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MSK > SHOULDER > Flashcards

SHOULDER Flashcards

1
Q

Lateral/anterior shoulder pain with overhead activities or exhibits a painful arc think what 3 pathologies

A

Subacromial impingement
Tendinitis
Bursitis

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2
Q

Instability, apprehension, and pain with activities, most often when shoulder is abducted and externally rotated, think, what 2 conditions

A

Shoulder instability

Possible labral tear if clicking is present

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3
Q

Decreased ROM and pain with resistance, think what 2 conditions

A

Rotator cuff

Long head of the biceps tendinitis

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4
Q

Pain and weakness with muscle loading, night pain; Age >60, think

A

RC tear

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5
Q

Poorly located shoulder pain with occasional radiation into elbow; Pain is usually aggravated by movement and relieved by rest; Age > 45; Females > Males, think

A

adhesive capsulitis

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6
Q

falling on the shoulder itself as an MOI, think

A

AC joint sprain

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7
Q

Upper extremity heaviness or numbness with prolonged postures and when lying on involved side, think

A

TOS

Vertebral radiculopathy

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8
Q

one non MSK pathology that would work for R and L side

A

MI

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9
Q

capsular pattern for GH joint

A

ER > abduction > IR > flexion

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10
Q

capsular pattern for other shoulder joints

A

px with extreme motions

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11
Q

when looking at posture, if there is an increased clavicular angle, this could indicate

A

tight upper trap

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12
Q

when looking at posture, if there is a depressed clavicular angle, suspect

A

lengthened upper trap

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13
Q

the spine of the scapula should be at level

A

T3

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14
Q

scapula lower on one side could indicate

A
  • Hand dominance
  • Long upper trap
  • Tight latissimus
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15
Q

elevated scap could indicate

A
  • Tight upper trap/levator scapulae

- Long lower trap

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16
Q

abd scap could indicate

A
  • Tight serratus anterior, pectoralis major

- Long mid trap, rhomboids

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17
Q

adducted scap could indicate

A
  • Tight mid trap, rhomboids

- Long pectoralis major, serratus anterior

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18
Q

what is ant tilted scap

A

inf angle lifted off

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19
Q

what could causes of ant tilt scap be

A
  • Tight pec minor

- Weak lower trap

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20
Q

upwardly rotated scap might indicate

A
  • Tight upper trap

- Weak rhomboids, levator scapulae

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21
Q

downwardly rotated scap might indicate

A
  • Tight rhomboids, levator scapulae

- Weak upper/lower trap

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22
Q

when you observe gross shoulder flexion, look for

A

• Pain
• 2:1 ratio humeral/scapular rhythm
• Symmetry in glenohumeral creases
- Deeper – not get enough inferior glide humerus
• End with 60⁰ scapular upward rotation
• Winging (with flexion and/or return from flexion)
• Appropriate scapular elevation
• Humeral position at end: medial or lateral rotation
• Minimal movement of spine

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23
Q

when you observe gross lateral rotation of shoulder at 90/90 look for

A
  • Scapula should not adduct during first 35 degrees motion
  • Humerus should rotate along vertical axis
  • Humeral head should be stable
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24
Q

main axns of upper trap and levator scap

A

elevate shoulders

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25
Q

main axn of middle trap

A

straight adduction of scap

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26
Q

axn of lower trap

A

adduction and depression of scap

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27
Q

main axn of rhomboids

A

retraction

DR

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28
Q

ant deltoids axn

A

main is flexion

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29
Q

coracobrachialis

A

flexion and adduction of shoulder

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30
Q

pec major

A

hor. adduction with some IR

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31
Q

supraspinatus

A

abd and ER

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32
Q

mid delts

A

abd

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33
Q

post delts

A

extension

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34
Q

shoulder extensors

A

Lats, teres major, post delt

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35
Q

main ER of shoulder

A

Infraspinatus, teres minor

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36
Q

IR of shoulder

A

Subscap, teres maj, lat dorsi, pec major

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37
Q

apley’s scratch test is for

A

general screen of ROM (reach over then under)

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38
Q

differentiating btwn supraspinatus and deltoid when doing resisted testing (other than location of px)

A

supraspinatus would not hurt with flexion and ext like the delt would

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39
Q

axns of teres major

A

adduction and medial rotation

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40
Q

subscap

A

IR only

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41
Q

capsular special tests (or instability tests)

A 
All (apprehensive)
Roads (relocation)
Lead (load and shift)
to
Sulcus (sulcus)
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42
Q

explain the apprehension test

A

they are supine, really you just ER shoulder and watch for apprehension or px

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43
Q

what is relocation test

A

you do it after the apprehension test
supine, you push the capsule post first, if they report no px or say that feels better…then push the capsule ant and that should cause sx

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44
Q

explain load and shift test

A

pt is seated

you apply superior load and then push shoulder ant and post

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45
Q

sulcus sign grading scale

A 
1+ = 0.5-1 cm
2+ = 1-2 cm
3+ = 2-3 cm or more 9
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46
Q

list the labrum/articulating surfaces tests

A 
crank
clunk
quadrant
obriens
yergasons
(crazy carl quietly overcame you)
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47
Q

explain the crank test

A

they are supine with arm at angle, elbow bent

apply load and fully ER and IR (no ant shift of humeral head)

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48
Q

explain clunk test

A

supine, elbow at 90 degrees, one hand on post aspect of their capsule, one hand at elbow. Do a slight ant glide (push forward) as you axial load to the body and push the elbow up to face and then full ER.

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49
Q

explain quadrant test

A

Supine again – 90 degrees, start in ER, do ant glide again,

elbow below head of humerus, axial load and just take forearm to head

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50
Q

explain pos findings for obriens

A

if pain is reported with resistance in the IR position, but lessens or disappears in the ER position. If superficial joint pain occurs, consider AC joint pathology

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51
Q

explain obriens test

A 
seated
slight adduction of shoulder
full pronation first and resist
then full supination and resist
(if px is only felt pronation = pos)
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52
Q

explain yergasons test

A

yurgonna try to put them in pronation
they are seated, elbow at 90
you are trying to push them into pronation

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53
Q

List the tests for RC tear

A 
Drop arm
Lift off
Supraspinatus
Lag sign (ER)
Cross over
Speeds
D L S L C S (dudes like single ladies cup sizes)
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54
Q

explain the drop arm test

A

they are standing
abd the arm with pronation
have them hold it and then they slowly lower
can they hold it up

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55
Q

explain the lift off test

A

arrested position

first AROM then resisted

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56
Q

pos lift off could indicate

A

subscapularis tear; pain in front of shoulder
biceps tendonopathy; difficulty holding against resistance
subscapularis tendonopathy; px during mvmt

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57
Q

explain supraspinatus test

A

full can test
scapular plane
thumb up and resist

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58
Q

explain lag sign

A

pt is seated
you place them in scap plane, then ER their upper arm and ask them to hold there
(pos is supra or infraspinatus)

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59
Q

explain cross over test

A

pt is seated as you essentially do a cross the body stretch

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60
Q

pos findings for cross over test

A

If pain is anterior = Subscapularis, Supraspinatus and long head of Biceps

If pain is superior = implicates the AC joint

If pain is posterior = implicates the Infraspinatus, Teres Minor, and/or the posterior capsule.

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61
Q

speeds tests for __ or __

A

SLAP or biceps

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62
Q

explain speeds

A

straight flexion as you resist (palm up)

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63
Q

for yergasons test, they are palm __

A

down

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64
Q

the “pseudojoint” of the shoulder region

A

scapula and thorax

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65
Q

issue with size of structures in shoulder joint

A

glenoid fossa is smaller than head of humerus

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66
Q

lateral portion of biceps tendon anchors to the

A

labrum

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67
Q

the post capsule is under stress in what positions

A

Under tension when shoulder in flexion, adduction, and/or IR

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68
Q

the superior GHL is under stress in what positions

A

Under tension with shoulder in adduction, inferior and posterior translation of humerus

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69
Q

the middle GHL is under stress in what positions (and resists what motion)

A

Under tension with shoulder in ER, resists anterior translation

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70
Q

which lig is the Primary restraint against anterior and posterior dislocations

A

Inf GHL

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71
Q

list all structures in the suprahumeral space

A 
Long head of biceps tendon
Superior joint capsule
Supraspinatus
Upper margins subscapularis and infraspinatus
Subacromial bursa
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72
Q

open packed position GH joint (AKA RESTING)

