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CONA 2 > SHOULDER COMPAINTS--WEEK 11 QUIZ > Flashcards

SHOULDER COMPAINTS--WEEK 11 QUIZ Flashcards

1
Q

Shoulder Complaints——Major categories X 8

1———–Impingement:
A- ____________- supraspinatus mm, subacromial bursa

B- ____________–: subscapularis mm

C- ___________–: posterior labrum, infraspinatus,
teres minor

A

Anterolateral:

Anteromedial

Posterolateral

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2
Q

Shoulder Complaints——Major categories X 8

2–Instability
EX–traumatic or nontraumatic

3–Tendinitis/bursitis

4–DJD

5–Adhesive capsulitis

6–AC separation/GH dislocation

7–Fracture

8–Referred pain

A

KNOW

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3
Q

History

1--Complaint: 
---------Pain, weakness, instability, tingling, etc.
2---Location: 
----------Anterior, posterior, lateral, superior
3--Traumatic vs. \_\_\_\_\_\_\_\_
4--\_\_\_\_\_\_\_\_\_\_\_ symptoms
5--Prior injuries
-----------Did they complete rehab?
A

overuse

Positional

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4
Q

HISTORY = Specific questions X 7

1— Was there TRAUMA!!???

A–Fall on outstretched arm?
EX—-__________ fx; posterior dislocation; biceps, suprapinatus, or labral tear

B–Land on top of shoulder?
EX—-____ separation, distal clavicle Fx

C–Arm abducted & extended at impact?
EX—–ANTERIOR dislocation

D–GH locks & “clicks” back in place?
EX—-_________ ________

A

Clavicle

AC

Labral tear

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5
Q

HISTORY = Specific questions X 7

2–Specific Questions—Do you perform repetitive activities?

A–General: capsule sprain, muscle strain, tendinitis

B–Overhead positions?

  • –___________ syndrome
  • –Biceps, supraspinatus, bursa

C–Worse with lifting weights and/or HEAVY objects?
—Osteolysis of the ________ clavicle, labral tear

A

Impingement

distal

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6
Q

HISTORY = Specific questions X 7

3—Specific Questions– Is there associated NECK pain?

A–Cervical spondylosis, disc lesion, facet
B–Trauma?
–Cervical sprain/strain, burner, ______ _______ injury
C–Is the neck & shoulder pain timing similar?
–Osteoarthritis (DJD), myofascial pain syndrome (MFPS)

A

brachial plexus

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7
Q

HISTORY = Specific questions X 7

Specific Questions—4) Complaint of MORE stiffness than pain?

A--Past history of trauma?
---Unreduced GH dislocation
B---Did the stiffness get worse after a few weeks of pain in shoulder?
 = \_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_
C--Arthritides?
A

Adhesive capsulitis

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8
Q

HISTORY = Specific questions X 7

Specific Questions—5) Sense of ________ or instability?

Past history of trauma?
 = GH Dislocation
1) Labral tear
2) Tendon 
3) Muscle
4) Capsule tear/rupture
A

weakness

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9
Q

HISTORY = Specific questions X 7

Specific Questions—6) _________ pain in other joints?

A--Rheumatoid arthritis
B--Ankylosing spondylitis
C--Pseudogout:
1) Calcium pyrophosphate deposition disease
2) Hydroxyapatite deposition disease
D--Degenerative joint disease
A

Concurrent

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10
Q

HISTORY = Specific questions X 7

Specific Questions—7) Visceral complaints same time as the shoulder complaint?

A-GI complaints?
 = Referred pain from \_\_\_\_\_\_\_\_\_\_
B--Pulmonary complaints?
 = Infection, tumor, etc. (“No, House, there’s no fever and the white count is normal . . .”)
C--Cardiac complaints
 =  Myocardial infarction
A

gallbladder

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11
Q

Location: Anterior

1) Traumatic
Fracture, GH dislocation, subacromial bursitis, capsular sprain, strain/rupture of the ____ _______ of biceps, labral tear

2) Non-traumatic or overuse
__________ syndrome, subcoracoid impingment, biceps tendinitis, subacromial bursitis, subscapularis tendinitis, subluxation

A

long head

Impingement

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12
Q

Location: Lateral

1) Traumatic
Contusion, __________ sprain/rupture

2) Non-traumatic or overuse
Impingement syndrome, deltoid strain, suprapinatus strain/rupture, visceral referral

