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517 Ortho > Shoulder > Flashcards

Shoulder Flashcards

1
Q

how much contact does the humeral head have with the glenoid fossa?

A

25%

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2
Q

how much contact does the humeral head have with the glenoid fossa and the labrum?

A

75%

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3
Q

mechanisms of stability at the shoulder most to least

A

muscular>ligamentous>structural

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4
Q

approximation

A

compression of a segment/joint surface
increase with pushing/weightbearing

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5
Q

centration

A

optimal joint position with balanced muscle forces
stabilization

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6
Q

local muscles

A

joint support/stabilization muscles

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7
Q

global muscles

A

movers of the joint

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8
Q

arthrokinematics of the rotator cuff

A

subscap: posterior glide in IR
ext rotators: anterior glide in ER

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9
Q

GH close packed

A

90 abd, full ER
or
full abd, full ER

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10
Q

GH open pack

A

55 abd, 30 h. add

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11
Q

GH capsular pattern

A

ER>Abd>IR

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12
Q

loss of abduction/flexion could indicate…

A

SAPS

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13
Q

loss of IR could indicate…

A

adhesive capsulitis (last part of capsular pattern)
or post op adhesions

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14
Q

night time awakening w shoulder pain could indiacte…

A

internal derangement

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15
Q

kibler type 1 dysfunction

A

inferior border protrudes due to anterior tilt of the scapula

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16
Q

causes of kibler type 1 dysfunction

A

pec minor or short head of biceps pulling coracoid anteriorly
weakness in lats, lower traps, serratus

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17
Q

kibler type 2 dysfunction

A

entire medial border off ribs with glenoid fossa pointed anteriorly
increased strain on anterior capsule and instability

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18
Q

causes of kibler type 2 dysfunction

A

weakness: serratus anterior/lower traps

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19
Q

kibler type 3

A

superior border of scapula elevated, especially as part of movement pattern

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20
Q

causes of kibler type 3 dysfunction

A

overactive upper traps, weak lower traps

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21
Q

other sources of shoulder pain to consider in differential

A

C spine nerve impingement
peripheral nerve entrapment
diaphragm irritation
intrathoracic tumor
MI
pancoast tumor

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22
Q

ACJ separation MOI

A

trauma: FOOSH, blow to shoulder, fall on anterior shoulder

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23
Q

ACJ separation
men vs women more?

A

more common in men than women

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24
Q

types of AC joint separation

A

type I: partial or complete disruption of AC ligaments, intact coracoclavicular ligaments
type iI: fully torn AC ligaments + coracoclavicular partial tear
III: coracoclavicular ligament complete tear, separation of clavicle from acromion
IV-VI: uncommon, involvement of muscle tear causing wide displacement

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25
Q

subjective of ACJ separation

A

relief with supported/cradled arm
localized pain over AC joint

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26
Q

objective fo ACJ separation

A

may be obvious deformity
pt supporting arm adducted
swelling
pain w passive adduction

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27
Q

ACJ special tests

A

cross body adduction test
AC resisted extension test

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28
Q

ACJ intervention

A

type 1 and 2 can heal with protection and rest, moving into gentle ROM, nonpainful strengthening of deltoid and traps
unrestricted activity 2-4 weeks later
types 3 and 4 may need surgery

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29
Q

what would happen with untreated ACJ

A

permanent deformity, weak shoulder abduction
ACJ arthritis
more likely to remain symptomatic the worse the grade of sprain

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30
Q

post op ACJ repair interventions

A

pain at end range due to limited clavicle motion
strengthen SCM, subclavius, deltoid, pec major, trap

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31
Q

adhesive capsulitis cause

A

primary vs secondary
primary: idiopathic, progessive, painful loss of motion in capsular pattern
secondary: traumatic in origin, disease process or neuro/cardio condition

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32
Q

adhesive capsulitis subjective

A

diffuse aching in shoulder
hard to sleep on involved side
hard to complete ADLs

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33
Q

3 clinical characteristics of adhesive capsulitis

A
  1. severe pain
  2. shoulder stiffness with reduced ER
  3. negative radiographic findings
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34
Q

stage 1 adhesive capsulitis

A

prefreezing
lasts 1-3 months
sharp pain with movement, start of motion limitations, worst in ER
hallmark symptom: pain

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35
Q

stage 2 adhesive capsulitis

A

freezing
3-9 months
progressive loss of movement and night pain

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36
Q

stage 3 of adhesive capsulitis

A

frozen
profound stiffness
pain at end range, starting to decrease

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37
Q

stage 4 adhesive capsulitis

A

thawing
12-15 months
minimal pain, gradual improvement in motion with remaining profound stiffness

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38
Q

objective findings of adhesive capsulitis

A

varies by stage
abnormal shoulder elevation mechanics
point tenderness
ER>Abd>flexion/IR limitations
hypomobile GH joint
end range pain