A

55 degrees abduction
30 degrees horizontal adduction
Neutral rotation

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73
Q

closed packed GH

A

ER, ABD

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74
Q

what role does AC joint play in elevation

A

Must rotate approximately 40-50 degrees for full elevation to occur
If not, elevation limited to ~110 degrees

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75
Q

ac joint and sc joint open packed position

A

arm at side

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76
Q

the sc joint is really for

A

stabalization

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77
Q

during arm elevation, the scapula should do what motions

A

60 degrees upward rotation,
15-25 degrees ER,
15-30 degrees posterior tilt

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78
Q

SC only has a ____ position

A

open packed (arm at side) does not have closed pack or capsular pattern

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79
Q

biomechanics of 0-90 elevation

A

Supraspinatus contracts to initiate abduction (depresses and stabilizes head in glenoid fossa)

Remaining rotator cuff muscles contract to pull the humeral head into the glenoid fossa

Around 20-30 degrees, scapular upward rotation begins with concurrent clavicular elevation and axial rotation

At 90 degrees (approx) upper extreme of GH abduction is reached and clavicular elevation ceases due to tension of costoclavicular ligament

At this point scapula has rotated upwardly around 30 degrees

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80
Q

biomechanics of end range elevation (90 - 150)

A

Scapula upwardly rotates about 60 degrees, with scapular contribution peaking between 90-140 degrees

~ 120 degrees of humeral elevation
~ 75 degrees of GH external rotation needed

Upward rotation accommodated at SC and AC by 30-40 degrees of posterior clavicular axial rotation and clavicular elevation of 30-36 degrees

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81
Q

biomechanics of 150 -180 elevation

A

Abduction beyond 150 requires adequate motion of upper thorax and cervical spine, while bilateral abduction requires thoracic extension and increase in lumbar lordosis

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82
Q

why is scapular plane ex a good idea

A

Length-tension relationship of RC muscles is ideal

Movement of the humerus is less limiting because GH capsule is not twisted

Mechanical axis of GH joint is in line with mechanical axis of scapula

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83
Q

Usually see more _____ changes in the tissues surrounding the glenohumeral joint

A

degenerative

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84
Q

restriction in AROM and PROM is

A

adhesive capsulitis or frozen shoulder

85
Q

associative factors of adhesive capsulitis

A 
Female 
> 40 y/o
Trauma
Diabetes
Prolonged immobilization
Thyroid disease
Stroke or MI
Presence of autoimmune diseases
86
Q

explain adhesive capsulitis

A

there is thickening of the tissue, adhesions are made which ends up limiting all motions

87
Q

what can lead to adhesive capsulitis

A

arm injuries that end up restricting shoulder motion= adhesions

they end up with synovial inflammation

88
Q

stages of adhesive capsulitis

A

Stage 1: Mild signs and symptoms

89
Q

what motions are lost in stage one of adh cap

A

Capsular pattern of motion (loss ER and abduction) present, described as achy at rest and sharp at extremes of ROM, pain palpation anterior and posterior capsules, pain radiates to deltoid insertion

90
Q

what motions are lost at stage 2 adh cap (and sx)

A

Pain palpation anterior and posterior capsules, pain radiates to deltoid insertion, loss of motion in all planes, pain in all parts of the range

91
Q

stage 3 adh cap manifests how

A

Often report painful phase that has resolved but continue to have stiff shoulder, poor scapulohunmeral rhythm during arm elevation, dominance upper trapezius, decreased inferior glide of the GH joint

92
Q

main feature of stage 4 ad cap

A

capsular end feel is reached before pt reports px

93
Q

which phase of healing do you really want to get more aggressive with adh cap

A

subacute

94
Q

most unstable direction is ___, this is where most dislocations happen

A

ant

95
Q

avulsion of the anterior inferior labrum from the glenoid rim, can lead to instability (lower labrum)

A

bankhart lesion

96
Q

compression fracture of the posterior humeral head at the site where the humeral head impacted the inferior glenoid rim

Posterior humeral head rub on the glenoid when it subluxes anteriorly inferiorly

A

hillsacs lesion = can lead to instability

97
Q

most common c/o is px, Pain with overhead movements due to inability to control their laxity
Symptoms occur in abducted and ER position. hx of swimming or repetetive mvmt that puts stress …think

A

instability

98
Q

what assessment must you perform if you suspect instability

A

joint mob assessment

99
Q

working on ____ and avoiding ____ and ___ motions is important with instability

A 
stabalizing structures (RC, scapula)
avoid ER and abd
100
Q

a bankhart tear is associated with ___ dislocation

A

ant

101
Q

what is torn in an bankhart tear

A

inf GHL

102
Q

what motion is often lost after a bankhart repair

A

some ER

103
Q

why is ER lost after bankhart repair

A

bc they have to attach the subscap and labrum to the glenoid cavity

104
Q

what pathology is often associated with GIRD

A

SLAP

105
Q

what constitutes GIRD

A

Loss of IR and total ROM loss

106
Q

common MOI for SLAP lesions

A

FOOSH – fall on outstretched hand

Forceful biceps contraction (catch heavy weight)

107
Q

5 tests for SLAP

A 
Y O C L S
O’Brien test
Clunk test/ Crank test
Yergason’s test
Load and shift test – for instability asssoc with SLAP
Speeds
108
Q

which types of AC joint sprain is associated with a fall or blow to lateral shoulder

A

I

II

109
Q

which types of AC joint sprain are associated with dislocation

A

III

IV

110
Q

what test is good for AC joint sprain

A

crossover

111
Q

how to differentiate btwn tendonitis and a tear

A

tendonitis usually improves after 3 weeks

also, tedonitis can achieve full ROM

112
Q

a clearly pos drop arm test would indicate

A

possible full thickness tear

113
Q

a clearly pos supraspinatus test would indicate

A

partial tear

114
Q

why is it important to get RC surgery if torn

A

it can end up limiting the sup space in the capsule as the humerus glides sup

115
Q

what is primary impingement

A

intrinsic degenerative process in the structures occupying the subacromial space,

anterior impingement
Intrinsic degenerative process in structures in subacromial space
Typically >40 y/o
Hypomobility may be associated

Occurs when superior aspect of RC is compressed and abraded by surrounding bony and soft tissues

116
Q

what is secondary impingement

A

lesser tuberosity of the humerus encroaches on the coracoid process

cause: GH instability or poor control of humeral head in overhead activities, hypermobility may be associated
Have a history of traumatic instability, labrum damage and/or posterior defect humeral head

Alters PICR, humerus migrates too superior

117
Q

impingment usually causes px with

A

overhead activity

118
Q

signs of secondary impingement

A

Limited IR
Excessive ER
Antero-superior humeral head migration

119
Q

the ___ joint is most common one in shoulder for arthritis

A

AC

120
Q

types of shoulder replacement

A

total- both are new
hemi- only humerus part is new
reverse- humerus is cave, glenoid is vex

121
Q

3 big causers of bursitis

A

infection
injury
calcifications

122
Q

test for bursitis

A

neer

123
Q

differentiating btwn bursitis and tendonitis

A

if they cant reach overhead - bursitis (pts with bursitis literally cannot reach overhead)

124
Q

most common fx bone in children

A

clavicle

125
Q

tell of clavicular fx

A

cant elevate past 60

126
Q

causes of brachial plexus injury

A 
Entrapment from “cervical rib”
Stretch injury
Radiation
Clavicular fractures
Compression by soft tissue
127
Q

causes of TOS

A

Caused by compression of tight muscles (eg scalenes, pec minor) or clavicle and first rib

128
Q

TOS has a ___ component (different than brachial plexus)

A

bv

129
Q

2 common peripherial nerves that can be injured

A

axillary - delt

radial

130
Q

stages of RSD

A

I (acute): burning pain, tenderness, swelling, vasomotor changes
II: persistent aching, swelling w/ hardening, skin/nail bed changes
III: skin and subcutaneous strophy, development contractures

131
Q

RSD is associated with

A

neuro trauma

132
Q

sx of RDS

A 
Discoloration
Hypersensitivity of skin
Moist skin
Chronic edema
Atrophy
Weaknes
133
Q

AC joint sprain 4-6’s they will do

A

surgery (1 -3 don’t)

134
Q

with tendonitis you HAVE FULL ROM but it’s just, with a tear you dont have ____

A

pxful

ROM

135
Q

if supraspinatus is injured, how does this effect delt

A

If supraspinatus is injured, the deltoid kicks in – but the movement of humeral head isn’t as efficient…..so when deltoid is dominant the humerus will glide superiorly instead of the supraspinatus controlling the motion from the top, the deltoid tries to control the motion from the bottom.

