Shoulder and elbow tidbits

Question 1

sprengel’s deformity

Answer 1

in utero deformation of scapulae, scapulae sit high on chest wall

Question 2

scapular winging is a problem with what N and what M?

Answer 2

long thoracic N

serratus anterior

Question 3

in general, what are the shoulder impingement categories?

Answer 3

external or internal,

then external broken down into primary or secondary?

Question 4

Dx? shoulder pain with max ER? caused by supraspinatus and infraspinatus tendons ribbing on glenoid and becoming frayed. Pt says “my shoulder never feels loose”, they have an IR limitation

Answer 4

internal impingement

Question 5

impingement that throwers get in late cocking phase.

Answer 5

internal impingement

Question 6

what is GIRD?

Answer 6

glenohumeral internal rotation deficit- happens in throwing shoulders

Question 7

limitations with GIRD?

Answer 7

most loss of IR, loss of total arc of motion tho

Question 8

tx for GIRD?

Answer 8

post. capsule stretching

Question 9

which type of impingement has to do with the type of acromion, like if it is hooked or not.

Answer 9

external… leads to impingement and eventually torn RC

Question 10

what type of impingement is due to decreased subacromial space and often requires a SAD with or w/o a DCE/mumford sx?

Answer 10

primary external imingement

Question 11

dx? ant. shoulder pain, lateral shoulder pain, limited IR and horizontal abduction, the pt says “I can’t fasten my bra, take off my shirt or put on my seatbelt”

Answer 11

primary external impingement

Question 12

what type of impingement is caused by GHJ instability or RC weakness which leads to humeral head migration?

Answer 12

secondary external impingement

Question 13

symps of secondary external impingement

Answer 13

ER/IR ratio is off
humeral head instable (pos. load and shift test),
pain with ER and abduction
(positive aprehension relocation test)

Question 14

who gets secondary external impingement?

Answer 14

OH athletes

Question 15

types of instability

Answer 15

inferior- hurts when i carry grocery bags
posterior- football lineman
anterior- pitchers
multi-directional- ligamentous laxity

Question 16

scapular _______ increases loads on labrum, so u should work into __________.

Answer 16

protraction inc. load on labrum, retraction dec. load on labrum

Question 17

horizontal abduction hurts worst with what dx?

Answer 17

acromioclavicular joint probs

Question 18

Best shoulder exercises:
Reinold Study!  supraspinatus
infraspinatus/teres minor
subscapularis
serratus anterior
lower trap
mid trap
upper trap
rhomboids/levator

Answer 18

supra- full can
infra/tm- SLER with towel
subscap: IR at 0
SA: pushup plus
lower trap: prone full can in scaption, (thumb up is key!)
middle trap- prone row, hand neutral, shoulder at 90
upper trap- shrug
rhomboids/levator- prone rob at neutral for rhomboid, 45 deg. for levator, and 90 degrees for mid trap!

Question 19

3 Fs of adhesive capsulitis

Answer 19

fat, female, 40

Question 20

9 Constitutional symptoms!

Answer 20

fever
fatigue
nausea
night sweats
dizziness
diaphoresis
diarrhea
pallor
weight loss

Question 21

systemic causes of shoulder pain?

Answer 21

pleural pain
bacterial endocarditis
pericarditis

Question 22

how do u know its pleural pain and not heart pain?

Answer 22

decreases when laying on affected side, worse with respiration

Question 23

how do u know if its bac. endocarditis?

Answer 23

1-2 joints have warmth or redness

Question 24

how do u know if its pericarditis?

Answer 24

substernal pain, coughing, pain radiates to shoulder

Question 25

test for pericarditis

Answer 25

kneel down and put elbows on floor, makes the pain better if its pericarditis, if it doesn’t get better its prob and MI.

Question 26

keys to dx AAA

Answer 26

sudden chest pain, back or neck pain, but NO ARM PAIN! tearing sensation!

Question 27

R shoulder pain is referred from where?

Answer 27

hepatic, splenic or biliary

diff. dx by full shoulder ROM and no local tenderness.

Question 28

pain in back and R scapula with nausea, vomiting, chills and dark urine with possible jaundice

Answer 28

cholecystitis (gall bladder)

Question 29

breast referrs pain where?

Answer 29

chest, axilla neck and post. shoulder girdle and down to 4th and 5th digits

Question 30

L shoulder pain?

Answer 30

ruptured ectopic pregnancy

Question 31

SLAP lesion?

Answer 31

peel back of superior labrum, where the longhead of biceps tendon inserts.

Question 32

causes of SLAP lesion?

Answer 32

little woman big dog syndrome, overloading biceps

Question 33

SLAP repair precautions

Answer 33

• no motion (not even passive) above 90 for 3-4 wks)
• no isolated biceps for 8 weeks
• no resisted movement above 90 for 8wks
• no bench or OH lifting for 12 weeks
• no closed chain for 8-10 wks

Question 34

Bankart lesion

Answer 34

inferior labrum

Question 35

Hill Sachs lesion

Answer 35

humeral head hits anterior glenoid and is fractured

Question 36

post. labral tear precautions

Answer 36

no IR or horizontal ADduction

Question 37

what is a latarjet-bristow procedure

Answer 37

take coracoid process and it’s attached mm (pec minor and biceps shorthead) and attach it to the front of glenoid where there is bone loss…

Question 38

typical presentation of arm elevation in person with RC injury

Answer 38

shoulder hike, traps and ant. delt kick in to help

Question 39

how long do u do PROM with RC repairs

Answer 39

4-6 weeks, need full PROM before starting AROM