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Musculoskeletal > Shoulder Complex > Flashcards

Shoulder Complex Flashcards

1
Q

Many problems for the shoulder can be related to ____.

A

age

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2
Q

RC degeneration/tears commonly occur in pts ___-____ years of age.

A

40-60

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3
Q

Primary impingement is seen in pts greater than ____ years old.

A

35

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4
Q

Secondary impingement is commonly seen in pts in their teens to _______.

A

early 20s

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5
Q

Chondrosarcomas usually occur in pts older than ____.

A

50

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6
Q

Calcium deposits may occur between ages ___-___.

A

20-40

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7
Q

Frozen shoulder is seen in pts ___-___ y/o if resulting from atraumatic origin.s

A

45-60

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8
Q

Kibler type: Inferior angle prominence, anterior tipping (commonly seen in pts with RC impingement).

A

Type I

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9
Q

Kibler type: Medial border scapula dysfunction; IR rotation of the scapula in the transverse plane; often seen in pts with GH instability.

A

Type II

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10
Q

Kibler type: Superior scapula dysfunction; involves early and excessive superior elevation during arm

A

Type III

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11
Q

Describe the normal movements of the scapula during elevation:

A

Scapular upward rotation, posterior tilting and ER.

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12
Q

Based on the pain symptoms, what is the likely cause?

Dull, toothache-like pain that is worse at night.

A

RC impairment

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13
Q

Based on the pain symptoms, what is the likely cause?

Hot, burning type pain

A

Calcific tendonitis

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14
Q

Based on the pain symptoms, what is the likely cause?

Numbness, tingling, shooting pain

A

Radiculopathy

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15
Q

Based on the pain symptoms, what is the likely cause?

Sharp, localized pain with elevation

A

RC impairment, impingement

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16
Q

Based on the pain symptoms, what is the likely cause?

Clunk, catch, click, sharp but subsiding

A

Labral impairment

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17
Q

List some red flags for shoulder impairment (10 total)

A

Age over 50
Night pain
Weight loss
Fever
Pain unrelated to activity
Pain not relieved by rest
Prior hx of cancer
Hx of smoking
Cardiac risk factors
Pleuritic pain

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18
Q

What does FHRSP stand for:

A

Forward head, rounded shoulder posture

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19
Q

Conditions and S/Sx to screen for include (6):

A

Non-mechanical pain
Cancer
Weight loss
Trauma
Neuro S/Sx
CVD/SOB

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20
Q

Primary scapular winging is a result of what?

A

Muscle weakness of scapular muscle stabilizers

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21
Q

Negative impact of primary scapular winging.

A

Disrupts normal muscle force couple balance of scapulothoracic complex.

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22
Q

Secondary scapular winging is a result of what?

A

An underlying pathology affecting the GH joint.

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23
Q

Dynamic scapular winging is caused by what?

A

A lesion to the long thoracic nerve (can also see with spinal accessory)

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24
Q

What does TUBS stand for?

A

Traumatic unilateral dislocations with a Bankart lesion requiring surgery.

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25
Q

What is the SPADI outcome measure?

A

Shoulder pain and disability index

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26
Q

What is the DASH outcome measure?

A

Disabilities of the arm shoulder and hand

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27
Q

5 things included in the observation portion of a shoulder exam.

A

Hands on hips
Symmetry of muscle tone
Swelling
Gait
Posture

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28
Q

What are the two most commonly involved rotator cuff muscles?

A

Supraspinatus
Infraspinatus

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29
Q

Increasing weakness with repeated contractions is termed ______.

A

Palsy

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30
Q

What range is considered normal laxity as a percentage?

A

0-25%

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31
Q

Describe grade I laxity and the percentage range:

A

A feeling of the humeral head riding up to the glenoid rim (25-50%).

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32
Q

Describe grade II laxity and the percentage range:

A

A feeling of the humeral head overriding the rim, but spontaneously reduces (>50%).

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33
Q

Describe grade III laxity and the percentage range:

A

A feeling of the humeral head overriding the rim, but remains dislocated (50%).

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34
Q

What is a hallmark sign of a rotator cuff pathology?

A

Weakness with elevation

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35
Q

RC Tendinopathy is usually caused by a ____________.

A

Repetitive mechanism / overuse (overhead activities)

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36
Q

Identify 3 symptoms of RC tendinopathy

A

Localized pain in Acromiohumeral space
May extend to lateral shoulder or elbow
Aggravated by elevation

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37
Q

___% of individuals who have RC tear are asymptomatic.

A

67

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38
Q

RC tear is similar to RC tendinopathy, but with greater ______________.

A

Loss of function

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39
Q

3 tests and measures for a RC pathology/tear.

A

Strength testing
Palpation
Special tests

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40
Q

Subacromial impingement syndrome may be cause by ________ or ________ of the structures occupying the acromiohumeral space.

A

Compression
Hypersensitivity

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41
Q

Subacromial impingement syndrome presents like ________, with positive impingement signs.

