Shoulder

Question 1

Med/Lat Pec

Answer 1

pec major C5-T1
pec minor (med only) C8-T1

Question 2

Thoracodosral

Answer 2

lats

C6-C8

Question 3

Axillary

Answer 3

deltoid, TMinor

C5-C6

Question 4

Suprascapular

Answer 4

RTC

C5-C6

Question 5

Musculocutaneous

Answer 5

coracobrachialis

C5-C6

Question 6

Spinal Accessory

Answer 6

trap

CN XI

Question 7

Dorsal Scapular

Answer 7

rhomboids, LS

C5

Question 8

Long Thoracic

Answer 8

SA

C5-C7

Question 9

Special Tests - instability/laxity

Answer 9

load and shift - A/P instability
sulcus - MDI
A/P draw - A/P lax
apprehension (crank) - shoulder instability
Fowler's Sign - ant GH instab

Question 10

Passive Stabilizers

Answer 10

superior GH lig - prevents inf HH sublux (limits ER 0 deg abd)
middle - limits ant trans 45 deg abd
inf - 3 bands (post, inf, ant)
post capsule - blends with RTC, enhances stab

Question 11

Special Tests - RTC/Impingment

Answer 11

possible RTC tear - empty/full can, ER lag sign, DA, belly press

impingement - HK, neer

Question 12

Special Tests - Labral

Answer 12

SLAP - biceps load, compression/rotation

labral involvement - crank

Obrien’s - slap vs ac involvement

Question 13

Special Tests - Biceps

Answer 13

Yergason’s - biceps tendon irritation

Speed’s - LH pathology, may indicate SLAP

Ludington’s - biceps rupture

Question 14

Imaging

Answer 14

trauma - axillary, Y view scap, AP
non trauma - routine axillary

US good for RTC full thickness
west point/striker - bankart and hill sach’s
zanca - AC jt

Question 15

Clavicular Fx (CET)

Answer 15

C - FOOSH, direct impact (most common in sports)
E - tilt head toward affected side with chin toward unaffected side, tender, possible deformity
T - sling/swath, immob 6-8 wks, sometimes surgery

Question 16

Scapular Fx (CET)

Answer 16

C - direct impact or force through humerus
E - swelling, pt tender
T - sling 3 weeks

Question 17

Humerus Fx (CET)

Answer 17

C - FOOSH, dislocation, direct blow
E - pain, inability to move arm, swelling
T - splint and immediate referral (shock possible), shaft 3-4 mo, prox 2-6 mo

Question 18

SC Jt Sprain (CET)

Answer 18

C - blow to clavicle, torsion of post ext arm (not very common)
E - swelling, possible displacement, pt tender
T - RICE, reduction if necessary, immob 3-5 wks

Question 19

AC Jt Sprain (CET)

Answer 19

C - direct impact to tip of shoulder, FOOSH on add/part flex arm
E - pain, tender, deformity > grade III
T - I (sling 2-4 days) II (sling 10-14 days) III (sling 2-3 weeks) IV+ (surgery)

Question 20

AC Jt Sprain Grades

Answer 20

I - mild sprain of AC/CC lig
II - complete tear of AC, CC sprain
III - complete tear AC/CC
IV - complete tears, clavicle separation
V - clavicle goes through trap
VI - clavicle locker under coracoid process

Question 21

RTC Tear (CEST)

Answer 21

C - trauma in younger pop, degeneration in older pop
E - nigh pain, weak, tender
S - cluster (DA, painful arc, infra)
T - conservative for partial or older, surgery

Question 22

RTC Repair

Answer 22

days 1-6
- abd brace until wk 6, PROM to 110, ER/IR in scap plane < 30

wk 2-7
- PROM to tol, scap iso, begin walking/bike for aerobics

wk 7-12

• initiate AAROM, DC brace, full PROM by wk 8, periscap ex, GH rhythmic stab
• initiate AROM when ROM WFL (no shrug)

wk 12-18

• full AROM by 12-14 wks, dynamic shoulder stab and strengthening, gradual return to fxnl activities
• wk 16 - low level plyo

wk 18 - light sports
wk 24 - interval sports program

Question 23

Anterior Instability

Answer 23

occurs after trauma in ER/abd
higher risk for bankart and SLAP
90% of all dislocation

Question 24

Posterior Instability

Answer 24

2-10% dislocations

higher risk of posterior labral tear

Question 25

MDI

Answer 25

not usually associated with traumatic events

may result in recurrent sublux or dislocations

Question 26

Anterior Stabilization

Answer 26

wk 1-3
- sling at all times, isos at wk 3

wk 4-5
- continue use of sling, PROM (caution with ER/abd)

wk 6-7
- wean from sling, full PROM, start AROM, isotonic/RS for RTC

wk 8-12 - progress
wk 12-16 - golf and tennis (serve at 4 mo), weight lifting (low weight, high reps)
wk 16-20 - interval sports program

Question 27

SLAP Tear (CEST)

Answer 27

C - FOOSH, dislocation, peel back lesion from throwing
E - feeling on instability popping, dec throwing power
S - Obrien’s, biceps load, clunk
T - arthroscopic most common

Question 28

SLAP Types

Answer 28

I - degenerative fraying of sup labrum, biceps attachment intact
II - biceps anchor has pulled away from attachment at glenoid
III - bucket handle tear of sup labrum with intact biceps anchor
IV - similar to III but extends into biceps anchor

I/III - debride, II/IV - repair

Question 29

SLAP Repair (II/IV)

Answer 29

day 1-wk 2
- sling 4 weeks, no AROM (PROM/AAROM), no biceps contractions, submax iso RTC

wk 3-4
- DC sling, RS exercise, continue PROM/AAROM

wk 5-6
- initiate AROM, PNF shoulder, no resisted biceps

wk 7-9
- begin isotonics, Throwers 10, submax painfree iso biceps

wk 10-12
- continue TT, resisted biceps 12 weeks

wk 12-14
- light, restricted sports (light swimming, half golf swing), light plyo

wk 16-20 - interval sports training progarm
mo 6-9 - RTS accordingly

Question 30

Bankart Lesion (CET)

Answer 30

C - most common with anterior shoulder dislocation (often accompanied by Hill Sach’s)
E - feeling of instability, popping, dec throwing power
T - arthroscopic

Question 31

Arthroscopic Bankart Repair

Answer 31

wk 0-6
- sling for 3-4 wks, PROM/AAROM, AROM 4-6 wks, submax sho isos at 4-6 wks

wk 6-12
- full AROM by 10-12 wks, isotonics, RS

wk 12+ - begin plyos, sport specific exercises
wk 20-24 RTS
mo 6-9 - RTS accordingly

Question 32

AC Jt Osteolysis (CET)

Answer 32

C - repetitive microtrauma, subchondral microfx overtime, heavy weight lifting (bench press, OH press inc incidence)
E - localized pain, swelling, weakness, (+) cross body add test, pain with resisted flex, crepitus
T - activity modification, allow for new bone formation, anti-inflammatories