SHOULDER Flashcards

Question

SHOULDER - CONDITIONS - BICIPITAL TENDONITIS

Answer 1

Hx - pain over anterior shoulder, history of repetitive elbow flexion (weight lifter) S&S - pain with direct palpation of biceps long head tendon; pain with resisted horizontal adduction DDx - cervical pathology, rotator cuff strain

Answer 2

Hx - pain over superior or lateral GH joint, pain at night, difficulty sleeping S&S - tender palpation over acromion/deltoid; decreased shoulder ROM in abduction & flexion; pain may be relieved by GH inferior distraction DDx - cervical pathology, ortator cuff strain, impingement syndrome

Answer 3

Hx - insidious onset of pain, morning stiffness, worse with excessive activity S&S - crepitus and pain with ROM; +ve Ellman compression test DDx - AC OA, GH instability, impingement syndrome

Answer 4

Hx - pain with overhead movements, may refer pain down lateral arm S&S - pain with ROM; +ve painful arc , Hawkins-Kennedy, Neer’s DDx - cervical pathology, GH instability, poor posture

Answer 5

Hx - prior trauma; patient may have increased motion; patient may have impingement type symptoms due to excess GH movement S&S - observation of sulcus sign; +ve load and shift test DDx - rotator cuff strain, impingement syndrome, congenital ligament laxity

Answer 6

Hx - prior trauma - lifting or throwing injury; degeneration of rotator cuff? (elderly) S&S - weakness in specific rotator cuff movements; abnormal scapulohumeral rhythm; +ve drop arm test, painful arc, impingement DDx - supraspinatus rupture, impingement syndrome, congenital ligament laxity

Answer 7

Hx - pain with overhead movements or hand placed behind back S&S - exquisite pain with resisted supraspinatus movements; pain with direct palpation; +ve empty can test, impingement DDx - cervical pathology, GH instability, complete supraspinatus rupture

Answer 8

Hx - pain and paresthesia, possible muscle weakness into shoulder, arm and/or hand S&S - my-spasm of cervical musculature (depending on cause); +ve TOS tests DDx - cervical radiculopathy, cervical disc herniation, carpal tunnel syndrome

Answer 9

- Pt seated or supine - Shoulder abducted 90, elbow flexed 90 - Examiner gently applies P-A pressure over the humerus - Observe pt for signs of apprehension or discomfort

Answer 10

**Anterior GH instability** - Excessive anterior translation - Dislocation - Pt apprehension

Answer 11

**SN**: 53 **SP**: 99

Answer 12

- Pt seated or supine - Shoulder abducted 150 - Examiner rotates humerus externally and applies anterior pressure on the humeral head

Answer 13

**Glenoid labral lesion, Anterior instability** - Shoulder pain - Crepitus

Answer 14

**SN**: 44 **SP**: 68

Answer 15

- Pt seated or supine - Shoulder abducted 180 and elbow flexed 90 - Examiner applies long axis compression and rotates humerus internally and externally

Answer 16

**Glenoid labral lesion** - Shoulder pain - Crepitus

Answer 17

**SN**: 46-91 **SP:** 93

Answer 18

- Pt seated - Examiner passively abducts shoulders to 90 with solid support - Examiner suddenly lets go and asks pt to catch themselves

Answer 19

**Painful arc syndrome, Bursitis, Rotator cuff strain or tear, tendinitis/impingement** - Pain/weakness - Racheting movement **Severe injury (grade 3 cuff strain)** - Unable to catch herself

Answer 20

**SN:** 8-27 **SP:** 88-100

Answer 21

- Pt standing or seated - Pt actively raises straight arm (palm up) to 120 in scapular plane - At apex pt internally rotates arm (thumb down) - Pt then lowers straight arm internally rotated slowly to the body

Answer 22

**Injury or lesion of supraspinatus muscle** - Pain or weakness

Answer 23

**SN**: 44-89 **SP**: 50-90

Answer 24

- Pt seated - Pt actively raises straight arm (palm up) to 120 in scapula plane - At apex examiner applies downward pressure and notes pt strength

Answer 25

**Injury or lesion of supraspinatus muscle** - Pain or weakness

Answer 26

**SN**: 86 **SP**: 57

Answer 27

- Pt seated - Shoulder abducted 90, elbow flexed 90 - Examiner internally rotates and horizontally adducts shoulder to pinch greater tuberosity of humerus against acromion

Answer 28

**Supraspinatus impingement** - Pain in anterolateral shoulder

Answer 29

**SN**: 50-100 **SP**: 44-76

Answer 30

**Posterior glenoid labrum pathology** - Pain in posterior shoulder

Answer 31

- Pt seated with back supported - Examiner stabilises pt elbow and middle humerus - Examiner flexes pt shoulder in the scapular plane - As shoulder flexion occurs examiner applies long axis compression to induce posterior-inferior glide of the humerus

