Shoulder Flashcards
1
Q
how much contact does the humeral head have with the glenoid fossa?
A
25%
2
Q
how much contact does the humeral head have with the glenoid fossa and the labrum?
A
75%
3
Q
mechanisms of stability at the shoulder most to least
A
muscular>ligamentous>structural
4
Q
approximation
A
compression of a segment/joint surface
increase with pushing/weightbearing
5
Q
centration
A
optimal joint position with balanced muscle forces
stabilization
6
Q
local muscles
A
joint support/stabilization muscles
7
Q
global muscles
A
movers of the joint
8
Q
arthrokinematics of the rotator cuff
A
subscap: posterior glide in IR
ext rotators: anterior glide in ER
9
Q
GH close packed
A
90 abd, full ER
or
full abd, full ER
10
Q
GH open pack
A
55 abd, 30 h. add
11
Q
GH capsular pattern
A
ER>Abd>IR
12
Q
loss of abduction/flexion could indicate…
A
SAPS
13
Q
loss of IR could indicate…
A
adhesive capsulitis (last part of capsular pattern)
or post op adhesions
14
Q
night time awakening w shoulder pain could indiacte…
A
internal derangement
15
Q
kibler type 1 dysfunction
A
inferior border protrudes due to anterior tilt of the scapula
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
17
Q
kibler type 2 dysfunction
A
entire medial border off ribs with glenoid fossa pointed anteriorly
increased strain on anterior capsule and instability
18
Q
causes of kibler type 2 dysfunction
A
weakness: serratus anterior/lower traps
19
Q
kibler type 3
A
superior border of scapula elevated, especially as part of movement pattern
20
Q
causes of kibler type 3 dysfunction
A
overactive upper traps, weak lower traps
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
22
Q
ACJ separation MOI
A
trauma: FOOSH, blow to shoulder, fall on anterior shoulder
23
Q
ACJ separation
men vs women more?
A
more common in men than women
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
25
subjective of ACJ separation
relief with supported/cradled arm
localized pain over AC joint
26
objective fo ACJ separation
may be obvious deformity
pt supporting arm adducted
swelling
pain w passive adduction
27
ACJ special tests
cross body adduction test
AC resisted extension test
28
ACJ intervention
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
29
what would happen with untreated ACJ
permanent deformity, weak shoulder abduction
ACJ arthritis
more likely to remain symptomatic the worse the grade of sprain
30
post op ACJ repair interventions
pain at end range due to limited clavicle motion
strengthen SCM, subclavius, deltoid, pec major, trap
31
adhesive capsulitis cause
primary vs secondary
primary: idiopathic, progessive, painful loss of motion in capsular pattern
secondary: traumatic in origin, disease process or neuro/cardio condition
32
adhesive capsulitis subjective
diffuse aching in shoulder
hard to sleep on involved side
hard to complete ADLs
33
3 clinical characteristics of adhesive capsulitis
1. severe pain
2. shoulder stiffness with reduced ER
3. negative radiographic findings
34
stage 1 adhesive capsulitis
prefreezing
lasts 1-3 months
sharp pain with movement, start of motion limitations, worst in ER
hallmark symptom: pain
35
stage 2 adhesive capsulitis
freezing
3-9 months
progressive loss of movement and night pain
36
stage 3 of adhesive capsulitis
frozen
profound stiffness
pain at end range, starting to decrease
37
stage 4 adhesive capsulitis
thawing
12-15 months
minimal pain, gradual improvement in motion with remaining profound stiffness
38
objective findings of adhesive capsulitis
varies by stage
abnormal shoulder elevation mechanics
point tenderness
ER>Abd>flexion/IR limitations
hypomobile GH joint
end range pain
39
testing for adhesive capsulitis
no special tests
imaging negative
arthorography shows 50% reduced joint volume in capsule
40
interventions for adhesive capsulitis
pt edu, pain management
high irritability: gentle manual therapy
low irritability/later stage: aggressive STM and joint mob
41
prognosis of adhesive capsulitis
18 mo-3 years
42
MUA
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
biceps tendonitis: categories
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
MOI for biceps tendon
FOOSH
traction: eccentric firing of biceps eg overhead throwing
peel back: abd/ER causing twisting of biceps attachment
45
subjective of biceps tendonitis
pain over anterior shoulder/bicipital groove with resisted elbow flexion
46
objective of biceps tendonitis
+painful arc
PTP over bicipital groove
loss of shoulder ROM similar to RC tendinopathy
47
biceps special tests
Speed's: resisted shoulder flexion w elbow extension
Yergason: resisted supination w elbow flexed
48
biceps tendonitis imaging
MRI
49
biceps tendonitis intervention
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
open vs closed chain in shoulder
closed chain easier due to increased stability/centration with compression of joint
open chain more challenging bc it requires more muscular stability
51
That one sports PT study in the slides: the ones they said were bad for biceps tendonitis
