Shoulder Conditions Flashcards
What is thoracic outlet syndrome?
Compression of neurovascular structures from the neck into the axilla.
What are the common compression points in thoracic outlet syndrome?
- Between rib 1 and the clavicle 2. Between anterior scalene and middle scalene 3. Pectoralis minor and coracoid process.
Who is commonly affected by thoracic outlet syndrome?
Overhead athletes and individuals with extended posture and protracted anterior GH.
What are the symptoms of neurogenic thoracic outlet syndrome?
Numbness, tingling, weakness, and pain in the arm and fingers, often affecting the ulnar nerve distribution.
What are the symptoms of arterial thoracic outlet syndrome?
Coldness, paleness, reduced pulses, potential claudication, and ischemia in the hand.
What are the symptoms of venous thoracic outlet syndrome?
Swelling, heaviness, bluish discoloration, and distended veins in the neck or chest.
What are key findings in the examination of thoracic outlet syndrome?
Observation of posture, discoloration, pain in the neck, shoulder, arm, and hand, and possible neuro changes.
What is the management for thoracic outlet syndrome?
Education, load/activity management, manual therapy, exercise rehabilitation, and possible surgical intervention.
What is the first choice of diagnostic imaging for acute shoulder injuries?
X-ray.
What is the common cause of acromioclavicular injury?
Trauma, usually from a fall onto the shoulder.
What are the types of traumatic acromioclavicular injuries?
Type 1: Sprain on capsule. Type 2: Tearing of AC ligaments. Type 3-6: Complete tearing with varying levels of displacement.
What are the clinical features of acromioclavicular injury?
History of trauma, localized pain over AC joint, palpable tenderness, swelling, and positive AC crossover test.
What is the management for Type 1 acromioclavicular sprain?
Sling immobilization for up to 1 week, ice for pain relief, and range of motion exercises.
What are SLAP lesions?
Lesions to the superior labrum that extend from the anterior to posterior aspects of the biceps tendon.
What are the clinical features of SLAP lesions?
Localized pain, popping, catching, grinding, and tenderness over the anterior shoulder.
What is adhesive capsulitis?
Loss of GHJ ROM >25% in at least 2 movement planes and at least 50% in ER at 0 degrees compared to the other side.
What are the key findings for adhesive capsulitis examination?
Atrophy of rotator cuff muscles, loss of both passive and active ROM, and pain at the capsule’s stretching point.
What is the management for pain-dominant adhesive capsulitis?
Pain relief, intra-articular injection, hydrodilatation, and exercises without significant pain.
What is subacromial pain syndrome (SAPS)?
Non-traumatic, usually unilateral shoulder pain around the acromion, worsening with arm lifting.
What are the examination findings for SAPS?
Decreased painful abduction, swelling, scapular protraction, and positive orthopedic tests.
What is the management for SAPS?
Education, load management, relative rest, corticosteroid injections, manual therapy, and exercise rehabilitation.
What are the classifications of rotator cuff injuries?
Grade 1: Strain without tearing. Grade 2: Partial tearing. Grade 3: Complete rupture.
What are key findings for rotator cuff muscle injury diagnosis?
Decreased active ROM, decreased active resisted testing, scapula protraction, and tenderness on palpation.
Key findings for diagnosing rotator cuff muscle injury
Decreased active ROM with minimal disruption to passive ROM, decreased active resisted testing in individual RC muscle likely due to pain, observation of scapula protraction, atrophy in long-term degenerative pathologies, tenderness on palpation, and specific orthopedic tests.
What is the significance of decreased active resisted testing in rotator cuff injuries?
It is likely due to pain rather than true neurological weakness.
What are the orthopedic tests for rotator cuff injuries?
Empty can test for supraspinatus pathology, lift-off test for infraspinatus, Hawkins Kennedy and Neer’s tests for subacromial pain syndrome.
Management strategies for rotator cuff strain/tear
Education on cause and prognosis, pain neuroscience education, reassurance, load management, manual therapy, and rehab/exercise prescription.
What is rotator cuff tendinopathy characterized by?
Pain and weakness on shoulder external rotation and elevation due to excessive load on rotator cuff tissues.
What are the four muscles that form the rotator cuff?
Supraspinatus, Infraspinatus, Subscapularis, Teres Minor.
What is the action of the supraspinatus muscle?
Assists deltoid in abduction of the arm and stabilizes the GH joint.
What is the action of the infraspinatus muscle?
Laterally rotates the arm and stabilizes the GH joint.
What is the action of the subscapularis muscle?
Medially rotates the arm.
What is the action of the teres minor muscle?
Laterally rotates the arm and stabilizes the GH joint.
Key findings for examination of rotator cuff tears
Pain on overhead movements, tenderness on palpation over the tendon, tenderness over the greater tuberosity, painful arc between 70-120 degrees, and pain on active resisted testing.
What are the management strategies for rotator cuff tears?
Education on cause and prognosis, pain neuroscience education, reassurance, load management, manual therapy, and exercise rehabilitation.
What is the purpose of manual therapy in rotator cuff management?
To offload surrounding structures and improve range of motion.
What types of exercises are recommended for rotator cuff rehabilitation?
Gentle movements with tolerable pain, isometrics, scapula control, and kinetic chain exercises.
