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PT OCS Exam > Shoulder > Flashcards

Shoulder Flashcards

1
Q

Dx pearls based on patient reports

A

Dec. Neck ROM suggests C/S assessment

Arms Slips suggests instability

Pain overhead suggests impingement

Altered ROM but no associated pain suggests RTC pathology or neuropathy

Heaviness after activity suggests vascular

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2
Q

R Shoulder Pain referral (non-MSK)

A

Liver
Stomach
Pancreas
Pancoast Tumor (apex of R lung)

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3
Q

L Shoulder pain referral (non-MSK)

A

Heart

Spleen

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4
Q

Normal mechanics for overhead elevation require scapula to perform what?

A

Upward rotation and posterior tilt

  • Dec. rotation in RTC pathology, impingement, instability’
  • Excess upward rotation and anterior tilt in Ad. capsulitis
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5
Q

Weak Serratus

A

Winged scapula with dec. Up.Rot. and Post. Tilt

*C5,C6,C7 nerve injury to Long Thoracic nerve possible

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6
Q

Hypertonic Upper Trap

A

Increased clavicular elevation

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7
Q

Hypertonic Pec. Minor

A

Inc. scapula IR and Ant. Tilt

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8
Q

Post. Capsule tightness

A

Inc. Scapula Ant. Tilt

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9
Q

Kyphotic Posture

A

Inc. IR and Ant. Tilt of the scapula with Dec. Up.Rot.

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10
Q

What is GIRD?

A

GH IR deficiency present in athletes with inc. ER, dec. IR
Measured with stable scap at 90/90
Tight Post. capsule with humeral retroversion causes anterior translation of the humeral head

*Can cause impingement related to weak SA, MT, LT with hypertonic UT

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11
Q

What is SICK scapula?

A

(S)capula malposition
(I)nferomedial border prominence
(C)oracoid pain/malposition
dys(K)inesis of movement

*Primarily affects overhead athlete
Dropped scapula on involved side with:
Tight Pec. Minor and possibly LS, Lats., Rhomboids
Shortened biceps

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12
Q

Scapular Exercises

A

Best for LT: Low Row, Robbery
Best for SA: Lawn Mower, Lower Row, Robbery, isometric Inf. glide

*Inc. LT activation also present in push-up with opposite hip Ext.
Low Row with opposite SLS increases recruitment of LT vs. UT

Dec. Hip IR in opposite LE
Inc. Lordosis (Tight Lats?)

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13
Q

SICK scapula DDx

A

Ant. coracoid pain can be confused with instability
(+)Impingement and subacromial pain due to biomechancis
AC joint pain from anterior tilt position
TOS (clavicle position)

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14
Q

Types of dyskinesia in overhead athletes

A

Ant. Tilt - prominence of inferomedial border, Labral involvement
IR - prominence of medial scapular border, Labral involvement
Down.Rot - prominence of superomedial border, Impingement/RTC pathology

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15
Q

Shoulder screening for pathology with ER vs. IR (IRRST)

A

ER painful or weaker than IR (RTC pathology)

IR weaker vs. ER (labrum involvement)

No difference B/T ER and IR (Extra-articular)
LHB, AC joint, Referred pain

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16
Q

Tests for RTC pathology

A

Dropping sign is best to R/O infraspinatus

(Cluster) HK, painful arc, infra MMT is good to rule in impingement and/or RTC pathology

ERLS good to R/I tear of Supra/Infra

IRLS good to R/I and R/O Subscap

Resisted IR good to R/I Subscap

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17
Q

RTC pathology cluster (3/3)

A 
HK (resisted ER/Flx in 90 degrees and IR position)
Infra MMT (resist ER with wrist against stomach)
Painful Arc (pain B/T 60-120 degrees in scapular plane)
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18
Q

SS tendinopathy cluster to rule in pathology (3/3)

A

Age >65
Infra MMT
Night Pain

*ERLS is a better test

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19
Q

Tests for Anterior Instability

A

Apprehension (R/I) BEST

Ant. Release (R/I and R/O) BEST

Apprehension & Relocation (R/I and R/O)

20
Q

Tests for SLAP

A

Biceps load I/II (R/I and R/O) BEST

Passive distraction, Active compression (R/I and R/O)

21
Q

Posterior Impingement/Labral Tests

A 
Kim Test (R/I and R/O)
Jerk Test (R/I and R/O)

Posterior Impingement test (R/O posterior impingement)

22
Q

AC joint (test cluster to R/I)

A

Crossbody ADDuction
O’brien’s
AC resisted extension

23
Q

Upper Cross Syndrome

A

Shortened: UT, LS, SCM and Pec. Minor

Weak: SA, Rhomboids, LT, DNF

24
Q

Primary Impingement

A

Caused by Abnormal relationship between the RTC and coracoacromial arch (Type 3 Acromion)
Age > 40
Unable to sleep on involved side
Ant. and upper lateral arm pain

25
Q

Secondary Impingement

A 
Dec. in subacromial joint space (caused by instability)
Biomechanical 
Younger patients, overhead athletes
"Dead Arm"
SICK scapula
26
Q

Posterior Impingement (undersurface impingement)

A

ABD+ER (Cocking phase of throwing)

Associated with anterior instability

27
Q

RTC tendinopathy rehabilitation

A

IR ROM deficits common

  • FF AROM causes SAI
  • ER AROM @90 causes internal impingement

ER strength deficits common followed by supraspinatus
*Strength deficits magnified by poor scapular position in protraction

28
Q

SLAP tear classification

A

Type 1 - Labrum frayed, biceps intact
Type 2 - Biceps anchor pulled away
Type 3 - Bucked Handle, biceps intact
Type 4 - Bucket Handle with biceps tear

*Types 2 and 4 require repair of biceps

29
Q

Cuff Repair Types

A

Arthroscopic - weaker fixation
Mini-Open - Allows for early deltoid AROM
Open - 6-8 weeks restriction of deltoid AROM

30
Q

RTC Tear classification

A

Small 5cm

31
Q

GH Laxity grading

A

Normal - mild translation
Grade 1 - Feel GH ride up to glenoid 25-50%
Grade 2 - GH overrides glenoid but reduces
Grade 3 - GH overrides glenoids but no reduction

32
Q

Shoulder instability classification (FEDS)

A

Frequency (episodes in last year?)
Etiology (Traumatic?)
Direction (which way did it go out?)
Severity (needed help to ‘pop’ it back in?)

33
Q

Presentation of shoulder dislocation

A

Arm held at side and painful, prominent acromion

*Axillary nerve regularly involved so there is weakness in the T. Minor and Deltoid (Anterior Dislocation)

34
Q

Shoulder Dislocation clinical exam

A

Load/Shift test
Apprehension/Relocation
Sulcus sign (>2 cm vs. uninvolved is clinically significant)

35
Q

Shoulder XR to perform after reduction to R/O other lesions

A

Scapular A/P (Glenoid fx)

Striker Notch (Hill-Sachs)

Westpoint Mod. Axillary view (IGHL avulsion, Bony Bankart, Ant.Inf. Glenoid insufficiency)

36
Q

Labrum radiological exam

A

MRI with contrast, hemarthtrosis serves as contrast in acute injuries

37
Q

Prox. humerus fracture

A

85% minimally displaced
Benefit from early scapular ROM
GH joint mobilization as early as 2 weeks to restore normal elevation by 27 days (1 month)

*Immobilization longer than 3 weeks is of NO benefit

38
Q

Calcific Tenonitis recommendations

A

R/O non-MSK conditions by timeframe which usually resolves in 1 week with NSAIDS

Benefit from high dose U/S (20+ visits at 3.3 mhz)

39
Q

Frozen Shoulder

A

Predictors:
Age 40-65
ER or IR limited above 90 deg
Passive ER limited with ADDuction

*(R/O if PROM normal)
Will usually resolve by 12-18 months

40
Q

Shoulder Functional Outcomes for Ad. Capsulitis

A

DASH
ASES
SPADI

41
Q

Adhesive Capsulitis

A

Early intra-articular injection recommended if highly irritable and painful in acute phase (0-3 months)

42
Q

Stages of Adhesive capsulitis

A

Stage 1 (0-3 months) (pain with A/PROM)

Stage 2 (3-9 months) FREEZING (significant ROM restriction)

Stage 3 (9-15 months) FROZEN (pain only at end range)

Stage 4 (15-24 months) THAWING

43
Q

Treatment of Impingement with T/S HVLA (3+/5)

A

Symptoms

44
Q

Radiology for Labral teat

A

MRA is best but arthroscopy is the gold standard

45
Q

ROM goals for RTC and Labral Repairs

A

Full ROM expected by 10-12 weeks

46
Q

ROM precautions for TSA and RTSA

A

TSA: excessive ER should be avoid (more than 45 degrees in first 6 weeks can indicate a possible subscap tear)

RTSA: Avoid ADDuction/IR/Extension

47
Q

Test for Subscap. tendinopathy or tear

A

IRLS BEST to R/I and R/O tear

Lift Off (better) and Resisted IR tests are best for diagnosing a tendinopathy

PT OCS Exam (8 decks)

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