Shoulder Flashcards
What is the purpose of the superior GH ligament?
restrain inferior translation of humeral head when arm is adducted at the side
What is the purpose of the middle GH ligament?
restrain anterior translation from mid range of abduction (45 degrees) and ER with arm at the side
What is the purpose of the anterior band of the inferior GH ligament?
limits anterior translation during ER and abduction to 90 degrees
What is the purpose of the posterior band of the inferior GH ligament?
limit posterior translation during IR and abduction to 90
What position is the dominant shoulder typically in?
sits lower typically
Describe the Kibler scapular slide test
measure distance from inferior angle of scap to spinous process at neutral and 90 degrees of elevation, compare side to side.
What is considered abnormal on the Kibler scapular slide test?
a difference of greater than 1.5 cm
What does the Kibler scapular slide test test for?
scapular dyskinesia
What are the three scapular dysfunction classifications Kibler proposed?
inferior, medial, superior
What does inferior scapular dysfunction indicate
weak lower trap
What does medial border scapular dysfunction indicate?
most often seen with GH joint instability
What does superior scapular dysfunction indicate?
most often is a rotator cuff weakness and force couple imbalance
describe the scapular assist test and what it indicates, what is a positive test
When you help with upward rotation, a positive test is if symptoms decrease or pain decreases. It indicates that they are weak in scapular upward rotators.
describe the scapular retraction test, what a positive test is, and what it indicates.
it is ER/IR at 90 degrees of abduction with manually assisted scapular retraction, a positive test is reduction in symptoms, it indicates poor scapular stabilization
describe the flip sign, what a positive test is, and what it indicates
resisted ER at the side, observe the medial border of the scapula, positive test if it comes away from the thorax, indicates weak SA and poor scapular stability
what is the optimal testing position for the supra?
champagne toast position
what is the optimal testing position for the infra?
arm at the side and in 45 degrees of IR
what is the optimal position to test the subscap
gerber test position (hand in low back)
What is a grade I on the humeral translation test?
humeral translation within the glenoid without edge loading or translation of the humerus over the glenoid rim
what is a grade II on the humeral translation test?
translation of the humeral head up over the glenoid rim with spontaneous return on removal of stress
what is a grade III on the humeral translation test?
translation of the humeral head over the glenoid rim without relocation upon removal of stress. Not seen in clinic
Where do labrum tears occur most often?
anterior superior and posterior superior, almost never anterior inferior
What happens to the ligaments in the GH joint after a SLAP tear?
there is a 100% increase in strain on the anterior band of the inferior GH ligament, lots of load
What 4 tests use a long axis compression to assess the labrum?
clunk, circumduction, compression rotation, and crank test
what 4 test use muscular exertion to test the labrum and what part of the labrum are they specifically testing?
O’Brian active compression, mimori test, biceps load test, and ER supination test
what may you see on radiographs that indicates a chronic rotator cuff?
irregularity of the greater tuberosity, sclerosis of the undersurface of the acromion, elevated humeral head
what is the ration of ER to IR
ER should be 66% of IR
Describe stage I of Neers impingement classification
involves edema and hemorrhage, reversible, conservatively managed, below 25 years old
describe stage II of Neers impingement classification
termed fibrosis and tendonitis, involves thickening of the subacromial bursae. Typically 25-40 years old
Describe stage III of Neers impingement classification
typically involves a partial or total RTC tear, typically over the age of 40
What type of acromium is associated with RTC tears? What type is not?
type III is associated with tears (80%), type I is not (3%)
What is step one of treating SAI?
scapular control, manual resisted pro/retr of the scap
In someone with primary impingement what do you want to check in terms of ROM that is commonly missed?
IR
what are the three initial goals of rehabbing SAI?
decrease pain through isometrics, normalize capsular pattern through mobilization, rotator cuff and scapular strengthening
why use a towel during ER exercises?
