Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

ANATOMY > SHOULDER > Flashcards

SHOULDER Flashcards

1
Q

SHOULDER - ROM

A
  • Flexion - 180
  • Extension - 60
  • Internal rotation - 90
  • External rotation - 80
  • Abduction - 180
  • Adduction - 35
  • Scapulohumeral (humerus : scapula) - 120 : 60
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

SHOULDER - MYOTOMES

A
  • Shoulder elevation - C4, XI
  • Deltoid - C5, C6 - axillary
  • Brachioradialis - C5, C6 - radial
  • Biceps - C5, C6 - musculocutaneous
  • Triceps - C6, C7, C8, T1 - radial
  • Wrist extensors - C6, C7, C8 - radial
  • Wrist flexors - C6, C7 - median/ulnar
  • Finger flexors - C7, C8, T1 - ulnar/median
  • Interossei - C7, C8, T1 - ulnar
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

SHOULDER ORTHO TESTS - SCREENING

A

SCREENING - Drop arm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

SHOULDER ORTHO TESTS - IMPINGEMENT

A

IMPINGEMENT - Hawkins-Kennedy, Painful arc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

SHOULDER ORTHO TESTS - BICEPS TENDINITIS

A

BICEPS TENDINITIS - Speeds, Yergasons

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

SHOULDER ORTHO TESTS - ROTATOR CUFF

A

ROTATOR CUFF - Empty can

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

SHOULDER ORTHO TESTS - LABRAL TEAR

A

LABRAL TEAR - Clunk, Crank, Obrien’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

SHOULDER ORTHO TESTS - GH JOINT INSTABILITY

A

GLENOHUMERAL JOINT INSTABILITY - Anterior/posterior drawer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

SHOULDER - JOINT TYPE

A
  • Ball & socket - glenohumeral
  • Gliding - scapulothoracic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

SHOULDER - ARTICULAR SURFACES

A
  • Glenohumeral - convex (head of humerus) on concave (glenoid fossa)
  • Scapulothoracic - concave (subscapular fossa) on convex (posterior ribs)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

SHOULDER - MAIN MUSCLE ACTIONS - FLEXION

A
  • FLEXION - anterior deltoid, biceps brachii, coracobrachialis, pectoralis major
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

SHOULDER - MAIN MUSCLE ACTIONS - EXTENSION

A
  • EXTENSION - posterior deltoid, latissimus dorsi, triceps brachii, teres major
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

SHOULDER - MAIN MUSCLE ACTIONS - ABDUCTION

A
  • ABDUCTION - middle deltoid, supraspinatus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

SHOULDER - MAIN MUSCLE ACTIONS - ADDUCTION

A
  • ADDUCTION - latissimus dorsi, teres major, pectoralis major
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

SHOULDER - MAIN MUSCLE ACTIONS - HORIZONTAL ADDUCTION

A
  • HORIZONTAL ADDUCTION - pectoralis major, coracobrachialis, anterior deltoid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

SHOULDER - MAIN MUSCLE ACTIONS - HORIZONTAL ABDUCTION

A
  • HORIZONTAL ABDUCTION - posterior deltoid, teres major
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

SHOULDER - MAIN MUSCLE ACTIONS - INTERNAL ROTATION

A
  • INTERNAL ROTATION - subscapularis, pectoralis major, latissimus dorsi
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

SHOULDER - MAIN MUSCLE ACTIONS - EXTERNAL ROTATION

A
  • EXTERNAL ROTATION - infraspinatus, teres minor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

SHOULDER - RESTING POSITION

A

GH: abduction - 55-70 horizontal adduction - 30

Acromioclavicular: arm at side

Sternoclavicular: arm at side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

SHOULDER - CLOSED PACKED POSITION

A

GH: maximal abduction & lateral rotation

Acromioclavicular: abduction - 90

Sternoclavicular: full elevation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

SHOULDER - NORMAL END FEEL

A

FLEXION - elastic, firm-bony contact

EXTENSION - firm

ABDUCTION - elastic

INTERNAL/EXTERNAL ROTATION - elastic/firm

HORIZONTAL ADDUCTION - soft tissue

HORIZONTAL ABDUCTION - firm/elastic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

SHOULDER - ABNORMAL END FEEL

A

Empty - Subacromial bursitis

Hard capsular - Frozen shoulder

Late myospasm - Instability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

SHOULDER - CONDITIONS - AC SEPERATION

A

Hx - prior trauma - fall onto shoulder or impact over shoulder
S&S - possible step defect; tenderness to palpation over AC joint; +ve Obrien’s
DDx - supraspinatus rupture, impingement syndrome, rotator cuff tear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

SHOULDER - CONDITIONS - ADHESIVE CAPSULITIS

A

Hx - Pt age 40-60, usually female, weeks of shoulder pain and restriction
S&S - restricted AROM in clear capsular pattern (external rotation > abduction > internal rotation); extermally painful & limited PROM
DDx - cervical pathology, impingement syndrome, rotator cuff tear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

