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PHTH 7232 Ortho > Shoulder algorithm > Flashcards

Shoulder algorithm Flashcards

1
Q

What special tests might you use for Superior Capsule Instability? (1)

A

Sulcus sign at 0, norm ~11mm (tests rotator interval, SGHL, superior capsule)

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2
Q

What preliminary instability tests would you perform to assess overall shoulder stability?

And what patients would you do this on?

A
  1. Sulcus sign at 0 (~11mm, superior structures)
  2. Sulcus sign at 90 (no norm, inferior structures)
  3. Anterior load and shift (~8mm, anterior structures)
  4. Posterior load and shift (~9mm, posterior structures)

All patients

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3
Q

What Tests could you perform to test for SLAP? (6)

A
  1. Compression-Rotation Test
  2. Speed’s Test
  3. O’Brien’s Test
  4. Anterior Slide test
  5. Posterior Slide
  6. Crank Test
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4
Q

What special tests could you perform to assess anterior instability? (3)

A
  1. Anterior Load & Shift (anterior capsule and ligaments)
  2. Jobe sublux/reloc test (microtrauma, anterior synovial lining & capsule and IGHL)
  3. Apprehension test (macrotrauma)
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5
Q

What special tests could you perform to assess posterior instability? (4)

A
  1. Posterior Load & shift (post. capsule, norm ~9mm)
  2. Posterior Glide I, [tight capsule] (post. capsule)
  3. Jerk Test (Post. capsule, if + only 14% recover with PT alone)
  4. Posterior Glide II, [lax capsule] (post capsule)
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6
Q

What special test could you perform to assess inferior capsule and SGHL instability? (1)

A

Sulcus sign at 90 (no norm data)

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7
Q

When comparing sides, do you test the involved or uninvolved side first?

A

Uninvolved

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8
Q

MDI definition

A

Multi-directional instability

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9
Q

If pt tests positive (for instability) in initial 4 instability tests, and positive during impingement tests, would you classify them as primary or secondary impingement?

A

secondary impingement

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10
Q

If pt tests negative (for instability) in initial 4 instability tests, and positive during impingement tests, would you classify them as primary or secondary impingement?

A

Primary impingement

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11
Q

What is the special term that refers to the way the joint returns to resting position after pressure on it is released?

A

Hysteresis

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12
Q

Hysteresis

A

The way the joint tissue springs back after being compressed/stretched

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13
Q

For special tests, how many times should do a non-resisted test and what is the purpose of each time?

A

3 times:

  1. get general idea
  2. implicate tissues
  3. corroborate finding
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14
Q

what is the term for when you have pushed a joint to its furthest and tightest position during stability testing?

A

Capsular end feel

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15
Q

Is springy rebound compliance/hystoresis or capsular end feel more important (in Dr. Davies opinion)?

A
  • springy rebound compliance/hystoresis
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16
Q

How hard should you push when doing load and shift tests (and maybe its for any manual tests??)

A

9.5 lbs

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17
Q

What does SLAP stand for?

A

Superior Labrum, Anterior to Posterior

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18
Q

Where is a peel back mechanism SLAP found and why?

A

On the superior posterior labrum (between 10-12 on right) because greater tubersosity rubs against the labrum there

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19
Q

Where is an eccentric deceleration SLAP tear found?

A

anterior superior part of labrum, 12-2 on right side

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20
Q

Bankhart tears occur where?

A

Below “equator” of the glenoid on the superior anterior portion of the labrum.

Left Bankart is from 6-9, Right Bankart is from 3-6.

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21
Q

Draw the Clock Face diagram (probably have to specify if it is for Right or Left for the SLAP part)

A

https://classconnection.s3.amazonaws.com/297/flashcards/2750297/png/clock_face-1482D4CF2A93064AF79.png

(link is to picture that is attached)

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22
Q

What three things could indicate a positive SLAP test?

A
  1. deep pain
  2. clicking/clunking
  3. pseudo-locking/locking especially clicking & clunking must be consistent; a few clicks and clunks here and there is not positive in and of itself. remember “one test is no test”
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23
Q

how many pain generators are in the sub-acromial space?

