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MSK 1 > Shoulder > Flashcards

Shoulder Flashcards

1
Q

what is a red flag?

A

symptoms that may require immediate attention and supersedes physical therapy

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2
Q

what is a yellow flag?

A

confounding variables which may be cautionary warnings regarding the patient’s condition, that require further investigation and for you to proceed with caution

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3
Q

numerical pain rating scale (NPRS)

A

rate pain 0-10
higher score indicates more pain

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4
Q

patient specific functional scale

A

-rate ability to perform 1-5 functional tasks on 0-10 scale
-scores are averaged
-lower score= greater disability

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5
Q

global rating of change

A

-recall based rating of change in wellbeing on an 11 point scale
0= no change
+5= meaningful improvement
-5= meaningful deterioration

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6
Q

disabilities of the arm, shoulder, and hand (DASH)

A

-30 items (21 physical, 5 pain, 4 emotional)
-scores range from 0-100
-higher score= greater disability

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7
Q

quick-DASH

A

-11 items addressing symptoms and physical function
-scores range from 0-100
-higher score= greater disability

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8
Q

shoulder pain and disability index (SPADI)

A

-13 items (5 pain, 8 disability) rated 0-10
-scores range from 0-100
-higher score= greater disability

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9
Q

penn shoulder score (PSS)

A

-rate level of pain, satisfaction, and function on 3 subscales
-pain and satisfaction scale both 10 point numeric rating scale
-function scale is 4 point likert scale
-scores range from 0-100
-higher score = low pain, high satisfaction, high function

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10
Q

what are we looking for in an upper quarter screen?

A

-symmetry
-quality of movement
-willingness to move
-pain
-end feel
-scapulohumeral rhythm

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11
Q

possible low shoulder causes

A

-adaptive laxity of shoulder
-leg length discrepancy
-scoliosis
-hand dominance

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12
Q

medial border of scapula sits

A

5-8cm from thoracic spine

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13
Q

superior angle of scapula is in line with

A

T2

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14
Q

inferior angle of scapula is in line with

A

T7

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15
Q
A
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16
Q

forward head posture may cause what positions at the scapula and shoulder?

A

scapula abducted, elevated, and internally rotated. shoulders protracted

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17
Q

equally limited/painful AROM & PROM, increased tone, strong but painful resistance

A

muscle tightness

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18
Q

equally limited/painful AROM & PROM, resistance not usually impacted, may or may not be capsular pattern

A

joint pain

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19
Q

limited AROM, painful palpation, weak and maybe painful resistance

A

muscle or tendon tear

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20
Q

painful AROM, painful stretching, painful palpation, strong but painful resistance

A

muscle strain or tendinitis

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21
Q

equally limited/painful AROM & PROM, resistance not usually impacted

A

ligamentous tear, sprain, or adhesion

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22
Q

equally limited/painful AROM & PROM, resistance not usually impacted, may or may not show capsular pattern

A

joint capsule hypomobility

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23
Q

AROM worse than PROM, uncomfortable palpation, weak resistance

A

nerve

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24
Q

referral pattern for rotator cuff injuries

A

anterior/ lateral upper arm. seldom goes below the elbow

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25
Q

causes of rotator cuff pathology

A

compression, tensile load, traumatic tear (macro trauma), degenerative tear (micro trauma)

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26
Q

tendinosis

A

intratendon degeneration often due to repeated microtrauma. haphazard tendon but no inflammatory response

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27
Q

rotator cuff tendinitis/ tendinosis symptomology

A

dull ache in lateral upper/lower arm
reaching away is painful
overhead activities painful

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28
Q

subacromial impingement is caused by what motion?

A

superior translation of humeral head with elevation

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29
Q

subacromial (outlet) impingement

A

-abrasion of structures in subacromial space
-shape of acromion, bone spur, tendon thickening can be factors
-pain in anterior/ lateral shoulder

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30
Q

what soft tissues are often involved in outlet impingement?

A

supraspinatus (primarily), long head of bicep, subacromial bursa

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31
Q

posterior internal (non-outlet) impingement

A

-impingement of rotator cuff muscles against posterior superior glenoid labrum and humeral head
-pain in posterior shoulder or lateral upper arm
-can be caused by repeated overhead motion
-greatest risk is with repeated arm elevation with shoulder IR

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32
Q

special tests for impingement

A

hawkins-kennedy
neer
empty can
painful arc
cross-body adduction
scapular assistance
scapular repositioning

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33
Q

what is a partial rotator cuff tear

A

damage to one or more rotator cuff tendons that leads to a tear that does not go all the way through the tendon

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34
Q

what is a complete rotator cuff tear

A

damage to one or more rotator cuff tendons that leads to a full tear where tendon is separated from bone

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35
Q

degenerative rotator cuff tears may be secondary to

A

sarcopenia, postural changes, and balance changes

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36
Q

rotator cuff tear symptoms

A
  1. weakness always present (amount related to size of tear)
  2. compensation with scapular motion
  3. pain when sleeping
  4. pain in lateral upper arm
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37
Q

special tests for rotator cuff tears

A

drop arm test
external rotation lag sign
infraspinatus muscle test
hornblowers sign
IR lag sign
belly press
lift off
empty can

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38
Q

rotator cuff tears greater than ___ cm are considered large

A

2.5cm or 1 inch

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39
Q

combination special tests
hawkins, painful arc, infraspinatus muscle test

A

2 positive = impingement
3 positive = rotator cuff tear

high specificity

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40
Q

causes of snapping scapula

A

1.inflammation of bursa between scapula and thorax
2. prominence of superomedial angle of scapula
3.muscle imbalace of scapula rotators
4. rib fracture
5. benign excess growth of bone on scapula
6. sprengel’s deformity

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41
Q

commonly tight muscles contributing to scapular dyskinesia

A

pec minor, posterior shoulder capsule, levator scap, latissimus dorsi, infraspinatus, teres minor

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42
Q

commonly weak muscles contributing to scapular dyskinesia

A

lower and mid trap, serratus anterior

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43
Q

symptoms of shoulder posterior instability

A

-instability with shoulder in flexed/ abducted position
-pain
-guarding

44
Q

posterior shoulder instability special test

A

jerk test

45
Q

symptoms of shoulder inferior instability

A

-pain
-guarding
-carrying weighted objects uncomfortable

46
Q

shoulder inferior instability special test

A

sulcus sign

47
Q

shoulder anterior instability special tests

A

-apprehension test
-relocation test

48
Q

complications of anterior dislocation

A

-neurovascular injury
-hill sachs lesion
-bankart lesion
-SLAP tear

49
Q

what is a bankart lesion

A

tear of anterior inferior labrum. AKA inferior labral tear

50
Q

what score on the beighton scale represents hypermobility

A

4+

51
Q

AMBRI

A

atruamatic multidirectional bilateral for rehabilitation and possibly inferior capsular shift surgery

52
Q

TUBS

A

traumatic unilateral bankart needing/ responding to surgery

53
Q

labral tears present similarly to ____ pathology

A

rotator cuff or instability

54
Q

SLAP tear

A

superior labral lesion from anterior to posterior. commonly involves long head of the bicep

55
Q

presentation of labral tear

A

pain in anterolateral arm
aggravation with overhead activities
pain with behind the back activities
locking/ clicking/ popping/ catching
tenderness over anterior shoulder

56
Q

labral tear special tests

A

o’brien test
biceps load 2
anterior slide
compression rotation (grind) test
speed test
yergasons

57
Q

observable deformity, local tenderness, and pain with end range shoulder motion are all consistent with what injury?

A

SC joint

58
Q

Type 1 & 2 AC joint injury treatment

A

immobilization period, gentle ROM, isometric exercises, progression to scapular stabilization exercises

59
Q

type 3 AC joint injury treatment

A

surgery or conservative
immobilization period, progression to PROM, progressive shoulder strengthening, return to sport 6-12 weeks, reconstruction if limitations persist past 3 months

60
Q

type 4,5,6 AC joint injury treatment

A

surgery
progress toward full ROM then strength progression, manual therapy, scapular stabilization, proprioception training

61
Q

mechanism of traumatic AC joint injury

A

humerus is driven inferiorly with force. usually MVA or sport related

62
Q

mechanism of degenerative AC joint injury

A

previous trauma or insidious onset. pain is worse in the morning after prolonged rest

63
Q

AC joint injury presentation

A

localized pain, pain at end range shoulder AROM and PROM, possible deformity, pain with resistance (especially shoulder elevation)

64
Q

AC joint special tests

A

AC joint palpation
cross-body adduction
AC resisted extension
paxino’s test

65
Q

risk factors for frozen shoulder

A

diabetes (5-6x more likely)
prior history
thyroid disease

66
Q

what conditions are frozen shoulder often misdiagnosed as?

A

impingement or rotator cuff tendinitis/tear

67
Q

stage 1 of frozen shoulder

A

0-3 months (pre-adhesive). mild symptoms, achy at rest but sharp at end range. capsular pattern loss of ROM, strong but possibly painful

68
Q

stage 2 of frozen shoulder

A

3-9 months (freezing stage). persistent more intense pain even at rest. multidirectional loss and pain at end range. pain referred to lateral upper arm & night pain sets in

69
Q

stage 4 of frozen shoulder

A

15-24 months (thawing). minimal pain and gradual return in ROM. stiffness and fibrosis may remain. receding synovial involvement

70
Q

stage 3 of frozen shoulder

A

9-14 months (frozen). painful stiffening of shoulder and significant ROM loss. pain may be lower than stage 2 but ROM still worse. poor scapulohumeral rhythm

71
Q

high irritability characteristics

A

-pain 7+/10
-night or resting pain
-high level of disability reported on outcome measures
-pain before end ranges of active or passive movements
-AROM < PROM due to pain

72
Q

moderate irritability characteristics

A

-pain 4-6/10
-intermittent night or resting pain
-moderate level of disability reported on outcome measures
-pain AT end range of active or passive movements
-AROM = PROM

73
Q

low irritability characteristics

A

-pain 3/10 or less
-no night or resting pain
-minimal level of disability reported on outcome measures
-pain with over pressures into end ranges of passive movements
-AROM = PROM

74
Q

Non PT interventions for frozen shoulder

A

-NSAIDS
-steroids
-steroid injection
-manipulation under anesthesia
-hydrodilation
-arthroscopy
-open release

75
Q

selective hypomobility presentation

A

-possible decreased ROM
-possible increased joint translation in the opposite direction
-possible pain at end range

76
Q

subacromial bursitis presentation

A

-similar findings as impingement
-pain develops gradually in lateral upper arm
-one or more resistive tests commonly painful
-conservative treatment

77
Q

calcified bursitis presentation

A

-similar findings as impingement
-secondary to decreased vascularization
-produced non capsular limitation in movement
-pain develops gradually in lateral upper arm
-one or more resistive tests commonly painful
-conservative treatment

78
Q

calcific tendinopathy presentation

A

-uncommon esp under age of 40
-reactive calcification of rotator cuff tendons
-cause unclear but could be hypovascularization, degeneration of tendon, metabolic disturbances

79
Q

bicipital tendionopathy presentation

A

-often secondary to impingement
-in younger population may be due to repeated trauma (pitcher)
-in older could be degenerative
-tenderness of bicipital groove
-painful resisted shoulder and/ or elbow flexion
+ speeds + yergasons

80
Q

subluxing biceps tendon presentation

A

-could lead to tendinopathy or rupture
-click may be present
-tenderness over bicipital groove
-painful resisted elbow flexion
+ speeds + yergasons

81
Q

GH osteoarthritis symptoms

A

-anterolateral shoulder pain
-A/PROM limitations
-crepitis
-weakness
-diminished mobility
-relief with traction

82
Q

AC joint osteoarthritis symptoms

A

-pain at AC joint
-pain with OH activities especially at end range
-painful/ limited shoulder AROM
+ ac palpation test
+ cross-body adduction
+AC resisted extension

83
Q

what actions reproduce trigger point symptoms?

A

stretching, activating, palpation

84
Q

populations at greater risk for humerus fracture

A

children
older adults
females
diabetes

85
Q

components of proximal humeral fractures

A

number of fractured parts
-greater
-lesser
-surgical neck
-anatomical neck
displacement

86
Q

proximal humerus fracture potential causea

A

low energy fall in elderly with osteoporosis
high energy fall/ FOOSH

87
Q

Systems review findings of proximal humerus fracture

A

integument may show possible swelling and bruising. check neuro and cardio distal to fx for potential vascular/ neurologic injury

88
Q

what should be avoided for a proximal humerus fracture?

A

-ROM (risk of displacement)
-MMT of shoulder, scap, and elbow if not healed
-joint mobility of glenohumeral joint

89
Q

special test for proximal humerus fracture

A

olecranon-manubrium percussion test

90
Q

what comorbidities may slow healing time post sx of humerus fracture?

A

-severe osteoporosis
-smoking
-drug and alcohol use
-diabetes
-RA
-immunocompromised

91
Q

goals of PT after fracture has healed

A

-regain AROM/ PROM
-strengthen
-improve function

92
Q

clavicle fracture examination history

A

low energy fall in elderly with osteoporosis
high energy fall/ FOOSH

93
Q

Clavicle fracture systems review

A

integumentary may show swelling/ bruising. check neuro and cardio for potential vascular neurologic injury

94
Q

clavicle fracture contraindications

A

-ROM testing
-MMT
-joint assessment of SC & AC joints

95
Q

clavicle fracture healing times

A

6 weeks in children
8 weeks in adults

96
Q

most common shoulder injuries in throwing athletes

A

-rotator cuff impingement
-snapping scapula
-labrum/ biceps complex
-joint capsule

97
Q

what is GIRD?

A

glenohumeral internal rotation deficit. when athletes have so much ER and very little IR.

136 ER, 40 IR, 90 ABD average

98
Q

components of swimmers shoulder

A

impingement: primarily due to IR
muscle overuse/ fatigue: teres minor, serratus anterior, subscap, pec major, lats
shoulder laxity: multidirectional but anterior in backstroke swimmers

99
Q

sprengels deformity

A

pediatric deformity where scapula fails to descend limiting shoulder elevation. more common in girls

100
Q

erbs palsy

A

traction injury of brachial plexus. common MOI is obstetric injury, falling, and tackling injury

101
Q

erbs palsy common presentation

A

-difficulty moving the arm or painful
-trouble gripping
-numbness/ tingling
-arm in waiters tip position

102
Q

treatment for erbs palsy

A

-children: use the limb
-strengthening
-ROM
-sensory stimulation
-splints/ brace/ tape
-surgery

103
Q

axillary web syndrome

A

-complication of breast cancer affecting msk and lymphatic system
-typically occurs after sx
-cords of subcutaneous tissue
symptoms: pain, numbness, pulling, limited ROM

104
Q

treatments for axillary web syndrome

A

-manual lymph drainage
-nerve mobilizations
-soft tissue mobilization
-patient education
-ROM

105
Q

pancoast tumor

A

lung cancer that begins at apex of the lung.
symptoms: shoulder pain along c8- T2 similar to ulnar nerve injury, horner syndrome, weakness/ atrophy of hand muscles

MSK 1 (2 decks)

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