SHOULDER - CONDITIONS - BICIPITAL TENDONITIS

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

SHOULDER - CONDITIONS - SUBACROMIAL BURSITIS

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

SHOULDER - CONDITIONS - GH OSTEOARTHRITIS

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

SHOULDER - CONDITIONS - IMPINGEMENT

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

SHOULDER - CONDITIONS - INSTABILITY

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

SHOULDER CONDITIONS - ROTATOR CUFF TEAR

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

SHOULDER - CONDITIONS - SUPRASPINATUS TENDONITIS

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

SHOULDER - CONDITIONS - TOS

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

SHOULDER - ORTHO TEST - APPREHENSION TEST

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

SHOULDER - ORTHO TEST - APPREHENSION TEST - POSITIVE

A

Anterior GH instability

  • Excessive anterior translation
  • Dislocation
  • Pt apprehension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

SHOULDER - ORTHO TEST - APPREHENSION TEST - SN & SP

A

SN: 53

SP: 99

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

SHOULDER - ORTHO TEST - CLUNK

A
  • Pt seated or supine
  • Shoulder abducted 150
  • Examiner rotates humerus externally and applies anterior pressure on the humeral head
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

SHOULDER - ORTHO TEST - CLUNK - POSITIVE

A

Glenoid labral lesion, Anterior instability

  • Shoulder pain
  • Crepitus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

SHOULDER - ORTHO TEST - CLUNK - SN & SP

A

SN: 44

SP: 68

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

SHOULDER - ORTHO TEST - CRANK

A
  • Pt seated or supine
  • Shoulder abducted 180 and elbow flexed 90
  • Examiner applies long axis compression and rotates humerus internally and externally
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

SHOULDER - ORTHO TEST - CRANK - POSITIVE

A

Glenoid labral lesion

  • Shoulder pain
  • Crepitus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

SHOULDER - ORTHO TEST - CRANK - SN & SP

A

SN: 46-91

SP: 93

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

SHOULDER - ORTHO TEST - DROP ARM TEST

A
  • Pt seated
  • Examiner passively abducts shoulders to 90 with solid support
  • Examiner suddenly lets go and asks pt to catch themselves
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

SHOULDER - ORTHO TEST - DROP ARM TEST - POSITIVE

A

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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

SHOULDER - ORTHO TEST - DROP ARM TEST - SN & SP

A

SN: 8-27

SP: 88-100

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

SHOULDER - ORTHO TEST - EMPTY CAN

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

SHOULDER - ORTHO TEST - EMPTY CAN - POSITIVE

A

Injury or lesion of supraspinatus muscle

  • Pain or weakness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

SHOULDER - ORTHO TEST - EMPTY CAN - SN & SP

A

SN: 44-89

SP: 50-90

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

SHOULDER - ORTHO TEST - FULL CAN

A
  • Pt seated
  • Pt actively raises straight arm (palm up) to 120 in scapula plane
  • At apex examiner applies downward pressure and notes pt strength
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

SHOULDER - ORTHO TEST - FULL CAN - POSITIVE

A

Injury or lesion of supraspinatus muscle

  • Pain or weakness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

SHOULDER - ORTHO TEST - FULL CAN - SN & SP

A

SN: 86

SP: 57

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

SHOULDER - ORTHO TEST - HAWKINS-KENNEDY

A
  • Pt seated
  • Shoulder abducted 90, elbow flexed 90
  • Examiner internally rotates and horizontally adducts shoulder to pinch greater tuberosity of humerus against acromion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

SHOULDER - ORTHO TEST - HAWKINS-KENNEDY - POSITIVE

A

Supraspinatus impingement

  • Pain in anterolateral shoulder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

SHOULDER - ORTHO TEST - HAWKINS-KENNEDY - SN & SP

A

SN: 50-100

SP: 44-76

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

SHOULDER - ORTHO TEST - KIM TEST - POSITIVE

A

Posterior glenoid labrum pathology

  • Pain in posterior shoulder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

SHOULDER - ORTHO TEST - KIM TEST

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

SHOULDER - ORTHO TEST - KIM TEST - SN & SP

A

SN: 80

SP: 94

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

SHOULDER - ORTHO TEST - APPREHENSION-RELOCATION TEST

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

SHOULDER - ORTHO TEST - APPREHENSION-RELOCATION TEST - POSITIVE

A

Posterior glenohumeral instability

  • Apprehension
  • Increased motion

Anterior instability

  • No apprehension
  • Decreased pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

SHOULDER - ORTHO TEST - APPREHENSION-RELOCATION TEST - SN & SP

A

SN: 92

SP: 100

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

SHOULDER - ORTHO TEST - NEER’S TEST

A
  • 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)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

SHOULDER - ORTHO TEST - NEER’S TEST - POSITIVE

A

Supraspinatus impingement, subacromial bursitis

  • Pain with internally rotated shoulder

Biceps long-head impingement

  • Pain with externally rotated shoulder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