A

11!

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24
Q

In order from best to worst what are the top three SLAP tests?

A
  1. O’Brien’s Test
  2. Crank Test
  3. Speed’s Test
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25
Q

What special tests could you perform to test the Long Head of the Biceps (LHB)? (6)

A
  1. Yergason’s Test (also tests THL)
  2. Speed’s Test
  3. Neer Test
  4. Coracoid Impingement (+ is pain at Ant./Med.)
  5. Cross-over test (+ is pain at Med.)
  6. O’Brien’s Test (davies mentioned in lecture I think)
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26
Q

What special tests could you perform to check AC joint? (3)

A
  1. O’Brien’s Test
  2. AC Anterior-Posterior Sheer test
  3. Cross-over (hug) test (+ sup. pain)
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27
Q

What special tests could you use to evaluate supraspinatus impingement? (4)

A
  1. Neer Test
  2. Kawkins-Kennedy Test (only test that isolates supraspinatus)
  3. Coracoid Impingement test (+ lat. pain)
  4. Cross-over (hug) test (+ lat. pain)
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28
Q

What special test could you do to evaluate rotator cuff tear in the supraspinatus? (2)

A
  1. ERLS II (External rotation Lag Sign II)
  2. 90/90 Lag sign II
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29
Q

What special tests could you do to evaluate subscapularis impingement?

A
  1. Coracoid Impingement test (+ Ant. Med. Pain)
  2. Cross-Over (hug) test (+ med. pain)
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30
Q

What special test could you do to assess subscapularis rotator cuff tear? (1)

A

IRLS (internal rotation lag sigin)

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31
Q

What special tests could you perform to asses Internal Impingement? (2)

A
  1. Jobe sublux/reloc test (+ post. pain for Int. Imp. Synd.)
  2. Cross-over (hug) test (+ posterior pain, not precise so could also be a lot of other stuff)
32
Q

What special tests could you do to assess Infraspinatus rotator cuff tear? (2)

A
  1. ERLS I (external rotation lag sign I)
  2. 90/90 Lag Sign I
33
Q

What special test could you do to assess infraspinatus/teres minor and posterior capsule imprecisely? (1)

A
  1. Cross-over (hug) test (+ post. pain)
34
Q

What special tests could you do to test for Bankart lesions? (3)

A
  1. Clunk Test I
  2. Clunk Test II (see-saw test)
  3. Crank Test
35
Q

Which special tests do you want to do on all patients? (4)

A
  1. Suclus sign at 0 (~11 mm norm, tests superior structures)
  2. Sulcus sign at 90 (no norm, tests inferior structures)
  3. Anterior load and shift (~8mm norm, tests anterior structures)
  4. Posterior Load and shift (~9mm norm, tests posterior structures)
36
Q

What should you consider testing if pt presents with the following symptoms:

  • MOI = macrotraumatic,
  • MOI = eccentric deceleration history of activities,
  • deep shoulder pain,
  • locking/pseudo-locking,
  • repetitive clicks/clunks
A

Check for SLAP

  1. Compression-rotation
  2. Anterior slide test
  3. Posterior slide test
  4. Speed’s test
37
Q

CKC stands for

A

Closed Kinetic Chain

38
Q

What is the most common CKC MOI for a slap tear?

A

A a FOOSH (falling on an outstretched hand)

CKC = closed kinetic chain)

39
Q

Define FOOSH

A

Falling On an Out-Stretched Hand

40
Q

What Tests to Consider for Symptom(s): All Patients. (4)

A

Overall Instabilities

  1. Sulcus Sign at 0 (norm ~11mm) [sup. Cap., SGHL, Rot. Interval]
  2. Sulcus Sign at 90 (no norm) [inf. Cap., IGHL]
  3. Anterior Load & Shift (norm ~8mm) [Ant. Cap. & ligaments]
  4. Posterior Load & Shift (norm ~9mm) [Post. Cap.]
41
Q

