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Ortho > Shoulder > Flashcards

Shoulder Flashcards

1
Q

15-35 y/o usually present with which kind of shoulder injury?

A

Rotator cuff dysfunction

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2
Q

> 40 y/o usually present with which kind of shoulder injury?

A

Degenerative change

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3
Q

40-60 y/o usually present with which kind of shoulder injury?

A

Frozen shoulder

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4
Q

Does frozen shoulder generally affect men or women more?

A

70% more women

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5
Q

FOOSH injury can cause

A

a SLAP lesion

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6
Q

A fall where the person lands on their elbow can cause

A

an AC separation- it drives the humeral head up against the acromion

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7
Q

Night pain, pain at rest generally means

A

Rotator cuff injuries

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8
Q

Lifting the arm over the head by a patient with instability or inflammation usually

A

exacerbates shoulder problems

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9
Q

Deep, boring, achy, pain in the neck or shoulder could possibly indicate

A

Thoracic outlet syndrome with or without radiculopathy

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10
Q

If the limb becomes tired after movement, this could indicate

A

vascular involvement

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11
Q

Usually the dominant shoulder

A

is often lower and shows greater muscularity and a decrease in ROM

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12
Q

Inspection of the Anterior view of the shoulder: “Step deformity”

A

AC dislocation, clavical lying superior to the acromion. It also indicates a tear of the acromioclavicular and possibly the coracoclavicular ligaments

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13
Q

Inspection of the Anterior view of the shoulder: “Sulcus Sign”

A

Appears with distal humeral traction, indicating multidirectional instability and a loss of muscle control due to a nerve injury

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14
Q

Inspection of the posterior view of the shoulder: “Classic Scapular winging”

A

the vertebral border of the scapula moves away from the chest wall, may be seen in weak or paralyzed serratus anterior or long thoracic nerve injury which is innervated by the C5, C6, C7, nerve roots.

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15
Q

Classic winging can be caused by which radiculopathies?

A

C3, C4 (trapezius)
C5 (rhomboids)
C7 (serratus anterior, rhomboids)

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16
Q

Inspection of the posterior view of the shoulder: “scapular tilt”

A

Also called “inferior border” winging ( the most common winging- the inferior border is tilted away from the chest wall) may occur due to weakness of the lower trapezius, latissimus dorsi, serratus anterior, or most likely a tight pectorals minor pulling on the coracoid process

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17
Q

AROM

A

Performed in a sitting position with painful movements last

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18
Q

Apley’s scratch test

A

Combines a bunch of movements to see where the problems is, medial rotation, extension and adduction, lateral rotation, flexion and abduction. Dominant shoulder may show restrictions, unless the activity the patient performs (pitching) happens to increase the ROM of the dominant shoulder

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19
Q

AROM: Shoulder flexion

A

180

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20
Q

AROM: Shoulder extension

A

60

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21
Q

AROM: Abduction

A

170-180

22
Q

AROM: Adduction

A

50-75

23
Q

AROM: Internal rotation

A

60-100

24
Q

AROM: External rotation

A

80-90

25
Q

IZ needed for Shoulder balancing treatment at the JOINT level of dysfunction

A

Infraspinatus
Teres Minor
Supraspinatus
Subscapularis

26
Q

IZ needed for Shoulder balancing treatment at the GIRDLE level of dysfunction

A

Rhomboids (Major/Minor)
Pectoralis (Major/Minor)
Lower Trapezius
Serratus Anterior

27
Q

The types of conditions often seen with improper glenohumeral arthrokinematics are:

A 
Rotator cuff injury 
Bicipital tendinopathy 
Subacromial Bursitis 
Impingement Syndrome (secondary leading to primary) 
Degenerative changes
28
Q

Glenohumeral Artrokinematics

A

Major reasoning behind most shoulder issues, both the shoulder girdle and the joint should be addressed during treatment because rarely is it purely one or the other

29
Q

Tears involving tendons, ligaments, and cartilage

A

They do not receive a good blood supply so they will either not heal completely or contribute to instability of the joint involved. Acupuncture can only increase the circulation of Qi to the structures and help with the body’s response to the pain.

30
Q

Main distal points for the shoulder

A

LI-4: relieves pain and opens the channel
Linggu, Dabai: Master Tung points, great for pain anywhere on the body, but also great shoulder points
TW-5: Luo pt. activates the channel and alleviates pain, expels wind and releases the exterior
LU-5: He-Sea point, relaxes sinews and alleviates pain, especially for anterior shoulder pain and Qi stagnation
SI-3: Good channel point, for posterior pain, infra, trees minor, upper back
SI-6: Xi-cleft point, good channel point for acute posterior shoulder pain
LI-10: Any shoulder problem, especially supraspinatus issues

31
Q

significant distal points

A

ST38- Shoulder pain along the LI channel, Yang Ming connection

GB34- Shoulder pain along the TW channel, Shao Yang connection, He Sea point

BL58- shoulder pain along the SI channel, Tai Yang connection, Luo point

*palpate bilaterally to find the most tender point. Can be needled when local points are not indicated and to improve ROM by decreasing acute pain.

