Shoulder Flashcards
what is the normal ratio of motion of the GH joint to scapulothoracic motion?
2:1 (120 to 60 degrees)
a positive lift off test indicates damage to what rotator cuff tendon?
subscapularis
a positive Hornblower’s test indicates pathology in which tendon?
teres minor
a positive Kim test is indicative of what type of lesion?
posteroinferior labral lesion
the biceps load test is performed with the patinet in what resting position?
supine
a patient is positioned supine, shoulder in 120 degrees of abduction, fully supinated with the elbow flexed to 90 degrees. Resisted elbow flexion reproduces pain. what is the most likely lesion?
SLAP tear
a patient’s hands are placed on the hips with the thumbs pointing posteriorly, axial load is applied to the elbow toward the GH joint against patient resistance. this produces pain. what is the most likely lesion and what is the name of the test?
anterior slide test, SLAP tear
the patient is supine, the examiner applies anterior force to the posterior humeral head while rotating the humerus with the other hand. pain, grinding occur. what is the test and what is the most likely lesion?
clunk test - labral tear / injury
the patient’s arm is flexed to 90 degrees at the elbow, abducted to 120 degrees and externally rotated. then the arm is lowered from 120 degrees to 60 degrees abduction, keeping the arm externally rotated. a positive painful click indicates damage to what structure? what is the name of the test?
modified dynamic labral shear - superior labral pathology
superior labrum tear without inolvement of the biceps long head is classified as what type of slap tear?
type III
what is the typical time to return to play after SLAP tear?
4-7 months
what is internal impingement of the shoulder?
articular side rotator cuff tear and SLAP tear combined
what type of shoulder impingement is worsened by activities that place the shoulder in an abducted/ER position?
internal impingement
what type of shoulder impingement is worsened by lying on the affected side?
subacromial
what type of shoulder impingement is exacerbated by activities that involve forward flexion and internal rotation?
subcoracoid impingement
what is a type III AC joint separation?
complete rupture of AC and CC ligament with 100% superior displacement of the clavicle
what is a type II AC joint separation?
complete AC ligament tear and partial CC tear with less than 100% displacement of the clavicle
what is a type III AC separation?
complete AC and CC ligament tear with 100% superior displacement of the clavicle
what is a type IV AC separation?
complete AC and CC ligament tear with the distal clavicle displaced posteriorly through the trapezial fascia
in what type of AC joint separation is the distal clavicle displaced by 100-300% superiorly?
type V
how are types I and II AC joint separation treated?
non operatively with brief immobilization in sling, ice, analgesics and physical therapy
if treated non operatively, what is the typical time for return to play for an AC joint injury?
1-6 weeks
how are types IV, V and VI AC joint separations treated?
surgically
a Zanca view XR shows osteopenia and expansion of the distal clavicle and joint space widening and cysts of the AC joint. what is the condition?
distal clavicular osteolysis
what is the initial treatment for distal clavicular osteolysis?
non operative including activity modification, weightlifting modification, nsaids, therapy, injections
what is the typical return to play time for an anterior SC joint dislocation?
6-8 weeks
80% of clavicle fractures occur in which portion?
middle third
how long should contact athletes be restricted from sports following a clavicle fracture?
2-3 months
what is the way to think about treatment of a clavicle fracture (between operative and non operative)?
there is no consensus on which is best, can treat with sling vs. surgery with higher complication rate with surgery, decision is individualized
when can non contact athletes return to play after clavicle fracture?
radiographic healing is present, AROM with near normal strength has returned
how does treatment start for proximal humerus epiphysitis?
3 months avoiding throwing
Shoulder XR in a 13 yo M throwing athlete shows proximal humerus epiphysis widening and metaphyseal fragmentation with periosteal reaction. what is the injury
proximal humerus epiphysitis
in a throwing athlete, there is a physiologic loss of internal rotation that is greater than gain in external rotation due to posterior capsular contraction. what is the condition?
glenohumeral internal rotation deficit (GIRD)
how do you make the diagnosis of GIRD?
clinical exam
what two conditions are commonly associated with GIRD ?
