Shoulder Flashcards
Anterior + lateral shoulder pain, pain with overhead motion
Night pain w/ sleeping on shoulder
Pain with internal rotation (getting dressed)
+/- crepitus or catching
impingement syndrome
Tendinitis, shoulder bursitis causing impingement of acromion, coracoacromial ligament, AC joint inflammation → can lead to RTC tear
impingement syndrome
Neer impingement sign
Hawking’s impingement sign
Empty can test
PE: tenderness over the greater tuberosity + subacromial bursa
Crepitus w/ ROM
Atrophy
Can inject for diagnosis
impingement syndrome
How do you treat impingement syndrome?
NSAIDs, stretching posterior capsule
Subacromial injection
Weakness + pain with overhead movement
Night pain
RTC injury
MCC = supraspinatus
Partial can cause impingement syndrome
RTC injury
PE: limited AROM, but PROM is normal
Empty can
+/- tenderness
Large tears = patient cannot raise arm when asked – only can shrug
MRI
Can consider ultrasound, MR arthogram/shoulder
RTC injury
How do you treat a RTC injury?
Partial tear can heal w/ scarring, PT, NSAIDs, steroid injection
Young, active patient w/ acute full thickness tear → surgery
Older, sedentary patient w/ full thickness tear = PT, surgery if no response
ANTERIOR:
Obvious deformity, patient holding arms externally rotated
POSTERIOR:
Patient holds arm internally rotated, hard to push door open
ATRAUMATIC/CHRONIC: sliding sensation with spontaneous reduction
shoulder dislocation
anterior or posterior shoulder dislocation: arm externally rotated
anterior
anterior or posterior shoulder dislocation: arm internally rotated
posterior
shoulder dislocations are mostly —-
anterior
What are two types of lesions that can help verify a shoulder dislocation?
“Hill-Sachs” lesion → indented compression fractures at posterior superior part of humeral head = anterior
Bankart lesion → tear in the anterior labrum surrounding the shoulder joint
Always, always, always check –
neurovascular status
How do you treat a shoulder dislocation?
ACUTE: reduce ASAP
→ TUBS - traumatic, unilateral, Bankart lesion, surgery
CHRONIC: PT, activity modification
→ AMBRI: atraumatic, multi-directional, bilateral, rehab, inferior capsule repair
TUBS
shoulder dislocation – ACUTE
traumatic, unilateral, Bankart lesion, surgery
AMBRI
shoulder dislocation – CHRONIC
atraumatic, multi-directional, bilateral, rehab, inferior capsule repair
Limited ROM w/ active + passive movement
Painful, tender at joint
adhesive capsulitis
What are RF for adhesive caspulitis?
40-65 years
women>men
Hypothyroidism
DM
What are the three phases of the “frozen shoulder”?
Inflammatory (4-6m)
Freezing (4-6m)
Thawing (~12m)
For adhesive capsulitis, you should – to rule out tumor or deposits, or fractures
XR
How do you treat adhesive capsulitis?
NSAIDs, PT
Consider manipulation under anesthesia after 3 months of failed treatment
Pain and stiffness –
Around shoulder + upper arm
Night pain
Progressive loss of motion
Difficulty with ADLs
commonly in >50
shoulder arthritis
What can be causes of shoulder arthritis?
Osteoarthritis
Rheumatoid arthritis
Post-trauma
RTC arthropathy
Wasting of muscles, tenderness all around shoulder
Crepitus
Decreased ROM w/ active + passive
XR: joint space narrowing, osteophytes, cysts
shoulder arthritis
How do you treat shoulder arthritis?
NSAIDS, activity modification, ice/heat, ROM exercises, steroid injection
Replacement surgery
Cannot raise arm, bump at fracture site, grinding with ROM
Skin “tented” over fracture
clavicle fracture
What are the MC bone injuries?
clavicle fracture
How do you treat a clavicle fracture?
Closed treatment -
sling/immobilizer/figure of 8 harness
3-4 weeks if <12 years
4-6 weeks if >12 years
ROM
No contact sports 6-12 weeks
Surgery becoming more common
Pain, swelling, discoloration, w/ inability to move arm, open or closed
deformity
proximal humerus fracture
proximal humerus fractures are common in –
elderly, obese, women w/ osteoporosis
a proximal humerus fracture happens from –
high energy trauma, fall on outstretched arm
proximal humerus fracture diagnosis
Check for brachial plexus + axillary artery injury (numbness/tingling, radial pulse)
XR: AP/lat/Y views
CT scan for pre-op
How do you treat a proximal humerus fracture?
Minimal displacement <1cm = sling for 1 week, ROM at least 1 week
> 1cm = surgery
4 part fracture often needs shoulder replacement, especially if >40 years old
Pain on back of shoulder, skin abrasions, tenderness, pain w/ motion
common with many, many other injuries, often overlooked
scapula fracture
How do you treat a scapula fracture?
Sling
ROM 1-2 weeks after injury
> 2 cm separation of glenoid → surgery
Consider pulmonary contusion if fracture of scapular body
Sudden, sharp pain in upper arm w/ audible snap
Bulge in lower arm
biceps tendon rupture
Bicep tendon rupture is more common in
older men
bicep tendon ruptures are associated with –
rtc tears
Ludington’s test accentuates bulge (show me your muscles)
Ecchymosis in mid-lower arm
XR: negative
Arthrogram if suspected RTC tear
Popeye sign
biceps tendon rupture
How do you treat a biceps tendon rupture?
Conservative – PT
Elderly is frequently associated w/ RTC tear
<40 years or active → surgery
Pain to palpation, cannot lift arm
Grade III = clear deformity
Commonly from fall onto tip of shoulder w/ arm tucked in, contact sports
acromioclavicular joint injury
—- classification for acriomioclavicular joint injury
rockwood
treatment for acromioclavicular joint
Type I + II = sling
Type III = controversial
Type IV+ = surgery