What Tests to Consider for Symptom(s): MOI = Macrotrauma, generally as its own condition . (4)

A

Four SLAP Tests

  1. Compression-rotation (+ deep pain, clicking/clunking, pseudo-locking/locking)
  2. Anterior slide test [ant. Sup. Acc. Dec.] (+ deep pain, clicking/clunking, pseudo-locking/locking)
  3. Posterior slide test [post. Sup. Peel back] (+ deep pain, clicking/clunking, pseudo-locking/locking)
  4. Speed’s Test (+ deep pain)
42
Q

What Tests to Consider for Symptom(s): MOI = Macrotrauma with functional disability (5)

A

Five Rotator Cuff Tests

  1. ERLS I [Infr.] (+ lag)
  2. ERLS II [Supra.] (+ lag)
  3. 90/90 Lag Sign I [Infr.] (+ lag)
  4. 90/90 Lag Sign II [Supra.] (+ lag)
  5. IRLS [Subscap.] (+ lag)
43
Q

What Tests to Consider for Symptom(s): MOI = Macrotrauma with ant/inf injury (1)

A

One Anterior Instability Test - macrotrauma

  • Apprehension Test [Ant. Cap. & IGHL] (+ fear, pain is not positive)
44
Q

What Tests to Consider for Symptom(s): MOI = Macrotrauma to cause post. Trauma (3)

A

Three Posterior Instability Tests

  1. Posterior Glide I (tight capsule) [Post. Capsule] (+ pain?)
  2. Jerk Test [post. Capsule] (+ pain & subluxation)
  3. Posterior Glide II (lax capsule) [Post. Capsule] (+ pain?)
45
Q

Hx of Macrotrauma indicates which special tests? (3)

A

Three Bankart Lesion Tests

  1. Clunk Test I [Ant/inf. Labrum] (+ deep pain, clicking/clunking, pseudo-locking/locking)
  2. Clunk Test II (see-saw test) [Ant/inf. Labrum] (+ deep pain, clicking/clunking, pseudo-locking/locking)
  3. Crank Test (also tests for SLAP) [Ant/inf. Labrum] (+ deep pain, clicking/clunking, pseudo-locking/locking)
46
Q
  • MOI = macrotrauma to superior shoulder,
  • MOI CKC (closed kinetic chain) position,
  • c/o Pain with Overhead Activities,
  • Pain “on Top” of Shoulder,
  • Pain with AC Palpation,
  • Pain with Cross-Over Activities, &
  • Asymmetrical Deformities of AC.

Indicates which special test? (1)

A

One AC Test

  • AC Anterior-Posterior Shear test (+ pain)
47
Q

MOI = Eccentric Deceleration history of activities indicates which special tests? (5)

A

The Four Main SLAP Tests

  1. Compression-rotation (+ deep pain, clicking/clunking, pseudo-locking/locking)
  2. Anterior slide test [ant. Sup. Acc. Dec.] (+ deep pain, clicking/clunking, pseudo-locking/locking)
  3. Posterior slide test [post. Sup. Peel back] (+ deep pain, clicking/clunking, pseudo-locking/locking)
  4. Speed’s Test (+ deep pain)

One LHB Test

  1. Yergasuon’s Test [LHB, THL] (+ pain or abnl. palpation)
48
Q

Repetitive Overhead Activities indicate which special tests? (5)

A

Four RTC Impingement Tests

  1. Neer Test [Supra. LHB] (+ pain)
  2. Hawkins-Kennedy Test [isolates supra] (+ pain)
  3. Coracoid Impingement [Ant./Med: LHB & Subscap, Lat: Supra] (+ pain)
  4. Cross-Over (hug)Test [Med: LHB & subsap, Lat: Supra, Sup: AC, Post: Inf/Teres m or post cap. & Inf. Impin] (+ pain)

One Anterior Instability Test - macrotrauma

  1. Apprehension Test [Ant. Cap. & IGHL] (+ fear)
49
Q

c/o Painful Palpation of LHB indicates which special test? (1)

