Shoulder

Question 1

Hill-Sachs lesion

Answer 1

compression fracture of the posterior humeral head

Question 2

SLAP tear

Answer 2

• superior labrum, anterior to posterior
• may involve biceps tendon

Question 3

bankart lesion

Answer 3

avulsion of the anterior-inferior capsule and glenoid labrum

Question 4

signs and symptoms of labral tear

Answer 4

• pain that cannot be localized to a specific point
• pain made worse by overhead activities or when arm is behind back
• weakness
• instability
• pain on resisted flexion of biceps
• tenderness over front of shoulder

Question 5

what is the gold standard for identifying labral tear

Answer 5

• arthroscopic surgery
• but MRI arthrogram is very effective

Question 6

what should you avoid for 12 weeks after surgical repair of labrum?

Answer 6

90/90 abduction/ER position
(“apprehension position”)

Question 7

Common areas of compression for TOS

Answer 7

• superior thoracic outlet
• scalene triangle
• between clavicle and first rib (costoclavicular space)
• between pec min and thoracic wall (corocoid process)

Question 8

Symptoms of TOS

Answer 8

• pain in neck and shoulder
• numbness of arm and hand
• cold hands
• weakness, fatigue of arm and hand
• difficulty with fine motor tasks
• muscle atrophy of hand
• poor skin quality/ color changes

Question 9

causes of TOS

Answer 9

• tight musculature
• poor posture
• repetitive activities
• obesity
• trauma
• tumor

Question 10

diagnostic test of TOS

Answer 10

• plain film extra and MRI
• electrodiagnostic test to assess nerve dysfunction

Question 11

PT interventions

Answer 11

• address contributing factors
• mobilizations (manip typically to 1st rib articulation to diminish pain and soft tissue restriction)
• posture education
• control of inflammatory process
• strengthening, functional training

Question 12

mechanism of injury for AC or SC joint disorders

Answer 12

fall onto shoulder with UE adducted or collision with another individual during sporting event

Question 13

UE position for AC or SC joint disorders

Answer 13

• positioned in neutral with sling in acute phase
• avoid shoulder elevation during acute phase of healing
• surgical repair is rare due to tendency of acromioclavicular joint degeneration following repair

Question 14

PT goals, outcomes, interventions for AC/SC joint disorders

Answer 14

– return of function without pain
- functional training, resistance training, endurancem, proprioception, coordination and flexibility
- manual therapy

Question 15

what is posterior/internal impingement characterized by?

Answer 15

• irritation between the rotator cuff and greater tuberosity or posterior glenoid and labrum

Question 16

Posterior/internal impingement is often seen in…

Answer 16

athletes performing overhead activities
- pain usually noted in poster shoulder

Question 17

can MRI be used for bicipital tendonosis/tendinopathy

Answer 17

yes but sometimes is not sensitive enough for accurate assessment

Question 18

humeral neck fracture

Answer 18

frequently occur with FOOSH among older osteoporotic women
- generally does not require immobilization or surgical repair since it is fairly stable fracture

Question 19

Stages of adhesive capsulitis

Answer 19

• gradual onset of pain (less than 3 mo)
• painful period (3-9 mo –> freezing)
• stiff period (9-15 mo –> frozen)
• recover period (15-24 mo –> thawing)

Question 20

adhesive capsulitis is commonly seen with…

Answer 20

diabetes and thyroid disease

Question 21

signs and symptoms of frozen shoulder

Answer 21

• insidious onset or some trauma
• pain, becoming severe, present at rest, vague, generalized, may refer to forearm
• self immobilization
• unable to lay on involved side

Question 22

Adhesive Capsulitis CPG - population

Answer 22

40-65 yo
female
previous episodes in contralateral arm
hx of diabetes or thyroid disease

Question 23

Adhesive Capsulitis CPG - pathoanatomic features

Answer 23

loss of PROM in multiple planes, esp ER

Question 24

Adhesive Capsulitis CPG - activity limitation measures

Answer 24

• use easily reproducible activity limitations associated with pain and function over the episode of care

Question 25

Adhesive Capsulitis CPG - outcome measures

Answer 25

use validated shoulder outcomes measures before and after interventions

Question 26

Adhesive Capsulitis CPG - interventions

Answer 26

• intra-articular corticosteroid injections combined with shoulder mobility and stretching provide short term pain relief and improved function compared to exercise alone (LEVEL I)
• pt ed (II)
• stretching (II)
• ultrasound, shortwave diathermy, e stim with exercise (III)
• joint mobs - level III