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OCS > Shoulder > Flashcards

Shoulder Flashcards

1
Q

Percentage of the population with adhesive capsulitis

A
  • 2-5.3% of the population

- 4-38% in those with diabetes or thyroid issues

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2
Q

Red flags for shoulder pain

A
  • diseases of digestive system
  • fracture of upper end of humerus
  • injury of blood vessels at the shoulder and upper arm level, including avascular necrosis
  • neoplasm
  • osteoporosis with pathological fracture
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3
Q

Yellow flags for shoulder pain

A
  • persistant somatoform pain disorder

- psychological and behavioral factors associated with disorders or diseases

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4
Q

To rule in adhesive capsulitis…

A
  • 40-65 y/o
  • gradual onset and progressive worsening of pain and stiffness
  • Glenohumeral PROM is limited in multiple directions
  • ER most limited, especially when combined with ABD
  • ER and IR ROM decreases as humerus is abducted from 45-90 degrees
  • PROM into end ranges reproduces patient’s pain (capsular)
  • Glenohumeral glides limited in all directions
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5
Q

To rule out adhesive capsulitis…

A
  • PROM is normal
  • Radiographic evidence of glenohumeral OA
  • Passive glenohumeral ER and IR ROM increases as humerus is abducted from 45-90 degrees
  • familiar shoulder pain reproduced with palpation of the subscapularis
  • ULTT reproduces familiar symptoms
  • familiar shoulder pain reproduced with palpation of nerve entrapment sites
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6
Q

Adhesive capsulitis stages

A
  1. early, often confused with subacromial impingement syndrome
  2. painful/freezing stage
  3. frozen stage
  4. thawing stage
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7
Q

Stage 1

A
  • early, up to 3 months
  • sharp pain at end of ranges
  • achy pain at rest
  • sleep disturbed
  • patho-anatomical…synovial reaction but no adhesions or contractures
  • differential diagnosis: subacromial impingement syndrome
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8
Q

Stage 2

A
  • Freezing
  • 3-9 months (6 months total)
  • gradual loss of ROM in all directions due to pain
  • aggressive synovitis
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9
Q

Stage 3

A
  • Frozen
  • lasts 9-15 months (6 months total)
  • pain and significant loss of ROM
  • capsuloligamentous fibrosis results in loss of axillary fold
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10
Q

Stage 4

A
  • Thawing
  • 15-24 months (9 months total)
  • decreased pain
  • motion restricted
  • capsuloligamentous complex fibrosis and receding synovial involvement
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11
Q

Interventions for adhesive capsulitis

A
  • intra-articular injections combined with manual therapy and stretching may provide short term pain relief.
  • match level of treatment with tissue irritability
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12
Q

High irritability

A
  • high pain levels (>7/10)
  • consistent/constant pain
  • high self reported disability
  • pain occurs before end range
  • AROM significantly less than PROM
  • interventions
  • -> heat and e-stim
  • -> patient education on activity modification
  • -> grade I and II joint mobs
  • -> pain free PROM and AAROM
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13
Q

Moderate irritability

A
  • 4-6/10 pain
  • intermittent night or resting pain
  • moderate levels of disability on self reported outcome tools
  • pain at end ranges of active or passive movement
  • AROM is equal to PROM
  • Interventions
  • -> heat and e-stim
  • -> patient education
  • -> moderate intensity joint mobs
  • -> moderate stretching
  • -> progressing intensity with duration without post treatment soreness
  • -> integrate gains in mobility with scapulohumeral movement. Performance of reaching activities
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14
Q

Low irritability

A
  • <4/10 pain
  • no night or resting pain
  • minimal levels of disability on self reported tools
  • pain with overpressure into end range PROM
  • AROM equal to PROM
  • interventions
  • -> patient education
  • -> end range joint mobs, grade III and IV
  • -> progressive duration into stretching
  • -> scapulohumeral movement during higher level performance activities. Working into recreational activities/training
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15
Q

Differential diagnoses for shoulder impingement/RTC syndrome

A
  • adhesive capsulitis
  • injury of muscle and tendon at UE level (labrum)
  • injury of nerves at UE level, including suprascapular involvement
  • OA of AC joint or GH joint
  • cervical spine referral
  • pain in thoracic spine
  • sprain of AC joint or SC joint
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16
Q

Glenohumeral OA symptoms

A
  • pain and stiffness with activity, osteophytes, 24 hour pain behavior or stiffness in AM or after rest
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17
Q

Glenohumeral instability symptoms

A
  • feeling of giving out, possible dislocation history and positive special tests
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18
Q

Referred pain symptoms

A
  • associated neck and thoracic signs and symptoms, myofascial structures
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19
Q

Adhesive capsulitis symptoms

A
  • slow onset of shoulder stiffness and limited ROM
20
Q

AC joint symptoms

A
  • TTP over AC joint and pain over top of shoulder
21
Q

Nerve entrapment symptoms

A
  • suprascapular or long thoracic nerve palsy
22
Q

Labral tear symptoms

A
  • deep and vague shoulder pain associated with clicking, popping, and catching.
23
Q

Biceps tendonopathy symptoms

A
  • pain and tenderness over anterior shoulder with associated TTP over bicep tendon
24
Q

Stage I of impingement

A
  • edema and hemorrhage
  • mechanical irritation of tendon with overhead activity
  • younger/athletic population
25
Q

Stage II of impingement

A
  • fibrosis and tendonitis
  • repeated episodes of mechanical irritation
  • thickening or fibrosis of subacromial bursa
  • age 25-40
26
Q

