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Ortho > Shoulder > Flashcards

Shoulder Flashcards

1
Q

Post disloc

A

Causes int rot, limited ext rot.
Light bulb sign
Postero lat or medil. Risk all 3 Ns.
Us closed reduc.

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2
Q

Shoulder movements

A

Flex- pec maj, deltoid ant, coracobrachialis
Ext- deltoid post, lat dorsi, pec maj, teres maj.
Abduc- suprapsinatus 15 deg then deltoid
Adduc- pec maj, lat dorsi, teres maj, subscap
Med rot- pec maj, deltoid mid, lat dorsi, teres maj, subscap.
Lat rot- teres minor, infraspinatus

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3
Q

scapula movements

A

Elevation- levator scap, trapezius
Depression- serratus ant, pec minor
Forward protraction- serratus ant, pec maj
Retraction- trapezius, rhomboid

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4
Q

Impingement tests

A

Painful arc btw 60-120 abduc, exacerbated by thumb down.
Neers- passive flexio with pronation/int rot while stabilise scapula.
Hawkins- shoulder and elbow 90 degs, pain on passive int rot

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5
Q

Rot cuff tests

A

Lift off subscap
Belly press for subscap
Empty beer can supraspinatus.
Ext rot ag resis for infrapsinatus and t minor.
Drop arm when slow adduc from 160 deg. Drop means dam at least 2 tendons.
Lag sign infraspinatus and t minor. Flex and abduc 90 deg and ext rot and hold.
Hornblower- abduc shoulder ad flex elbow 90, ext rot ag resis.

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6
Q

AC jnt tests

A

Scarf- pos if LOC pain in SCJ

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7
Q

Painful arc

A

Tendinopathy or partial rot cuff tear causes tend to catch in subacromial sp dur abduc.

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8
Q

Rot cuff mx

A

Open or arthroscopic repair to tendon, unless over 70yo.
If under 70 then re att tendon, sling 6 wk, physio.
Full tear never heals alone.
If over 70 then injec and physio.

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9
Q

Impingement syndrome

A

On abduc 70-140 deg. Pain in deltoid.
Nocturnal pain.
Causes-
Supraspinatus tendinopathy or partial rupt- physio and PK, subascromial bursa CS injec, subacrom decomp surg.
Calcifying tendinopathy- lot inflamm. Physio, NSAID, ster injec, occas Ca excision.
ACJ OA- rest, NSAID, ster injec. Excis last resort.
Sclerosisi of acromion and its tuberosity.
Ix- US rot cuff.
Mx gen- ster up to 3 injecs, physio, subacromial decomp.

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10
Q

frozen shoulder

A

Phases
-pain and freezing- up to 1 yr. active and passive abduc reduced to under 90, ext rot under 30.
-frozen- pain settles but stiff. 6-12 mnth.
-thawing- regain ROM. 1-3 yr.
can be assoc with cervical spondylosis, DM, thyr dis.
Tx- physio init bad but LT good, NSAID, CS injec, surgic rel. MUA. Stretch exercises. Distension arthrogram saline injec under press, leave, interval rel (esp coracohumeral lig) foll by physio.
ext rot restric over 50% means frozen shoulder v likely. Global ROM restric and ant pain.

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11
Q

Frac clavicle

A

Us direct force
Comm mid third. Prox frag pulled super by SCM.
Mx- broad arm sling, foll up XR 6wk.
ORIF if v displ- high risk non union.
Risk brach plexus inj, SC vessels. Pneumothorax complic.

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12
Q

ant disloc

A 
95%
Signs- loss contour, ant bulge.
Risk to axillary N
Mx- 
Simple reduc-longit traction in abduction with gentle humerus press. 
Kochers method reduc
Supp in int rot with broad arm sling
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13
Q

Humerus frac

A

Shaft- humeral brace and traction with collar and cuff sling.
Immob 8-12 wk.
Risk radial N.
surg locking or comp plating.