A

suprapinatus

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13
Q

Location: Superior

1) Traumatic
___ separation, distal clavicle fracture

2) Non-traumatic or overuse
= Osteoarthritis (DJD) affecting the AC joint, osteolysis of the _______ clavicle

A

AC

distal

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14
Q

Location: Posterior

1) Traumatic
__________ fracture, posterior dislocation

2) Non-traumatic or overuse
Posterior impingement, infraspinatus/teres minor mm strain/tendinitis, posterior ______/________ mm strain

A

Scapular

deltoid/triceps

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15
Q

Examination—1) Palpation

A--Superficial to deep
B--Tenderness of what?
------Be \_\_\_\_\_\_\_, it will often pinpoint the diagnosis
C--Edema
D--Deformity
E--Laxity

Examination—2) Range of motion

A) Trauma and pain in ALL ranges
— = ___________/fracture/rupture
B) Pain at MIDRANGE of abduction (70 -110°)
— = ___________ _________
C) Restriction of ACTIVE ROM only:
—_________/___________(duh)
D) Restriction of active & PASSIVE ROM:
— = ___________/__________
E) Inability to HOLD/LOWER the abducted arm:
— =____________ __________

A

specific

Dislocation

Impingement syndrome

Muscle/tendon

Capsule, bone

Rotator cuff

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16
Q

Examination—3) Instability tests

A) DO NOT PERFORM on the ACUTE patient
B) Many patients are normally lax
C) Tests:
1) Crank test
2) Load and shift test
3) Apprehension test(s) 
***NOTE: When combined, found to be as sensitive as MRI for \_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_***
A

labral tears

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17
Q

Impingement

1---\_\_\_\_\_\_\_\_ \_\_\_\_\_\_
A---Suprapinatus tendon
---Empty can (“Jobe’s”)
B--Biceps tendon
---Speed’s
C--Subacromial bursa
---“Push button” test
2---\_\_\_\_\_\_\_\_ -\_\_\_\_\_\_\_\_\_
A---Posterior labrum
---Infraspinatus mm
(Resisted external rotation with the arm at the side)
---Teres minor mm
A

Acromial arch

Posterior impingement

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18
Q

Diagnoses—1) AC separation/sprain

A—Sudden pain from fall on outstretched arm or fall on TOP of shoulder, lifting heavy objects
B—_______/__________ deformity
C—Grade 1 & 2: = conservative care
1= SOME TEARING, no instability,
2= RUPTURE of AC lig, unstable
3= rupture of AC AND coracoclavicular ligs
(conoid and trapezoid), = __________
D—Grade 3: conservative care with Kenny Howard sling (2-3 weeks) then rehab (if not recovered, then send for surgical consult)

A

Palpable/visible

unstable

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19
Q

Diagnoses—2) Adhesive Capsulitis

A—Usually over 40 y.o.
B—Females > Males
C—History of pain lasting for WEEKS (may or may not have a history of trauma) followed by gradual ________ of the shoulder as the pain diminishes
D—May be _________ in nature
E—Pain in active and passive ROM, especially _________ _______ AND ___________
F–Cervical spondylosis, hypothyroidism, and diabetes are related conditions
G–Patients note a dramatic DECREASE in shoulder ROM
I—In many cases, there is spontaneous resolution after 1-3 years (motion is RE-GAINED)

A

stiffening

autoimmune

external rotation and abduction

20
Q

Diagnoses—3) Osteoarthritis

A–Should be considered in ALL _______ or __________ patients
B–Insidious onset of achy pain and loss of ROM
C—Loss of active and passive ROM

A

elderly

postraumatic

21
Q

Diagnoses—4) Traumatic Instability

A—Pain or weakness with ___________ activity or in apprehension position
B—History of shoulder _____________
—-Potential damage to capsule, labrum, ligaments, tendons, humerus
C—ACUTE
—-Stabilize, passive care to decrease pain
D—CHRONIC
—-Evaluate for stability, begin rehab (surgical consult if treatment ineffective or condition not resolving)

A

overhead

dislocation

22
Q

Dislocations

A—MALES > Females
B—YOUNGER (teens, early twenties)
C—The younger the age for the FIRST dislocation the GREATER the risk of ___________
D—The labrum, rotator cuff, and capsule can ALL be involved to varying degrees

A

re-dislocating

23
Q

Care and/or treatment of DISLOCATIONS

A–Shoulder sling
—If over 30 → ONE week
—If under 30 → THREE weeks of immobilization
B–________ dislocators will require LESS time
C–Rehab may take up to ____ months

A

Chronic

3

24
Q

T.U.B.S. (“Torn Loose”)

T–raumatic
U–nidirectional
B–ankart Lesion
S–urgery should be considered

Bankart Lesions

CLASSIC BANKART LESION (80%) - Labral avulsion from the ______ ______ with capsular stripping from the scapular neck.

