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Ortho > Shoulder-Clavicle-Brachial Disorders > Flashcards

Shoulder-Clavicle-Brachial Disorders Flashcards

1
Q

Bones & Joints of the Shoulder

A 
Clavicle
Sternum
Scapula
Humerus
Ribs
SC joint
AC joint
Glenohumeral joint
Scapular thoracic joint
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2
Q

Muscles of the Shoulder

A 
Supraspinatus
Infraspinatus
Subscapularis
Teres minor
Pectorals major
Biceps
Deltoid
Trapezius
Serratus anterior
Rhomboid
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3
Q

Types of Conditions of the Shoulder

A 
Traumatic
Overuse
Instability
Fractures
Age related processes
Nerve injuries
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4
Q

What is AC separation typically a result of?

A

Falling directly on the tip of the shoulder

Hockey player getting checked into the boards

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5
Q

Describe Grade 1 AC Separation

A

Strain of the acromioclavicular ligament

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6
Q

Describe Grade 2 AC Separation

A

Tear of acromioclavicular ligament

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7
Q

Describe Grade 3 AC Separation

A

Tear of acromioclavicular & coracoclavicular ligaments

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8
Q

Clinical Findings with AC Separation

A 
Tenderness at AC joint
Possible deformity at AC joint
Pain with adduction
\+ cross arm test
\+ Paxinos test
Pain with doing a dip
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9
Q

Treatment of AC Separation

A

Rest
Ice
NSAIDs
Sling for comfort
Weaver-Dunn procedure- reconstruction of CC ligament
Return to activity: when patient is comfortable

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10
Q

MOI of a Clavicle Fracture

A

Falling directly on the tip of the shoulder

Hockey player getting checked into the boards

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11
Q

Clinical Findings with Clavicle Fracture

A

Tenderness to palpation
Pain with adduction
Patient sitting with shoulders rolled forward
Deformity at fracture site

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12
Q

Treatment of Clavicle Fractures

A 
Rest
Ice
NSAIDs
Sling for comfort
Surgery: significant displacement
Return to activity: 8 weeks
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13
Q

Rotator Cuff Tendonitis

A

Overuse injury
Result of inability to train appropriately
Result of a “weekend warrior”

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14
Q

What is happening internally with rotator cuff tendonitis?

A

Inflammation of cuff tendon
Degenerative fraying
Bursitis

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15
Q

Clinical Presentation of a Rotator Cuff Tendonitis

A

Pain after an aggravating activity
Pain can be insidious without specific injury
Localized to anterior/lateral shoulder
Pain worse with reaching overhead/behind the body
Pain at night/difficulty sleeping

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16
Q

Clinical Exam Findings for a Rotator Cuff Tendonitis

A 
Tender to palpation
Painful arc of motion/elevation
Full ROM
Pain with resisted supraspinatus testing
No weakness
\+ Hawkins
\+ Neers
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17
Q

Treatment of Rotator Cuff Tendonitis

A

6 weeks of rest
Graduated throwing program
PT for strengthening
Subacromial steroid injection

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18
Q

Risk Factors for a Rotator Cuff Tear

A

Smoking
Age
Fall

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19
Q

Which rotator cuff muscles are most commonly torn?

A

Infraspinatus

Supraspinatus

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20
Q

How is the subscapularis generally torn?

A

Trauma

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21
Q

Clinical Presentation of a Rotator Cuff Tear

A 
Pain with reaching overhead
Nocturnal pain
Can't get comfortable lying on shoulder
Weakness
Pain over anterior/lateral shoulder
Pain radiates to deltoid tuberosity
Pain insidious or sudden
May have felt pop at time of injury
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22
Q

Clinica Exam Findings of a Rotator Cuff Tear

A 
Tender to palpation
Painful arc of motion/elevation
Full passive ROM
Pain with resisted supraspinatus testing
Weakness
\+ Hawkins
\+ Neers
Belly compression test
Lift off test
Bear hugger test
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23
Q

If there is weakness with external rotation, what is the probable muscle that is torn?

A

Infraspinatus

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24
Q

If there is weakness with empty can test, what is the probable muscle that is torn?