SHOULDER - ORTHO TEST - NEER’S TEST - SN & SP

A

SN: 0-89

SP: 48-100

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

SHOULDER - ORTHO TEST - OBRIEN’S TEST

A
  • 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)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

SHOULDER - ORTHO TEST - OBRIEN’S TEST - POSITIVE

A
  • 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)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

SHOULDER - ORTHO TEST - OBRIEN’S TEST - SN & SP

A

SN: 16-88

SP: 13-90

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

SHOULDER - ORTHO TEST - PAINFUL ARC

A
  • Pt standing or seated
  • Examiner asks pt to abduct shoulders
  • Observe for signs of discomfort or pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

SHOULDER - ORTHO TEST - PAINFUL ARC - POSITIVE

A

Rotator cuff, AC pathology, Impingement syndrome

  • Shoulder pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

SHOULDER - ORTHO TEST - PAINFUL ARC - SN & SP

A

SN: 33-98

SP: 10-81

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

SHOULDER - ORTHO TEST - RELOCATION TEST

A
  • Pt supine
  • After attempting the anterior apprehension test the examiner applys anterior to posterior pressure over the GH joint
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

SHOULDER - ORTHO TEST - RELOCATION TEST - POSITIVE

A

GH instability, anterior glenoid labrum tear

  • Decreased in pain or apprehension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

SHOULDER - ORTHO TEST - SPEED’S TEST

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

SHOULDER - ORTHO TEST - SPEED’S TEST - POSITIVE

A

Bicipital tendinitis, impingement syndrome, labral lesion or bursitis

  • Pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

SHOULDER - ORTHO TEST - SPEED’S TEST - SN & SP

A

SN: 4-100

SP: 11-100

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

SHOULDER - ORTHO TEST - YERGASON’S TEST

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

SHOULDER - ORTHO TEST - YERGASON’S TEST - POSITIVE

A

Tendonitis or strain

  • Pain over bicipital groove

Glenoid labrum pathology

  • Pain in shoulder

Torn transverse humeral ligament (bicipital instability)

  • Tendon slipping out of groove
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

SHOULDER - ORTHO TEST - YERGASON’S TEST - SN & SP

A

SN: 9-50

SP: 79-93

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

SHOULDER - ORTHO TEST - MODIFIED YERGASON’S TEST

A
  • Pt seated
  • Pt abducts shoulder to 90, externally rotates arm and supinates forearm
  • Examiner applies resistance to motion and palpates bicipital groove
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

SHOULDER - ORTHO TEST - MODIFIED YERGASON’S TEST - POSITIVE

A

Torn transverse humeral ligament

  • Pain or tendon slipping out of the groove
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

SHOULDER - TENDINITIS/BURSITIS/SUBACROMIAL IMPINGEMENT

A
  • Subacromial impingement is also known as rotator cuff tendinitis or bursitis
  • Occurs when the rotator cuff becomes irritated underneath the acromion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

SHOULDER - TENDINITIS/BURSITIS/SUBACROMIAL IMPINGEMENT - RISK FACTORS

A
  • Sports
  • Occupational risks
    • Overhead motions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

SHOULDER - TENDINITIS/BURSITIS/SUBACROMIAL IMPINGEMENT - POPULATION AFFECTED

A
  • Over 40
  • Can be younger but there is often an underlying problem in this case
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

SHOULDER - TENDINITIS/BURSITIS/SUBACROMIAL IMPINGEMENT - CLINICAL PRESENTATION

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

SHOULDER - TENDINITIS/BURSITIS/SUBACROMIAL IMPINGEMENT - PROGNOSIS

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

SHOULDER - CALCIFIC TENDINITIS

A
  • Calcium hydroxyapatite crystals are deposited in the supraspinatus tendon
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

SHOULDER - CALCIFIC TENDINITIS - RISK FACTORS

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

SHOULDER - CALCIFIC TENDINITIS - POPULATION AFFECTED

A

Acute

  • 30 – 50-year-olds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

SHOULDER - CALCIFIC TENDINITIS - CLINICAL PRESENTATION - ACUTE

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

SHOULDER - CALCIFIC TENDINITIS - CLINICAL PRESENTATION - CHRONIC

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

SHOULDER - CALCIFIC TENDINITIS - PROGNOSIS

A

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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

SHOULDER - AC JOINT ARTHRITIS

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

SHOULDER - AC JOINT ARTHRITIS - RISK FACTORS

A
  • Secondary OA of the AC
    • Occupational heavy lifting
    • Manual work
    • Repetitive micro trauma
    • Inflammatory arthropathies
    • Septic arthritis
    • Instability
    • Traumatic injury
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

SHOULDER - AC JOINT ARTHRITIS - POPULATION AFFECTED

A
  • Over 50
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

SHOULDER - AC JOINT ARTHRITIS - CLINICAL PRESENTATION

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

SHOULDER - AC JOINT ARTHRITIS - PROGNOSIS

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

SHOULDER - ROTATOR CUFF TEAR

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

SHOULDER - ROTATOR CUFF TEAR - RISK FACTORS

A
  • Age - More common in people over 45
  • Some occupations - Jobs that require repetitive overhead arm motions
  • Certain sports
    • Baseball
    • Tennis
    • Weightlifting
  • Family history
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