BONY BANKART LESION (3%) Labral avulsion WITH BONE from the anterior glenoid rim and capsular stripping from the medial scapular neck.

A

glenoid rim

25
Q

Chronic Labral Tears

A—Pain and _________ with rotational movements, but ROM is usually full
B—History of trauma or instability or laxity

A

clicking

26
Q

A.M.B.R.I.

A--traumatic
M--ultidirectional Instability
B--ilateral Laxity
R--ehabilitation Helps
I--nferior Capsule Tightened

Surgical tightening of rotator interval
The rotator interval is a triangular portion of the shoulder capsule which lies between the ________&_________ tendons

A

supraspinatus and subscapularis

27
Q

These are difficult to tell apart & may occur together

Impingement
Tendinitis
Bursitis
Rotator cuff “tear” (strain)

A

KNOW

28
Q

Impingement Syndrome

1—Shoulder pain that is worse with overhead activities, Hx of overuse.

2—Site of tenderness depends on structure being impinged

  • -Anterior: - ___________ bursa
  • -Humeral tuberosity: = __________
  • -Posterior: = ________/__________

3—Painful arc, Hawkins-Kennedy, Supraspinatus test, Impingement sign

A

subacromial

supraspinatus

teres minor/infraspinatus

29
Q

Rotator Cuff Tear

1–History of chronic or acute trauma
Overhead lifting, fall on an outstretched arm, arm twisted, etc…
—Chronic degeneration, overuse

2–Complain of pain with OVERHEAD activities or unable to RAISE THE ARM

3–__________: Most commonly torn tendon

4–Signs like impingement, may have weakness

A

Supraspinatus

30
Q

Etiology of ROTATOR CUFF TEAR

75% of the time: Secondary to __________
10% of the time: Acute injury
15% of the time: Secondary to instability/laxity

A

impingement

31
Q

Radiographs OF ROTATOR CUFF TEAR

Early stages show some _____ ________, but otherwise normal

Late stages look similar to ________ ________ and DJD will often result from the damage that has occurred

A

mild sclerosis

degenerative arthritis

32
Q

Biceps tendon tear

1---Bunching up of the muscle 
2---(+) Transverse humeral ligament test
3---Testing reveals:
---Weak and painful = \_\_\_\_\_\_\_\_ tear
---Weak and painless = \_\_\_\_\_\_\_ tear 
(with or without neurologic damage)
4---Approx 50% of all ruptures occur thru the tendon of the \_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_
---Some strength will remain (short head remains intact)
A

partial

full

long head

33
Q

Proximal Biceps Tendon Rupture (Long Head)

1–From resisted forced flexion (eccentric)
2—May be secondary to repetitive ______ ________
3—Discoloration
4—Palpable and visible defect with “_________” muscle
5—Weakness on ___________ (Yergason’s)
6—Surgery for young; conservative care for elderly

A

cortisone injections

popeye

supination

34
Q

“SLAP” Lesion

1–Superior Labrum, Anterior-to-Posterior
2–Detachment lesion of the superior aspect of the glenoid labrum, which serves as the __________ of the long head of the biceps
C–A ________ injury, such as catching oneself falling, is a common cause
D–A fall on the outstretched hand (“F.O.O.S.H.”), or repetitive activities (_______) may predispose to this injury

A

insertion

traction

pitching

35
Q

“SLAP” Lesion (cont.)

