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Ortho > Shoulder-Clavicle-Brachial disorders > Flashcards

Shoulder-Clavicle-Brachial disorders Flashcards

1
Q

Bones and jts of the shoulder?

A
  • scapula
  • humerus
  • clavicle
  • sternum
  • ribs
  • SC jt
  • AC jt
  • glenohumeral jt
  • scapular thoracic
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2
Q

Muscles of the shoulder?

A
  • rotator cuff: supraspinatus, infraspinatus, subscap, teres minor
  • pec major
  • biceps: long and short head
  • deltoid
  • trap
  • serratus anterior
  • rhomboid
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3
Q

Fxn of the shoulder?

A
  • sig mobility which allows for vast amt of fxn
  • there is an intricate balance b/t mobility and stability
  • each muscle group which allows for one plane of movement is controlled by another to provide stability to the shoulder
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4
Q

Diff types of shoulder conditions?

A
  • traumatic
  • over use
  • instability
  • fractures
  • age related processes
  • nerve injuries
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5
Q

Usual etiology of AC separation?

A
  • result of falling directly on tip of shoulder or hockey player checked into boards
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6
Q

Severity of AC separation?

A
  • varies as well as expected time of recovery
  • could have involved disruption of CC ligaments and AC ligament
  • grade 1: only AC jt sprained, no x-ray evidence of injury
  • grade 2: disruption of AC ligmaents, CC stretched as well
  • Grade 3: disruption of of all 3 ligaments: CC and AC
  • grade 4: visibly lifted up `
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7
Q

Clinical findings of AC separation?

A
  • tenderness of AC jt
  • possible deformity at AC jt
  • pain w/ adduction of shoulder
    • cross arm test
    • paxinos test w/ anterior and posterior instability
  • pain w/ doing a dip
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8
Q

Tx of AC separation?

A
  • rarely tx w/ surgery(if grade 3 or 4)
  • rest, ice, NSAIDs
  • sling for comfort for wk or 2
  • return to play and activity is determined on pt’s comfort level
  • Weaver-dunn procedure if pain is persisting despite conservative management, reconstruction of CC ligament
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9
Q

MOI of clavicle fracture?

A
  • similar to AC sep only energy passes through bone causing a fracture
  • rarely tx w/ surgery although becoming more common to fix
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10
Q

Clinical findings of clavicle fracture?

A
  • tenderness to palpation over fracture site of clavicle
  • pain w/ adduction of shoulder
  • pt will be sitting w/ shoulders rolled forward
  • deformity at fx site possible tenting of skin
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11
Q

Tx of clavicle fx?

A
  • rest, ice, NSAIDs
  • sling for comfort, possible figure 8 (not that helpful)
  • return to activity is roughly 8 wks
  • surgery if sig displacement (over 200%)
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12
Q

MOI of rotator cuff tendonitis?

A
  • overuse injury typically occurring in throwers in athletes in 40-50s
  • often result of inability to train approp. during the off season for athletes, weekend warriors
  • inflammation of cuff tendon, degenerative fraying, bursitis
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13
Q

Presentaiton of rotator cuff tendonitis?

A
  • development of pain after aggravating activity such as painting house, in throwers
  • pain can be insidious w/o specific injury
  • localized to anterior lateral aspect of shoulder
  • pain is worse w/ reaching overhead or behind body
  • pain at night, hard to sleep
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14
Q

Exam findings of rotator cuff tendonitis?

A
  • tenderness to palpation over greater tuberosity or bicepital groove
  • painful arc of motion and elevation
  • full ROM
  • pain w/ resisted supraspinatus testing
  • no weakness on exam
    • Hawkins, + Neers impingement sign
  • no need for MRI unless refractory to tx
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15
Q

Tx of rotator cuff tendonitis?

A
  • tx aggressively w/ rest in throwers (6 wks)
  • graduated throwing program
  • PT for rotator cuff strengthening
  • subacromial steroid injection
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16
Q

MOI of rotator cuff tear? RFs? What tendons are MC torn?

A
  • MC a degenerative process w/ tears occurring as a result of breakdown of tendon and eventual wearing out
  • supraspinatus and infraspinatus MC torn
  • subscap more commonly torn from trauma
  • tear uncommon b/f 30yo
  • RFs: age, smoking, fall, meds, arthritis
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17
Q

Clinical presentation of rotator cuff tear?

A
  • similar to that of tendonitis
  • pain w/ reaching overhead, night pain, can’t get comfy lying on shoulder, weakness, difficulty reaching overhead, pain over anterior lateral aspect of shoulder
  • pain radiates to deltoid insertion
  • pain can be insidious or as a result of trauma such as a fall or lifting something
  • may have felt a pop at time of the injury
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18
Q

Exam findings of rotator cuff tear? Special tests?