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
GH instability: types
most are anteroinferior from dislocation/subluxation
SLAP
Bankart
53
Bankart lesion
TUBS: instability from Traumatic event, Unidirectional, Bankart lesion, Surgery
bankart lesion is 7-4 o'clock, anteroinferior`
54
inferior labral lesion
AMBRI: Atraumatic, Multidirectional, Bilateral, treat with Rehab, Inferior capsular shift surgical intervention if rehab fails
55
complication of anterioinferior dislocation
brachial plexus injury
assess for neural tension if pt experiences N/T
56
subjective of GHJ instability
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
objective of GHJ instability
+ sulcus signL inf instability/multidirectional
+ apprehension/relocation tests: anterior
+ jerk test?: posterior
58
intervention for GHJ instability
strengthen RC, shoulder stabilization progression
focus on IR for anterior instability to provide posterior glide
59
GHJ OA
loss of joint space and cartilage degeneration
results from trauma
leads to increased ligament laxity, decreased stability, and osteophyte formation
60
subjective of GHJ OA
gradual onset, deep pain, stiffness all direction
progressive loss of ROM and function
history of trauma to shoulder
61
objective of GHJ OA
forward humeral head, protraction
joint line tenderness
swelling
decreased AROM/PROM, esp ABD and ER
crepitation
imaging shows joint space narrowing
62
GHJ OA interventions
improve GHJ flexibility, RC strengthening
control pain for progressive condition, avoid total shoulder replacement when pt loses function
63
SAPS
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
types of acromions
flat - 17%
curved - 43%
hooked - 40%
flat is ideal, hooked is worst for joint space
65
subjecive of SAPS
pain lateral arm near deltoid/anterior shoulder
functional loss
can't sleep on involved side
pain with ADLs, esp flexion/IR
66
stages of SAPS
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
special tests of SAPS
hawkin's kennedy
painful arc
ER iso
+ neer's, empty/full can
68
interventions for SAPS
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
RC tear
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
subjective of RC tear
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
objective of RC tear
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
RC special tests
drop arm (supra)
empty can
lift off (subscap)
diagnose by MRI
73
RC tear intervention
strengthen RC and scapular stabilizers
full thickness tear often needs surgery
74
criteria for surgery for RC tear
<60 y/o
failure to improve w conservative treatment
full thickness tear
pt requires shoulder for work
pt consent
75
RC repair options
single, double, suture bridge, or transosseous repairs
double seems to repair tissue at humeral insertion point better
76
RC repair success stats
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
safe MVIC level after early RC repair
15%
78
RC phases of rehab
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
RC healing times
repair at 20% strength 6 weeks, 30-50% at 12 weeks
caution with resistance exercise through 15 weeks
80
SLAP lesion
injury to superior labrum and biceps attachment
81
MOI of SLAP
repetitive injury or trauma such as FOOSH, deceleration fall/catch
82
type 1 SLAP lesion
degeneration of sup. labrum edge
reduced ability to h. abd or ER due to pain
83
type 2 SLAP
detachment of labrum and biceps anchor
84
type 3 SLAP lesion
vertical tear with remaining portions intact
85
type 4 SLAP lesion
vertical tear extending into biceps tendon, tear and flap displacing into GH joint
86
type 5 SLAP lesion
Bankart lesion of anterior capsule extending into anterior superior labrum
87
type 6 SLAP lesion
disruption of biceps tendon anchor with ant/post superior labral flap tear
88
type 7 SLAP lesion
extension of SLAP lesion nteriorly into inf/middle GH ligament
89
subjective of SLAP tear
trauma/overuse with pain/instability in overhead activities
click/catch
90
objective of SLAP
similar symptoms to RC and instability
pain
clicking
91
special tests for SLAP
Obriens
active compression
crank
biceps load I and II
Kim?
Jerk
92
intervention for SLAP
dynamic stabilization
93
SLAP repair protocol
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
thoracic outlet syndrome
symptoms attributable to compession of neurovascular bundle in thoracic outlet
brachial plexus, subclavian artery/vein
clavicle, first rib, scapula
95
subjective of TOS
diffuse arm/shoulder pain overhead
widespread symptoms in UE/head
N/T, parasthesia, weakness, heavy, swelling
neural compression most common
96
objective of TOS
swelling
different distal pulses
differing sensory and motor function of peripheral nerves
+ special tests
c8-T1 most commonly compressed
97
TOS special tests
adson, allen, roos
98
TOS intervention
correct postural abnormalities with stretching and strengthening/mobilization
99
criteria for TOS surgery
failure to respond to PT
muscle atrophy
intermittent paresthesia replaced by sensory loss
incapacitating pain