Answer 32

**SN**: 80 **SP**: 94

Answer 33

- Pt supine - Shoulder abducted 120 and elbow flexed 90 - Examiner externally rotates pt shoulder and applies a posterior force over the anterior humeral head - Examiner observes pt for pain or apprehension

Answer 34

**Posterior glenohumeral instability** - Apprehension - Increased motion **Anterior instability** - No apprehension - Decreased pain

Answer 35

**SN**: 92 **SP**: 100

Answer 36

- Pt seated with arms in dependant position - Examiner first raises pt’s straight arm through full range of flexion (passively) with arm externally rotated (palm up) - Repeat with arm internally rotated (palm down)

Answer 37

**Supraspinatus impingement, subacromial bursitis** - Pain with internally rotated shoulder **Biceps long-head impingement** - Pain with externally rotated shoulder

Answer 38

**SN**: 0-89 **SP**: 48-100

Answer 39

- Pt seated - Shoulder flexed to 90 and arm adducted 10-20 - Internally rotate pt arm (thumb down) - Examiner pushes down on the arm while pt attempts to maintain position - Externally rotate pt arm (palm up)

Answer 40

- Pt seated - Shoulder flexed to 90 and arm adducted 10-20 - Internally rotate pt arm (thumb down) - Examiner pushes down on the arm while pt attempts to maintain position - Externally rotate pt arm (palm up)

Answer 41

**SN**: 16-88 **SP**: 13-90

Answer 42

- Pt standing or seated - Examiner asks pt to abduct shoulders - Observe for signs of discomfort or pain

Answer 43

**Rotator cuff, AC pathology, Impingement syndrome** - Shoulder pain

Answer 44

**SN**: 33-98 **SP**: 10-81

Answer 45

- Pt supine - After attempting the anterior apprehension test the examiner applys anterior to posterior pressure over the GH joint

Answer 46

**GH instability, anterior glenoid labrum tear** - Decreased in pain or apprehension

Answer 47

- Pt seated - Forearm extended and supinated with arm at pt side - Pt actively flexes arm to 120 - Examiner applies resistance to this motion while palpating the bicipital groove

Answer 48

**Bicipital tendinitis, impingement syndrome, labral lesion or bursitis** - Pain

Answer 49

**SN**: 4-100 **SP**: 11-100

Answer 50

- Pt seated - Elbow flexed 90, forearm pronated - Examiner grips forearm and palpates biceps long head tendon - Pt actively flexes and supinates forearm and externally rotates arm - Examiner resists patient motion

Answer 51

**Tendonitis or strain** - Pain over bicipital groove **Glenoid labrum pathology** - Pain in shoulder **Torn transverse humeral ligament (bicipital instability)** - Tendon slipping out of groove

Answer 52

**SN**: 9-50 **SP**: 79-93

Answer 53

- Pt seated - Pt abducts shoulder to 90, externally rotates arm and supinates forearm - Examiner applies resistance to motion and palpates bicipital groove

Answer 54

**Torn transverse humeral ligament** - Pain or tendon slipping out of the groove

Answer 55

- Subacromial impingement is also known as rotator cuff tendinitis or bursitis - Occurs when the rotator cuff becomes irritated underneath the acromion

Answer 56

- Sports - Occupational risks - Overhead motions

Answer 57

- Over 40 - Can be younger but there is often an underlying problem in this case

Answer 58

- Most symptoms of impingement begin gradually and have a chronic component that progresses over several months - Pt likely presents with - Recent history of overactivity or Onset of moderate to occasionally severe pain with AROM of the shoulder - Pt often complains of pain on the top and front of the shoulder - Symptoms also include - Localised tenderness - Inflammation - Edema - Loss of function - Weakness and stiffness of the shoulder may also occur, but this is usually secondary to pain and not muscle weakness

Answer 59

- Most pt with impingement syndrome or small rotator cuff tearing will recover within 6 months - Supervised physical therapy and NSAIDs are valuable - In time symptoms will gradually subside

Answer 60

- Calcium hydroxyapatite crystals are deposited in the supraspinatus tendon

Answer 61

- Aging - Damage to the tendons - A lack of oxygen to the tendons - Genetics - Abnormal thyroid gland activity - Cells growing abnormally - Chemicals produced by the body to fight inflammation - Metabolic diseases - Diabetes

