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OCS > Shoulder > Flashcards

Shoulder Flashcards

1
Q

What is the purpose of the superior GH ligament?

A

restrain inferior translation of humeral head when arm is adducted at the side

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2
Q

What is the purpose of the middle GH ligament?

A

restrain anterior translation from mid range of abduction (45 degrees) and ER with arm at the side

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3
Q

What is the purpose of the anterior band of the inferior GH ligament?

A

limits anterior translation during ER and abduction to 90 degrees

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4
Q

What is the purpose of the posterior band of the inferior GH ligament?

A

limit posterior translation during IR and abduction to 90

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5
Q

What position is the dominant shoulder typically in?

A

sits lower typically

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6
Q

Describe the Kibler scapular slide test

A

measure distance from inferior angle of scap to spinous process at neutral and 90 degrees of elevation, compare side to side.

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7
Q

What is considered abnormal on the Kibler scapular slide test?

A

a difference of greater than 1.5 cm

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8
Q

What does the Kibler scapular slide test test for?

A

scapular dyskinesia

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9
Q

What are the three scapular dysfunction classifications Kibler proposed?

A

inferior, medial, superior

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10
Q

What does inferior scapular dysfunction indicate

A

weak lower trap

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11
Q

What does medial border scapular dysfunction indicate?

A

most often seen with GH joint instability

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12
Q

What does superior scapular dysfunction indicate?

A

most often is a rotator cuff weakness and force couple imbalance

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13
Q

describe the scapular assist test and what it indicates, what is a positive test

A

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.

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14
Q

describe the scapular retraction test, what a positive test is, and what it indicates.

A

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

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15
Q

describe the flip sign, what a positive test is, and what it indicates

A

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

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16
Q

what is the optimal testing position for the supra?

A

champagne toast position

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17
Q

what is the optimal testing position for the infra?

A

arm at the side and in 45 degrees of IR

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18
Q

what is the optimal position to test the subscap

A

gerber test position (hand in low back)

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19
Q

What is a grade I on the humeral translation test?

A

humeral translation within the glenoid without edge loading or translation of the humerus over the glenoid rim

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20
Q

what is a grade II on the humeral translation test?

A

translation of the humeral head up over the glenoid rim with spontaneous return on removal of stress

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21
Q

what is a grade III on the humeral translation test?

A

translation of the humeral head over the glenoid rim without relocation upon removal of stress. Not seen in clinic

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22
Q

Where do labrum tears occur most often?

A

anterior superior and posterior superior, almost never anterior inferior

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23
Q

What happens to the ligaments in the GH joint after a SLAP tear?

A

there is a 100% increase in strain on the anterior band of the inferior GH ligament, lots of load

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24
Q

What 4 tests use a long axis compression to assess the labrum?

A

clunk, circumduction, compression rotation, and crank test

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25
Q

what 4 test use muscular exertion to test the labrum and what part of the labrum are they specifically testing?

A

O’Brian active compression, mimori test, biceps load test, and ER supination test

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26
Q

what may you see on radiographs that indicates a chronic rotator cuff?

A

irregularity of the greater tuberosity, sclerosis of the undersurface of the acromion, elevated humeral head

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27
Q

what is the ration of ER to IR

A

ER should be 66% of IR

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28
Q

Describe stage I of Neers impingement classification

A

involves edema and hemorrhage, reversible, conservatively managed, below 25 years old

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29
Q

describe stage II of Neers impingement classification

A

termed fibrosis and tendonitis, involves thickening of the subacromial bursae. Typically 25-40 years old

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30
Q

Describe stage III of Neers impingement classification

A

typically involves a partial or total RTC tear, typically over the age of 40

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31
Q

What type of acromium is associated with RTC tears? What type is not?

A

type III is associated with tears (80%), type I is not (3%)

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32
Q

What is step one of treating SAI?

A

scapular control, manual resisted pro/retr of the scap

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33
Q

In someone with primary impingement what do you want to check in terms of ROM that is commonly missed?

A

IR

34
Q

what are the three initial goals of rehabbing SAI?

A

decrease pain through isometrics, normalize capsular pattern through mobilization, rotator cuff and scapular strengthening

35
Q

why use a towel during ER exercises?

A

Increases muscle activity by 10%

36
Q

do you want to chase strength or endurance at then beginning phase of treatment for SAI

A

endurance

37
Q

when advancing to discharge, what test can you use in a SAI patient to clear them?

A

the same you used to diagnose them, neer, hawkins, yocum

38
Q

what are the determinants of rehab progression in RTC repair patients?