A

One LHB Test

  • Yergasuon’s Test [LHB, THL] (+ pain or abnormal palpation)
50
Q

c/o Pain-Anterior Shoulder indicates which special tests? (4)

A

One LHB Test

  1. Yergasuon’s Test [LHB, THL] (+ pain or abnl palp)

Three Bankart Lesion Tests ( all + deep pain, clicking/clunking, pseudo-locking/locking)

  1. Clunk Test I [Ant/inf. Labrum]
  2. Clunk Test II (see-saw test) [Ant/inf. Labrum]
  3. Crank Test (also SLAP) [Ant/inf. Labrum]
51
Q

c/o Constant Dull Ache in Shoulder would suggest you do which special tests? (5)

A

Five Rotator Cuff Tests

  1. ERLS I [Infr.] (+ lag)
  2. ERLS II [Supra.] (+ lag)
  3. 90/90 Lag Sign I [Infr.] (+ lag)
  4. 90/90 Lag Sign II [Supra.] (+ lag)
  5. IRLS [Subscap.] (+ lag)
52
Q

c/o Posterior shoulder pain would suggest you do which special tests? (4)

A

One Internal Impingement Syndrome Test

  1. Jobe Subluxation/Relocation test [Artic. sides Supra & Infra hit on post. Sup. Lab.] (+ post. Pain in sublux, red. in reloc.)

Three Posterior Instability Tests

  1. Posterior Glide I (tight capsule) [Post. Cap] (+ pain?)
  2. Jerk Test [post. Capsule] (+ pain & subluxation)
  3. Posterior Glide II (lax cap) [Post. Capsule] (+ pain?)
53
Q
  • c/o Pain “Deep” or “in” Shoulder, &
  • Locking/Pseudo-Locking

suggests you do which special tests? (7)

A

Four SLAP Tests

  1. Compression-rotation
  2. Anterior slide test
  3. Posterior slide test
  4. Speed’s Test

Three Bankart Lesion Tests

  1. Clunk Test I
  2. Clunk Test II (see-saw test)
  3. Crank Test (also tests for SLAP)
54
Q
  • c/o Pain in Lateral Aspect of Shoulder/Arm,
  • Night Pain, &
  • Compensatory Shoulder Shrug Sign

suggests you do which special tests? (9)

A

Four RTC Impingement Tests

  1. Neer Test [Supra. LHB] (+ pain)
  2. Hawkins-Kennedy Test
  3. Coracoid Impingement
  4. Cross-Over (hug) Test

Five Rotator Cuff Tests

  1. ERLS I [Infr.] (+ lag)
  2. ERLS II [Supra.] (+ lag)
  3. 90/90 Lag Sign I [Infr.] (+ lag)
  4. 90/90 Lag Sign II [Supra.] (+ lag)
  5. IRLS [Subscap.] (+ lag)
55
Q
  • c/o Painful Arc Syndrome,
  • Painful Arc During AROM, or
  • Overuse of Arm in Unaccustomed Activities

suggests you do which special tests? (4)

A

Four RTC Impingement Tests

  1. Neer Test [Supra. LHB] (+ pain)
  2. Hawkins-Kennedy Test [only test that isolates supra] (+ pain)
  3. Coracoid Impingement [Ant./Med: LHB & Subscap, Lat: Supra] (+ pain)
  4. Cross-Over (hug) Test [Med: LHB & subsap, Lat: Supra, Sup: AC, Post: Inf/Teres minor or post cap. & Inf. Impingement] (+ pain)
56
Q

Pt Older than 40 suggest you do which special tests? (10)

A

One AC Test

  1. AC Anterior-Posterior Shear test

Four RTC Impingement Tests

  1. Neer Test
  2. Hawkins-Kennedy Test
  3. Coracoid Impingement
  4. Cross-Over (hug)

Test Five Rotator Cuff Tests

  1. ERLS I ,
  2. ERLS II,
  3. 90/90 Lag Sign I,
  4. 90/90 Lag Sign II,
  5. IRLS
57
Q
  • Pt Age Younger Than 30,
  • Sensation of Shoulder Weakness, &
  • No Overt Signs of Instability

suggest you do which special tests? (1)