Answer 62

**Acute** - 30 – 50-year-olds

Answer 63

- Aching, sometimes following overuse develops and increases in severity within hours - After a few days pain subsides, and the shoulder gradually returns to normal - In some pt the process is less dramatic and recovery slower - During the acute stage the arm is held immobile as the joint is usually too tender to permit palpation or movement - Pain may be intense during the acute phase and can be confused with acute infection

Answer 64

- Asymptomatic calcification of the rotator cuff is common - Often is only found as an incidental finding in shoulder x-rays - Can be seen in association with impingement syndrome

Answer 65

**Acute** - If symptoms are not severe and the arm is rested in a sling, pt can cope with a short course of NSAIDs - If pain is more intense a corticosteroid injection is done into the subacromial space **Chronic** - Treatment should be directed at the impingement lesion, rather than the calcification - Physical therapy will help avoid a loss of mobility

Answer 66

- Osteoarthritis of the AC joint is a common source of shoulder pain that is often neglected by doctors - Suggested about 60% of elderly people will have x-ray evidence of degenerative changes of the AC joint - Primary OA - Develops as a consequence of constant stress on the joints - Secondary OA - Due to other associated causes like post-trauma or other underlying diseases such as rheumatoid arthritis

Answer 67

- Secondary OA of the AC - Occupational heavy lifting - Manual work - Repetitive micro trauma - Inflammatory arthropathies - Septic arthritis - Instability - Traumatic injury

Answer 68

- Pt presents with shoulder pain that is not well localised to the AC joint - Often a dull ache involving the deltoid area that is exacerbated by motion - Shoulder pain on the top of the shoulder is a common symptom - Most planes of motion will cause pain, but horizontal adduction will be most symptom provoking - Pt will often complain of inability to sleep on the affected side - Pt should give nearly full but painful passive ROM - Common for a painful arc in a range greater than that associated with rotator cuff impingement

Answer 69

- The arthritis will gradually become more severe - Treatment options are limited - Initial treatment is similar to that of osteoarthritis in other joints - NSAIDs - Emphasis on activity modification

Answer 70

- Seen in both young and older people - In younger pt there is usually a traumatic injury or a demand for unusual use of the shoulder - As people age the muscle and tendon tissue of the rotator cuff loses some elasticity so becomes more susceptible to injuries

Answer 71

- Age - More common in people over 45 - Some occupations - Jobs that require repetitive overhead arm motions - Certain sports - Baseball - Tennis - Weightlifting - Family history

Answer 72

- Most common in pt over 45 - Can happen to anyone

Answer 73

- Most common symptom is pain - Pain is often felt over the outside of the shoulder and upper arm in the deltoid region - Pt will describe it as generalised discomfort that is made worse with specific movements of the shoulder - May also be a loss of motion - Depending on the severity of the tear - Pt may also complain of - Crepitus - Catching - Stiffness - If it is an incomplete tear pain will likely be the most prominent symptom - Decreased strength may also be noted but is not usually pts primary complaint - A complete tear may result in an inability to move the shoulder, but some pt demonstrate minimal functional limitations with a tear

Answer 74

- Nonoperative treatment is recommended for pt with rotator cuff disease who present with pain without dramatic or progressive weakness - Rotator cuff tears do not heal well with time - But rotator cuff tears do not necessarily need to heal in order for the symptoms to resolve - Many people have rotator cuff tears but no symptoms of shoulder pain - Initial treatment is conservative - Physical therapy - NSAIDs - Cortisone injections - In some cases early surgery should be recommended - Especially a traumatic tear in a younger pt

Answer 75

- Instability of the GH joint is a common cause of disability and pain in the adolescent and young adult population

Answer 76

- Unidirectional instability - Men affected more than women - Trauma - Multidirectional instability - Women affected more than men - Sports that repetitively cycle the GH joint - Swimming - Volleyball

Answer 77

- Adolescents and young adults

Answer 78

- Pt presents with a variety of symptoms - Pain - Varying degrees of instability - The sensation of joint subluxation - Transient neurologic symptoms - Unidirectional anterior instability - Can often remember a specific event that may have brought on the symptoms - Unidirectional instability is usually as a result of significant trauma to the shoulder - Multidirectional instability - Classic complaint is pain

Answer 79

- Nonoperative treatment - Multidirectional instability - Pt who have primarily multidirectional instability physical therapy is the main treatment - Physical therapy should be continued for at least 6 months - Pt who have significant discomfort and have difficulty progressing during therapy can be given a short course of analgesic or NSAIDs - This can resolve with age as the shoulder stiffens - Unidirectional instability - Most pt with this have experienced a traumatic anterior dislocation and may require an initial period of sling immobilisation to relieve symptoms - Immobilisation should be brief though - Surgical treatment - If conservative treatments fail to relieve the instability and pt continues to have difficulty with activities of daily living, recreation or occupational duties, surgical treatment is an option