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14
Q 
Atraumatic instabil (recurr disloc)
Structural eg artic surf, capsule.
A

Jnt laxity.

AMBRI- atraumatic, multidirec, bilat, rehab, inferior capsular shift surg if rehab fails.

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15
Q 
traumatic instabil (recurr disloc)
Structural eg Bankart
A

TUBS- traumatic, unilat, bankart, surgic tx.
Bankart- avulsion of glenoid labrum.
Hill sachs lesion- impaction frac of humeral head foll ant disloc.

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16
Q

habitual instabil

Non structural eg abn musc patt. Often bilat.

A

-

17
Q

Scapula position

A

Anteverted 30 degs

18
Q

cephalic V posit

A

Btw deltoid and pec maj

19
Q

Supraspinatus outlet contents

A

Supraspinatus tendon

Subacromial bursa.

20
Q

Supraspinatus

A

Abduction to 15 deg

Suprascapular N

21
Q

infraspinatus

A

Ext rot

Suprascapular N

22
Q

Teres minor

A

Ext rot

Axillary N

23
Q

subscapularis

A

Int rot

Upper and lower subscapular N

24
Q

joint stabilisers

A 
Labrum- incrs depth 30 %
Ligs
Capsule
Muscles
Neg press
Contact/friction.
25
Q

Yng comm probs

A 
Frac
Disloc
Instabil
Impingement
Tendonitis
26
Q

eld comm probs

A 
Frozen shoulder
Rot cuff tear
Calcific tendonitis
Arhtritis- GH and ACJ
Frac
Disloc
Neck
27
Q

Hx

A 
Domin side
Age, sex
Trauma
Site
Onset
Prog
Sev
Lims- ADL, hand to head, hand beh back
Social incl occupat
Drugs
Exacerbating and relieving
Prev probs or surg
Tx already had
Allergies
Can sleep on both sides
Pmh esp DM
28
Q

4 acute shoulder condits

A

Trauma
Infec
Acute calcific tendonitis
Brachial neuritis aka pasronage turner brachial plexus inflamm- intense pain 1 wk, then musc weak, self lim, resolve 12 mnth.

29
Q

Condits by age

A

10-30 instabil
40-60 impingem, adhesive capsulitis, inflamm arthrop
60-80 degen cuff tear, OA, cuff arthrop

30
Q

SLAP tear

A

Superior labral tear from ant to post

Glenoid labrum inj

31
Q

OA

A

Global restric movem active and passive.
Mx- PK, ster, arhtroplasty
Shoulder repl only if cuff intact, rev repl if not. Always lose abil to rot.

32
Q

instabil tests

A

Apprehension test ext rot and abduc and press on humeral head
Relocat test supp ant humerus
Sulcus sign
Post test edge bed elbow flex and int rot then post press.
Beighton score.

33
Q

ROM normal

A

Flex/ext -40-170
Abduc/adduc -40-180
Ext rot 40-60

34
Q

Jnt injec

A

Triamcinolone and bupivacaine

35
Q

graft jacket repair

A

Arthroscopic
Compl, degen, irreparable cuff tears
Allograft acellul human dermal matrix- coll, elastin, pg’s, hyaluronic ac etc.

36
Q

Exam

A 
Inspec- wasting
Feel- tenderness and locat
Move- active and passive elv, abduc, adduc, ER, IR.
MRC power- ER, lift off, elevation.
Lift off or belly press- subscap
Empty beer- supraspinatous
ER against eresis- infra and t minor
Scarf- ACJ
Hawkins- impingement
Apprehension and reloc- instabil
37
Q

Post disloc

A 
MOI- eg greak fall with arm
Px- ext rot and adduc
Mx- reduc, broad arm sling, physio
Reverse hills sachs lesion
Common occurs- seizures, electricution
38
Q

clavicle frac surg indics

A

Skin tethering
Over 2cm displ, shorten
Severe communition

39
Q

Frozen shoulder px

A

Stiffness

Night pain

Ortho (26 decks)

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