136
Q

How will you tell diff btwn primary and secondary impingement –

A

primary impingement is hypomobile –deg changes

secondary impingement is associated with hypermobility or instability.

do mob assessment to see

137
Q

weird tx for calcification with bursitis

A

ionto with vinegar

138
Q

precursor for any bursitis

A

RA or autoimmune

139
Q

injuries caused by foosh (4)

A

clavicle fx,
SLAP lesion,
proximal humerus fx,
RC tear

140
Q

3 pathologies with pxful arc

A

bursitis, RC, impingement

141
Q

how can you differentiate btwn TOS and RSD

A

Complex regional px syndrome – px is out of proportion to injury
TOS is more “typical” neuro sx.
What is same about the conditions: both can have BV issues
RSD or complex regional px syndrome happens after trauma, usually the distal extremeties are effected first

142
Q

pathologies associated with scap downward rotation syndrome

A 
•	impingement
•	Thoracic outlet syndrome (TOS)
•	Instability
•	Rotator cuff
        tendinopathy/tear
•	Nerve injury
•	Bursitis

T I T I R B N

143
Q

explain scapular downward rotation syndrome

A

in resting, scap is “stuck” in DR

very limited UR occurs during AROM

144
Q

what is probably to tight in scapular downward rotation syndrome

A

dominant: rhomboids, levator scap, pecs, lats

145
Q

what is probably weak with scapular DR syndrome

A

weak serr ant and weak traps

146
Q

WHAT IS PROB DOMINANT IN SCAP DEPRESSION SYNDROME

A

LATS
PECS
LOWER TRAP

147
Q

pathologies asst with depression syndrome

A 
•	 impingement
•	Thoracic outlet syndrome (TOS)
•	Upper trap strain
•	Rotator cuff tendinopathy/tear
•	Neck pain
 IN RUT
148
Q

SCAPULAR DEPRESSORS

A

latissimus, pectoral muscles, and lower trap

149
Q

SCAPULAR ELEVATORS

A

upper trap and levator scapulae

150
Q

2 muscles that abd the scap

A

serratus ant and pec major

151
Q

scapular adductors

A

rhomboids

mid traps

152
Q

WHAT IS A TELL OF SCAP DEPRESSION SYNDROME

A

THE SCAP ITSELF WILL BE LOWER THAN T2-T7

OR SPINE IS LOWER THAN T 3

153
Q

SCAP ABDUCTION SYNDROME HAS WHAT RYTHYM

A

1:1

154
Q

SCAP ABDUCTION SYNDROME PRESENTS HOW

A

THE SCAP IS PROTRUDING LATERALLY

155
Q

WHICH OF THE ACROMION TYPES IS THE MOST CURVED

A

III

156
Q

DIFF BTWN SUPRA AND DELTS

A

DELT INVOLVES FLEXION OR EXT TOO

157
Q

TERES MAJOR

A

ADDUCTION AND IR

158
Q

ANYTIME THERE ARE GH MOB ISSUES YOU ALWAYS LOOK AT ___ FIRST

A

SCAPULA

159
Q

EXPLAIN THE MOB ASSESSMENT OR PAM ASSESSMENT PRIOR TO MOBS

A

Assess distraction, inferior glide, posterior glide and anterior glide.

160
Q

INF SHOULDER GLIDE FACILITATES

A

• Facilitates abduction and flexion

161
Q

POST GLIDE OF SHOULDER FACILITATES

A

• Facilitates medial rotation, flexion, horizontal adduction

162
Q

POST GLIDES AT END RANGE, YOU WILL PROB USE WHAT GRADES

A

3, 4, 5

163
Q

ANT SHOULDER GLIDES FACILITATE

A

• Facilitates lateral rotation, extension, and horizontal abduction

164
Q

STERNOCLAVICULAR JOINT MOB RULES

A

it is a convex surface moving on a concave surface for elevation/depression (SUP AND INF GLIDES)

and it is a concave surface moving on a convex surface for protraction/retraction. (DORSAL AND VENTRAL GLIDES OR ANT POST)

165
Q

CAUDAL IS AKA

A

INF

166
Q

POST STERNOCLAVICULAR GLIDES FACILITATE

A

Facilitates retraction/horizontal abduction.