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39
Q

testing for adhesive capsulitis

A

no special tests
imaging negative
arthorography shows 50% reduced joint volume in capsule

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40
Q

interventions for adhesive capsulitis

A

pt edu, pain management
high irritability: gentle manual therapy
low irritability/later stage: aggressive STM and joint mob

41
Q

prognosis of adhesive capsulitis

A

18 mo-3 years

42
Q

MUA

A

very aggressive with high complication rate/injury and excessive scarring
should only be done when conservative treatment fails, improves ROM but less so symptoms

43
Q

biceps tendonitis: categories

A

disorder of the long head of the biceps, 3 categories
1. inflammatory/degeneration: often w SAPS, overuse overhead motion
2. instability of biceps tendon often w RC injury
3. SLAP: injury to biceps attachment on labrum

44
Q

MOI for biceps tendon

A

FOOSH
traction: eccentric firing of biceps eg overhead throwing
peel back: abd/ER causing twisting of biceps attachment

45
Q

subjective of biceps tendonitis

A

pain over anterior shoulder/bicipital groove with resisted elbow flexion

46
Q

objective of biceps tendonitis

A

+painful arc
PTP over bicipital groove
loss of shoulder ROM similar to RC tendinopathy

47
Q

biceps special tests

A

Speed’s: resisted shoulder flexion w elbow extension
Yergason: resisted supination w elbow flexed

48
Q

biceps tendonitis imaging

A

MRI

49
Q

biceps tendonitis intervention

A
  1. control pain/inflammation with rest; restore ROM and accessory motion
  2. AROM, early strengthening to stabilize GHJ
  3. strengthen dynamic stability: closed kinetic chain to open chain
  4. return to sport/work
50
Q

open vs closed chain in shoulder

A

closed chain easier due to increased stability/centration with compression of joint
open chain more challenging bc it requires more muscular stability

51
Q

That one sports PT study in the slides: the ones they said were bad for biceps tendonitis

A

DON’T:
strengthen UT, pec major
manip C spine or GH joint
transverse friction biceps tendon or muscle, or IASTM
Modalities: no ionto, phonophoresis, IFC, NMES, TENS, ultrasound, laser, dry needling tendon/surrounding muscles
no taping, shock wave, cupping

52
Q

GH instability: types

A

most are anteroinferior from dislocation/subluxation
SLAP
Bankart

53
Q

Bankart lesion

A

TUBS: instability from Traumatic event, Unidirectional, Bankart lesion, Surgery
bankart lesion is 7-4 o’clock, anteroinferior`

54
Q

inferior labral lesion

A

AMBRI: Atraumatic, Multidirectional, Bilateral, treat with Rehab, Inferior capsular shift surgical intervention if rehab fails

55
Q

complication of anterioinferior dislocation

A

brachial plexus injury
assess for neural tension if pt experiences N/T

56
Q

subjective of GHJ instability

A

looseness, noisy shoulder
may/may not have trauma
abd/ER feels like joint is slipping with anterior instability
vague, activity related symptoms with multidirectional instability

57
Q

objective of GHJ instability

A

+ sulcus signL inf instability/multidirectional
+ apprehension/relocation tests: anterior
+ jerk test?: posterior

58
Q

intervention for GHJ instability

A

strengthen RC, shoulder stabilization progression
focus on IR for anterior instability to provide posterior glide

59
Q

GHJ OA

A

loss of joint space and cartilage degeneration
results from trauma
leads to increased ligament laxity, decreased stability, and osteophyte formation

60
Q

subjective of GHJ OA

A

gradual onset, deep pain, stiffness all direction
progressive loss of ROM and function
history of trauma to shoulder

61
Q

objective of GHJ OA

A

forward humeral head, protraction
joint line tenderness
swelling
decreased AROM/PROM, esp ABD and ER
crepitation
imaging shows joint space narrowing

62
Q

GHJ OA interventions

A

improve GHJ flexibility, RC strengthening
control pain for progressive condition, avoid total shoulder replacement when pt loses function

63
Q

SAPS

A

closely related to RC dysfunction
impingement of RC between coracoacromial arch and humeral head
anything decreasing this space can cause impingement
ACJ arthritis can contribute

64
Q

types of acromions

A

flat - 17%
curved - 43%
hooked - 40%
flat is ideal, hooked is worst for joint space

65
Q

subjecive of SAPS

A

pain lateral arm near deltoid/anterior shoulder
functional loss
can’t sleep on involved side
pain with ADLs, esp flexion/IR

66
Q

stages of SAPS

A

stages of SAPS:
1. tenderness at supra insertion/acromion, painful arc, RC weakness w pain
2: crepitus, PROM restriction
3: atrophy of infra/supra, more AROM/PROM limitation