A

Tendinopathy

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42
Q

When subacromial impingement syndrome is caused by an anatomical predisposition, it’s termed _________.

A

Primary compressive disease.

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43
Q

Three things that can cause primary compressive disease:

A

Outlet stenosis
Hooked acromion
Bony spurring of the acromion

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44
Q

Primary impingement causes a _____ within the joint.

A

Lack of mobility

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45
Q

Secondary impingement causes ________ within the joint.

A

Reduced dynamic stability

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46
Q

Changes in the osteology of the joint causes _______.

A

Primary impingement

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47
Q

What is important to consider when testing for secondary impingement?

A

Similar to primary impingement tests, BUT must be looking at function and capacity of the RC and scapular stabilizers, as well as overall available mobility.

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48
Q

Identify 3 MOIs for Labral pathology

A

FOOSH
Extreme abduction
Forceful eccentric biceps contraction

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49
Q

2 S/S of labral pathology:

A

Clicking, popping, catching,
instability

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50
Q

Most common labral pathology

A

SLAP: superior labrum anterior (to) posterior

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51
Q

Type I SLAP:

A

Labral fraying (most common)

52
Q

Type II SLAP:

A

Instability of labral-biceps complex (most common SLAP seen surgically)

53
Q

An age over ___ is a red flag for shoulder impairment.

A

50

54
Q

What cervical structures/conditions can refer pain to the shoulder (6)?

A

Nerve root
brachial plexus
supraclavicular nerves
facets
uncoverterbral joints
myelopathy.

55
Q

The ___________ is an example of a cranial nerve that can refer pain to the shoulder.

A

Trigeminal nerve

56
Q

This pathology in the thoracic region can refer pain to the shoulder.

A

Thoracic outlet syndrome

57
Q

3 cardiovascular issues that can refer pain to the shoulder

A

Ischemia, aortic disease, MI

58
Q

3 pulmonary issues that can refer pain to the shoulder

A

Upper lobe pneumonia
pulmonary embolism
pneumothorax

59
Q

2 malignancies that can refer pain to the shoulder

A

Pancoast tumor
metastatic carcinoma

60
Q

4 abdominal organs that can refer pain to the shoulder

A

Pancreas, liver, gallbladder, esophagus (GI)

61
Q

The elbow may refer pain to the __________ shoulder

A

lateral

62
Q

The wrist may refer pain to the __________ shoulder

A

lateral

63
Q

The TMJ may refer pain to the ____, _____, and ____________

A

traps, pecs, lateral shoulder

64
Q

functions of the rotator cuff

A

Forward flexion
Abduction
ER
IR
Stabilize head of humerus

65
Q

During an overhand throwing/hitting motion, what is the role of the rotator cuff?

A

Decelerate the arm

66
Q

What is the most common complaint of rotator cuff pathology?

A

Pain

67
Q

_________ is more common under 40 years, _______ is more common over 40 years.

A

Tendinopathy; Tearing

68
Q

In order to have a RC tear under 40 yrs, what event is generally required?

A

a macro-traumatic event

69
Q

RC pathology may be thought of as a ________ disease.

A

degenerative

70
Q

RC tendinopathy is usually brought on by a ________ mechanism

A

repetitive/overuse

71
Q

What type of activities are more likely to result in RC tendinopathy?

A

Overhead activities

72
Q

67% of individuals who have a RC tear are _________.

A

Asymptomatic

73
Q

Outline the general protocol for RC repair and rehabilitation

A

Early PROM is stressed
Early ROM preferred in ER but not IR
Week 3-4 begin scapular strengthening (progress to AAROM)
Week 5-6 full PROM and AROM in all planes
By week 12 progress to max isokinetic exercise

74
Q

SAIS stands for ____________.

A

Subacromial impingement syndrome

75
Q

3 structures that might be compressed/hypersensitive in SAIS

A

Supraspinatus, LH of biceps tendon, subacromial bursa

76
Q

SAIS presents like _________, with positive ___________ signs.

A

Tendinopathy; impingement signs

77
Q

Identify three things that may cause SAIS

A

Outlet stenosis, hooked acromion, bony spurring of AC

78
Q

PRIMARY impingement is due to:

A

lack of mobility within the joint from changes in osteology (i.e. hooked acromion)

79
Q

Secondary impingement is due to:

A

Reduced dynamic stability. Head of humerus is not being held “snug” in glenoid fossa.

80
Q

How are tests and measures different for secondary impingement compared to primary impingement?

A

Similar, but must be looking at function and capacity of the RC and scapular stabilizers as well as overall mobility.

81
Q

3 mechanisms for a labral pathology:

A

FOOSH
Abducted arm
Forceful eccentric biceps contraction

82
Q

Potential S/S of labral pathology (5)

A

Clicking, popping or catching
Instability
Positive anterior and/or posterior instability tests
Positive labrum tests
May also have positive LH biceps tendon tests

83
Q

RC tears are more commonly seen in the NONDOMINANT/DOMINANT arm.

