shoulder Flashcards
Shoulder instability/subluxation:
Instability = abnormal motion at the glenohumeral joint
Types:
- Traumatic = Usually anterior; Bankart lesion: labrum detachment from glenoid rib + unidirectional
- Atraumatic = Often bilateral & multidirectional
PE:
- Apprehension test: pain + palpable clunk = labrum tear
Dx: AP, Y scapula, axillary view
- MRI/MR arthrogram if soft tissue suspected
Tx: PT, surgery if recurrent instability
Anterior glenohumeral dislocation:
- MC type of dislocation
- Trauma/blow to abducted, externally rotated and extended arm - blocking a basketball shot***
- PE:
○ Abducted, Externally rotated arm **
○ Prominent acromion with loss of normal contour - Associated injury:
○ Hills sach - cortical depression of humeral head
○ Bankart lesion - glenoid rim fracture
○ Axillary nerve -> check neurovascular status post dislocation!!! (very common)
§ - Tx: reduce and sling, PT
AC joint separation - shoulder separation: AC vs CC; presentation
AC ligament = horizontal stability
coracoclavicular ligament = vertical stability
presentation:
- direct blow to adducted shoulder
- pain with lifting arm, decreased ROM and pain with movement of arm
- local tenderness
- obvious deformity at AC joint, prominent distal clavicle
AC joint separation grades
I: normal xray - ligament sprain
II: slight widening - AC rupture, CC sprain
III: significant widening - AC and CC ruptured
IV: III AND displacement of the clavicle into the trapezius
V: IV AND disruption of the clavicular attachments
VI: clavicle falls underneath coracoid
I-III: conservative tx
IV-VI: surgery
MCC shoulder pain > 40 yrs old
rotator cuff tear
rotator cuff injury: presentation, etiology, tx
- SITS: supraspinatus, infraspinatus, teres minor, subscapularis
- MOA:
○ Degeneration - chronic, older age
○ Impingement
○ Overload - tension overload in athlete, repetitive overhead movement - Presentation:
○ OVERHEAD PAIN
§ Pt is reaching up; brushing hair
§ Pain over the lateral deltoid
○ PAIN AT NIGHT
○ tendonitis: associated with subacromial bursitis
Can’t sleep due to pain at night
- MOA:
tx:
- tendonitis: PT, NSAIDS, injections, PRP
-RTC: conservative, surgery if complete tear or no response to conservative
rotator cuff injury: special tests
● Empty Can Test; 90% specificity or
assessing supraspinatus involvement
● Hawkins Test; Elbow/shoulder flexed @90deg with anterior shoulder pain with IR
● Drop Arm Test; Pain with inability to lift arm shoulder height or hold it up, or pain when slowly lowering the arm.
● Neer Test; Arm fully pronated with pain during forward flexion while shoulder is held down to prevent shrugging.
Adhesive capsulitis: frozen shoulder
- Painful and stiff glenohumeral joint that lost distensibility and ROM (PROM AND AROM)
- Risk factor:
○ DM!!!!! (type 1DM = 70% chance of getting it)
○ Thyroid ds
○ Female 50-60s - Dx: clinical
Tx: self-limited (recovery in 18-30 months); sx relief: PT, glucocorticoid injections, NSAIDS
- Risk factor:
clavicle fractures
MC fracture in what popuation what groups
M.C. fx. In children, adolescents & newborns @ birth***
➔ Group I: midshaft, middle 1⁄3 (m.c)
➔ Group II lateral, distal third
➔ Group III: proximal, medial third
clavicle fractures
mechanism, PE, tx, complicaiton
Mechanism: FOOSH, cancerm child abuse
PE:
● Pain with ROM
● +deformity
● Often holds arm against chest
Tx:
- sling immobilization 6-12 wks adults; 3-6 wks children
- operative: open fractures, displaced with skin tenting, subclavian artery or vein injuries, severe displacement, shortening
complication: Brachial plexus injury=peripheral neuropathy
Proximal Humerus Fracture
mechanism:
- FOOSH
- metastatic breast cancer
dx: xray, CT for preop plan
tx: Majority are nondisplaced and
treated sling immobilization, p.t.
complication: Axillary & subscapular nerve
(weakness with abduction & ER) injuries
Biceps Tendonitis
Inflammation of the long head of the biceps tendon. Overuse injury - repetitive overhead activities, lifting
sx:
● Pain or tenderness anteriorly, which
worsens with overhead lifting or activity
● Pain or achiness that is referred distally
● An occasional snapping sound or sensation
PE: SPEEDS TEST**
Tx:
● Non - Operative: Rest, Ice, NSAIDs, Steroid injection,
Physical Therapy
● Operative - refractory cases, Biceps Tenodesis
biceps tendon rupture
The proximal long head of the biceps tendon.
Signs & Symptoms
● Sudden pain accompanied by an a audible snap; then mild pain
Diagnosis
● Clinical - Have patient flex their arm
● MRI: confirm or r/o RTC tear
tx:
- conservative: usually subsides and pt regains full ROM
- operative: young pt or athlete
Humeral Shaft Fracture
Mechanism:
● FOOSH
P/E:
● Arm pain & swelling, ecchymosis,
decreased ROM
● Rule out Radial Nerve Injury (wrist drop***, weakness with wrist, finger & thumb extension, decreases sensation dorsal web space between thumb & index.
Tx:
● Non-operative: Majority -
Coaptation splint
● Operative: open, vascular or nerve injury