Stage III of impingement

A
  • Bone spurs and tendon rupture
  • continual mechanical compression of RTC
  • RTC tears, biceps tendon lesions, bony alterations of acromion
27
Q

Secondary impingement

A
  • underlying instability of GH joint
  • associated dysfunction of static stabilizers (capsular ligaments, labrum), and dynamic stabilizers (neuromuscular control)
  • not necessarily associated with patho-anatomical finding
28
Q

RTC impingement test cluster

A

(+) hawkins kennedy
(+) painful arc
(+) IR muscle test
-High probability (+) neer, (+) empty can along with aforementioned tests

29
Q

Instability vs laxity

A

Laxity: can be normal and asymptomatic
Instability: is symptomatic and patients have pain, apprehension, fear, parasthesia, fatigue. There is loss of centering of humeral head in glenoid

30
Q

Traumatic instability (TUBS)

A
  • Traumatic
  • Unidirectional
  • Bankart lesion
  • Surgery is required
31
Q

Atraumatic instability (AMBRII)

A
  • Atraumatic
  • Multidirectional
  • Bilateral
  • Rehab is choice
  • Inferior capsular shift
  • Internal closure
32
Q

Types of instability

A
  • congenital
  • multi directional
  • primary dislocation
33
Q

Multi directional instability

A
  • dislocation of GH joint

- (+) sulcus sign may be acquired

34
Q

Multi directional instability considerations

A
  • capsular enlargement
  • GH ligament incompetence
  • increased GH volume
  • excess laxity
  • shape of glenoid cavity
  • muscular imbalance or neuromuscular control issues
  • underlying connective tissue pathology
  • those with a high beighton score
35
Q

Primary dislocation

A
  • dislocation and subluxation of GH joint
  • age of 20’s is common as well as 60’s
  • most commonly displaced anteriorly
  • 95% first time dislocation trauma
  • often athletes or sports related injuries
  • Remainder are from MDI or congenital instability
36
Q

Primary dislocation anterior MOI

A
  • Forced shoulder ER and ABD
  • FOOSH
  • direct force to posterior humeral head
37
Q

Possible related issues post dislocation

A
  • anterior labrum detachment (Bankart lesion)
  • compression fracture of humeral head (hill-sachs lesion)
  • scapulothoracic motion issues
  • proprioception loss
  • re-occurence (70% in 2 years after first)
38
Q

Anterior instability

A
  • pain with cocking phase of a throw

- shoulder in ER and horizontal ABD

39
Q

Posterior instability

A
  • pain during follow through

- shoulder in IR and horizontal ADD

40
Q

Symptoms of rotator cuff tear

A
  • c/o anterior/lateral shoulder pain
  • compensatory shoulder shrugging with overhead motion
  • gross functional disabilities
  • constant achiness in the shoulder
  • night pain - pain that wakes the patient during sleep
  • patient age of 40 or greater
41
Q

Symptoms of anterior capsulolabral instability, anterior labral lesions, or bankart lesions

A
  • c/o anterior shoulder pain
  • apprehension and/or pain in positions of ABD and ER
  • a history of anterior/inferior trauma
  • recurrent or volitional anterior/inferior subluxation and/or dislocations
  • joint clicking/clunking
  • complaints of joint locking
  • a history of “dead arm syndrome”
42
Q

Symptoms of posterior capsular instability or labral lesions

A
  • c/o deep posterior pain
  • apprehension and/or pain in positions of horizontal ADD
  • apprehension or pain during activities that involve pushing (especially coupled with horizontal ADD)
  • apprehension or pain during closed kinetic chain positions
  • a history of posterior/inferior trauma
  • recurrent or volitional posterior/inferior subluxations and/or dislocations
  • complaints of joint clicking/clunking
43
Q

Symptoms of SLAP lesion

A
  • C/o deep shoulder pain, clicking/clunking, complaints of joint locking
  • pain with activities that require eccentric deceleration of the upper extremity (such as throwing or swinging)
  • pain with muscular loading of the biceps (especially during shoulder flexion and arm supination)
44
Q

Symptoms of articular-sided internal impingement syndrome of the rotator cuff

A
  • c/o very specific posterior/superior pain during shoulder ABD and ER
  • possible pain during activities that require eccentric deceleration of the upper extremity (such as throwing or swinging an object)
45
Q

Symptoms of long head of bicep tendinopathy

A
  • c/o anterior pain
  • painful palpation to the proximal aspect of the long head of the biceps
  • pain with activities that require eccentric deceleration of the upper extremity (such as throwing or swinging an object)
  • pain with muscular loading of the biceps (especially during shoulder flexion and arm supination)
46
Q

Acromioclavicular joint lesions

A
  • c/o superior joint pain
  • pain with end-range elevation activities
  • pain with horizontal adduction activities
  • painful palpation to the AC joint
  • a notable AC joint “Step-off” on observation
  • an injurious mechanism that involves a fall on the shoulder
47
Q

Internal rotation resisted strength test

A
  • if internal rotation strength is less than external rotation strength is positive for intra-articular pathology
  • -> glenoid erosion or labral tears, middle GH ligament tearing, articular sided RTC partial tears, posterior labral lesions, and SLAP tears
  • if internal rotation strength is greater than external rotation strength the test is positive for RTC pathology
  • -> thickened or inflamed subacromial bursa, erosions on the CA ligament and undersurface of the acromion, bursal side partial or full thickness RTC tear

OCS (11 decks)

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