Increases muscle activity by 10%
do you want to chase strength or endurance at then beginning phase of treatment for SAI
endurance
when advancing to discharge, what test can you use in a SAI patient to clear them?
the same you used to diagnose them, neer, hawkins, yocum
what are the determinants of rehab progression in RTC repair patients?
full/partial thickness tear, tear size, degree of tear, muscles involved
what causes bursal sided RTC tears?
SAI
what causes articular sided RTC tears?
tensile load and GH instability
what is considered a small RTC tear?
less than 1 cm
what is considered a medium RTC tear?
between 1-3 cm
what is considered a large RTC tear?
between 3-5 cm
what is considered a massive RTC tear?
greater than 5 cm
does early mobilization vs immobilization lead to an increase in RTC tears at one year follow ups?
no
which of the following instabilities is most common: anterior, posterior, multidirectional?
anterior
when do you expect to see full ROM in anterior capsulolabral repair, bankhart repair, and inferior capsular shift?
10-12 weeks
what is obligate motion in the shoulder and why is it important to be aware of after instability surgery?
it is the unwanted movement of the shoulder anteriorly due to posterior capsular tightness, can put pressure on repair site
what is considered the gold standard for anterior instability?
the open Bankart
what is the Latarjet procedure and what is it used for?
it is a transfer of the coracoid bone to block anterior motion of the shoulder, used for anterior instability
what motions must be protected after a Latatjet procedure?
external rotation due to involvement of the subscapularis
when should you start sport activity training after Latarjet?
16 weeks
what has been correlated with great shoulder dysfunction in athletes?
balance and stability deficits.
which type of SLAP lesions can be conservatively managed?
type I, type II-IV typically require surgery
what should be the focus on SLAP tear conservative management?
RTC strength, scapular stabilizers, AND posterior shoulder mobility
when is full motion expected after a SLAP repair?
12 weeks
When can elbow flexion with supination be loaded after a SLAP repair?
10 weeks
When can athletes start to RTP after a SLAP repair?
4 months
in what plane does the AC ligament provide stability
anterior to posterior
what is a type I AC injury?
AC ligament sprain without tearing
what is a type II AC injury?
AC ligament and capsule are ruptured, no injury to CC ligaments
What is a type III AC injury?
complete rupture of the AC and CC ligaments, visible step off
what is a type IV-VI AC injury
complete rupture of the AC and CC ligaments with various degrees of soft tissue damage.
What levels of AC injuries are usually treated conservatively?
type I-III
what motions place the most stress on the AC joint?
IR, horizontal adduction, end range flexion and end range extension
what may you see in someone with a chronic AC injury?
cervical hypolordosis
who tends to be affected by frozen shoulder?
40-65, more females than males
describe phase I of frozen shoulder
pre-adhesive phase, may last up to 3 months, may have sharp pain at end range, achy pain at rest, sleep disturbances
describe phase II of frozen shoulder
freezing phase, thickened red synovitis, 3-9 month period, very painful end ranges
describe phase III of frozen shoulder
frozen phase, capsuloligamentous fibrosis, loss of motion with little pain
describe phase IV of frozen shoulder
thawing phase, occurs at 15-24 months from onset, painless stiffness, motion gradually improves
can you use capsular patterns to diagnose frozen shoulder?
no!
How do you diagnose frozen shoulder?
ROM loss of greater than 25% in at least 2 planes, passive ER loss that is greater than 50% of the uninvolved shoulder or less than 30 degrees of ER.
what intervention has level A evidence as an intervention for FS?
corticosteroid injection
what must you be aware of after a hemi or TSA?
the subscapularis is released, be careful with ER!
after HA for an acute fx what are typical flexion, ER, and functional IR?
flextion 101, ER 18, functional IR L3
what is capsulorraphy arthropathy?
arthritis due to surgery to fix instability
if you see greater than _____ degrees of ER in a TSA withing the first 6 weeks you should contact the surgeon
45
when can someone typically start sports activities (golf, swimming, biking) after a TSA?
4-6 month
what 3 conditions do you normally see the RSA in?
massive or irreparable RTC tear, PHF resulting in a deficient RTC, revision of previous arthroplasty that has concurrent RTC deficiency