SHOULDER - ROTATOR CUFF TEAR - POPULATION AFFECTED

A
  • Most common in pt over 45
  • Can happen to anyone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

SHOULDER - ROTATOR CUFF TEAR - CLINICAL PRESENTATION

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

SHOULDER - ROTATOR CUFF TEAR - PROGNOSIS

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

SHOULDER - SHOULDER INSTABILITY

A
  • Instability of the GH joint is a common cause of disability and pain in the adolescent and young adult population
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

SHOULDER - SHOULDER INSTABILITY - RISK FACTORS

A
  • Unidirectional instability
    • Men affected more than women
    • Trauma
  • Multidirectional instability
    • Women affected more than men
    • Sports that repetitively cycle the GH joint
      • Swimming
      • Volleyball
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

SHOULDER - SHOULDER INSTABILITY - POPULATION AFFECTED

A
  • Adolescents and young adults
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

SHOULDER - SHOULDER INSTABILITY - CLINICAL PRESENTATION

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

SHOULDER - SHOULDER INSTABILITY - PROGNOSIS

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

SHOULDER - SHOULDER ARTHRITIS

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

SHOULDER - SHOULDER ARTHRITIS - RISK FACTORS

A
  • Advanced age
  • Genetics
  • Increased weight
  • Joint infection
  • History of shoulder dislocation
  • Previous injury
  • Certain occupations
    • Heavy construction
    • Overhead sports
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

SHOULDER - SHOULDER ARTHRITIS - POPULATION AFFECTED

A
  • Over 50
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

SHOULDER - SHOULDER ARTHRITIS - CLINICAL PRESENTATION

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

SHOULDER - SHOULDER ARTHRITIS - PROGNOSIS

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

SHOULDER - ADHESIVE CAPSULITIS

A
  • 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
111
Q

SHOULDER - ADHESIVE CAPSULITIS - RISK FACTORS

A
  • 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
112
Q

SHOULDER - ADHESIVE CAPSULITIS - POPULATION AFFECTED

A
  • 40 – 60 years
113
Q

SHOULDER - ADHESIVE CAPSULITIS - CLINICAL PRESENTATION

A
  • 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
114
Q

SHOULDER - ADHESIVE CAPSULITIS - PROGNOSIS

A
  • 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
115
Q

SHOULDER - DISORDERS OF THE ROTATOR CUFF

A
  • 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
116
Q

SHOULDER - DISORDERS OF THE ROTATOR CUFF - RISK FACTORS

A
  • Degeneration
  • Trauma and impingement
  • Vascular reaction
  • This process can be summed up as ‘wear, tear and repair’
117
Q

SHOULDER - DISORDERS OF THE ROTATOR CUFF - POPULATION AFFECTED

A

Chronic tendinitis

  • 40 – 50 years

Rotator cuff tear

  • Usually over 45
118
Q

SHOULDER - DISORDERS OF THE ROTATOR CUFF - PAINFULL ARC SYNDROME

A

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
119
Q

SHOULDER - DISORDERS OF THE ROTATOR CUFF - CHRONIC TENDINITIS

A

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
120
Q

SHOULDER - DISORDERS OF THE ROTATOR CUFF - ROTATOR CUFF TEAR

A

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
121
Q

SHOULDER - DISORDERS OF THE ROTATOR CUFF - PROGNOSIS - CONSERVATIVE TREATMENT

A

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
122
Q

SHOULDER - DISORDERS OF THE ROTATOR CUFF - PROGNOSIS - SURGICAL TREATMENT

A

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
123
Q

SHOULDER - DISORDERS OF THE ROTATOR CUFF - PROGNOSIS - REPAIRING TEARS

A

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
124
Q

SHOULDER - LESIONS OF THE BICEPS TENDON - TENDINITIS

A

Tendinitis

  • Tendon of long head of biceps lies adjacent to the rotator cuff and may be involved in the impingement syndrome
125
Q

SHOULDER - LESIONS OF THE BICEPS TENDON - TORN OF LONG HEAD BICEPS

A

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
126
Q

SHOULDER - LESIONS OF THE BICEPS TENDON - RISK FACTORS

A
  • Males over 30
  • Smoking
  • Corticosteroid injections
127
Q

SHOULDER - LESIONS OF THE BICEPS TENDON - POPULATION AFFECTED - TENDINITIS

A

Tendinitis

  • Older adults
128
Q

SHOULDER - LESIONS OF THE BICEPS TENDON - POPULATION AFFECTED - TORN LONG HEAD OF BICEPS

A

Torn long head of biceps

  • Middle aged or elderly
129
Q

SHOULDER - LESIONS OF THE BICEPS TENDON - CLINICAL PRESENTATION - TENDINITIS

A

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
130
Q

SHOULDER - LESIONS OF THE BICEPS TENDON - CLINICAL PRESENTATION - TORN LONG HEAD OF BICEPS

A

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
131
Q

SHOULDER - LESIONS OF THE BICEPS TENDON - PROGNOSIS - TENDINITIS

A

Tendinitis

  • Rest
  • Local heat
  • Deep transverse frictions
  • If recovery is delayed a corticosteroid injection can help
132
Q