A

Supraspinatus

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25
If there is weakness with internal rotation, what is the probable muscle that is torn?
Subscapularis
26
Treatment of a Rotator Cuff Tear
``` Rest Ice NSAIDs PT for strengthening Subacromial steroid injection MRI to determine size of cuff tear Surgical repair ```
27
Define Calcific Tendonitis
Deposition of calcium "hydroxyapatite" in the rotator cuff tendon
28
Which phase is calcific tendonitis more painful & inflammatory?
Liquid or tooth paste phase
29
Clinical Presentation of Calcific Tendonitis
Insidious or sudden "White knuckle pain" Pain with any movement of shoulder Unable to sleep
30
Clinical Exam Findings of Calcific Tendonitis
``` Tenderness over greater tuberosity Limited AROM due to pain Pain with firing of the rotator cuff Full PROM Weakness of cuff due to pain ```
31
Treatment of Calcific Tendonitis
``` Rest Ice NSAIDs PT to prevent stiffness Subacromial steroid injection with needling of calcium deposit Surgical decompression & debridement ```
32
Define Adhesive Capsulitis (Frozen Shoulder)
Loss of motion of the shoulder as a result of tightening & shrinking of the shoulder capsule
33
Risk Factors for Adhesive Capsulitis (Frozen Shoulder)
Female Diabetic Hypothyroidism
34
3 Phases of Adhesive Capsulitis
Freezing Frozen Thawing
35
Clinical Presentation of Adhesive Capsulitis
``` Insidious onset Progressive loss of motion May follow trauma, but idiopathic Pain at end of ROM Nocturnal pain Can't reach into back pocket ```
36
Clinical Exam Findings of Adhesive Capsulitis
Loss of PROM & AROM | Pain at end of ROM
37
Treatment of Adhesive Capsulitis
PT to work on capsular stretching Glenohumeral steroid injection to decrease inflammation Manipulation under anesthesia Arthroscopic capsular release
38
What populations are labral injuries common?
Overuse: throwers Traumatic: football, wrestling, volleyball, tennis
39
Define a Labral Injury
Injury to soft tissue cartilage ring around socket of the shoulder which provides stability
40
Clinical Presentation of a Labral Tear
Painful pop in shoulder Difficulty throwing a ball Mild sense of instability
41
Clinical Exam Findings in a Labral Tear
Full ROM Crepitus with internal/external rotation + O'brien test
42
Treatment of a Labral Tear
PT for rotator cuff strengthening & stabilization | Surgical repair if persistent pain
43
Treatment of Impingement Problems
Aggressive stretching program for anterior capsule | Strength program for the rotator cuff
44
Which dislocation is more common, anterior or posterior?
Anterior: elevation & external rotation
45
When is a posterior dislocation more common?
Seizure Electrocution Football lineman MVA
46
Clinical Presentation of an Anterior Dislocation
Pain following injury 1st time: reduction & early immobilization PT for strengthening & stabilization
47
Clinical Exam Findings of an Anterior Dislocation
+ Apprehension sign + Relocation test Increase anterior translation Pain with ROM & guarding with reaching overhead
48
Treatment of Anterior Dislocation Treatment
X-ray to rule out glenoid fracture X-ray for Hillsach's deformity PT for strength & stability Return to play: 4-6 weeks
49
Treatment with Recurrent Dislocations
Surgery
50
Treatment of Posterior Dislocation
Reduce & immobilization PT for strengthening Bracing
51
Which population are the worst offenders for shoulder multidirectional instability?
Wrestlers | Volleyball players
52
Presentation of Shoulder Instability
+/- multi-joint laxity Report recurrent shoulder dislocation without ER visits Dull ache in the shoulder
53
Treatment of Shoulder Instability
PT to strengthen scapular stabilizers & rotator cuff | Surgery: last option
54
Risk for OA of the Glenohumeral Joint
``` Previous trauma Dislocations Instability issues Hereditary Heavy laborer ```
55
Clinical Presentation of Glenohumeral OA
Insidious onset of shoulder pain Loss of ROM Pain at end of ROM with sudden movement
56
Clinical Exam Findings with Glenohumeral OA
``` Loss of ROM especially internal/external rotation Normal strength Crepitus Cogwheeling Tender of anterior/posterior capsule ```
57
Treatment of Glenohumeral OA
``` NSAIDs, Tylenol Terminal stretching Glucosamine/Chondrotin Activity modification Steroid injection Total shoulder replacement ```
58
Define Parsonage Turner Syndrome
Inflammation of a network of nerves that innervate the muscles of the chest, shoulders & arms
59
Clinical Presentation of Parsonage Turner Syndrome
Severe pain across shoulder & upper arm Weakness Atrophy Paralysis of shoulder muscles
60
Clinical Exam Findings of Parsonage-Turner Syndrome
Atrophy of supraspinatus & infraspinatus Significant weakness of affected muscles Non-tender May not tolerate palpation
61
Treatment of Parsonage Turner Syndrome
``` EMG studies MRI Oral steroids Neurontin Pain medication PT ```
62
Other Shoulder Injuries
``` Stinger/brachial plexus traction injury Proximal humerus fracture Scapular fractures Long thoracic nerve injury "scapular winging" OA of AC joint Long head biceps rupture Spinoglenoid cyst ```
63
Prevention of Shoulder Injuries
Strengthening | Stretching
64
Supraspinatus Exercises
Empty can test with thumb down | Light dumbbells or rubber tubing
65
Infraspinatus & Teres Minor Exercises
Place elbow at side | Externally rotate against resistance
66
Subscapularis Exercises
Elbow at side | Internally rotate against resistance

Ortho (22 decks)

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