32
Q

May present with a history of shoulder injury wroth pain located over the anterior/lateral glenohumeral head, typically LI15. Pain also presents at night, difficult to find a comfortable position. Possible painful areas are between 60-120 degrees of abdunction, worse with RROM. If PROM produces pain, it is usually with the shoulder flexion and abduction at end range where the insertion of the tendon may be impinged. Often the shoulder will show an upper crossed pattern

A

Supraspinatus Tendinopathy/Injury HIPS

33
Q

Test to confirm Supraspinatus tendinopathy

A

Empty Can Test

MMT PROM ABD first 20 degrees

34
Q

TCM DX of Supraspinatus tendiopathy

A

Qi and Blood Stagnation of the LI, SI meridians

35
Q

TX of Supraspinatus tendinopathy

A

Disperse stagnation in effected meridians, address any underlying imbalance such as LV blood deficiency, SP Blood deficiency etc.

36
Q

Acute: rest with ice 24-48 hours after injury
Local: EA 4 hz LI15-SI12, or LI15-LI10, depending on pain referral: 40 min., SI12
Distal: Xi Cleft LI7, LU6, SI6, TW7 as needed, LI10, LI4, TW5 threaded to TW8, ST38 (same side), ST42

Chronic:

local: LI15, TW14, LI16, SI12
distal: TW5 threaded to TW8, LI10. LI4, ST38 (ss), IZ: infra, supra, teres minor, subscap

A

Supraspinatus TX points

37
Q

Indicates further progression of muscular imbalance in the rotator cuff resulting in repetitive stress injury, subacromial thickening or swollen supraspinatus tendon attachment

A

Impingement Syndrome: HIPS

38
Q

populations >40 y/o is usually d/t degenerative changes in the rotator cuff, acromion process, the corticoid process and anterior tissue. This type of impingement may involve an acromion spur. In these patient poor muscle dynamics also exist.

A

Primary Impingement

39
Q

in young patients (15-35) anterior shoulder pain is usually due to problems with muscle dynamics involving the glenohumeral and scapulothoracic articulations.

A

Secondary Impingement

40
Q

Posterior impingement may occur in…

A

throwing overhead but it is not seen in the general population

41
Q

Tests performed with diagnosing impingement syndrome

A

Neer impingement test

Hawkins-Kennedy Impingement test

42
Q

TCM DX of Impingement syndrome

A

Q/B stagnation of the LI, SI meridians, Bi syndrome in Primary (usually cold or bone bi), LV Qi stag, possibly SP blood def.

43
Q

TX of Impingement Syndrome

A

Dispel Bi, Move Qi and Blood, Smooth LV Qi, Build SP blood, relax sinew channel

44
Q

“Shoulder balancing treatment-joint level”: IZ of the Infra, Supra, SubScap, and Teres minor

SI3, SI9, SI11, GB21, SI14, TW14, LI4, LU7, LI10, LI16, LI15

A

TX point for secondary Impingement

45
Q

Mechanism of Injury can be falling and bracing arm which drives the humeral head up into the AC joint. Pain with PROM elevation, especially when they cross their arm and touch the opposite shoulder. Point tenderness over distal end of the clavicle, directly over the AC joint is a great way to determine this pathology as the pain tends to be specific. Possibly over coraco-clavicular ligaments as well if its involved. Step deformity of the clavicle, on the acromion sign may be seen

A

AC Sprain/Arthritis

46
Q

TCM Diagnosis of AC Sprain/Arthritis

A

Qi and Blood stagnation of the LI and TW meridians

47
Q

TX of AC Sprain/arthritis

A

Move Qi and Blood in LI and Tw

  • when acute do not needle into the joint
  • when chronic, osteoacupuncture is indicated

Local: LI16, LI15, LI10, TW14
Distal: SI12, Gb34, LI1, TW1

48
Q

Commonly idiopathic (without known cause). Decrease in PROM of arm into abduction and external/lateral rotation. Can follow a period of pain in the shoulder with muscle guarding but can also be considered to be an unknown cause. It about 1/3 of cases, frozen shoulder can occur in both arms. Women are more affected than men and its unusual onset begins between ages of 40 and 65. This condition affects approximately 10% to 20% of diabetics. The process itself is when the capsule becomes fibrous tirruse causing the inferior olds of the capsule to become adhered to each other

A

Frozen shoulder HIPS

49
Q

4 stages of Frozen shoulder

A 
initial (most pain 0-3 mo) 
freezing stage (3-9 mo)
frozen stage (decease in pain, 9-15 mo) 
thawing stage (15-24 mo)
50
Q

TCM DX of frozen shoulder

A

wind cold invasion with progression from cold bi to fixed bi

51
Q

Dispel fixed or painful bi, move Qi and Blood, relax the sinew channel

Local: LI15, GB21, TW14, sticky needle subscap
Distal: LI10, LI4, LU7, GB34, ST38

A

Treatment of Frozen shoulder

Ortho (4 decks)

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