SHOULDER - LESIONS OF THE BICEPS TENDON - PROGNOSIS - TORN LONG HEAD OF BICEPS

A

Torn long head of biceps

  • Function is rarely disturbed so treatment is unnecessary
  • Treatment can be given if associated rotator cuff symptoms need attention
133
Q

SHOULDER - SLAP LESION

A
  • A fall on an outstretched arm can sometimes damage the superior part of the glenoid labrum anteriorly and posteriorly (SLAP)
134
Q

SHOULDER - SLAP LESION - RISK FACTORS

A
  • Overhead sports
  • Contact sports
135
Q

SHOULDER - SLAP LESIONS - POPULATION AFFECTED

A
  • 30 – 50
136
Q

SHOULDER - SLAP LESIONS - CLINICAL PRESENTATION

A
  • 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
137
Q

SHOULDER - SLAP LESION - PROGNOSIS

A
  • Good
  • Lesion is treated by re-attachment or debridement
138
Q

SHOULDER - CHRONIC INSTABILITY OF THE SHOULDER - ANTERIOR DISLOCATION

A
  • Anterior dislocation
    • Most common - over 95% of cases
    • Usually follows an acute injury where the arm is forced into abduction, external rotation and extension
139
Q

SHOULDER - CHRONIC INSTABILITY OF THE SHOULDER - RECURRENT DISLOCATION

A
  • 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
140
Q

SHOULDER - CHRONIC INSTABILITY OF THE SHOULDER - ANTERIOR SUBLUXATION

A
  • 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
141
Q

SHOULDER - CHRONIC INSTABILITY OF THE SHOULDER - POSTERIOR DISLOCATION

A
  • Posterior dislocation
    • Rare
    • Usually due to a violent jerk in an unusual position, e.g. after an epileptic fit
142
Q

SHOULDER - CHRONIC INSTABILITY OF THE SHOULDER - ATRAUMATIC INSTABILITY

A
  • Atraumatic instability
    • Associated with capsular and ligamentous laxity
    • This is not the same as true instability
143
Q

SHOULDER - CHRONIC INSTABILITY OF THE SHOULDER - RISK FACTORS

A
  • Male
  • Age - Young adults or 50+
144
Q

SHOULDER - CHRONIC INSTABILITY OF THE SHOULDER - POPULATION AFFECTED

A
  • Young adults
  • People over 50
145
Q

SHOULDER - CHRONIC INSTABILITY OF THE SHOULDER - CLINICAL PRESENTATION - ANTERIOR INSTABILITY

A

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
146
Q

SHOULDER - CHRONIC INSTABILITY OF THE SHOULDER - CLINICAL PRESENTATION - POSTERIOR INSTABILITY

A

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
147
Q

SHOULDER - CHRONIC INSTABILITY OF THE SHOULDER - CLINICAL PRESENTATION - ATRAUMATIC INSTABILITY

A

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
148
Q

SHOULDER - CHRONIC INSTABILITY OF THE SHOULDER - PROGNOSIS - ANTERIOR DISLOCATION

A

Anterior instability

  • Indications for operative treatment are
    • Frequent dislocations, especially if painful
    • Fear or recurrent subluxation
    • Dislocation sufficient to prevent participation in everyday activities
149
Q

SHOULDER - CHRONIC INSTABILITY OF THE SHOULDER - PROGNOSIS - POSTERIOR INSTABILITY

A

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
150
Q

SHOULDER - CHRONIC INSTABILITY OF THE SHOULDER - PROGNOSIS - ATRAUMATIC INSTABILITY

A

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
151
Q

SHOULDER - DISORDERS OF THE GLENOHUMERAL JOINT

A

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
152
Q

SHOULDER - DISORDERS OF THE GLENOHUMERAL JOINT - RISK FACTORS

A
  • Advancing age
  • Genetics
  • Obesity
153
Q

SHOULDER - DISORDERS OF THE GLENOHUMERAL JOINT - POPULATION AFFECTED

A

TB arthritis

  • Adults

Osteoarthritis

  • 50 – 60
154
Q

SHOULDER - DISORDERS OF THE GLENOHUMERAL JOINT - CLINICAL PRESENTATION - TUBERCULOSIS ARTHRITIS

A

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
155
Q

SHOULDER - DISORDERS OF THE GLENOHUMERAL JOINT - CLINICAL PRESENTATION - RHEUMATOID ARTHRITIS

A

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
156
Q

SHOULDER - DISORDERS OF THE GLENOHUMERAL JOINT - CLINICAL PRESENTATION - OSTEOARTHRITIS

A

Osteoarthritis

  • Pt complains of pain in shoulder
  • May have a history of previous shoulder problems
  • Most typical sign is progressive restriction of shoulder movements
157
Q