67
Q

special tests of SAPS

A

hawkin’s kennedy
painful arc
ER iso
+ neer’s, empty/full can

68
Q

interventions for SAPS

A
  1. reduce pain, swelling, guarding, work on PROM
  2. strengthen RC, isometric to con to ecc
    vascularity, AROM, mobs, stretching
  3. PNF con/ecc, full ROM
  4. full strength/ROM
69
Q

RC tear

A

under umbrella of RCRPS
acute or degenerative
often 40+ y/o unless traumatic
injury in critical zone: avascular zone/transitional zone from muscle to tendon to bone

70
Q

subjective of RC tear

A

significant weakness/pain with abd/ER
localized shoulder pain
popping at injury
partial more painful bc pain receptors intact
pain may refer down to elbow but not below

71
Q

objective of RC tear

A

atrophy/deformity
pain at greater tuberosity
loss of PROM/AROM
weakness w large tears, pain w small tears
massive tears: + drop sign, profound weakness in raising arm

72
Q

RC special tests

A

drop arm (supra)
empty can
lift off (subscap)
diagnose by MRI

73
Q

RC tear intervention

A

strengthen RC and scapular stabilizers
full thickness tear often needs surgery

74
Q

criteria for surgery for RC tear

A

<60 y/o
failure to improve w conservative treatment
full thickness tear
pt requires shoulder for work
pt consent

75
Q

RC repair options

A

single, double, suture bridge, or transosseous repairs
double seems to repair tissue at humeral insertion point better

76
Q

RC repair success stats

A

depends on severity and type of tear as well as pt’s health
requires protection in early healing, sling
retear rates 25-75%
tend to fail in first 3-6 months

77
Q

safe MVIC level after early RC repair

A

15%

78
Q

RC phases of rehab

A

2-6: passive flexion/ROM, no IR, ER to 30
7-9: AAROM flexion, rotation, progressing to active, AAROM IR
10: AROM flexion, strengthen rotation, flexion, rows
20: strengthening, advanced

79
Q

RC healing times

A

repair at 20% strength 6 weeks, 30-50% at 12 weeks
caution with resistance exercise through 15 weeks

80
Q

SLAP lesion

A

injury to superior labrum and biceps attachment

81
Q

MOI of SLAP

A

repetitive injury or trauma such as FOOSH, deceleration fall/catch

82
Q

type 1 SLAP lesion

A

degeneration of sup. labrum edge
reduced ability to h. abd or ER due to pain

83
Q

type 2 SLAP

A

detachment of labrum and biceps anchor

84
Q

type 3 SLAP lesion

A

vertical tear with remaining portions intact

85
Q

type 4 SLAP lesion

A

vertical tear extending into biceps tendon, tear and flap displacing into GH joint

86
Q

type 5 SLAP lesion

A

Bankart lesion of anterior capsule extending into anterior superior labrum

87
Q

type 6 SLAP lesion

A

disruption of biceps tendon anchor with ant/post superior labral flap tear

88
Q

type 7 SLAP lesion

A

extension of SLAP lesion nteriorly into inf/middle GH ligament

89
Q

subjective of SLAP tear

A

trauma/overuse with pain/instability in overhead activities
click/catch

90
Q

objective of SLAP

A

similar symptoms to RC and instability
pain
clicking

91
Q

special tests for SLAP

A

Obriens
active compression
crank
biceps load I and II
Kim?
Jerk

92
Q

intervention for SLAP

A

dynamic stabilization

93
Q

SLAP repair protocol

A

1-2: ROM limits to 90 flexion, ER 15-30
protect
3: PROM/AAROM, full flexion, 130 abd, 35 ER
4-6: isometrics, work up to full ROM, work up to concentric strengthening
6-12: full ROM and light resistance exercise
12-24: full ROM, advanced strengthening and dynamic activities

94
Q

thoracic outlet syndrome

A

symptoms attributable to compession of neurovascular bundle in thoracic outlet
brachial plexus, subclavian artery/vein
clavicle, first rib, scapula

95
Q

subjective of TOS

A

diffuse arm/shoulder pain overhead
widespread symptoms in UE/head
N/T, parasthesia, weakness, heavy, swelling
neural compression most common

96
Q

objective of TOS

A

swelling
different distal pulses
differing sensory and motor function of peripheral nerves
+ special tests
c8-T1 most commonly compressed

97
Q

TOS special tests

A

adson, allen, roos

98
Q

TOS intervention

A

correct postural abnormalities with stretching and strengthening/mobilization

99
Q

criteria for TOS surgery

A

failure to respond to PT
muscle atrophy
intermittent paresthesia replaced by sensory loss
incapacitating pain

517 Ortho (11 decks)

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