167
Q

ANT SC GLIDES FACILTATE

A

PROTRACTION

168
Q

SC JOINT MOB, INF GLIDE FACILITATES

A

ELEVATION OF SHOULDER

169
Q

TO TEST AC JOINT, STABALIZE THE AC AND MOVE THE

A

CLAVICLE

170
Q

ALL AC MOBS FACILITATE

A

ELEVATION

171
Q

WHICH SC GLIDE DO YOU PUSH THE STERNUM POST

A

ANT GLIDE

172
Q

NORMAL CARRYING ANGLE

A

5º-15º in men; 15º-20º in women.

173
Q

IF OLECRANON FACES LATERALLY, THEN THE ARM IS REALLY IN ___ ROTATION

A

INTERNAL

174
Q

WHEN INF ANGLE OF SCAP IS LOCATED MORE LATERALLY

A

UR SCAP

175
Q

FORWARD HEAD INDICATES SHORT ___ AND LONG __

A

SHORT EXT LENGHTENED NECK FLEXORS

176
Q

WHEN DOING ER, SCAP SHOULD NOT ADDUCT WITHIN THE FIRST ___ DEGREES

A

35

177
Q

AT END RANGE SHOULDER FLEXION, SCAP SHOULD BE UR __ DEG

A

60

178
Q

All SC glides are ____ of what you think makes sense

A

opp

179
Q

which SC glide is the one you press on the sternum

A

for ant glide you push the sternum post-this aids in protraction

180
Q

normal shoulder flexion

A

165

181
Q

normal shoulder ext

A

60

182
Q

normal shoulder ABD

A

165

183
Q

normal shoulder add

A

40

184
Q

normal shoulder ER

A

90

185
Q

normal shoulder IR

A

70

186
Q

Strong and painless:

A

not muscle

187
Q

Strong and painful:

A

muscle

188
Q

Weak and painless:

A

neuro issue

189
Q

adhesive capsulitis will usually show what “tell” sx

A

loss of PROM in capsular pattern (especially ER and ABD)

190
Q

what 2 systemic pathologies are pts at risk for adhesive capsulitis

A

diabetes and thyroid issues

191
Q

what 3 outcome measures are good for adhesive capusulitis

A

DASH (disability arm shoulder hand)
ASES (american shoulder and elbow surgeons)
SPADI (shoulder pain and disabilty index)

192
Q

List all outcome measures for arm/shoulder

A 
UEFI (upper ext functional index)
DASH
Quik DASH
SPADI
ASES
193
Q

which of the outcome measures are lower score is worse

A

UEFI

ASES

194
Q

Which of the outcome measures is higher score is worse

A

DASH
Quick DASH
SPADI

195
Q

best tx for adhesive cap

A

steroid shots
mobs
stretching

196
Q

dull ache is associated with what 3 pathologies

A

RC
AD Cap
Bursitis

197
Q

anterior shoulder px is associated with

A

Impingement

198
Q

rapid onset after activity is what pathology

A

bursitis

199
Q

px at end range of crossing arm over body is what pathology

A

AC

200
Q

impingement usually comes about due to

A

repetetive motions (ex swimming)

201
Q

recent clavicle fx, and now px with tingling….think what pathology

A

TOS

202
Q

is PROM effected (in the direction of the normal muscle motion) with muscle pathologies

A

no

PROM would only cause sx when you go in the opposing direction (stretching)

203
Q

impingement has what 2 motions limited

A

hor abd

IR

204
Q

reveresed scap/humeral rythym with dominent delts, think

A

RC

205
Q

what is considered pos for the lat length test

A

if the second measurement (elbows bent hands towards head) is smaller than reg shoulder ROM then the lats are short

206
Q

what do you have to do for any scap mobing

A

give them a pillow in front of their body

207
Q

what do you have to do for any SC mobing

A

give them a pillow to hold at chest

208
Q

explain ant GH glide

A

hamburger grip as they are supine

MSK (10 decks)

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