Shoulder Flashcards

Question

Synovial membrane pathology

Answer 1

Adhesive capsulitis/ frozen shoulder

Answer 2

Damage to glenoid labrum Superior Labral tear from ant. To post. (SLAP) Bankart – damage to inferior, anterior labrum. =ongoing instability Rotator cuff pathology/ subacromial shoulder pain Includes rotator cuff tendinopathy, rotator cuff tears and subacromial bursitis

Answer 3

1) Those that need onward referral 2) Referred from the neck 3) Traumatic injuries- fractures, dislocations and AC joint sprain 4) Atraumatic pathology - Instability, Acromioclavicular joint disease, Glenohumeral joint disease – Frozen shoulder, Arthritis and Rotator Cuff Tendinopathy

Answer 4

35-75 years

Answer 5

Malignancy- Weight loss, night pain, night sweats and fever Acute rotator cuff- Trauma, pain and weakness Septic arthritis - fever or systemically unwell, red skin, hot, painful joint Unreduced dislocation - Loss movement, trauma leading to loss of rotation and abnormal shape Inflammatory arthritis- Swelling, early morning stiffness, FH RA, swollen joint +- heat Neurological lesion- Gait disturbances, unexplained muscle wasting and weakness, sensory loss UMN - babinski and clonus LMN - reflexes, dermatomes and myotomes

Answer 6

Pain in one or both upper extremities which corresponds to the dermatome of the involved cervical nerve root. Most common cause degenerative change: disc herniation, spondylosis (spinal OA) causing bony hypertrophy of facet joints.

Answer 7

Symptoms reproduced with Neck active and passive ROM. +/- Changes in Dermatomes, Myotomes and reflexes. Urgent referral if severe or progressive motor weakness or severe or progressive sensory loss If 4-6 weeks or more or neurological signs refer to confirm diagnosis (medical Rx) <4-6 weeks and no objective neurological signs = conservative management

Answer 8

pins and needles, numbness, weakness, aggravating and easing linked to neck, symptoms may go down the arm

Answer 9

Reassurance that prognosis is good in most cases. Most will improve regardless of treatment. 88% will improve within four weeks with non-operative treatment (Childress and Becker 2016) Encourage activity and return to normal lifestyle (inc work). If neck restricted not to drive. No collars.

Answer 10

Localised pain. Pain and function reflective of stage of healing.

Answer 11

Obs: protracted shoulder girdle position Difficulty with active Protraction, Retraction, elevation and depression and active and passive GH flexion and abduction through elevation.

Answer 12

Common shoulder fractures (child>adult) Sling 2-6 weeks of immobilisation Reassurance- good outcome in >90% cases of minimally displaced or not displaced at 24 weeks (Robinson et al 2004) Sometimes will need physio for AROM, stretches, strengthening with an aim to return function.

Answer 13

(synovial plane = gliding) Close packed position: Maximum shoulder elevation.

Answer 14

(synovial plane = gliding) During Abduction and flexion the clavicle rotates about its long axis posteriorly. If unable, the movement of the scapula is affected which affects GH joint flex and Ab.

Answer 15

Coracoclavicular ligament Acromioclavicular ligament Coracoacromial ligament Role of AC joint: Allows overhead and across the body movement Transmits force from arm to rest of body during activities such as pushing, pulling and lifting

Answer 16

Localised pain over AC joint, aggravated by heavy lifting, over head and across the body movements.

Answer 17

Obs- swelling, bruising, hard lump may be present at top of shoulder. Palpation: specific tenderness over AC joint Difficulty with GH flexion through elevation and horizontal adduction (Cross body test)

Answer 18

Ligament healing times: 6-8 weeks, in this time protect from over stretching (may use sling) Physio: normalise joint ROM, muscle lengths, proprioception, minimise your chance of re-injury (return to work or sport 8-12 weeks)

Answer 19

MILD: Grade I (intact joint minor tear of acromioclavicular ligaments) Grade II (up to 50% and stretching of ligaments) SEVERE: Grade III (>50% vertical subluxation)= Orthopaedic opinion

Answer 20

Arm outstretched in an externally rotated and abducted position

Answer 21

Restrictions: Concave glenoid, labrum, capsule, superior, middle and inferior GH ligament long head of biceps rotator cuff. Damage to labrum and middle and inferior GH ligaments Rotator Cuff tears Gr tuberosity fracture

Answer 22

Orthopaedic instruction. Obs: position of joint, posture AROM as comfortable

Answer 23

Mechanism, relocation -time, who, where, pre-existing sh instability? Next clinic appointment.

Answer 24

A&E and fracture clinic. Orthopaedic management and review. Following assessment and reduction: *Early mobilization as pain allows, course of physiotherapy usually 4-12 weeks. *Urgent Ortho opinion if pain and weakness 2-3 weeks post dislocation, suspect rotator cuff tear.

Answer 25

At 1-year - recurrent instability rate was 39% (Olds et al. 2015), 55.7% within first two years and 66.8% by the fifth year

Answer 26

<40 years olf - 13 x men - 3 x Gretaer tuberosity fracture- 7 x Hyperlaxity - 3 x

Answer 27

GH joint Synovial ball and socket with 3 degrees of freedom Mobility; the shoulder joint is capable of large complex movements in all anatomical planes. Stability; because of the lack of congruency stability is largely dependent on muscles, capsule and ligaments. Increased mobility + decreased stability = imbalance

Answer 28

Performing functional movements that reproduce symptoms. Often instability tests are not required. Normally full active range of motion, Proprioception Muscle power: isometric test rotator cuff in different positions. Ax whole kinetic chain e.g. squat, SLS, bridge

Answer 29

Onset (gradual vs sudden), “falls out” versus “pulled out”. Doesn’t feel right, not is place. Feels like it needs to click. PMH: Connective tissue Disorders (EDS, Marfans), hypermobility

Answer 30

Conservative rehabilitation program. Rotator cuff strengthening, proprioception, building speed and using the whole kinetic chain. Psychological aspect-to address any contributing factors, regain confidence and reduce fear. Improve general activity Prognosis: Aim to return to activity and function

Answer 31

A painful contracture of the GH joint capsule which leads to stiffness and disability. 3 phases 1) Painful 2-9 months 2) Stiffness 4-12 months 3) Resolution 12-42 months Recently classified as pain predominant and stiffness predominant

Answer 32

Reduced AROM and PROM Capsular pattern - limited Ex rot Reduced Accessory movements: convex humeral head glides in opposite direction to angular movement of bone.

Answer 33

Idiopathic (gradual onset) or secondary to trauma. Pain in deltoid region with worsening stiffness. Difficulty doing up bra strap, putting on deodorant, putting on coat, changing gear in car

Answer 34

Symptoms settle in 18-24 months. Analgesia–Paracetamol, NSAIDS, corticosteroid inj. Physiotherapy for 6/52 then RV and either refer to secondary care or cont for 6/52. To continue to use the arm when painful to maintain ROM, manual therapy, stretches, hydrotherapy, heat

Answer 35

Painful high arc on AROM Positive cross body arm test. Tender on palpation of AC joint

Answer 36

Difficulty with activities above the head, washing hair, putting out washing. Risk factors are those that do over-head work: painters, plasters, weight-lifters. >60 years for OA 20-50 years for injuries to AC joint.

Answer 37

Activity modification (avoiding cross over and heavy lifting), analgesia, referral to physio. Physio- management of symptoms

Answer 38

rotator cuff tendinopathy, rotator cuff tears and subacromial bursitis

Answer 39

Painful arc of Abduction (in scapula plane). Pain between 70-120 degrees -Pain worse if thumb down and against resistance. *Isometric muscle testing – belly press +/- lift off sign for subscapularis *Special tests- Hawkins and Kennedy and Neer.

Answer 40

Can describe: “catches me out”, pain on lifting e.g. kettle, or activities with arm above head. May describe a painful arc. **Onset: **May occur gradually or after a change in activity/loading – sport, occupation, recent life change (moved house) or training Sleep: May have night pain due to difficulty laying on shoulder

Answer 41

Origin: Entire under surface of the scapula (subscapular fossea). Insertion: Less tubercle of the humerus.

Answer 42

Origin – Posterior crest of the ilium (via the Thoracolumbar fascia). Posterior sacrum. Spinous processes of T7-L5. Insertion – Intertubercular groove (between the greater and lesser tuberosities) of the humerus.

Answer 43

Origin – Posterior surface of the scapula (below the spine of the scapula). Insertion – Greater tuberosity on the humerus

Answer 44

Origin: Midsection of the lateral border of the scapula. Insertion: Greater tuberosity on the humerus.

Answer 45

Origin: Lower 1/3 of the lateral border of the scapula. Insertion: Intertubercular goove (between the greater and lesser tubercles) of the humerus

Answer 46

Origin: Supraspinous fossa. Insertion: Greater tuberosity of the humerus.

Answer 47

Origin –Outer 1/3 of the clavicle Acromion process Spine of the scapula Insertion –Deltoid tuberosity on the humerus

Answer 48

Malignancy S) h/o cancer, weight loss, night pain, night sweats and fever O) Mass or swelling Acute rotator cuff tear S) Trauma, pain and weakness O) sudden inability to raise arm (with or without trauma) Septic arthritis. S) fever or systemically unwell O) Red skin, hot, painful joint 4. Unreduced dislocation S) Loss Movement O) Trauma leading to loss of rotation and abnormal shape 5. Inflammatory arthritis S) Swelling, Early Morning Stiffness (EMS), FH RA, O) Swollen joint +/- heat 6. Neurological lesion S) Gait disturbance and O) Unexplained muscle wasting and weakness, sensory loss UMN- Babinski and clonus LMN- reflexes, dermatomes and myotomes.