Shoulder

Question 1

What is subacromial impingement?

Answer 1

Subacromial bursa becomes intrapped under subacromial arch leading to pain and inflammation

Question 2

What are the three stages of impingement?

Answer 2

Stage 1: Edema & Hemorrhage
Stage 2: Fibrosis & Tendinitis
Stage 3: AC Spur and Rotator Cuff Tear

Question 3

What are the three special tests used to detect impingement?

Answer 3

Neer Test: IR humerus, Pronate forearm, passive shoulder flexion
Hawkins Test: shoulder flexed to 90, elbow bent, passive internal rotation
Compression Test: cup the AC joint and compress from both sides

Question 4

What is the conservative treatment for impingement and RC tears?

Answer 4

Avoid repeated injury (rest), Ice, NSAIDs

Decrease pain, increase ROM, increase strength/stability

Question 5

What is the surgical treatment for impingement and RC tears?

Answer 5

Arthroscopic decompression

1. Debreed subacromial bursa
2. Remove impingement (osteophytes etc.)

Post op: cuff mobility and strengthening

Question 6

What is the MOI for tendinitis and RC tears?

Answer 6

TRAUMA

Dislocations, fractures, labral tears (SLAP lesion)

Question 7

What three special tests are used to identify tendinitis and RC tears?

Answer 7

1. Drop Arm: supraspinatus tear (RC tear)
2. Yergasons: SLAP lesion
3. Speeds: bicipital tendinitis (forearm supinated, resist shoulder flexion)

Question 8

What are the two types of labral tears? What are they associated with?

Answer 8

Bankart: associated with dislocation and bony lesion

SLAP lesion: associated with biceps rupture

Question 9

What is the peel back sign and what does it test for?

Answer 9

Test for SLAP lesion

Done post op arthroscopy
Shoulder is externally rotate and abducted (baseball pitch)
+ biceps rupture will peel back labrum

Question 10

What is thermal capsulohorraphy? Is it effective?

Answer 10

Heating of the shoulder capsule to tighten it

Not long term effective: stretches out over time

Question 11

What type of shoulder dislocation is most common? What is the MOI and incidence?

Answer 11

ANTERIOR DISLOCATION

MOI: hyper abduction and external rotation
Incidence: very common (age<20: 94% of dislocations)

Question 12

What is the treatment for an anterior dislocation?

Answer 12

Bankart Repair: protect subscap and labral repair
No passive ER/active IR for 6 weeks

Anterior Capsulolabral Reconstruction: no protection of subscap
6 weeks of ROM and strengthening

Arthroscopic Repair: same as anterior reconstruction

Question 13

What is the MOI and incidence for a posterior dislocation?

Answer 13

Recurrent posterior subluxation (Frank dislocation)
Pain with adduction and IR

4% of all GH dislocations
50-80% go unrecognized

Question 14

What is the difference between unidirectional and multidirectional instability?

Answer 14

SYMPTOMATIC

Uni: dislocation in one direction
Multi: dislocation in 2 or more directions

Question 15

What are the four types of multidirectional instability?

Answer 15

Type I: laxity with global instability
Type II: laxity with anteroinferior instability
Type III: laxity with posteroinferior instability
Type IV: laxity with anteroposterior instability

ALL INVOLVE LAXITY

Question 16

What is the MOI and clinical presentation of multidirectional instability? What population does it usually affect?

Answer 16

Generalized pain and capsular laxity

Affected young adults <30 y/o
Male = Female
MOI: single trauma or small repetitive trauma

Question 17

What is the best treatment for multidirectional instability?

Answer 17

NON-OPERATIVE MANAGEMENT (90% effective)
Low incidence of reoccurrence
Strengthen ADD, IRs, ERs, and progressive ROM

Question 18

Adhesive capsulitis is associated with what two pathologies?

Answer 18

Diabetes

Hypothyroidism

Question 19

What is the conservative treatment for AC joint disloaction and adhesive capsulitis?

Answer 19

6 months of: NSAIDs, AGGRESSIVE ROM, strengthening