A

Dominant

84
Q

What medical tests can help diagnose a SLAP tear?

A

MRI with contrast / arthrogram

85
Q

General principles of labral pathology rehab(5):

A

Early protection of repair (limit abduction and/or ext. rotation.
Gradual return to normal AROM (stretching/joint mob.)
Strengthening focusing on RC
Neuromuscular re-ed.
Scapular musculature strengthening.

86
Q

Type ___-___ SLAP will typically require surgical repair,

A

II-IV

87
Q

S/P Labral rehab weeks 0-4

A

Gradually increase ER 10 deg. p/week, not to exceed 30 deg. by week 4. Scapular isometrics can begin early on.

88
Q

S/P Labral rehab weeks 5-6

A

GH ROM is increased throughout, ER progresses to 50 degrees, active elbow flexion begins.

89
Q

S/P Labral rehab weeks 7-12

A

Improve strength, balance RC and scap strength, by end of week 9 elevation is full and ER progressed to 90 deg. Week 10 submax isometrics.

With acceptable clinical exam able to begin overhead activities at 4 months post-op.

90
Q

Avulsion of the anterior labrum from the rim of the glenoid is called a _______.

A

Bankart lesion

91
Q

What symptom is present with a Bankart lesion?

A

Anterior instability

92
Q

Those with a Bankart lesion may also have __________.

A

Hills-Sachs lesion

93
Q

Impaction fracture on the posterior aspect of the humeral head.

A

Hills-Sachs lesion

94
Q

Bankart lesion occurs in up to ___% of GH dislocations.

A

85%

95
Q

Considered the gold standard for anterior instability:

A

Bankart procedure

96
Q

Shoulder instability surgical interventions can be classified according to these:

A

Atraumatic (AMBRI)
Traumatic (TUBS)

97
Q

AMBRI stands for:

A

Atraumatic
Multidirectional
Bilateral
Rehabilitation
Inferior capsular shift

98
Q

TUBS stands for:

A

Traumatic
Unilateral
Bankart
Surgery

99
Q

Main symptom associated with biceps tendinopathy

A

Anterior shoulder pain

100
Q

phase of healing: -itis

A

acute

101
Q

Phase of healing: -osis

A

Persistent. Load it!

102
Q

typical MOI for traumatic shoulder instability:

A

Excessive force into ER while in 90 degrees of abduction.

103
Q

What kind of dislocation is most common in a traumatic shoulder instability?

A

Anterior (inferior) dislocation

104
Q

S/S: pain, apprehension with abduction, ER (90), weakness.

A

Traumatic shoulder instability

105
Q

Traumatic shoulder instability management (4):

A

Rest
Manage acute edema/pain
RC strengthening and neuromuscular reeducation
Gradual return to activity

106
Q

Altered scapular motion and position is termed ________.

A

Scapular dyskinesis

107
Q

Scapular dyskinesis is more of a _________ than a diagnosis.

A

Symptom

108
Q

AC joint pathology is associated with _______ and ________.

A

Traumatic sprains and dislocations

109
Q

2 MOIs for AC joint pathology:

A

FOOSH, fall on tip of shoulder.

110
Q

Calcific tendinitis is most common in _____________ tendon.

A

Supraspinatus

111
Q

S/S: Acute pain/inflammation, then pain with movement through painful arc, radiographs show deposit.

A

Calcific tendinitis

112
Q

Adhesive capsulitis stage I:

A

pain around GH joint, no stiffness

113
Q

Adhesive capsulitis stage II:

A

Pain predominates; pain even with small movements

114
Q

Adhesive capsulitis stage III:

A

Pain and stiffness; significant limitation of ROM

115
Q

Adhesive capsulitis stage IV:

A

Stiff; little or no pain

116
Q

T/F adhesive capsulitis eventually will resolve

A

True

117
Q

Adhesive capsulitis is more common in FEMALES/MALES.

A

females

118
Q

PT consideration for adhesive capsulitis pain phase:

A

DO NOT MOB

119
Q

PT management in early phases of adhesive capsulitis:

A

Modalities to address pain
NSAIDS

120
Q

There is an increased incidence AND poorer prognosis of adhesive capsulitis in patients with ____.

A

DM

121
Q

Two characteristics of OA

A

Pain that is slowly progressive
Usually worse in a.m. and evening hours

122
Q

Three interventions for hemiplegic shoulder:

A

Sling - alleviate positional pain
Strengthen RTC if possible
FES

123
Q

Direct result of compression of the RC tendons b/t the humeral head and overlying anterior third of the acromion.

A

Primary compressive disease

124
Q

Shoulder complex muscles that tend to be weak (3)

A

Serratus anterior
Mid/lower trapezius
Rhomboids

125
Q

Shoulder muscles that tend to be strong (and/or tight) (3)

A

Upper trap
Lev scap
Pec minor and major

Musculoskeletal (11 decks)

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