Answer 80

- GH arthritis occurs in up to 20% of adults - Most common type is osteoarthritis but there are also other causes - Rheumatoid arthritis - Inflammatory arthritis - Osteonecrosis - Rotator cuff arthropathy - Posttraumatic or postsurgical arthritis

Answer 81

- Advanced age - Genetics - Increased weight - Joint infection - History of shoulder dislocation - Previous injury - Certain occupations - Heavy construction - Overhead sports

Answer 82

- Pain in the affected shoulder is most common complaint - Shoulder stiffness is also a frequent problem - Pt may note a sensation of crepitus with shoulder movement - Symptoms usually begin gradually and are chronic and progressive - Discomfort is typically worsened with activity - Pt may awake in the night from pain - Functional limitations may be present - Inability to perform overhead activities - Reach behind back - Pt history is vital as it can provide important clues as to which type of arthritis it is - GH joint line tenderness is typical - Active and passive ROM is typically restricted, usually in multiple planes

Answer 83

- The arthritis will gradually become more severe, symptoms are usually intermittent and it may take decades for symptoms to become significant - Treatment varies depending on specific etiology - Initial management is typically nonoperative and includes - Modification of activity - Use of NSAIDs - Use of intra-articular corticosteroid injections - Physical therapy

Answer 84

- Lifetime prevalence of frozen shoulder is estimated to be 2 to 5 percent of the general population - Frozen shoulder is found to affect 8.2% of men and 10.1% of women of working age

Answer 85

- Age - 40+ - Sex - Females affected more than males - Immobility or reduced mobility - Systemic diseases - Diabetes - Overactive thyroid (hyperthyroidism) - Underactive thyroid (hypothyroidism) - Cardiovascular disease - Parkinson’s disease

Answer 86

- 40 – 60 years

Answer 87

- Characterised by pain and stiffness which usually resolves itself after about 18 months - Pain gradually increases in severity and often prevents sleeping on the affected side - After several months pain begins to subside - As pain gets better, stiffness becomes more and more of a problem - If untreated, stiffness persists for another 6 – 12 months - Gradually movement is regained but may not return to normal - May be slight muscle wasting - There may be some tenderness, but movements are always limited

Answer 88

- Conservative treatment with analgesics, anti-inflammatory drugs, local heat and exercise aims at relieving pain and preventing further stiffening while awaiting recovery - Physical therapy and steroid injections are not proven to work - Operative treatment is occasionally called for

Answer 89

- The commonest cause of pain around the shoulder is a disorder of the rotator cuff – rotator cuff syndrome - Rotator cuff syndrome comprises of several conditions - Subacute tendinitis (painful arc syndrome) - Chronic tendinitis (impingement syndrome) - Rotator cuff tears

Answer 90

- Degeneration - Trauma and impingement - Vascular reaction - This process can be summed up as ‘wear, tear and repair’

Answer 91

**Chronic tendinitis** - 40 – 50 years **Rotator cuff tear** - Usually over 45

Answer 92

**Painful arc syndrome** - Pt develops anterior shoulder pain after vigorous or unaccustomed activity - Shoulder looks normal but is acutely tender along the anterior edge of the acromion

Answer 93

**Chronic tendinitis** - Pt gives a history of recurrent attacks of subacute tendinitis, the pain settling down with rest or anti-inflammatory treatment, only to recur when more demanding activities are resumed - Pain is worse at night - Pt cannot lie of affected side often finds it more comfortable to sit up out of bed - A marked feature is coarse crepitation or palpable snapping over the rotator cuff when the shoulder is passively rotated

Answer 94

**Rotator cuff tear** - Most advanced stage of the disorder is progressive fibrosis and disruption of the cuff resulting in either a partial or full thickness tear - Pt has history of pain with increasing stiffness and weakness - Partial tears - Not easily detected - Continuity of the remaining cuff fibres permits active abduction with a painful arc - If in doubt pain can be eliminated by injecting local anaesthetic into the subacromial space - If abduction is now possible the tear must only be partial - Full thickness tears - There is sudden pain and pt is unable to abduct the arm - Few weeks full tear - Pain has subsided, Abduction is impossible, Attempting abduction produces a characteristic shrug

Answer 95

**Conservative treatment** - Uncomplicated impingement syndrome is often self-limiting, and symptoms settle down after aggravating activity is eliminated - Physiotherapy should be done to help the pt through the painful healing phase - Short course of NSAIDs sometimes brings relief - If none of this works, an injection of corticosteroids into the subacromial space can help - Modification of activity should be done for 6 months

Answer 96

**Surgical treatment** - If pt has useful ROM, adequate strength and well controlled pain, no operative measures are needed - If symptoms do not subside after 3 months of conservative treatment, operation can be considered - Indication is more pressing if there is evidence of a full tear in a young person - The procedure allows for early rehab

Answer 97

**Repair of tears** - Indications for operative repair are - Chronic pain - Weakness of the shoulder - Significant loss of function - The younger and more active a pt is, the greater justification for surgery - Procedure is either open or an arthroscopy - Advantages of arthroscopy - Less soft tissue damage - Faster rehab - Better cosmetic appearance

Answer 98

**Tendinitis** - Tendon of long head of biceps lies adjacent to the rotator cuff and may be involved in the impingement syndrome

Answer 99

**Torn long head of biceps** - Degeneration and disruption of the tendon of the long head of biceps is common and is often associated with rotator cuff problems

Answer 100

- Males over 30 - Smoking - Corticosteroid injections

Answer 101

**Tendinitis** - Older adults

Answer 102

**Torn long head of biceps** - Middle aged or elderly

Answer 103

**Tendinitis** - Pain and tenderness are sharply localised to the bicipital groove - Stressing the biceps tendon will provoke pain - Can do this by resisting elbow flexion and supination

Answer 104

**Torn long head of biceps** - While lifting a heavy object pt feels something snap - The shoulder then aches for a time and bruising appears over the front of the arm - Soon the ache subsides and good function returns but when the elbow is flexed actively the belly of the muscle contracts into a prominent lump

Answer 105

**Tendinitis** - Rest - Local heat - Deep transverse frictions - If recovery is delayed a corticosteroid injection can help

Answer 106

**Torn long head of biceps** - Function is rarely disturbed so treatment is unnecessary - Treatment can be given if associated rotator cuff symptoms need attention

Answer 107

- A fall on an outstretched arm can sometimes damage the superior part of the glenoid labrum anteriorly and posteriorly (SLAP)

Answer 108

- Overhead sports - Contact sports

Answer 109

- 30 – 50

Answer 110

- History of a fall followed by pain in the shoulder - As initial symptoms settle, the pt continues to experience a painful ‘click’ on lifting the arm above shoulder height - This is also experienced with a loss of power when using the arm in this position - Pt may also complain of an inability to throw with that arm

Answer 111

- Good - Lesion is treated by re-attachment or debridement

Answer 112

- **Anterior dislocation** - Most common - over 95% of cases - Usually follows an acute injury where the arm is forced into abduction, external rotation and extension

Answer 113

- **Recurrent dislocation** - The labrum and capsule are often detached from the anterior rim of the glenoid - Pt may describe a ‘catching’ sensation followed by numbness or weakness - 1/3 of pts are under 30, 1/5 of pts are over 50

Answer 114

- **Anterior subluxation** - May follow and alternate with episodes of dislocation - Joint feels as if it pops out briefly during certain actions (only becomes partially displaced) - Pt may describe ‘catching’ sensation, followed by ‘numbness’ or ‘weakness’ – dead arm syndrome

Answer 115

- **Posterior dislocation** - Rare - Usually due to a violent jerk in an unusual position, e.g. after an epileptic fit

Answer 116

- **Atraumatic instability** - Associated with capsular and ligamentous laxity - This is not the same as true instability

Answer 117

- Male - Age - Young adults or 50+

Answer 118

- Young adults - People over 50

Answer 119

**Anterior instability** - Usually occurs as sequel to acute anterior dislocation, with detachment or stretching of the glenoid labrum and capsule - In those over 50, dislocation is often associated with a rotator cuff tear - Pt describes an initial episode of the shoulder coming out of the joint following an injury - After the initial injury pt complains of the shoulder repeatedly ‘coming out of joint’ during over-arm movements, each time having to manipulate it back into place

Answer 120

**Posterior instability** - Sometimes persists after an acute posterior dislocation - Usually takes the form of recurrent subluxation rather than full dislocation - The shoulder subluxate when the arm is held in flexion and internal rotation

Answer 121

**Atraumatic instability** - Pt complains of the shoulder going ‘out of joint’ with remarkable ease - Can occur in athletes who overload and fatigue the stabilising muscles around the shoulder leading to pain and subluxation in various directions - Another form is associated with individuals who are able to voluntarily subluxate or dislocate their shoulders

Answer 122

**Anterior instability** - Indications for operative treatment are - Frequent dislocations, especially if painful - Fear or recurrent subluxation - Dislocation sufficient to prevent participation in everyday activities

Answer 123

**Posterior instability** - Treatment is usually conservative - Muscle strengthening exercises and voluntary control of the joint - Operative reconstruction is only needed if disability is marked - No gross joint laxity - There is a structural abnormality found on a CT or MRI scan

Answer 124

**Atraumatic instability** - Usually treated by physiotherapy to strengthen the muscles and to restore proprioception - Occasionally surgery is needed to tighten the capsule (for athletes) - Treatment for individuals who can voluntarily subluxate involves physiotherapy and sometimes psychological counselling

Answer 125

**Tuberculosis arthritis** - TB arthritis in the shoulder is uncommon **Rheumatoid arthritis** - The AC joint, the GH joint and various synovial pouches around the shoulder are frequently involved in rheumatoid disease **Osteoarthritis** - GH OA is usually secondary to other fairly obvious disorders

Answer 126

- Advancing age - Genetics - Obesity

Answer 127

**TB arthritis** - Adults **Osteoarthritis** - 50 – 60

Answer 128

**Tuberculosis arthritis** - Usually starts as osteitis - May proceed to abscess and sinus formation - Pt presents with constant ache and stiffness lasting many months - Striking feature is muscle wasting around the shoulder - There is diffuse warmth and tenderness - All movements are limited and painful

Answer 129

**Rheumatoid arthritis** - Pt usually has generalised arthritis - Pt complains of pain in the shoulder and difficulty with tasks that involve lots of movement - Active movements are limited - Passive movements are painful and marked with crepitus

Answer 130

**Osteoarthritis** - Pt complains of pain in shoulder - May have a history of previous shoulder problems - Most typical sign is progressive restriction of shoulder movements

Answer 131

**Tuberculosis arthritis** - Systemic treatment with antituberculosis drugs - Shoulder should also be rested until acute symptoms have settles - After acute symptoms have subsided, movement is encouraged and as long as the articular cartilage is not destroyed prognosis for painless function is good - Joint should be arthrodesed if there are repeated flares or if the articular surfaces are extensively destroyed

Answer 132

**Rheumatoid arthritis** - Corticosteroid may be injected into the joint and the subacromial bursa if general measures do not control synovitis - If synovitis persists, surgical options are available

Answer 133

**Osteoarthritis** - Analgesics and anti-inflammatory drugs relieve pain - Exercises may improve mobility - Most pt manage to live with the restrictions (imposed by the stiffness) as long as pain is not severe

Answer 134

- A form of arthritis - Crystal induced, rapidly progressive arthropathy - Sometimes associated with massive tears of the rotator cuff

Answer 135

- Women affected more - Previous shoulder trauma - Especially rotator cuff injuries

Answer 136

- Mainly older women - Over 70

Answer 137

- Pt presents with swelling of the shoulder - X-rays show a bizarrely destructive form of arthritis - Suggested this is a crystal-induced, rapidly progressive arthropathy - Sometimes associated with massive tears of the rotator cuff

Answer 138

- Not great - There is no treatment - Arthroplasty may relieve pain but will not improve function because the joint is unstable

Answer 139

- Many people are affected by disorders of the scapula and clavicle - Disorders can be congenital or due to old age or other risk factors.

Answer 140

**Winged scapula** - Damage to the long thoracic nerve - Injury to the brachial plexus or the 5, 6, and 7 cervical nerve roots - Viral infections of the nerve roots - Certain types of muscular dystrophy

Answer 141

**Osteoarthritis of the AC joint** - Older age

Answer 142

- Degenerative conditions (e.g. OA of the AC) are experienced more by older people - Klippel-Feil syndrome and Sprengel’s shoulder are congenital disorders

Answer 143

**Congenital elevation of the scapula (Sprengel’s shoulder)** - Shoulder on the affected side is elevated - Scapula looks and feels abnormally high, smaller than usual and somewhat prominent - Movements are painless but abduction may be restricted - Associated deformities such as fusion of cervical vertebrae, kyphosis or scoliosis may be present

Answer 144

**Klippel-Feil syndrome** - Rare congenital disorder - Bilateral failure of scapular descent - Fusion of several cervical vertebrae - Neck is unusually short and may be webbed - Cervical mobility is restricted

Answer 145

**Winged scapula** - Scapula juts out under the skin - Due to a weakness in the serratus anterior - May cause asymmetry of the shoulders but is often not apparent till pt tries to contract serratus anterior against resistance

Answer 146

**Grating scapula** - Found in about 1/3 of normal people - Cause not usually found - Occasionally x-ray will show osteochondroma - Involves popping, grating, grinding or snapping of bones and tissue in the shoulder blade area when lifting and moving the arm

Answer 147

**Acromioclavicular instability** - Common condition - Results from dislocation of the AC joint and rupture of ligaments which surround the outer end of the clavicle - Pt may complain of pain and weakness during strenuous activities with the arm above shoulder height - On exam there is a fairly obvious bump over the AC joint and pressure over the joint may be painful

