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Summer FDTN Exam 4 > Shoulder 2 > Flashcards

Shoulder 2 Flashcards

1
Q

In younger patients, high energy trauma results in

A

Humerus fractures!

While in elderly, MCC is a simple fall

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2
Q

How do humerus fractures present

A

Severe pain
Limited ROM
Swelling
Ecchymosis

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3
Q

How do you classify a humerus fracture

A

Neers classification for the proximal humerus; based on location, fracture parts, and displacement

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4
Q

What are the types of humerus fractures

A

Two, Three, or Four part
Transverse
Oblique
Spiral (like a candy cane)

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5
Q

A posterior fracture preserves

A

Extension! B/c it does not affect the radial nerve?

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6
Q

What is Subacromial Impingement Syndrome

A

most frequent cause of shoulder pain!

Decreased subacromial space

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7
Q

What is the MOI of a subacromial impingement

A

Repetitive microtrauma to supraspinatus tendon, subacromial bursa, and long head of biceps

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8
Q

What can cause increased compression in SAIS

A

increased inflammation affecting volume in subacromial space

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9
Q

Tendon degeneration can be caused by

A

Inflammation
Repetitive microtrauma
Reduction in stress intolerance

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10
Q

What are the types of acromion morphology

A

I: Flat
II: Curved
III: Hooked

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11
Q

Hooked acromion results in

A

Increased subacromial pressure and decreased space
More contact with rotator cuff tendons
Increased risk of SAIS= increased risk of rotator cuff tear

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12
Q

What is a primary impingement

A

Driven by degenerative changes
MC in 35+ y/o
Associates osteophytes and calcified deposits
This is true or classic impingement

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13
Q

What is secondary impingement

A

Due to repetitive overhead movement (Abduct and ER)
MC <35 y/o, overhead athlete
Faulty scapular posture (hunched forward)

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14
Q

What contributes to faulty scapular posture

A

Forward head, Increased thoracic kyphosis

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15
Q

Faulty scapular posture leads to

A

adaptive muscle imbalance
tight pec minor= anterior tilting and protraction= decreased subacromial space= impingement= inflammation and degeneration of subacromial structures

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16
Q

SAIS presents with

A

Gradual onset antero/lateral shoulder pain, worse w/ overhead activity
Night pain and difficulty sleeping on affected side
TTP over greater tuberosity, subacromial bursa, and long head of biceps tendon

17
Q

Impingement tests are

A

Neers (No pain from 45-60 and >170)

Modified Hawkins-Kennedy

18
Q

Strength testing for SAIS includes

A

Empty can test (supraspinatus)
ER against resistance (infraspinatus)
Lift off (subscap)- internally rotate behind back and push against provider’s hand

19
Q

Muscles of the rotator cuff are

A

Supreaspinatus: Abduction
Infraspinatus: ER
Teres minor: ER
Subscapularis: IR

20
Q

What radiographs can you get with SAIS suspicion

A

X-ray: always if traumatic, to r/o Fx, eval for calcifications, bone spurs, and acromial morphology

21
Q

How do you treat SAIS

A

NSAIDs
avoid offending activities
PT and home therapy to correct posture

22
Q

If there is no improvement in 6 weeks of SAIS w/ initial therapy

A

Consider subacromial injection and continued therapy

Surgery (subacromial decompression) if failed conservative care, or if you have a calcification or bone spur!

23
Q

What causes rotator cuff tear

A

MC: Overuse (age related degeneration, chronic mechanical impingement)
Traumatic
Full thickness is NOT common <40

24
Q

Rotator cuff tears typically originate

A

in Supraspinatus tendon, and may progress

25
Q

How do rotator cuff tears typically present

A

Recurrent shoulder pain for months, or specific injury triggering Sx
Subacromial pain, Pain localized to deltoid tuberosity
Night pain and difficulty sleeping on affected side
Weakness, catching, grating when lifting arm overhead

26
Q

On rotator cuff PE you may find

A

TTP over subacromial space
Decreased ROM (shoulder shrug w/ abduction)
+ drop arm test
Pain/weakness w/ isolation of involved RC muscles

27
Q

What imaging should you get for rotator cuff injuries

A

XR: all traumatic injuries to r/o Fx, eval for calcifications and bone spurs
GOLD is MRI*: if chronic or concern for partial tear add arthroscopy. If full thickness, don’t need arthrogram

28
Q

What is non-surgical Tx of rotator cuff

A

NSAIDs, PT, avoid overhead activities if <5-% tear

Steroid injection to decrease inflammation of subacromial bursitis, and short term pain relief

29
Q

Why should pts not get more than 3 subacromial injections per year

A

can lead to weakened tendon, and accelerate propagation of the tear

30
Q

When would you preform surgery to fix a rotator cuff

A

Significant Sx and failed rehab >3-6 months

Acute traumatic cuff tear (surgery w/in 6 weeks of injury!)

31
Q

What is adhesive capsulitis

A

Idiopathic loss of active and passive motion
MC affects patients 40-60
Due to inflammation in GH capsule

32
Q

Adhesive capsulitis is related to these comorbidities

A

MC* DM type 1

Also, hypothyroid, cervical herniation (what level???????), Parkinsons, and Dupuytren contracture

33
Q

Adhesive capsulitis leads to

A

gradual loss of ROM that pt is not aware of

mechanical restriction- ER (MC*), abduction, and flexion

34
Q

When evaluating adhesive capsulitis, you may find

A 
Reduced ROM (50% or more) in ER (mostly), flexion and abduction 
Pain dull and achy at rest, sharp at end ROM of GH joint 
Diffuse shoulder ttp
35
Q

XR can be used for what in adhesive capsulitis

A

R/o other pathology

36
Q

MRI can be used for what in adhesive capsulitis

A

contracted capsule and loss of inferior pouch on arthrography

37
Q

What are the phases of adhesive capsulitis

A

Freezing: pain and progressive loss of motion
Thawing: decreased discomfort associated w/ slow but steady improvement in ROM
-can take 6 months-2 years for resolution aka end of thawing phase

38
Q

How do you treat adhesive capsulitis

A

Intra-articular steroid injection
PT (aggressive ROM)
Consider for pain control prior to PT visits
If no improvement in 9-12 months, consider surgery

Summer FDTN Exam 4 (14 decks)

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