Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MSK 1 - Shoulder > Shoulder Complex- Dislocation thru Humeral Apophysitis > Flashcards

Shoulder Complex- Dislocation thru Humeral Apophysitis Flashcards

1
Q

What is the most dislocated joint?

A

GH joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the cause of an anterior dislocation ?

A

ER and ABd with FOOSH
(closed packed positions with bony contact, taut ligaments & capsule)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What type of shoulder dislocation is most common?

A

anterior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What direction does the humeral head go in with an anterior dislocation?

A

Anterior - inferior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the cause of a posterior dislocation?

A

90˚ flexion with FOOSH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How common are posterior dislocations?

A

only 2-4% of dislocations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What causes recurrent dislocatons?

A

Pathological instability
- can cause dislocations with low force things
- most often in young people

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the three types of shoulder dislocations?

A

Anterior
Posterior
Recurrent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What structures are most involved with dislocations of the shoulder?

A

Stretch/tear capsule/ligaments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What can also possibly be damaged with dislocation?

A

Anterior labrum tear (aka Bankart lesion)
SLAP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What type of impingement likely results from a dislocation?

A

Hypermobility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What makes fibrocartilage different than articular cartilage?

A

thicker and concave vs articular cartilage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are some characteristics of fibrocartilage?

A

Outer potion is thick
inner portion is thin
Widens and deepens joint surface

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Where can we find fibrocartilage?

A
  • Shoulder and hip labrum
  • SC, Tibiofemoral, AC, ulnotriquestral, intervertebral, and pubic symphysis joints
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What makes up fibrocartilage?

A
  • fibro- and chondryocytes
  • collagen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is outer fibrocartilage made out of? What does it do?

A

Type I collagen
- resists tension for stabilization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the majority type of all fibrocartilage?

A

Type I collagen to resist tension - including glenoid labrum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is inner fibrocartilage made up of? What does it do?

A

Secondarily and less type II, III, and IV collagen - resists compression for shock absorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the function of outer fibrocartilage?

A

Neural attributes for proprioception/ kinesthesia like ligament/annulus for STABILIZATION

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What kind of tissue is outer fibrocartilage?

A

Vascular and neural

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What type of tissue is inner fibrocartilage?

A

Hypo- or avascular/aneural/alymphatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What causes fibrocartilage to form?

A
  • acute tears with RTC tears/dislocations
  • Gradual tears from repetitive and/or extreme motion and compressive stresses often with sports and impingement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Where is fibrocartilage better at healing? WHY?

A

The periphery due to greater vascularity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

When does tensile strength of fibrocartilage initially improve?

A

~3-5 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

When does even greater tensile strength improve?

A

When dense fibrous tissue fills in at ~8-12 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What should we do if no improvement by 8-12 weeks

A

Back to doc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the MET focus with fibrocartilage?

A

Tissue integrity/proliferation with vascularity issues

Stabilization due to stabilizing role of fibrocartilage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are other possible complications with a disclocation?

A
  • Fractures aka Hill Sachs Lesion - compression fracture of humeral head
  • RC tear(s)
  • Neurovascular structures in extreme cases
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are symptoms of shoulder dislocations?

A

like impingement plus…
- trauma in characteristic position
- acute presentation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are signs we will find of a shoulder dislocation?

A
  • ROM - limited and painful most directions
  • Resisted/MMT - weak and painful most directions
  • Stress tests - likely positive depending on structure involved
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are some possible special tests for labrum?

A

Anterior instability
Anterior labrum
Postero-inf labrum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are anterior instability special tests?

A

+ apprehension
+ relocation
Apprehension ( may also be positive with general hypermobility)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are the LR of anterior instability anterior dislocation special tests?

A

LR + = 39.68 if both +
LR - = 0.19 if both -

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is a test for the anterior labrum?

A

Speeds
* high sens (rule in)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is a test for the postero-inferior labrum?

A

Jerk test

LR + 1.25-36.5

36
Q

What are some possible SLAP tests for labrum with dislocation?

A

Sulcus with inferior drawer
Biceps load
Pain provocation
Passive compression
Yergason’s

37
Q

What are some possibly positive special tests for fracture with dislocation?

A

Olecranon-Manubrium percussion test
Bony Apprehension Test

38
Q

What is the benefit of the Olecranon-manubrium percussion test?

A

High spec/sens (rule out and in)
LR + 84

39
Q

What should we treat dislocation like? (other condition)

A

A worse case of impingement due to hypermobility/instability

40
Q

How long is someone immobilized after dislocation of the shoulder?

A

Up to 6 weeks

41
Q

How can we improve rotator cuff activation while immobilized?

A

Contralateral UE use
Ipsilateral hand squeezing activities

42
Q

What are some positives of a shorter period of immobilization?

A

muscle integrity
proprioception
peripheral and central neural activity
dynamic stability

43
Q

What are some pt rx for dislocation?

A

Immobilization
POLICED

44
Q

What does MET focus on with dislocation?

A

Stabilization
Tissue integrity and proliferation

45
Q

What are initial contraindications for anterior dislocations?