SHOULDER - DISORDERS OF THE GLENOHUMERAL JOINT - PROGNOSIS - TUBERCULOSIS ARTHRITIS

A

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
158
Q

SHOULDER - DISORDERS OF THE GLENOHUMERAL JOINT - PROGNOSIS - RHEUMATOID ARTHRITIS

A

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
159
Q

SHOULDER - DISORDERS OF THE GLENOHUMERAL JOINT - PROGNOSIS - OSTEOARTHRITIS

A

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
160
Q

SHOULDER - RAPIDLY DESTRUCTIVE SHOULDER ARTHROPATHY

A
  • A form of arthritis
  • Crystal induced, rapidly progressive arthropathy
  • Sometimes associated with massive tears of the rotator cuff
161
Q

SHOULDER - RAPIDLY DESTRUCTIVE SHOULDER ARTHROPATHY - RISK FACTORS

A
  • Women affected more
  • Previous shoulder trauma - Especially rotator cuff injuries
162
Q

SHOULDER - RAPIDLY DESTRUCTIVE SHOULDER ARTHROPATHY - POPULATION AFFECTED

A
  • Mainly older women
  • Over 70
163
Q

SHOULDER - RAPIDLY DESTRUCTIVE SHOULDER ARTHROPATHY - CLINICAL PRESENTATION

A
  • 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
164
Q

SHOULDER - RAPIDLY DESTRUCTIVE SHOULDER ARTHROPATHY - PROGNOSIS

A
  • Not great
  • There is no treatment
  • Arthroplasty may relieve pain but will not improve function because the joint is unstable
165
Q

SHOULDER - DISORDERS OF THE SCAPULA AND CLAVICLE

A
  • Many people are affected by disorders of the scapula and clavicle
  • Disorders can be congenital or due to old age or other risk factors.
166
Q

SHOULDER - DISORDERS OF THE SCAPULA AND CLAVICLE - RISK FACTORS - WINGED SCAPULA

A

Winged scapula

  • Damage to the long thoracic nerve
  • Injury to the brachial plexus or the 5, 6, and 7cervical nerve roots
  • Viral infections of the nerve roots
  • Certain types of muscular dystrophy
167
Q

SHOULDER - DISORDERS OF THE SCAPULA AND CLAVICLE - RISK FACTORS - OA OF THE AC JOINT

A

Osteoarthritis of the AC joint

  • Older age
168
Q

SHOULDER - DISORDERS OF THE SCAPULA AND CLAVICLE - POPULATION AFFECTED

A
  • Degenerative conditions (e.g. OA of the AC) are experienced more by older people
  • Klippel-Feil syndrome and Sprengel’s shoulder are congenital disorders
169
Q

SHOULDER - DISORDERS OF THE SCAPULA AND CLAVICLE - CLINICAL PRESENTATION - CONGENITAL ELEVATION OF THE SCAPULA

A

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
170
Q

SHOULDER - DISORDERS OF THE SCAPULA AND CLAVICLE - CLINICAL PRESENTATION - KLIPPEL-FEIL SYNDROME

A

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
171
Q

SHOULDER - DISORDERS OF THE SCAPULA AND CLAVICLE - CLINICAL PRESENTATION - WINGED SCAPULA

A

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
172
Q

SHOULDER - DISORDERS OF THE SCAPULA AND CLAVICLE - CLINICAL PRESENTATION - GRATING SCAPULA

A

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
173
Q

SHOULDER - DISORDERS OF THE SCAPULA AND CLAVICLE - CLINICAL PRESENTATION - AC INSTABILITY

A

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
174
Q

SHOULDER - DISORDERS OF THE SCAPULA AND CLAVICLE - CLINICAL PRESENTATION - OA OF THE AC JOINT

A

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
175
Q

SHOULDER - DISORDERS OF THE SCAPULA AND CLAVICLE - PROGNOSIS - CONGENITAL ELEVATION OF THE SCAPULA

A
  • Mild cases are best left untreated
  • Marked limitation of abduction or severe deformity may need an operation to lower the scapula
176
Q

SHOULDER - DISORDERS OF THE SCAPULA AND CLAVICLE - PROGNOSIS - KLIPPEL-FEIL SYNDROME

A
  • Usually left untreated
177
Q

SHOULDER - DISORDERS OF THE SCAPULA AND CLAVICLE - PROGNOSIS - WINGED SCAPULA

A
  • Some disorders causing winged scapula are self-limiting and the condition gradually improves
  • Even without improvement, disability is usually slight and is best accepted
178
Q

SHOULDER - DISORDERS OF THE SCAPULA AND CLAVICLE - PROGNOSIS - GRATING SCAPULA

A
  • No treatment needed
179
Q

SHOULDER - DISORDERS OF THE SCAPULA AND CLAVICLE - PROGNOSIS - AC INSTABILITY

A
  • 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
180
Q

SHOULDER - DISORDERS OF THE SCAPULA AND CLAVICLE - PROGNOSIS - OA OF THE AC JOINT

A
  • Analgesics
  • Corticosteroid injections
  • If these don’t work, pain may be relieved by excision of the lateral end of the clavicle
181
Q

SHOULDER - AROM - FLEXION - MUSCLES ACTIVATED

A

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

182
Q

SHOULDER - AROM - FLEXION - TISSUES STRETCHED

A

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

183
Q

SHOULDER - AROM - FLEXION - TISSUES COMPRESSED

A

Supraspinatus tendon
Subdeltoid bursa
Upper GH joint capsule

184
Q

SHOULDER - AROM - EXTENSION - MUSCLES ACTIVATED

A

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

185
Q

SHOULDER - AROM - EXTENSION - TISSUES STRETCHED

A

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

186
Q

SHOULDER - AROM - EXTENSION - TISSUES COMPRESSED

A

Posterior GH capsule

187
Q

SHOULDER - AROM - ABDUCTION - MUSCLES ACTIVATED

A

Supraspinatus
Deltoid (middle fibres)
Trapezius
Serratus anterior

188
Q

SHOULDER - AROM - ABDUCTION - TISSUES STRETCHED

A

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

189
Q

SHOULDER - AROM - ABDUCTION - TISSUES COMPRESSED

A

Supraspinatus tendon
Subdeltoid bursa
Upper GH joint capsule

190
Q

SHOULDER - AROM - ADDUCTION - MUSCLES ACTIVATED

A

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

191
Q

SHOULDER - AROM - ADDUCTION - TISSUES STRETCHED

A

Deltoid (middle fibres)
Posterior GH capsule

192
Q

SHOULDER - AROM - ADDUCTION - TISSUES COMPRESSED

A

Pectoralis major
AC & SC joint
Anterior GH capsule

193
Q

SHOULDER - AROM - EXTERNAL ROTATION - MUSCLES ACTIVATED

A

Infraspinatus
Teres minor
Posterior deltoid

194
Q

SHOULDER - AROM - EXTERNAL ROTATION - TISSUES STRETCHED

A

Pectoralis major
Subscapularis
Anterior GH capsule

195
Q

SHOULDER - AROM - EXTERNAL ROTATION - TISSUES COMPRESSED

A

Posterior GH capsule

196
Q

SHOULDER - AROM - INTERNAL ROTATION - MUSCLES ACTIVATED

A

Pectoralis major
Subscapularis
Anterior deltoid
Teres major
Latissimus dorsi

197
Q

SHOULDER - AROM - INTERNAL ROTATION - TISSUES STRETCHED

A

Infraspinatus
Teres minor
Posterior deltoid
Posterior GH capsule

198
Q

SHOULDER - AROM - INTERNAL ROTATION - TISSUES COMPRESSED

A

Anterior GH capsule

199
Q

DELTOID - ORIGIN

A

Lateral 1/3 of clavicle
Acromion
Spine of scapula

200
Q

DELTOID - INSERTION

A

Deltoid tuberosity of humerus

201
Q

DELTOID - ACTION

A

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

202
Q

DELTOID - INNERVATION

A

Axillary nerve (C5-C6)

203
Q

DELTOID - TRIGGER POINT REFERRAL

A

Referal local to the area

204
Q

DELTOID - STRETCH

A

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

205
Q

DELTOID - STRENGTHEN

A

Resisted shoulder abduction, flexion or extension
Front raises
Lateral raises

206
Q

ROTATOR CUFF MUSCLES

A

Supraspinatus
Infraspinatus
Teres minor
Subscapularis
Coracobrachialis

207
Q

SUPRASPINATUS - ORIGIN

A

Supraspinous fossa of scapula

208
Q

SUPRASPINATUS - INSERTION

A

Greater tubercle of humerus (superior facet)

209
Q

SUPRASPINATUS - ACTION

A

Abduction of shoulder
Stabilises GH joint

210
Q

SUPRASPINATUS - INNERVATION

A

Suprascapular nerve (C5-C6)

211
Q

SUPRASPINATUS - TRIGGER POINT REFERRAL

A

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

212
Q

SUPRASPINATUS - STRETCH

A

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

213
Q

SUPRASPINATUS - STRENGTHEN

A

Resisted shoulder abduction
Lateral raises

214
Q

INFRASPINATUS - ORIGIN

A

Infraspinous fossa
Inferior portion of spine of scapula

215
Q

INFRASPINATUS - INSERTION

A

Greater tubercle of humerus

216
Q

INFRASPINATUS - ACTION

A

Lateral rotation of shoulder
Stabilises GH joint

217
Q

INFRASPINATUS - INNERVATION

A

Suprascapular nerve (C5-C6)