A
  • similar exam to tendonitis w/ exception of ***weakness of affected rotator cuff
  • full PROM but limited AROM
  • weakness in external rotation = infraspinatus tera
  • weakness w/ empty can: supraspinatus
  • weakness w/ internal rotation = subscap
  • xray will have subtle findings but most time negative
- special tests:
Bear hugger test = subscap 
lift off = subscap
belly compression = subscap
\+ Hawkins, + neers
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19
Q

Tx of rotator cuff tear?

A
  • rest, ice, NSAIDs
  • PT for rotator cuff strength program
  • subacromial steroid injection
  • MRI to eval size of rotator cuff tear or rule it in
  • surgical repair of rotator cuff in specific pop
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20
Q

What is calcific tendonitis?

A
  • deposition of Ca++ “hydroxyapatite” the rotator cuff tendon - supraspinatus MC
  • diff consistency of Ca++ deposit, during liquid/tooth paste phase more painful and inflammatory
  • chalk consistency more dormant and no inflammation, less pain
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21
Q

Clinical presentation of calcific tendonitis?

A
  • can be insidious in onset or sudden development of severe “white knuckle pain”
  • pain w/ any movement of the shoulder
  • unable to sleep due to pain
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22
Q

Exam findings of calcific tendonitis?

A
  • tenderness over greater tuberosity
  • limited AROM secondary to pain
  • pain w/ firing of rotator cuff
  • full PROM and not as painful as active
  • weakness of cuff due to pain only, no true weakness
23
Q

Tx of calcific tendonitis?

A
  • NSAIDs, ice, rest
  • PT to prevent stiffness (typically not helpful)
  • subacromial steroid injection w/ needling of Ca deposit
  • surgical decompression and debridement of Ca deposit
24
Q

What is adhesive capsulitis? RFs? 3 phases?

A
  • frozen shoulder is a loss of motion of shoulder as a result of tightening and shrinking of the shoulder capsule
  • may follow a trauma to the shoulder
  • RFs: female, diabetic, hypothyroidism
  • idiopathic
  • 3 phases: freezing, frozen, thawing, can take as long as 2 yrs
25
Q

Presentation of adhesive capsulitis?

A
  • insidious onset of pain and progressive loss of motion
  • may follow a trauma but normally idiopathoic
  • pain at end ROM
  • night pain
  • can’t reach into back pocket, can’t fasten bra
  • pain worse in freezing and frozen stage (can’t go past 90 degrees of ROM)
26
Q

Clinical exam of adhesive capsulitis?

A
  • loss of both PROM and AROM

- pain at end of ROM

27
Q

Tx of adhesive capsulitis?

A
  • PT*** to work on capsular stretching
  • during freezing stages: glenohumeral steroid injection in early stages to decrease inflammation of capsule
  • manipulation under anesthesia “tear adhesions and capsule”
  • arthroscopic capsular release
28
Q

Labral injuries are common in what pop? Describe the injury?

A
  • common in throwers as an overuse injury or traumatic in football, wrestling, volleyball, tennis
  • injury to soft tissue cartilage ring around socket of shoulder which provides stability to shoulder
  • SLAP: superior labral, anterior-posterior
29
Q

Presentation of labral tear?

A
  • common complatin is painful pop in the shoulder
  • difficulty throwing the ball
  • some mid sense of instability
30
Q

Exam findings of labral tear?

A
  • full ROM, crepitus w/ internal and external rotation

- + obrien test = SLAP tear

31
Q

Tx for labral tear?

A
  • tx is conservative w/ no significant time off needed from sports
  • PT for rotator cuff strength and stabilization
  • if pain is presenting despite conservative measures then surgical repair
32
Q

Impingement problems of the shoulder?

A
  • posterior impingement is common in throwers due to increased laxity to anterior shoulder capsule during cocking phase of throwing and tightness in the back (pain and impingement occurs in acceleration and deceleration phase)
  • most will complain of pain in back of shoulder getting worse while throwing
  • tx w/ aggressive stretching program for anterior capsule of shoulder and strength program for rotator cuff
33
Q

When do shoulder dislocations commonly occur? Which dislocation is more common?

A
  • occurs most often due to elevation and external rotation of the shoulder
  • anterior much more common than dislocation
  • *** posterior dislocation more common in fb linemen due to blocking position, also result of seizure and electrocution
  • if you see bony bankart (part of glenoid bone broken off - indicates that labrum and ligaments in front part of shoulder aren’t attached to glenoid) : need surgery
34
Q

Clinical presentation of anterior dislocation?

A
  • pain following an injry: felt a pop and sensation of dislocation w/ signifcant pain. May stay out and need to be reduced or self reduces
  • 1st time dislocation is tx w/ reduction of dislocation and early immobilization
  • PT to work on shoulder stabilization w/ rotator cuff strengthening
35
Q

exam findings of anterior dislocation?

