Shoulder Flashcards
Rotator cuff tear size classifcations
s < 1 cm; m- 1-3 cm; L 3-5; massive > 5 cm
RTC tear depth (average cuff depth 9-12m)
grade 1 <3mm; 2- < 6mm, 3- +6mm
Characteristics for unfavorable RTC tear outcomes
- pain > 1 year, cuff tear > 1 cm squared, 3. poor functional impairment at eval (+ emptycan test)
Indications for RTC sx
- failed 3 months conservative treatment, with 6 weeks PT, subacromial injection, oral NASAIDs; 2. significant pain and or weakness, 3. worsening function
MOI for AC jt injury
Trauma, direct pressure; inferior force on superior acromion on fixed clavicle (supported by SC ligaments)
TUBS
Shoulder dislocations “ Traumatic, unidirectional, bankart lesion usually present, Surgery (PT <20% effective)
Primary vs Secondary adhesive capsulitis
Primary- insidious, Secondary- known cause
Inferior GH ligament
restrics anterior, inferior and posterior translation of humerus at higher levels of abd. STRONGEST
Middle GH ligament
restrics ant translation in lower ranges of motion
anterior GH ligament
restrics anterior/inferior translation
Passive GH stabilizers
- labrum 2. GH ligaments 3. Capsule
Dynamic GH stabilizers
- RTC 2. Biceps 3. Scapulothoracic muscles and propricceptors ( Pacinian and ruffinian)
GH jt dysfunction
painful arc from 60-120
AC jt dysfunction
painful arc from 120-160 shoulder flexion
Which type of AC joint injuries are operative?
Type 4,5,6 recommend Op. Type 1,2,3 recommend non-op. Type 3 injury in pitcher/athlere could be op
Type 1 AC joint Seaparation
mild trauma, TTP. AC jt stable. no dislocation AC and CC ligaments intact. No deformity
Type 2 AC joint Separation
mod TTP. Distal clavicle unstable, CC ligament intact. Pain with shoulder AROM
Type 3 AC joint Separation
Disruption of CC and AC ligaments. Can be less painful than type 2. Shoulder abd causes most pain. manual reduction technique possible.
Type 4 AC joint Separation
AC and CC ligament disruption+ distal clavicle displaced posteriorly. Manual reduction technique not possible.
Type 5 AC joint Separation
AC and CC ligament disruption + detachment of deltoid and UT muscle attachments from distal 1/3 of clavicle. Entire UE drops inferiorly.
Type 6 AC joint Separation
AC and CC ligament disruption. Distal clavicle displaced posteriorly under coracoid process. RARE. Due to traumatic abd force to UE.
Upward rotation force couple
UT and SA
- allows for rotation of the scap
- maintains LT relationship for deltoid
- prevents SA impingment
- provides stable scapular base
Scapular upward rotators
SA and Lower trap
scapular downward rotators
rhomboids, levator scap, pec minor
Bankart Lesion
anterior inferior labral detachment
SLAP lesion
Superior labral detachment from A-P
- increases anterior band of inferior GH ligament by 100-120%
Hill Sachs lesion
dent in posteriorlateral humeral head due to trauma with anterior labrum during dislocation
Primary Impingment
Impingment due to abnormal relationship between coracoacromial arch
- sub acromial irritation to tendon b/w humeral head, ant 1/3 of clavicle, Coracoacromial ligament coracoid or AC joint
Secondary Impingement
due to underlying Glenohumeral instability and tendon wear. Because of increased anterior humeral head translation (think upper crossed syndrome), biceps tendon and RTC can become impinged
Posterior impingement
90/90 abd/er position cause tendons of supra and infra to contact postero-superior glenoid lip (tight posterior capsule)
RTC guidelines (medium tear)
weeks 1-2: PROM, submax isometrics*, joint mobs
Week 6: isotonics
week 8: begin closed chain step up/qped rhythmic stab, UE plyo
week 10: initiation of submax isokinetic IR/ER
week 12: begin interval return programs, max isokinetics
Best view for hill sachs lesion
Stryker notch view
best view for west point modified axillary view
avulsion of IGHL
bony bankart
Anterior inferior glenoid deficiency
Humeral fx
- early access to PT important
- jt mobs as early as 2 weeks
- normal flexion ROM by 24 days
- immobilization 3 weeks no benefit