218
Q

INFRASPINATUS - TRIGGER POINT REFERRAL

A

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

219
Q

INFRASPINATUS - STRETCH

A

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

220
Q

INFRASPINATUS - STRENGTHEN

A

Lying lateral rotation

221
Q

TERES MINOR - ORIGIN

A

Superior lateral border of scapula

222
Q

TERES MINOR - INSERTION

A

Greater tubercle of humerus

223
Q

TERES MINOR - ACTION

A

Lateral rotatioon of shoulder
Stabilises GH joint

224
Q

TERES MINOR - INNERVATION

A

Axillary nerve (C5-C6)

225
Q

TERES MINOR - TRIGGER POINT REFERRAL

A

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

226
Q

TERES MINOR - STRETCH

A

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

227
Q

TERES MINOR - STRENGTHEN

A

Resisted lateral rotation
Lying lateral rotation

228
Q

SUBSCAPULARIS - ORIGIN

A

Subscapular fossa of scapula

229
Q

SUBSCAPULARIS - INSERTION

A

Lesser tubercle of humerus

230
Q

SUBSCAPULARIS - ACTION

A

Medial rotation of the shoulder
Stabilises GH joint

231
Q

SUBSCAPULARIS - INNERVATION

A

Upper and lower subscapular nerves (C5-C6)

232
Q

SUBSCAPULARIS - TRIGGER POINT REFERRAL

A

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

233
Q

SUBSCAPULARIS - STRETCH

A

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

234
Q

SUBSCAPULARIS - STRENGTHEN

A

Resisted shoulder medial rotation
Lying medial rotation
Standing medial rotation

235
Q

CORACOBRACHIALIS - ORIGIN

A

Coracoid process of scapula

236
Q

CORACOBRACHIALIS - INSERTION

A

Medial shaft of humerus

237
Q

CORACOBRACHIALIS - ACTION

A

Flexion and adduction of shoulder
Horizontal adduction of shoulder

238
Q

CORACOBRACHIALIS - INNERVATION

A

Musculocutaneous nerve (C5-C7)

239
Q

CORACOBRACHIALIS - TRIGGER POINT REFERRAL

A

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

240
Q

CORACOBRACHIALIS - STRETCH

A

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

241
Q

CORACOBRACHIALIS - STRENGTHEN

A

Front raises
Fly
Bench press

242
Q

TERES MAJOR - ORIGIN

A

Inferior, lateral border of scapula

243
Q

TERES MAJOR - INSERTION

A

Medial lip of bicipital groove of humerus

244
Q

TERES MAJOR - ACTION

A

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

245
Q

TERES MAJOR - INNERVATION

A

Lower subscapular nerve (C5-C7)

246
Q

TERES MAJOR - TRIGGER POINT REFERRAL

A

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

247
Q

TERES MAJOR - STRETCH

A

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

248
Q

TERES MAJOR - STRENGTHEN

A

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

249
Q

SERRATUS ANTERIOR - ORIGIN

A

Ribs 1-9

250
Q

SERRATUS ANTERIOR - INSERTION

A

Costal surface of medial border of scapula

251
Q

SERRATUS ANTERIOR - ACTION

A

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

252
Q

SERRATUS ANTERIOR - INNERVATION

A

Long thoracic nerve (C5-C7)

253
Q

SERRATUS ANTERIOR - TRIGGER POINT REFERRAL

A

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

254
Q

SERRATUS ANTERIOR - STRETCH

A

Shoulders extend with scapulas fully retracted and stick chest out

255
Q

SERRATUS ANTERIOR - STRENGTHEN

A

Boxing/punching
Push ups
Incline shoulder raises
Resisted shoulder protraction

256
Q

PECTORALIS MAJOR - ORIGIN

A

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

257
Q

PECTORALIS MAJOR - INSERTION

A

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

258
Q

PECTORALIS MAJOR - ACTION

A

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

259
Q

PECTORALIS MAJOR - INNERVATION

A

Medial and lateral pectoral nerve (C8-T1)

260
Q

PECTORALIS MAJOR - TRIGGER POINT REFERRAL

A

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)

261
Q

PECTORALIS MAJOR - STRETCH

A

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

262
Q

PECTORALIS MAJOR - STRENGTHEN

A

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

263
Q

PECTORALIS MINOR - ORIGIN

A

Ribs 3-5 (anterior lateral portion)

264
Q

PECTORALIS MINOR - INSERTION

A

Coracoid process of scapula

265
Q

PECTORALIS MINOR - ACTION

A

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

266
Q

PECTORALIS MINOR - INNERVATION

A

Medial pectoral nerve (C8-T2)

267
Q

PECTORALIS MINOR - TRIGGER POINT REFERRAL

A

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

268
Q

PECTORALIS MINOR - STRETCH

A

Shoulders extended with scapulas fully retracted, stick out chest

269
Q

PECTORALIS MINOR - STRENGTHEN

A

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

270
Q

LEVATOR SCAPULAE - ORIGIN

A

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

271
Q

LEVATOR SCAPULAE - INSERTION

A

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

272
Q

LEVATOR SCAPULAE - ACTION

A

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

273
Q

LEVATOR SCAPULAE - INNERVATION

A

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

ANATOMY (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions