Shoulder

Question 1

Neer impingement stage 1

Answer 1

Less than 25 years old, minimal changes on diagnostic imaging. Characterized by edema and inflammation

Question 2

Neer impingement stage 2

Answer 2

Between age 25 to 40 years old, show symptoms of tendonitis and fibrosis in supraspinatus tendon

Question 3

Neer impingement stage 3

Answer 3

Imaging shows bone spurs, tendon degeneration, tend to be older than 40 years old

Question 4

External rotation lag sign

Answer 4

94% specificity for ruling in full thickness. Rotator cuff tears of super spinatus and infraspinatus

Question 5

Lateral scapula slide test

Answer 5

Can indicate weakness of scapular stabilizers.

Determine scapular position with arm abducted to zero, 45, 90°. Measure distance of scapula. Patients with suspected scapular weakness have increased measurements on involved side

Question 6

Wright test

Answer 6

Highest sensitivity test for ruling out Thoracic outlet syndrome. Implicates axillary interval (space posterior to pec minor)

AKA hyperabduction test

Question 7

Type 1 SLAP lesion

Answer 7

Isolated fraying of superior labrum. Degenerative in nature

Typically associated w RTC pathology

Question 8

Type II SLAP lesion

Answer 8

Detachment of superior labrum and origin of LHB from supraglenoid tubercle

Question 9

Type 3 slap lesion

Answer 9

Bucket handle tear of labrum with intact bicep insertion newly
Tend to be associated with traumatic instability

Question 10

Type 4 SLAP lesion

Answer 10

Bucket handle tear of labrum that extends into the bicep tendon

Tends to be associated with dramatic instability

Question 11

Type 5 slap lesion

Answer 11

Bankart lesion of anterior capsule extending into anterior superior labrum

Question 12

Type 6 SLAP lesion

Answer 12

Anterior or posterior superior labral flap tear that disrupts bicep tendon anchor

Question 13

Type 7 SLAP lesion

Answer 13

Legion that extends anteriorly to involve inferior or middle glenohumeral ligament

Question 14

SLAP special tests for compressive injuries

Answer 14

Active compression test
Compression-rotation test
Clunk test
Anterior slide

Question 15

SLAP special tests for traction injuries

Answer 15

Speeds test
Dynamic speeds test
Active compression test

Question 16

SLAP special tests for OH injuries (peel back mechanism)

Answer 16

Pronated load test.
Resisted soup nation external rotation
Bicep load test 1 and 2
Pain provocation test
Crank test

Question 17

Shoulder impingement special tests

Answer 17

Hawkins-Kennedy (most Sens)
Neers
Painful arc

Question 18

Scapular retraction test (SRT)

Answer 18

PT manually repositions and stabilizes medial border of scapula.

+ if improved muscle strength in scapula with stabilized position or decreased pain and impingement during jobe relocation tests

Question 19

Scapular assistance test( SAT)

Answer 19

PT manually facilitates scapular upward rotation as patient abducts arm

+ With relief of impingement, clicking, or rotator cuff weakness once assisted

Question 20

Shoulder labral special tests

Answer 20

Generally, low sensitivity, limited value for ruling out label pathology
Yergason, bicep load, crank test have decent Sp.

Yergason Sp = 0.95 but low +LR
crank test Sp = 0.72

Question 21

Shoulder (anterior) instability special testing

Answer 21

All tests have high specificity, good for rolling in instability

Surprise test has best Sn (Sn = 0.81, with low -LR)
Apprehension test had highest Sp
Relocation test also has strong Sp

Question 22

TUBS

Answer 22

Traumatic, Unilateral shoulder dislocation, often results in Bankart lesion, requiring Surgery

Often results from anterior force to shoulder while it is abducted and externally rotated.
May also accompany bony abnormalities like hill sachs lesion

Question 23

MDI or AMBRI

Answer 23

Multi-directional instability, or Atraumatic Multi-directional Bilateral shoulder dislocation that responds best to Rehab or Inferior capsular shift

Often require extensive rehab. If no favorable response is seen after 3 months, additional rehab will probably not be beneficial. May need inferior capsular shift

Question 24

Anterior shoulder dislocation

Answer 24

MOI often involves traumatic nature, particularly from abducted and externally. Rotated position

Concomitant axillary nerve or labral injury

Question 25

Posterior shoulder dislocation

Answer 25

MOI often involves discordinated muscle contraction like spasms or seizure
May have concomitant axillary nerve injury

Question 26

Shoulder stabilization procedures

Answer 26

Capsulolabral repair:
Bankart repair
Modified bankart

Subscap shortening:
Putti-platt
Magnuson-stack

Coracoid transfer:
Laterjet
Bristow

Question 27

Remplissage procédure

Answer 27

Arethoscopic stabilization procedure for moderate or large hill sachs lesion(> 25% of glenoid)

“Fills in” hill sachs lesion using infraspinatus tenodesis to reduce instability

Question 28

Subacromial impingement

Answer 28

Bursal sided RTC impingement in OH positions or maximal IR

Question 29

Internal shoulder impingement

Answer 29

Impingement of articular sided RTC tendon at maximal ER + abduction (late stage cocking)

Associated with PASTA lesion and SLAP tear. May see diffuse pain of posterior shoulder, IR ROM deficit

Question 30

Adhesive capsulitis risk factors

Answer 30

*DM type ii
*Thyroid disease
*Female
*Age 40-65
*Prex hx adhesive capsulitis on contralateral side

Autoimmune conditions
Trauma
Stroke/heart attack
Prolonged immobilization

Question 31

Lateral scapular slide test

Answer 31

Measures amount of protraction at zero, 45, 90° of shoulder abduction
Lateral excursion increased in cases of scapular weakness