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Sports Medicine > Shoulder > Flashcards

Shoulder Flashcards

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1
Q

what is the normal ratio of motion of the GH joint to scapulothoracic motion?

A

2:1 (120 to 60 degrees)

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2
Q

a positive lift off test indicates damage to what rotator cuff tendon?

A

subscapularis

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3
Q

a positive Hornblower’s test indicates pathology in which tendon?

A

teres minor

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4
Q

a positive Kim test is indicative of what type of lesion?

A

posteroinferior labral lesion

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5
Q

the biceps load test is performed with the patinet in what resting position?

A

supine

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6
Q

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?

A

SLAP tear

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7
Q

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?

A

anterior slide test, SLAP tear

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8
Q

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?

A

clunk test - labral tear / injury

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9
Q

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?

A

modified dynamic labral shear - superior labral pathology

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10
Q

superior labrum tear without inolvement of the biceps long head is classified as what type of slap tear?

A

type III

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11
Q

what is the typical time to return to play after SLAP tear?

A

4-7 months

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12
Q

what is internal impingement of the shoulder?

A

articular side rotator cuff tear and SLAP tear combined

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13
Q

what type of shoulder impingement is worsened by activities that place the shoulder in an abducted/ER position?

A

internal impingement

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14
Q

what type of shoulder impingement is worsened by lying on the affected side?

A

subacromial

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15
Q

what type of shoulder impingement is exacerbated by activities that involve forward flexion and internal rotation?

A

subcoracoid impingement

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16
Q

what is a type III AC joint separation?

A

complete rupture of AC and CC ligament with 100% superior displacement of the clavicle

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17
Q

what is a type II AC joint separation?

A

complete AC ligament tear and partial CC tear with less than 100% displacement of the clavicle

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18
Q

what is a type III AC separation?

A

complete AC and CC ligament tear with 100% superior displacement of the clavicle

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19
Q

what is a type IV AC separation?

A

complete AC and CC ligament tear with the distal clavicle displaced posteriorly through the trapezial fascia

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20
Q

in what type of AC joint separation is the distal clavicle displaced by 100-300% superiorly?

A

type V

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21
Q

how are types I and II AC joint separation treated?

A

non operatively with brief immobilization in sling, ice, analgesics and physical therapy

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22
Q

if treated non operatively, what is the typical time for return to play for an AC joint injury?

A

1-6 weeks

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22
Q

how are types IV, V and VI AC joint separations treated?

A

surgically

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23
Q

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?

A

distal clavicular osteolysis

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24
Q

what is the initial treatment for distal clavicular osteolysis?

A

non operative including activity modification, weightlifting modification, nsaids, therapy, injections

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25
Q

what is the typical return to play time for an anterior SC joint dislocation?

A

6-8 weeks

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26
Q

80% of clavicle fractures occur in which portion?

A

middle third

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27
Q

how long should contact athletes be restricted from sports following a clavicle fracture?

A

2-3 months

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28
Q

what is the way to think about treatment of a clavicle fracture (between operative and non operative)?

A

there is no consensus on which is best, can treat with sling vs. surgery with higher complication rate with surgery, decision is individualized

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29
Q

when can non contact athletes return to play after clavicle fracture?

A

radiographic healing is present, AROM with near normal strength has returned

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30
Q

how does treatment start for proximal humerus epiphysitis?

A

3 months avoiding throwing

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31
Q

Shoulder XR in a 13 yo M throwing athlete shows proximal humerus epiphysis widening and metaphyseal fragmentation with periosteal reaction. what is the injury

A

proximal humerus epiphysitis

32
Q

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?

A

glenohumeral internal rotation deficit (GIRD)

33
Q

how do you make the diagnosis of GIRD?

A

clinical exam

34
Q

what two conditions are commonly associated with GIRD ?

A

SLAP tear and impingement

35
Q

What is a Bennet lesion on MRI of the shoulder?

A

posterior capsular calcification

36
Q

physical therapy treatment for GIRD focuses on what?

A

posterior capsule stretching

37
Q

during what months of the time course of adhesive capsulitis do the freezing and frozen stages occur, respectively?

A

freezing: 3-9 months
frozen: 9-15 months

38
Q

what is the management for a complete distal tear of the pectoralis major tendon?

A

surgical

39
Q

how would you start treatment for a partial distal tear of pectoralis major tendon?

A

non surgical: rest, physical therapy, strengthening after 6 weeks

40
Q

what is the threshold for displacement requiring surgical intervention for proximal humerus fracture?

