shoulder and upper arm conditions Flashcards
clavicle fracture etiology
fall onto lateral or superior shoulder
clavicle fracture PE: inspection
guarded, deformity, ecchymosis, bleeding
clavicle fracture PE: palpation
focal tenderness over clavicle
clavicle fracture PE: strength
guarded, limmited by pain
clavicle fracture PE: sensation
intact, check radial nerve
clavicle fracture treatment
refer
distal clavicle fracture treatment
surgical - heal poorly without
AC separation: mechanism
fall onto lateral shoulder (classic is being tackled)
AC separation: presentation
pain, guarding, often deformity
AC separation PE: inspection
often a visible deformity, tenting of skin
AC separation PE: palpation
tenderness at AC joint
AC seperation PE: ROM
can accomplish motion and RTC fxn intact
AC separation PE: sensation
intact, check axillary nerve
what to look for on AC separation xray
spacing between coracoid and clavicle
when should you refer for a clavicle fracture?
skin tenting, overriding greater than 1.5 cm
when should you consider surgery for an AC separation?
grade 3 and above
impingement syndrome etiology
pinching of the supraspinatus tendon over the humeral head and below the acromion
hallmark of impingement syndrome
pain
tests for impingement syndrome
arc of pain - 90 to 120 degrees
hawkins maneuver - internal rotation at 90 degrees
impingement test - downward force on acromion with forward flex
AC joint arthritis etiology
pain at the AC joint with overhead arm use or push pull movement
AC joint arthritis findings
pain on crossed arm adduction
localized pain at the AC joint with forward flexion, abduction
rotator cuff tears: treatment
surgery
what muscles make up the rotator cuff
supraspinatus, infraspinatus, teres minor, subscapularis
rotator cuff tear: presentation
weakness > pain, poor ROM in some
rotator cuff tear PE: inspection
maybe atrophy
rotator cuff tear PE: palpation
minimal tenderness
rotator cuff tear PE: ROM
forward flexion, abduction
rotator cuff tear PE: special tests
drop arm, virtually diagnostic when positive
difference between impingement and RTC
maintained rotator cuff strength with impingement
glenohumeral dislocation etiology
fall with axial load and external rotation
glenohumeral dislocation PE: inspection
deformity
glenohumeral dislocation PE: palpation
gently and with neuro exam
glenohumeral dislocation PE: sensation
test peripheral nerves (axillary, musculocutaneous, ulnar)
what imaging view is best for shoulder dislocation
axillary view
Scapular Y
glenohumeral dislocation treatment
reduction, PT
adhesive capsulitis
frozen shoulder
contraction and scarring of the joint capsule
insidious onset
female 40-55
adhesive capsulitis presentation
stiffness
loss of function (ADL’s)
adhesive capsulitis PE: palpation
diffuse tenderness
adhesive capsulitis PE: ROM
limited by stiffness more than pain
ACTIVE = PASSIVE ROM
adhesive capsulitis treatment
pain management and PT
thoracic outlet syndrome etiology
compression of the subclavian artery. can involve brachial plexus
SUPER RARE
what can thoracic outlet syndrome mimic
carpal tunnel syndrome, cubital tunnel syndrome, radiculopathy, musc, axillary, and radial nerve palsy
thoracic outlet syndrome tests
loss of radial pulse with raising arm over head
thoracic outlet syndrome presentation
pain + tingling that can radiate from neck to shoulder, arm, forearm, and fingers
SALT etiology
long thoracic nerve palsy leading to serratus anterior nerve palsy which leads to scapular winging
SALT presentation
loss of tone of rhomboid major, minor and trapezius muscles