Shoulder Flashcards
Name all AC joint ligaments
anterior, posterior, superior, inferior
What direction do AC ligaments provide stability?
anterior posterior direction
Name all coracoclavicular ligament portions
conoid(medially) and trapezoid(laterally)
What direction do CC ligaments provide stability?
superior inferior direction
-conoid > trapezoid
When does middle GH ligament most contribute to shoulder stability?
shoulder abducted 45* and externally rotated
Name both bands and relative positions of inferior GH ligament
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
What does inferior GH ligament mainly stabilize?
primarily inferior GH joint translation
Force couples at GH joint
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
Greatest predictors for failed surgical repair of rotator cuff tear
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
Nociceptive pain
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
Nociplastic pain
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
Neuropathic pain
arises from a lesion or disease of the CNS or PNS
-may follow a radicular pattern
AKA pain from somewhere in the nervous system
What is Parsonage-Turner syndrome?
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
OSPRO-ROS for Red Flags
23 item version accurately identified 100% of responders with potential red flags
shorter 10 item version accurately identified 94%
OSPRO-ROS for Yellow Flags
17 item tool
-identifies yellow flags 85% of the time and estimates multiple psychological questionnaire scores w/o pt having to complete` each instrument
Keele STarT MSK Tool
similar to STarTBACK tool
-stratifies pts into low/medium/high risk of likelihood of persistent pain, disability, and poor treatment outcomes
MCID for NPRS for shoulder pain
2 points
-example would be manual correction to a movement and then subsequent change in concordant sign
define concordant sign
movements or positions that reproduce the pt’s priary complaint
modified painDETECT questionnaire for shoulder
reliable and sensitive to discriminate nociceptive vs neuropathic pain
score of -1 to 38
12+ suggests primarily neuropathic pain presentation
Hand Held dynamometer MDC
15% change is MDC in “make test”
Subacromial pain syndrome test cluster
-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
Test cluster for anterior instability
-Apprehension test
-relocation
-anterior release(surprise)
Sensitivity 81%
Specificity 98%
+LR 39.7
-LR 0.19
Test cluster for posterior instability
posterior apprehension test
Sensitivity 19%
Specificity 99%
+LR 19
-LR 0.82
Test for inferior instability
hyper-abduction test
SN 67%
SP 89%
+LR 6
-LR 0.37