A
    • apprehension sign
    • relocation sign (after + apprehension test, provides relief to pt)
  • increased anterior translation
  • pain w/ ROM and guarding w/ reaching overhead
36
Q

Tx of anterior dislocation?

A
  • xray to r/o ant/inf glenoid fracture “bony bankart”
  • x ray hillsachs deformity
  • PT to work on cuff strength and stabilization
  • return to play roughly 4-6 wks and may reqr bracing to prevent re-dislocation
  • recurrent dislocations will rqr surgery
  • MRI of shoulder if older than 50 to r/o tear
37
Q

Tx of posterior dislocation?

A
  • tx conservatively w/ reduction and immobilization
  • PT to work on rotator cuff strength exercises
  • bracing may help w/ prevention
  • recurrent dislocation reqr surgery to stabilize
38
Q

Etiologies of posterior dislocation?

A
  • MC in linemen due to blocking or being blocked
  • shoulder will get forced out the back by getting struck in shoulder or by blocking an immovable object
  • MVA, seizure, electrocution
39
Q

Worst offendors of shoulder multi-directional instability?

A
  • wrestlers and vball players
40
Q

Presentation of shoulder instability?

A
  • may have multi-jt laxity
  • report recurrent shoulder dislocation but have never had to go to ER to have shoulder reduced
  • will also complain of dull ache in shoulder
41
Q

Tx of shoulder instability?

A
  • tx w/ aggressive PT to strengthen scapular stabilizers as well as rotator cuff
  • surgical intervention is last tx option
42
Q

What is glenhumeral OA? RFs?

A
  • OA of shoulder less common than knee or hip OA due to fact the shoulder isn’t wt bearing
  • RFs: previous trauma (dislocation), instability issues, hereditary, heavy laborer
43
Q

Clinical presentation of glenohumeral OA?

A
  • insidious onset of shulder pain located anterior lateral pr posterior. Pain typically is achy w/ sharp overtones
  • loss of ROM, may not be obvious to pt
  • pain at end of ROM w. sudden movement
44
Q

Exam findings of glenohumeral OA?

A
  • loss of ROM especially external rotation and internal rotation
  • strength will be normal
  • crepitus w/ ROM of glenohumeral jt “cog wheeling”
  • tender over anterior or posterior capsule of shoulder
45
Q

Tx of glenohumeral OA?

A
  • NSAIDs, tylenol
  • terminal stretching to prevent further stiffness
  • glucosamine/chondrotin
  • activity modification
  • glenohumeral steroid injection
  • total shoulder replacement (if 60 or older (only last for 15 years))
46
Q

What is parsonage turner syndrome?

A
  • brachial plexus neuritis or neuralgic amyotrophy, is condition characterized by inflammation of network of nerves that innervate the muscles of chest, shoulders, arms “suprascapular nerve”
  • although individuals w/ condition may experience paralysis of affected areas for months or in some cases years, recovery is usually eventually complete
  • usually follows viral URI, white knuckle pain, risk of shoulder wasting away
47
Q

Exam findings of parsonage turner syndrome?

A
  • atrophy of supra and infraspinatus muscles
  • significant weakness of affected muscles
  • usually non-tender
  • if in acute phase, pt may not tolerate palpation and are in extreme pain
48
Q

Tx of parsonage-turner syndrome?

A
  • EMG studies or MRI may be helpful and excluding cervical radiculopathy, rotator cuff tear
  • oral cortical steroids
  • neurontin
  • pain meds
  • PT
49
Q

Other shoulder conditions an injuries?

A
  • stinger or brachial plexus traction injury: fb player, unable to move or feel arm
  • proximal humerus fracture: elderly women falling
  • scapular fractures: high impact, dirt bike, fall off roof
  • long thoracic nerve injury “scapular winging”: vball player - constantly serving, serratus anterior affected, can’t do push up w/o scapula winging out
  • OA of AC jt: rfs - AC sep, bench press, tx: steroid injection, surgery
  • long head biceps rupture: 60 yo throwing bales - feels electric shock, bruise and popeye deformity, tx: reassurance, assoc of rotator cuff degeneration
  • spinoglenoid cyst: kid w/ weakness w/ resistance on external rotation - tear of labrum, form cyst on posterior aspect of labrum, take out cyst, and fix labrum
50
Q

Supraspinatus exercises?

A
  • empty can w/ thumb down

- dumbbells or rubber tubing

51
Q

rotator cuff strengthing exercises?

A
  • not significantly large and don’t carry notoriety of other muscles of body like pec major
  • impt to add rotator cuff programs to daily regimen of athletes to prevent injury from occurring
52
Q

Infra and teres minor exerciess?

A
  • cable or ruber tubing exercises w/ elbow at side the arm externally rotates against resistance
53
Q

Subscap exercises?

A
  • strongest of the cuff muscles, best strengthened w/ cables or rubber tubing (internal rotation)

Ortho (24 decks)

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