A

One Anterior Instability Test – Microtrauma

  1. Jobe Subluxation/Relocation test [Ant. Synovial lining, Ant. Cap., IGHL.] (+ ant. Pain upon sublux, red. in reloc.)
58
Q

History of Recurrent Subluxations suggests you should perform which special tests? (4)

A

One Anterior Instability Test –

  1. macrotrauma Apprehension Test [Ant. Cap. & IGHL] (+ fear, pain is not positive)

Three Bankart Lesion Tests

  1. Clunk Test I [Ant/inf. Labrum] (+ deep pain, clicking/clunking, pseudo-locking/locking)
  2. Clunk Test II (see-saw test) [Ant/inf. Labrum] (+ deep pain, clicking/clunking, pseudo-locking/locking)
  3. Crank Test (also tests for SLAP) [Ant/inf. Labrum] (+ deep pain, clicking/clunking, pseudo-locking/locking)
59
Q

Volitional Subluxations (history or current) indicate you should perform which special tests? (3)

A

Three Posterior Instability Tests

  1. Posterior Glide I (tight capsule) [Post. Capsule] (+ pain?)
  2. Jerk Test [post. Capsule] (+ pain & subluxation)
  3. Posterior Glide II (lax capsule) [Post. Capsule] (+ pain?)
60
Q

Lots of c/o Clunking/Clicking suggests you should perform what special tests? (11)

A

The Four Main SLAP Tests

The One Main Anterior Instability Test - macrotrauma

The Three Main Posterior Instability Tests

The Three Main Bankart Lesion Tests

61
Q

Functional Disability suggests you should perform which special tests? (5)

A

Five Rotator Cuff Tests

  1. ERLS I [Infr.] (+ lag)
  2. ERLS II [Supra.] (+ lag)
  3. 90/90 Lag Sign I [Infr.] (+ lag)
  4. 90/90 Lag Sign II [Supra.] (+ lag)
  5. IRLS [Subscap.] (+ lag)
62
Q

Horizontal Extension Motion suggests which special test should be performed? (1)

A

One Internal Impingement Syndrome Test

  1. Jobe Subluxation/Relocation test [Artic. sides Supra & Infra hit on post. Sup. Lab.] (+ post. Pain in sublux, red. in reloc.)
63
Q
  • c/o Dead Arm Syndrome, &
  • Positive Apprehension Test

suggests which special test should be performed? (1)

A

One Anterior Instability Test – macrotrauma

  1. Apprehension Test [Ant. Cap. & IGHL] (+ fear, pain is not positive)
64
Q

What are the indications for the following group of special tests? (1)

Overall Instabilities:

  • Sulcus Sign at 0
  • Sulcus Sign at 90
  • Anterior Load &
  • Shift Posterior Load & Shift
A

All Patients

65
Q

What are the indications for the following group of special tests? (5 things)

Four SLAP Tests

  • Compression-rotation
  • Anterior slide test
  • Posterior slide test
  • Speed’s Test
A
  1. MOI = macrotraumatic injury
  2. MOI = eccentric deceleration history of activities
  3. c/o pain “deep” or “in” shoulder
  4. Sensations of locking/pseudo-locking
  5. Repetitive clicking/clunking
66
Q

What are the indications for the following group of special tests? (3)

One LHB Test

  • Yergasuon’s Test [LHB, THL] (+ pain or abnormal palpation)
A
  1. MOI - Eccentric deceleration history
  2. Pain to palpation of LHB
  3. c/o Pain in anterior shoulder
67
Q

What are the indications for the following group of special tests? (8)

One AC Test

  • AC Anterior-Posterior Shear test (+ pain)
A
  1. Age > 40
  2. MOI = macrotrauma to superior shoulder
  3. MOI = CKC position
  4. c/o pain “on top” of shoulder
  5. c/o pain to AC palpation
  6. c/o pain with cross-over activities
  7. c/o pain with overhead activities
  8. Asymmetrical deformities of AC
68
Q