Answer 148

**Osteoarthritis of the acromioclavicular joint** - Develops spontaneously - Common in older people - When it occurs in younger people it may be due to previous injuries or repetitive stress - Pt complains of pain over top of the shoulder - Particularly whilst using the arm above shoulder height - Tenderness and swelling localised to the AC joint

Answer 149

- Mild cases are best left untreated - Marked limitation of abduction or severe deformity may need an operation to lower the scapula

Answer 150

- Usually left untreated

Answer 151

- Some disorders causing winged scapula are self-limiting and the condition gradually improves - Even without improvement, disability is usually slight and is best accepted

Answer 152

- No treatment needed

Answer 153

- Treatment is often unnecessary as the condition causes little disability during non-strenuous activities - But certain types of work activity may be seriously affected - In such cases surgery should be considered

Answer 154

- Analgesics - Corticosteroid injections - If these don’t work, pain may be relieved by excision of the lateral end of the clavicle

Answer 155

Deltoid (anterior fibres) Biceps brachii Pectoralis major Coracobrachialis (1st 60 only)

Answer 156

Latissimus dorsi Teres major Pectoralis major (low fibres) Triceps brachii (long head) Inferior GH capsule Conoid ligament

Answer 157

Supraspinatus tendon Subdeltoid bursa Upper GH joint capsule

Answer 158

Deltoid (posteiror fibres) Latissimus dorsi Teres major/minor Infraspinatus Triceps brachii

Answer 159

Deltoid (anterior fibres) Biceps brachii Pectoralis major Anterior GH capsule

Answer 160

Posterior GH capsule

Answer 161

Supraspinatus Deltoid (middle fibres) Trapezius Serratus anterior

Answer 162

Latissimus dorsi Teres major Pectoralis major (lower fibres) Triceps brachii (long head) Inferior GH capsule Conoid ligament

Answer 163

Supraspinatus tendon Subdeltoid bursa Upper GH joint capsule

Answer 164

Deltoid (anterior fibres) Pectoralis major Latissimus dorsi Teres major Coracobrachialis Trapezius

Answer 165

Deltoid (middle fibres) Posterior GH capsule

Answer 166

Pectoralis major AC & SC joint Anterior GH capsule

Answer 167

Infraspinatus Teres minor Posterior deltoid

Answer 168

Pectoralis major Subscapularis Anterior GH capsule

Answer 169

Posterior GH capsule

Answer 170

Pectoralis major Subscapularis Anterior deltoid Teres major Latissimus dorsi

Answer 171

Infraspinatus Teres minor Posterior deltoid Posterior GH capsule

Answer 172

Anterior GH capsule

Answer 173

Lateral 1/3 of clavicle Acromion Spine of scapula

Answer 174

Deltoid tuberosity of humerus

Answer 175

**Anterior** - flexion, horizontal adduction and internal rotation of the shoulder **Middle** - Abduction of the shoulder **Posterior** - extension, horizontal abduction and lateral rotation of the shoulder

Answer 176

Axillary nerve (C5-C6)

Answer 177

Referal local to the area

Answer 178

**Anterior** - extend shoulder to stretch anterior **Middle** - Pull and adduct shoulder inferiorly behind back to stretch middle **Posterior** - Pull shoulder anteriorly across the body to stretch posterior

Answer 179

Resisted shoulder abduction, flexion or extension Front raises Lateral raises

Answer 180

Supraspinatus Infraspinatus Teres minor Subscapularis Coracobrachialis

Answer 181

Supraspinous fossa of scapula

Answer 182

Greater tubercle of humerus (superior facet)

Answer 183

Abduction of shoulder Stabilises GH joint

Answer 184

Suprascapular nerve (C5-C6)

Answer 185

Felt as a deep ache in the mid-deltoid region of the shoulder Pain often extends down the lateral arm and upper forearm Pain may concentrate at the lateral epicondyle

Answer 186

Adduct shoulder and pull arm inferiorly behind back Adduct shoulder and pull arm inferiorly in front of body

Answer 187

Resisted shoulder abduction Lateral raises

Answer 188

Infraspinous fossa Inferior portion of spine of scapula

Answer 189

Greater tubercle of humerus

Answer 190

Lateral rotation of shoulder Stabilises GH joint

Answer 191

Suprascapular nerve (C5-C6)

Answer 192

Occur mainly in the muscle belly Primary referral is to the anterior deltoid region and in the shoulder joint Pain may extend down front and lateral aspect of arm and forearm and sometimes include the radial half of hand

Answer 193

While seated, place both hands on waist with thumbs forward, bend forward and let elbows fall toward floor