SLAP tear and impingement
What is a Bennet lesion on MRI of the shoulder?
posterior capsular calcification
physical therapy treatment for GIRD focuses on what?
posterior capsule stretching
during what months of the time course of adhesive capsulitis do the freezing and frozen stages occur, respectively?
freezing: 3-9 months
frozen: 9-15 months
what is the management for a complete distal tear of the pectoralis major tendon?
surgical
how would you start treatment for a partial distal tear of pectoralis major tendon?
non surgical: rest, physical therapy, strengthening after 6 weeks
what is the threshold for displacement requiring surgical intervention for proximal humerus fracture?
> 1cm
minimally displaced fractures of the proximal humerus can be treated with what?
sling and early passive ROM
what is the typical time for return to play after proximal humerus fracture for non contact non overhead athletes?
2-3 months
what are the two recommended evaluation studies when brachial neuritis is suspected?
EMG and MRI
what are the two most common sites of suprascapular neuropathy injury?
suprascapular notch and spinoglenoid notch
a ganglion or paralabral cyst in the shoulder commonly leads to entrapment of what nerve?
suprascapular nerve
describe the difference in outcome/dysfunction between suprascapular nerve impingement at the suprascapular notch vs. the spinoglenoid notch?
suprascapular notch - both infraspinatus and supraspinatus affected
spinoglenoid notch - only infraspinatus affected
ganglion cysts in the spinoglenoid notch are often the result of what type of other shoulder pathology?
superior labral pathology
most patients with suprascapular nerve impingement can be treated in what way?
conservative treatment including activity modification, nsaids, physical therapy
what finding is present in type 1 scapular dyskinesia?
prominence of the inferior medial scapular border
what finding is present in type II scapular dyskinesia?
prominence of the medial scapular border
what is the finding in type III scapular dyskinesia?
prominence of the superiomedial scapular border
types I and II scapular dyskinesia are associated with what other type of shoulder pathology?
labral pathology
type III scapular dyskinesia is associated with what other two shoulder conditions?
impingement and rotator cuff pathology
what is the mainstay of treatment for scapular dyskinesia?
physical therapy
patients with SICK scapular dyskinesia will have pain at the anterior shoulder overlying what structure? what is the cause?
coracoid process - tight pec minor
what XR view is a cephalic tilt at 10-15 degrees to assess AC and CC joint?
Zanca view
80% of clavicle fractures are in what portion?
middle third
how long should you immobilize most middle and proximal clavicle fractures?
3-4 weeks
surgery should be considered for clavicle fracture if there is how much displacement or shortening?
100% or more displacement, > 2cm shortening
how long should you immobilize a non displaced AC joint injury?
3-7 days
Bennett and Rolando fractures affect what portion of the hand?
1st MC base fractures
what type of injury is caused by axially directed force throug the shaft of the flexed thumb metacarpal?
Bennet / Rolando fracture - 1st MC base
which type of 1st MC base fracture is characterized by intraarticular fracture with proximal and radial dislocation of the 1st MC?
Bennett’s fracture
what type of 1st MC base fracture is characterized by intraarticular fracture with Y shaped configuration?
Rolando’s fracture
Bennett’s and Rolando’s fractures are managed in what way?
surgically
after surgery, what is the typical amount of time needed in immobilization before gradual RTP in a 1st MC base fracture?
6 weeks
what bone serves as the ulnar insertion point of the transverse carpal ligament?
hamate
what type of hand fracture results in reproduction of pain with resisted ring and small finger flexion with the wrist in ulnar deviation?
Hook of Hamate fracture
how can you manage a non displaced Hook of Hamate fracture?
cast immobilization
what type of hand fracture, if left untreated, can cause delayed rupture of the ring and small finger FDP tendons?
Hook of Hamate fracture
what structure provides stability to the distal radioulnar joint throughout the full range of supination and pronation?
TFCC
a patient experiences recurrent ulnar sided chronic wrist pain with activities such as push ups, golf, tennis. what is the most likely injury?
TFCC tear
how do you assess DRUJ?
translate the ulna and radius in opposite directions
symptomatic instability of the DRUJ is best treated in what way?
surgical repair
which portion of the TFCC is most vascularized?
peripheral portion
t/f central and degenerative tears of the TFCC are relatively avascular and do not heal after repair
true
in the case of flexor tendon laceration, what is the timeline for the need of surgical intervention / repair?
surgery within 10 days
