Shoulder

Question 1

Name all AC joint ligaments

Answer 1

anterior, posterior, superior, inferior

Question 2

What direction do AC ligaments provide stability?

Answer 2

anterior posterior direction

Question 3

Name all coracoclavicular ligament portions

Answer 3

conoid(medially) and trapezoid(laterally)

Question 4

What direction do CC ligaments provide stability?

Answer 4

superior inferior direction
-conoid > trapezoid

Question 5

When does middle GH ligament most contribute to shoulder stability?

Answer 5

shoulder abducted 45* and externally rotated

Question 6

Name both bands and relative positions of inferior GH ligament

Answer 6

anterior band (2 to 4 o clock)
-resists anterior translation when shoulder abducted 90 degrees and externally rotated

posterior band (7 to 9 o clock)
-resists posterior translation when shoulder flexed and internally rotated

Question 7

What does inferior GH ligament mainly stabilize?

Answer 7

primarily inferior GH joint translation

Question 8

Force couples at GH joint

Answer 8

subscapularis and infraspinatus provide dynamic stability
-compressive force in transverse plane
-infraspinatus prevents superior and anterior translation
-subscapularis involved w/ forward flexion

all rotator cuff muscles and deltoid muscles
-compression to offset force of deltoid and pec muscles

Question 9

Greatest predictors for failed surgical repair of rotator cuff tear

Answer 9

Fat infiltration OR=9.3
Multiple tendon involvement OR=6.0
Larger tear size OR=4.3
Lower pre-op muscle strength OR=4.0
Older age OR=2.8

Question 10

Nociceptive pain

Answer 10

arises from damage to non-neural tissues
-due to activation of nociceptors

AKA pain from other tissues that activates pain receptors

typically a localized pain in the shoulder

Question 11

Nociplastic pain

Answer 11

arises from altered nociception
-despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease/lesion of the somatosensory system

AKA pain from nociceptors firing, although no overt link to damage or disease

Question 12

Neuropathic pain

Answer 12

arises from a lesion or disease of the CNS or PNS
-may follow a radicular pattern

AKA pain from somewhere in the nervous system

Question 13

What is Parsonage-Turner syndrome?

Answer 13

rare syndrome causing UE weakness, atrophy and wasting
-about 1.6 people per 100,000 each year
-risk factors include postoperative, post-trauma, post-vaccination, post-infection

essentially brachial plexus neuropathy
-acute onset radiating pain followed by weakness and numbness

usually resolves in 18-24 months
-age is a factor and long term complications/deficits exist

Question 14

OSPRO-ROS for Red Flags

Answer 14

23 item version accurately identified 100% of responders with potential red flags

shorter 10 item version accurately identified 94%

Question 15

OSPRO-ROS for Yellow Flags

Answer 15

17 item tool
-identifies yellow flags 85% of the time and estimates multiple psychological questionnaire scores w/o pt having to complete` each instrument

Question 16

Keele STarT MSK Tool

Answer 16

similar to STarTBACK tool
-stratifies pts into low/medium/high risk of likelihood of persistent pain, disability, and poor treatment outcomes

Question 17

MCID for NPRS for shoulder pain

Answer 17

2 points
-example would be manual correction to a movement and then subsequent change in concordant sign

Question 18

define concordant sign

Answer 18

movements or positions that reproduce the pt’s priary complaint

Question 19

modified painDETECT questionnaire for shoulder

Answer 19

reliable and sensitive to discriminate nociceptive vs neuropathic pain

score of -1 to 38
12+ suggests primarily neuropathic pain presentation

Question 20

Hand Held dynamometer MDC

Answer 20

15% change is MDC in “make test”

Question 21

Subacromial pain syndrome test cluster

Answer 21

-Neer Sign
-Hawkins Kennedy
-Jobe(empty can)
-painful arc
-pain/weakness w/ resisted shoulder ER

3 of 5 positive
+LR 2.93
-LR 0.30

+LR 10.56 when (hawkins, painful arc, painful ER)
-LR 0.17 when all 3 negative

Question 22

Test cluster for anterior instability

Answer 22

-Apprehension test
-relocation
-anterior release(surprise)

Sensitivity 81%
Specificity 98%
+LR 39.7
-LR 0.19

Question 23

Test cluster for posterior instability

Answer 23

posterior apprehension test

Sensitivity 19%
Specificity 99%
+LR 19
-LR 0.82

Question 24

Test for inferior instability

Answer 24

hyper-abduction test

SN 67%
SP 89%
+LR 6
-LR 0.37

Question 25

Test cluster for multidirectional instability (MDI)

Answer 25

at least 2 directions of positive tests
-anterior apprehension, posterior apprehension, hyperabduction
AND
Beighton score 5/9 or higher

Question 26

Primary vs secondary adhesive capsulitis

Answer 26

Primary
-loss of AROM/PROM specifically ER, pain w/ end ranges of motion

-more common in women, diabetes, hypothyroidism, other autoimmune disease
-requires referral for X-ray to rule out serious pathology or differentiate early OA at GH

Secondary
-typically a result period of immobilization(surgery, injury, etc)

Question 27

Adhesive capsulitis 4 stage continuum

Answer 27

1. pre-freezing
2. freezing
3. frozen
4. thawing

~18 months after appearance of initial symptoms

Question 28

Rotator cuff tear sizes

Answer 28

Small < 1 cm
Medium 1-3 cm
Large 3-5 cm
Massive >5 cm

measured by greatest diameter

Question 29

Shoulder dislocation data

Answer 29

typically anterior > posterior
-posterior caused by trauma (67%) or seizure (31%)

7x more common in young males than age matched females

most occur age 15-29 but second peak occurs in women > 70yo

Question 30

Primary GH joint dislocation plan of care

Answer 30

immobilization in traditional sling < 1 week
-encourage weaning

restore ROM and then early RTC and scapular isometrics

expect less pain after 10-14 days
-progress ROM in safe ranges, motor control, proprioception

SINEX program > traditional care for instability at 12 weeks

Question 31

SINEX program vs standard care(Rockwood program) for GH instability

Watson program vs Rockwood program

Answer 31

SINEX>Rockwood

Watson> Rockwood

essentially, neuromuscular control, stability, etc are superior to resistance band exercises for shoulder and scapula