Answer 194

Lying lateral rotation

Answer 195

Superior lateral border of scapula

Answer 196

Greater tubercle of humerus

Answer 197

Lateral rotatioon of shoulder Stabilises GH joint

Answer 198

Axillary nerve (C5-C6)

Answer 199

Primary referral is over a very small area of the back and shoulder, near the lateral border of the scapula; the back of the arm, deep in the posterior deltoid

Answer 200

While seated, place both hands on waist with thumbs forward, bend forward and let elbows fall to the floor

Answer 201

Resisted lateral rotation Lying lateral rotation

Answer 202

Subscapular fossa of scapula

Answer 203

Lesser tubercle of humerus

Answer 204

Medial rotation of the shoulder Stabilises GH joint

Answer 205

Upper and lower subscapular nerves (C5-C6)

Answer 206

Pain referral is over the posterior axillary fold and medial arm Sometimes pain refers down to the wrist and over the mid deltoid

Answer 207

Abduct and externally rotate shoulders above head against shair or bench, pull body inferiorly

Answer 208

Resisted shoulder medial rotation Lying medial rotation Standing medial rotation

Answer 209

Coracoid process of scapula

Answer 210

Medial shaft of humerus

Answer 211

Flexion and adduction of shoulder Horizontal adduction of shoulder

Answer 212

Musculocutaneous nerve (C5-C7)

Answer 213

Usually referred over anterior deltoid and down posterior arm to the dorsum of hand May extend to the tip of the middle finger Referral may skip elbow and wrist

Answer 214

Standing against wall or door with shoulder extended, slightly abducted and externally rotated

Answer 215

Front raises Fly Bench press

Answer 216

Inferior, lateral border of scapula

Answer 217

Medial lip of bicipital groove of humerus

Answer 218

Medial rotation and adduction of shoulder Extension of shoulder from a flexed position

Answer 219

Lower subscapular nerve (C5-C7)

Answer 220

Feeling of sharp pain in posterior shoulder and arm Pain often described in deltoid muscle

Answer 221

Abduct and externally rotate shoulders above head against wall or door, pull body inferiorly

Answer 222

Medial rotation of the shoulder Pull over Chin up Swimming breast stroke

Answer 223

Costal surface of medial border of scapula

Answer 224

Protraction (abduction) and upward rotation od scapula Stabilises scapula for upper extremity movements

Answer 225

Long thoracic nerve (C5-C7)

Answer 226

Referral is usually over the lateral inferior portion of the scapula Pt may also experience pain while exhaling

Answer 227

Shoulders extend with scapulas fully retracted and stick chest out

Answer 228

Boxing/punching Push ups Incline shoulder raises Resisted shoulder protraction

Answer 229

**Clavicular** - medial 1/2 of clavicle **Sternal** - anterior sternum **Costal** - costal cartilage ribs 1-6

Answer 230

Lateral lip of bicipital groove of humerus (crest of the greater tubercle)

Answer 231

Adduction and medial rotation of shoulder Horizontal adduction of shoulder Flexion of shoulder (clavicular portion)

Answer 232

Medial and lateral pectoral nerve (C8-T1)

Answer 233

Pain may extend up over subclavicular area and may cover the entire ipsilateral pectoral and anterior deltoid region Pain may radiate down the ulnar side, elbow, forearm and hypothenar side of hand (last 3 digits)

Answer 234

**Lower** - elbow flexed, shoulder abduct 150 and extend against door or wall **Middle** - elbow flexed, shoulder abducted 100 and extend against the door or wall **Upper** - elbow flexed, shoulder adducted 60 and extended against the door or wall

Answer 235

Push ups Flys Pull over Chest dips Bench press - incline for upper, decline for lower

Answer 236

Ribs 3-5 (anterior lateral portion)

Answer 237

Coracoid process of scapula

Answer 238

Stabilises scapula for arm movements Depresses and downwardly rotates scapula Elevates rib 3-5

Answer 239

Medial pectoral nerve (C8-T2)

Answer 240

Pain is most prominent over the anterior deltoid but may extend up over subclavicular area and may cover the entire ipsilateral pectoral and anterior deltoid region

Answer 241

Shoulders extended with scapulas fully retracted, stick out chest

Answer 242

Pectoralis minor is recruited during most shoulder movements and pec major exercises

Answer 243

TPs of C1-C2 vertebrae Posterior tubercles of TPs of C3-C4

Answer 244

Superior angle of scapula Medial border of scapula superior to spine of scapula

Answer 245

Elevates and downwardly rotates shoulder girdle at AC and SC joints Extends and laterally flexes neck at cervical vertebral joints

Answer 246

Dorsal sub scapular nerve (C5) Anterior rami of C3 - C4

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SHOULDER Flashcards

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