Type I: _______ and degeneration of the superior labrum (with firm attachment to the glenoid), normal biceps; usually degenerative in nature

Type II: Detachment of _________ labrum and biceps insertion from the supra-glenoid tubercle (this is the MOST common type of SLAP lesion; may resemble a normal variant)

Type III: “_______ ______-________” tear
(biceps anchor is intact)

Type IV: Vertical tear of the superior labrum, which extends into ______; may be treated w/ biceps tenodesis if more than 50% of the tendon is involved

A

Fraying

superior

Bucket handle-type

biceps

36
Q

Tendinitis & Bursitis

1—Usually _______ pain that is WORSE with most ROM (insidious, related to overuse, or result of a trauma)

2—_________ location of palpatory tenderness

3—Treat as any other tendinitis/bursitis

4—SLING for support, but do NOT leave it on for extended periods of time, and encourage shoulder exercises to tolerance

A

severe

Distinct

37
Q

Subacromial Bursa

1—A large synovial membrane which is adherent to ______________ of coracoacromial ligament, acromion, & deltoid laterally.
(floor is adherent to rotator cuff & __________tuberosity)

2—Envelops proximal humerus.
(facilitates GLIDING of proximal humerus UNDER coracoacromial arch)

A

undersurface

greater

38
Q

Calcific Tendinitis –1

1—Usually NOT seen until the _____ decade
2—________ patients are more likely to develop asymptomatic rotator cuff calcium deposits
—> ____% of insulin-dependent diabetics had tendon calcification (

A

4TH

Diabetic

30%

39
Q

Calcific Tendinitis –2

3–In most cases, clinical symptoms will resolve spontaneously in __-___ days.
(where as the DEPOSIT may persist on radiographs)
—Treat as for all tendinitis

A

7-10

40
Q

Osteolysis of the Clavicle

1—Diffuse pain felt at the _________ clavicle
2—Patient is often a young, serious weightlifter.
— (as opposed to an old, casual weightlifter?)
3—Complaints of pain with bench pressing, overhead pressing, and/or dips.
4–Cause unknown— (usually related to ____ trauma resulting in resorption of the distal clavicle)
5—Pain with ____ >90, ortho exam is often unremarkable
6—AC spot view
— (WIDENING of joint space, subchondral defects)
7–Ergonomically modify to NARROW grip, avoid dips
8—Surgery= acromioplasty

A

distal

AC

ABD

41
Q

Management OF OSTEOLYSIS

–Conservative care for up to 6 months
–Palliative care for symptoms
–_________ exercises
–Broomstick exercises
–Wall crawl
–Body blade
–Tubing
(followed by more challenging strength exercises)

A

Pendulum

42
Q

Little Leaguer’s Shoulder

1–Proximal humerus pain in an adolescent that occurs primarily with ________ _________
2–Salter Harris Type __
(due to ROTATIONAL stress on the growth plate)
3–Palpable tenderness
4–Pain on resisted EXTERNAL rotation and supraspinatous test
5–Diagnosed by x-ray—WIDENED humeral physis (comparison to non-painful side)
6–Switch to interval training

A

throwing hard

1

43
Q

Nerve Entrapments Near the Shoulder

1—__________ nerve
Sensory: Supraspinatous area (Spinal nerve root?)
SUPRAspinatus/INFRAspinatous mm atrophy
Secondary to suprascapular notch trauma

2—__________ (circumflex) nerve
Sensory: Lateral DELTOID area (Spinal nerve root?)
Deltoid/teres minor mm atrophy
Secondary to anterior humeral dislocation

3—________ nerve
Sensory: DORSAL surface of hand (Spinal nerve root(s)?)
Elbow/wrist extensor mm atrophy
Secondary to humerus fracture

A

Suprascapular

Axillary

Radial

44
Q

Nerve Entrapments

4—_____________ N
Sensory: Lateral forearm (Spinal nerve root?)
Elbow flexor mm atrophy (BICEPS)
Secondary to forced elbow hyperextension or repetitive pronation

5—_______ ________
SERRATUS ANTERIOR mm atrophy (“scapular winging”)
backpack

6—___________ __________ N
Trapezius mm atrophy
backpack

A

Musculocutaneous

Long Thoracic

Spinal Accessory

45
Q

Fractures

1—Clavicle- usually MIDDLE third
2—Scapula
3—Humerus
—______ fracture: occurs in the great tubercle secondary to relocation of an anterior dislocation

A

Flap

46
Q

Myositis Ossificans

1—-___________ bone formation secondary to trauma to sheath covering muscle or bone

Refer if:

1--\_\_\_\_\_\_\_\_\_\_ is discovered
2--Ligament/tendon rupture is suspected
instability that would likely result in permanent disability
3--Non-reduced dislocation
4--Infection
5--Tumor
A

Heterotopic

***Heterotopic ossification— is the name used to describe the formation of bone in abnormal locations. Usually forming in soft tissues of the body,

Fracture

CONA 2 (7 decks)

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