What are the indications for the following group of special tests? (7)

Four RTC Impingement Tests

  • Neer Test
  • Hawkins-Kennedy Test
  • Coracoid Impingement
  • Cross-Over (hug) Test
A
  1. Age > 40 2.
  2. Repetitive overhead activities
  3. Overuse of arm in unaccustomed activities
  4. c/o pain in lateral aspect of shoulder
  5. c/o night pain
  6. c/o painful arc syndrome
  7. Painful arc during AROM
  8. Compensatory Shoulder shrug sign
69
Q

What are the indications for the following group of special tests? (8)

Five Rotator Cuff Tear Tests

  • ERLS I [Infr.] (+ lag)
  • ERLS II [Supra.] (+ lag)
  • 90/90 Lag Sign I [Infr.] (+ lag)
  • 90/90 Lag Sign II [Supra.] (+ lag)
  • IRLS [Subscap.] (+ lag)
A
  1. Age > 40
  2. Macrotraumatic injury with functional disability
  3. Idiopathic onset of functional disability of shoulder
  4. c/o pain in lateral aspect of arm
  5. c/o dull constant ache in shoulder
  6. c/o night pain; often wakes patient
  7. compensatory shoulder shrug sign
  8. functional disability
70
Q

What are the four rules/steps for interpreting/executing the RTC Tear special tests?

A
  1. AAOM to predetermined position
  2. Isometric hold at position successful = normal Muscle-tendon unit
  3. < 5-10 degree lag = partial RTC tear
  4. > 10 degree lag = full RTC tear
71
Q

What are the indications for the following group of special tests? (4)

One Anterior Instability Test – macrotrauma

  • Apprehension Test [Ant. Cap. & IGHL] (+ fear, pain is not positive)
A
  1. Macrotrauma with ant/inf injury
  2. history of recurrent subluxations
  3. c/o “dead arm syndrome”
  4. Positive apprehension test
72
Q

“Dead Arm Syndrome”

A

paralyzing pain and weakness in shoulder, that may be transient. Means athlete is NOT OK suggests anterior shoulder instability

73
Q

What are the indications for the following group of special tests? (6)

One Anterior Instability Test – Microtrauma

  • Jobe Subluxation/Relocation test [Ant. Synovial lining, Ant. Cap., IGHL.] (+ ant. Pain upon sublux, red. in reloc.)
A
  1. Age < 30
  2. Repetitive Overhead Activities
  3. c/o pain with overhead activities
  4. no overt signs of instability
  5. c/o click/clunk in shoulder
  6. Sensations of shoulder weakness
74
Q

What are the indications for the following group of special tests? (2)

One Internal Impingement Syndrome Test

  • Jobe Subluxation/Relocation test [Artic. sides Supra & Infra hit on post. Sup. Lab.] (+ post. Pain in sublux, red. in reloc.)
A
  1. Specific c/o pain in the posterior shoulder inferior to the postero-lateral acromion
  2. Horizontal extension motion
75
Q

What are the indications for the following group of special tests? (5)

Three Posterior Instability Tests

  • Posterior Glide I (tight capsule) [Post. Capsule] (+ pain?)
  • Jerk Test [post. Capsule] (+ pain & subluxation)
  • Posterior Glide II (lax capsule) [Post. Capsule] (+ pain?)
A
  1. MOI: macrotrauma to cause posterior trauma
  2. History of volitional subluxation
  3. c/o posterior shoulder pain
  4. Patient can volitionally sublux shoulder
  5. c/o click/clunk
76
Q

What are the indications for the following group of special tests? (5)

Three Bankart Lesion Tests

  • Clunk Test I
  • Clunk Test II (see-saw test)
  • Crank Test (also tests for SLAP)
A
  1. History of macrotrauma
  2. history of recurrent subluxations
  3. c/o pain anterior or “deep” in shoulder
  4. c/o click/clunk
  5. sensation of pseudo-locking
77
Q
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PHTH 7232 Ortho (21 decks)

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