A

Abduction, Eternal rotation, and Flexion ROM

46
Q

What movements are initially ideal for dislocations in terms of MET?

A

Isometrics and isotonics into opposite directions initially

47
Q

What makes recurrent dislocations highly likely?

A

If under 30 years of age

48
Q

What should we remember with prognosis of dislocations?

A

healing of all potentially involved tissue

49
Q

What are some MD rx for dislocations?

A

Arthroscopic vs. open procedures

50
Q

How long is the prognosis is the prognosis for MD dx (surgery)?

A

3-6 months

51
Q

What is done while under anesthesia that ensures movment?

A

Full ROM

52
Q

What is a coracoid transfer?

A

Reposition coracoid process and coracobrachialis and short biceps head to GH neck

53
Q

What is a capsular shirt / capsuloraphy?

A

Overlap of torn portions of capsular folds

54
Q

Which surgery is most common with dislocations?

A

Capsuloraphy

55
Q

What type of fracture of the shoulder is common in the elderly?

A

Proximal humeral fracture

56
Q

What is the etiology of a proximal humeral fracture?

A

FOOSH

57
Q

What structures are involved with a proximal humeral fracture?

A

Surgical humeral neck

58
Q

What is our dose response with fractures?

A

How we use the body
- i.e. immobilization less than previously active

59
Q

What are some complications with a proximal humeral fracture?

A
  • Axillary artery damage
  • Adhesive capsulitis from prolonged immobilization
60
Q

What can axillary artery damage lead to?

A

Coldness and blanching
Emergency referral
Possible avascular necrosis (tissue death)

61
Q

What is the etiology of a clavicular fracture?

A

compression mechanism the long axis of clavicle

62
Q

Where is the location of clavicular fractures?

A

Weak spot at S curve

63
Q

What are complications of clavicular fractures?

A

Large displacement may require sx
Epiphyseal plate injury as it is the last bone to ossify

64
Q

When does the clavicle ossify?

A

18-25 years of age

65
Q

What are some S&S of fracture in the UE covered

A

Olecranon - manubrium percussion test
Apprehension test

66
Q

When do we start PT with fractures?

A

When clinical union occurs between 4-8 week s

67
Q

What is pain from fractures not typically from?

A

Bone

68
Q

What is PT for fractures focused on?

A

Consequences of prolonged immobilization where every tissue is negatively influenced

69
Q

What is proximal humeral apophysitis also known as?

A

Little League Shoulder

70
Q

What is the prevalence of proximal humeral apophysitis?

A

rare but increasing

71
Q

What population is most likely to get proximal humeral apophysitis?

A

Adolescents, biological males more than females, MOSTLY overhead throwers but also racquet sports

72
Q

What is the etiology of proximal humeral apophysitis?

A

Growth with high activity

73
Q

What are the pathomechanics of proximal humeral apophysitis?

A
  • Bone grown exceeds rotator cuff lengthening
  • increased tendon tension
  • Growth plate is the weak spot as opposed to tendon in adults
    ** MOST often imflammation
74
Q

What are complications with proximal humeral apophysitis?

A

avulsion and/or premature closure

75
Q

What are symptoms of proximal humeral apophysitis?

A
  • Gradual onset of shoulder pain with overuse
  • A “pop” may indicate trauma and an avulsion (most concerning with force)
  • Above etiology with possible loss of velocity
76
Q

What are some signs of proximal humeral apophysitis?

A

Impingement like
* resisted/MMT limited plus lower ER:IR strength ration in adolescent athletes with GIRD >1
* Special tests positive for impingement , up to 30% with GIRD > 1
* Palpation - TTP over anterio- and posterolateral aspect of proximal humerus

77
Q

What is the most common sign of proximal humeral apophysitis?

A

TTP over antero- and posterolateral aspect of proximal humerus

78
Q

What should patient education include with proximal humeral apophysitis?

A

Soreness rule
Load management (pitch count, active rest, rest days, alternative defensive postions)
Movement cues (throwing mechanics)

79
Q

What are the rx for proximal humeral apophysitis?

A

POLICED
throwing mechanics
patient ed
normalize motion
Careful stretching
Return to Play

80
Q

What can normalizing motion do with proximal humeral apophysitis?

A

improve GIRD ratio

81
Q

Why should we be careful with prolonged stretching with proximal humeral apophysitis?

A

Vulnerability of growth plate

82
Q

What should MET include for proximal humeral apophysitis?

A

Cuff but also trunk, scapular, and LE impairements

83
Q

What should we have caution with MET for proximal humeral apophysitis?

A

muscles/tendons attached to growth plate

84
Q

How early do most return to preinjury levels with proximal humeral apophysitis?

A

as early as 2 months, but possibly up to 2-8 months

85
Q

How long until return to competition with an avulsion with proximal humeral apophysitis?

A

~4.5 months

86
Q

When does the growth plate typically close?

A

Between 16-20 years of age

87
Q

Can proximal humeral apophysitis be recurrent?

A

Yes

MSK 1 - Shoulder (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions