Shoulder Flashcards
What are the five overall categories of shoulder conditions?
- Instability (Hypermobility)
- Hypomobility (Adhesive Capsulitis)
- Rotator Cuff Conditions (Tendinopathy, Partial-Thickness Tear…)
- Intra-Articular (Mostly Labral)
- Extra-Articular (Mostly Biceps & AC joint)
These categories help in classifying shoulder conditions to aid in diagnosis and treatment.
What is the significance of High Sensitivity (SnNOUT) in special tests?
Helps rule out conditions when the test result is negative
High sensitivity tests are crucial for ensuring that a disorder is not present.
What are the two important metrics in clinometrics for shoulder special testing?
- Sensitivity (True Positive Rate)
- Specificity (True Negative Rate)
Understanding these metrics helps in evaluating the effectiveness of special tests.
What does a Positive Likelihood Ratio (+LR) greater than 10 indicate?
A large conclusive shift in probability, suggesting a high likelihood of the disorder being present
It is considered a ‘slam dunk’ for confirming a diagnosis.
What are the risk factors for Shoulder Instability?
- Young Age
- Athletes involved in overhead sports
- Generalized ligamentous laxity
These factors contribute to the likelihood of developing shoulder instability.
What is a common symptom of Rotator Cuff Tear?
Constant achiness, night pain, and pain that wakes the patient
Symptoms can significantly impact the patient’s quality of life.
What does the Capsular pattern indicate in Adhesive Capsulitis?
- External rotation loss most limited
- Then abduction
- Then internal rotation
This pattern helps in diagnosing adhesive capsulitis.
True or False: The majority of shoulder conditions can be classified as either instability or hypomobility.
True
These classifications help in guiding treatment options.
Which tendon inserts medial to the Bicipital Groove?
Subscapularis
Which tendons insert lateral superior to the Bicipital Groove?
Supraspinatus
Where does the Infraspinatus and Teres Minor insert?
Middle just below the Bicipital Groove
What is inserted more distally medial to the Biceps Groove?
Pectoralis Tendon, Lat Dorsi, Teres Major
What is necessary for differentiation when assessing shoulder symptoms?
Additional testing to rule out non-MSK pathology
What should be screened for any patient complaining of shoulder pain?
C-Spine
What is the Arm Squeeze Test used for?
Differentiation of Neck vs Shoulder pain
What indicates a positive Arm Squeeze Test?
Pain rating at least 3 points higher on VAS during arm squeeze
What does the Shoulder Symptom Moderation Procedure (SSMP) involve?
Movement differentiation and symptom testing
What are the components of the SSMP?
- Thoracic Kyphosis
- Scapular Position
- Humeral Head Procedures
- Symptom neuromodulation
What does the Zaslav test assess?
Shoulder conditions based on strength testing
What does a positive result in the Zaslav test indicate?
- Rotator Cuff Pathology (IR MMT»ER MMT)
- Extra-Articular Pathology (IR MMT ~~ ER MMT)
- Intra-Articular Pathology (IR MMT«ER MMT)
What are the tests included in the Rotator Cuff Tendinopathy / Impingement Syndrome cluster?
- HK
- Infraspinatus Muscle Test
- Painful Arc
CPR for use of C-T-Spine OMPT for Shoulder Pain
- Pain free shoulder FLX < 127°
- Shoulder IR < 53° at 90° Abduction
- Negative Neer’s Impingement
- Not taking pain medications
- Duration of symptoms < 90 days
What are the risk factors for adhesive capsulitis?
Most commonly affects individuals between 40 and 60 years old. More prevalent in females than males. Associated conditions: Individuals w/ diabetes or thyroid disorders are at a higher risk
What are the key symptoms of Tendinopathy or SIS?
Anterior-lateral pain, pain with overhead motion/painful arc, night pain
SIS stands for Sub-acromial Impingement Syndrome.
What are the symptoms of a Rotator Cuff Tear?
Anterior-lateral pain, constant achiness, night pain, compensatory shoulder shrugging with overhead motion, gross functional disabilities, age > 40
Night pain may wake the individual.
What are the characteristics of Anterior Capsulolabral instability (Bankart or anterior labral lesions)?
Deep posterior pain, apprehension or pain in positions of ABD and ER, history of anterior-inferior trauma, recurrent or volitional anterior/inferior subluxations/dislocations, joint clicking/clunking, complaints of joint locking, history of ‘dead arm syndrome’
ABD stands for abduction, ER stands for external rotation.
What symptoms are associated with Posterior Capsulolabral instability (Labral lesions)?
Deep posterior pain, apprehension and/or pain during activities of pushing (especially coupled with horizontal ADD), apprehension or pain during CKC positions, history of posterior-inferior trauma, recurrent or volitional posterior/inferior subluxations/dislocations, complaints of joint clicking/clunking
CKC stands for closed kinetic chain.
What are the common signs of SLAP lesions?
Deep shoulder pain, complaints of clicking/clunking, complaints of joint locking, pain with eccentric deceleration of the UE (e.g., throwing or swinging), pain with muscle loading of the biceps (especially during shoulder flexion and arm supination)
SLAP stands for Superior Labrum Anterior to Posterior.
What defines Articular sided internal impingement syndrome of the rotator cuff?
Very specific posterior/superior pain during shoulder ABD and ER, possible pain during eccentric deceleration of the UE (e.g., throwing or swinging)
ABD stands for abduction, ER stands for external rotation.
What are the symptoms of LHB tendinopathy?
Anterior pain, pain with palpation of the proximal LHB, pain with activities requiring eccentric deceleration of the UE (e.g., throwing or swinging), pain with muscular loading of the biceps (shoulder flexion and arm supination)
LHB stands for Long Head of the Biceps.
What are the key characteristics of AC joint lesions?
Superior joint pain, pain with end-range elevation activities, pain with horizontal ADD activities, painful palpation of the AC joint, step-off deformity of the AC joint
AC joint stands for Acromioclavicular joint.
Peptic ulcer referral pattern
right shoulder, lateral border, right scapula
Gallbladder referral pattern
right upper trap, right shoulder
liver disease (hepatitis, cirrhosis, metastatic tumor, abscess) referral pattern
right shoulder, right subscapular
Pancreas referral pattern
Left shoulder
Diaphragm referral pattern
Ipsilateral shoulder
What tests are included in the full thickness rotator cuff tear CPR
- +DROP-ARM Test
- Painful Arc
- Infraspinatus Muscle Test
What is the most frequent direction of shoulder dislocation?
Anterior direction
Anterior dislocations occur more often than posterior or inferior dislocations.
What should be checked in case of an acute shoulder dislocation?
Neurovascular status
It is crucial to assess the nerves and blood vessels around the shoulder to prevent complications.
What is another traumatic associated condition with shoulder dislocations?
Labral tears
Labral tears can occur as a result of the dislocation, affecting the shoulder’s stability.
True or False: Collagen disorders can be associated with shoulder dislocations.
True
Certain collagen disorders may predispose individuals to joint instability and dislocations.
What is the primary cause of scapular fractures?
High Energy – MVC, Blunt force trauma
What major injuries are frequently associated with scapular fractures?
- Rib Fx
- TBI
- Spine Fx
What type of incidents can lead to non-accidental scapular fractures?
Child / domestic abuse e.g., blunt force
What is the mechanism of injury (MOI) for clavicle fractures?
Fall onto lateral shoulder or direct impact
These are common causes of clavicle fractures.
Which ligaments are key for displacement in clavicle fractures?
Coracoclavicular ligaments
They play a crucial role in maintaining clavicle position.
What are the two parts of the coracoclavicular ligaments?
Conoid (medial) and trapezoid (lateral)
They provide primary resistance to superior displacement.
True or False: The conoid ligament is located laterally.
False
The conoid ligament is the medial part of the coracoclavicular ligaments.
Fill in the blank: The conoid and trapezoid ligaments provide primary resistance to _______ displacement of the lateral clavicle.
superior
This resistance depends on the fracture location.
What is the key movement screen for clavicle dislocation?
Clavicle rotates 40-50° posteriorly with shoulder elevation
This movement is crucial for assessing clavicle stability.
What do the acromioclavicular (AC) ligaments control?
Horizontal motion and anterior-posterior stability
AC ligaments have superior, inferior, anterior, and posterior components.
What happens during an AC dislocation?
Disrupts AC and possible CC ligaments
This can lead to significant instability in the shoulder girdle.
What is the mechanism of injury (MOI) for a sternoclavicular (SC) dislocation?
Collision in contact sports or atraumatic if ligamentous laxity
Atraumatic dislocations may occur in conditions like Ehlers-Danlos syndrome (EDS).
True or False: SC dislocation is common.
False
SC dislocations are considered rare.
What is the classification for a type I AC dislocation?
Sprain, non-displaced
Type I indicates the least severe form of AC dislocation.
What characterizes a type II AC dislocation?
Less than 25% clavicle elevation, AC ruptured
Type II shows more severity with partial elevation.
What occurs in a type III AC dislocation?
Clavicle elevation, AC, CC ligaments & joint capsule ruptured, deltoid & trap detached
Type III involves complete disruption and detachment.
In a type IV AC dislocation, how is the clavicle positioned?
Displaced posterior into trap
Type IV indicates a posterior displacement of the clavicle.
What is the defining feature of a type V AC dislocation?
Elevated space greater than 25mm
Type V is characterized by significant elevation of the clavicle.
Describe the displacement in a type VI AC dislocation.
Clavicle displaced behind coracobrachialis and biceps tendons
Type VI is the most severe with posterior displacement.
When is the anterior G-H ligament under tension?
When the shoulder is in extension, abduction, and/or external rotation (ER).
When is the posterior G-H ligament under tension?
In flexion and external rotation (ER).
What positions put the inferior G-H ligament under tension?
When the shoulder is abducted, extended, and/or externally rotated.
Why is the inferior G-H ligament significant for overhead athletes?
It is likely the most important stabilizing structure of the shoulder in the overhead athlete.
Close packed position of shoulder
ABD 90 and Full ER or Full ABD and ER
Open packed position of shoulder
ABD 55 and Horizontal ABD 30
Shoulder Instability special tests
Sulcas Sign
Load & Shift
Apprehension
Relocation
Suprise Test
SIS, Tendiopathy, or partial thickness RCT special tests
Hawkins-Kennedy
Infraspinatus Muscle Test
Painful Arc
Neers
Full thickness RCT tear special tests
Infraspinatus Muscle Test
Painful Arc
Drop Arm Test
ER Lag Sign
Drop Sign (Not the same as Drop Arm Test) (infraspinatus)
Hornblower’s sign (teres minor)
Subscapularis tear special tests
Lift off sign
Internal rotation lag sign
Belly Press test
Bear Hug test
Labral Tear (Anterior / Bankart Tear) special tests
Anterior Slide (Kibler)
Crank Test
Active Compression Test (O’Brien)
Yergason
Superior Labral Anterior-Posterior (SLAP) Tear special tests
Biceps Load I
Biceps Load II
Kim Test
Jerk Test
Articular Sided Rotator Cuff Impingement (Posterior) special tests
Posterior Impingement Sign (ABER)
Long-Head Biceps Tendinopathy / Tendinosis special tests
Yergason’s
Speeds
Gilcrest Palm-Up test
Upper Cut test
AC (Acromioclavicular) special tests
AC Resisted Extension
Cross Body ADD
Active Compression