A

> 1cm

41
Q

minimally displaced fractures of the proximal humerus can be treated with what?

A

sling and early passive ROM

42
Q

what is the typical time for return to play after proximal humerus fracture for non contact non overhead athletes?

A

2-3 months

43
Q

what are the two recommended evaluation studies when brachial neuritis is suspected?

A

EMG and MRI

44
Q

what are the two most common sites of suprascapular neuropathy injury?

A

suprascapular notch and spinoglenoid notch

45
Q

a ganglion or paralabral cyst in the shoulder commonly leads to entrapment of what nerve?

A

suprascapular nerve

46
Q

describe the difference in outcome/dysfunction between suprascapular nerve impingement at the suprascapular notch vs. the spinoglenoid notch?

A

suprascapular notch - both infraspinatus and supraspinatus affected
spinoglenoid notch - only infraspinatus affected

47
Q

ganglion cysts in the spinoglenoid notch are often the result of what type of other shoulder pathology?

A

superior labral pathology

48
Q

most patients with suprascapular nerve impingement can be treated in what way?

A

conservative treatment including activity modification, nsaids, physical therapy

49
Q

what finding is present in type 1 scapular dyskinesia?

A

prominence of the inferior medial scapular border

50
Q

what finding is present in type II scapular dyskinesia?

A

prominence of the medial scapular border

51
Q

what is the finding in type III scapular dyskinesia?

A

prominence of the superiomedial scapular border

52
Q

types I and II scapular dyskinesia are associated with what other type of shoulder pathology?

A

labral pathology

53
Q

type III scapular dyskinesia is associated with what other two shoulder conditions?

A

impingement and rotator cuff pathology

54
Q

what is the mainstay of treatment for scapular dyskinesia?

A

physical therapy

55
Q

patients with SICK scapular dyskinesia will have pain at the anterior shoulder overlying what structure? what is the cause?

A

coracoid process - tight pec minor

56
Q

what XR view is a cephalic tilt at 10-15 degrees to assess AC and CC joint?

A

Zanca view

57
Q

80% of clavicle fractures are in what portion?

A

middle third

58
Q

how long should you immobilize most middle and proximal clavicle fractures?

A

3-4 weeks

59
Q

surgery should be considered for clavicle fracture if there is how much displacement or shortening?

A

100% or more displacement, > 2cm shortening

60
Q

how long should you immobilize a non displaced AC joint injury?

A

3-7 days

61
Q

Bennett and Rolando fractures affect what portion of the hand?

A

1st MC base fractures

62
Q

what type of injury is caused by axially directed force throug the shaft of the flexed thumb metacarpal?

A

Bennet / Rolando fracture - 1st MC base

63
Q

which type of 1st MC base fracture is characterized by intraarticular fracture with proximal and radial dislocation of the 1st MC?

A

Bennett’s fracture

64
Q

what type of 1st MC base fracture is characterized by intraarticular fracture with Y shaped configuration?

A

Rolando’s fracture

65
Q

Bennett’s and Rolando’s fractures are managed in what way?

A

surgically

66
Q

after surgery, what is the typical amount of time needed in immobilization before gradual RTP in a 1st MC base fracture?

A

6 weeks

67
Q

what bone serves as the ulnar insertion point of the transverse carpal ligament?

A

hamate

68
Q

what type of hand fracture results in reproduction of pain with resisted ring and small finger flexion with the wrist in ulnar deviation?

A

Hook of Hamate fracture

69
Q

how can you manage a non displaced Hook of Hamate fracture?

A

cast immobilization

70
Q

what type of hand fracture, if left untreated, can cause delayed rupture of the ring and small finger FDP tendons?

A

Hook of Hamate fracture

71
Q

what structure provides stability to the distal radioulnar joint throughout the full range of supination and pronation?

A

TFCC

72
Q

a patient experiences recurrent ulnar sided chronic wrist pain with activities such as push ups, golf, tennis. what is the most likely injury?

A

TFCC tear

73
Q

how do you assess DRUJ?

A

translate the ulna and radius in opposite directions

74
Q

symptomatic instability of the DRUJ is best treated in what way?

A

surgical repair

75
Q

which portion of the TFCC is most vascularized?

A

peripheral portion

76
Q

t/f central and degenerative tears of the TFCC are relatively avascular and do not heal after repair

A

true

77
Q

in the case of flexor tendon laceration, what is the timeline for the need of surgical intervention / repair?

A

surgery within 10 days

78
Q
A

Sports Medicine (10 decks)

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