule out the condition. -LR should be close to zero
Symptoms of anterior instability
-Feeling shoulder will dislocate when in throwing position
-Shoulder abducted and externally rotated
What percentage of dislocations reccur in less than 20 year olds?
Dislocation has been reported to recur in 66% to 100% of people aged 20 years or under
What percentage of shoulder dislocations occur in people aged between 20 and 40 years?
13% to 63%
Are you at large risk of shoulder dislocation if you are over 40?
No- 0-16%
What are signs of inferior instability:
paresthesia when carrying a heavy object at their side
symptoms of posterior instability
Symptoms when pushing a heavy door or performing pushups
Describe a Putti Platt surgery
Putti-Platt -will stabilize with a soft tissue restriction rather than a bony block allowing for less pain and degeneration,
This procedure divides the subscapularis tendon, overlaps it, and repositions it to achieve anterior capsular stability.
This is not performed in throwers due to the risk for range of motion loss. While this material was not covered in your weekly material, you will see a
Benefit of a bankart repair
Bankart repair can prevent anterior head translation during cocking phase of throwing
What happens to the shoulder during The cocking phase
– the torsional peel back force occurs on the biceps labral complex
-Accleration phase leads to more medial elbow injuries