A

full/partial thickness tear, tear size, degree of tear, muscles involved

39
Q

what causes bursal sided RTC tears?

A

SAI

40
Q

what causes articular sided RTC tears?

A

tensile load and GH instability

41
Q

what is considered a small RTC tear?

A

less than 1 cm

42
Q

what is considered a medium RTC tear?

A

between 1-3 cm

43
Q

what is considered a large RTC tear?

A

between 3-5 cm

44
Q

what is considered a massive RTC tear?

A

greater than 5 cm

45
Q

does early mobilization vs immobilization lead to an increase in RTC tears at one year follow ups?

A

no

46
Q

which of the following instabilities is most common: anterior, posterior, multidirectional?

A

anterior

47
Q

when do you expect to see full ROM in anterior capsulolabral repair, bankhart repair, and inferior capsular shift?

A

10-12 weeks

48
Q

what is obligate motion in the shoulder and why is it important to be aware of after instability surgery?

A

it is the unwanted movement of the shoulder anteriorly due to posterior capsular tightness, can put pressure on repair site

49
Q

what is considered the gold standard for anterior instability?

A

the open Bankart

50
Q

what is the Latarjet procedure and what is it used for?

A

it is a transfer of the coracoid bone to block anterior motion of the shoulder, used for anterior instability

51
Q

what motions must be protected after a Latatjet procedure?

A

external rotation due to involvement of the subscapularis

52
Q

when should you start sport activity training after Latarjet?

A

16 weeks

53
Q

what has been correlated with great shoulder dysfunction in athletes?

A

balance and stability deficits.

54
Q

which type of SLAP lesions can be conservatively managed?

A

type I, type II-IV typically require surgery

55
Q

what should be the focus on SLAP tear conservative management?

A

RTC strength, scapular stabilizers, AND posterior shoulder mobility

56
Q

when is full motion expected after a SLAP repair?

A

12 weeks

57
Q

When can elbow flexion with supination be loaded after a SLAP repair?

A

10 weeks

58
Q

When can athletes start to RTP after a SLAP repair?

A

4 months

59
Q

in what plane does the AC ligament provide stability

A

anterior to posterior

60
Q

what is a type I AC injury?

A

AC ligament sprain without tearing

61
Q

what is a type II AC injury?

A

AC ligament and capsule are ruptured, no injury to CC ligaments

62
Q

What is a type III AC injury?

A

complete rupture of the AC and CC ligaments, visible step off

63
Q

what is a type IV-VI AC injury

A

complete rupture of the AC and CC ligaments with various degrees of soft tissue damage.

64
Q

What levels of AC injuries are usually treated conservatively?

A

type I-III

65
Q

what motions place the most stress on the AC joint?

A

IR, horizontal adduction, end range flexion and end range extension

66
Q

what may you see in someone with a chronic AC injury?

A

cervical hypolordosis

67
Q

who tends to be affected by frozen shoulder?

A

40-65, more females than males

68
Q

describe phase I of frozen shoulder

A

pre-adhesive phase, may last up to 3 months, may have sharp pain at end range, achy pain at rest, sleep disturbances

69
Q

describe phase II of frozen shoulder

A

freezing phase, thickened red synovitis, 3-9 month period, very painful end ranges

70
Q

describe phase III of frozen shoulder

A

frozen phase, capsuloligamentous fibrosis, loss of motion with little pain

71
Q

describe phase IV of frozen shoulder

A

thawing phase, occurs at 15-24 months from onset, painless stiffness, motion gradually improves

72
Q

can you use capsular patterns to diagnose frozen shoulder?

A

no!

73
Q

How do you diagnose frozen shoulder?

A

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.

74
Q

what intervention has level A evidence as an intervention for FS?

A

corticosteroid injection

75
Q

what must you be aware of after a hemi or TSA?

A

the subscapularis is released, be careful with ER!

76
Q

after HA for an acute fx what are typical flexion, ER, and functional IR?

A

flextion 101, ER 18, functional IR L3

77
Q

what is capsulorraphy arthropathy?

A

arthritis due to surgery to fix instability

78
Q

if you see greater than _____ degrees of ER in a TSA withing the first 6 weeks you should contact the surgeon

A

45

79
Q

when can someone typically start sports activities (golf, swimming, biking) after a TSA?

A

4-6 month

80
Q

what 3 conditions do you normally see the RSA in?

A

massive or irreparable RTC tear, PHF resulting in a deficient RTC, revision of previous arthroplasty that has concurrent RTC deficiency

OCS (12 decks)

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