Shoulder Disorders Flashcards
Acromioclavicular Separation (shoulder separation)
Etiology
Clinical Symptoms/Signs & PE tests
Acromion: the scapula & clavicle connection point gets separated
Etiology
- males, contact athletes
- a sprain (which is a pull of the ligaments: attching bone to bone) or disrpution of the ligaments
- direct: a hit to the side and the force disrupts the ligament
- indirect: a fall on outstreched arm; the force of the fall causes the separation
Clinical Findings
- a clinical diagnosis: pt. compains of pop, injury or pain that is focal to the AC joint spcifically
- on PE: the clavicle will be popping up and out a step-off deformity
- pains with ADDuction: cross body test
- pain with O’Brien’s test: crossing body with thumb downward resisting pressure
AC Joint Separation
Imaging
Types & Treatment
Imaging
x-ray is the gold standard : bilateral AP, Axillary & Zanca (a close up of the AC)
- can get CT for operative planning
- can get US for quick scan
Types of AC separations
Type 1: sprained ligament
Type 2: sprained and ruputred ligaments
Type 3: ligaments ruputred: muscles detached
Type 4: ruputred ligaments & clavicle through trap.
Type 5: rupture of all ligamets (severe)
Type 6: all ligaments disrupted and muscles dsrupted
Treatment
Type 1-2 : rest, ice, tylenol, immobilzation with early movement (sling + pendulum swing!!!)
Type 3: conservative treatment first; may need surgery
Type 4-6: surgery
Brachial Plexus Injuries
Etiology
Symptoms and PE
Etiology
- the result of a supra or infraclavicaulr injury
- high-speed MVA/motorcycle accident
- penitrating trauma, shoulder surgery or radiation
Symptoms
- weakness, recent trauma, numbness
- generally a trauma call
- neuopathic pain (sharp and burning)
- signs of neuologic impariment
- C5: deltoid & infraspinatus
- C6: biceps
- C7: extensor muscles weak: pulled in flexion
- Horner’s Syndrome: PAM
Brachial Plexus Injury
- Diagnosis
- Imaging
- Treatment
Diagnosis
- X-ray: good to start to assess: AP, lateral and clavicle
- CT myleography is gold standard : done 3-4 weeks post injury once inflammation gone to assess nerve damange
- MRI: to see soft tissue
- EMG: nerve conduction test can be done
(when testing: a tinnels test would shold there is nerve wokring in the arm!!! even if numb)
Treatment
- conservative: oversvation, neurology, EMGs
- Operative (most): for sharp, penetrating tauma, open injuries
Rotator Cuff Tendinitis
Etiology
Risk Factors
Etiology
- most common cause of shoulder pain: also known as subacromial impingment
- risk in overhead atheltes: pitchers
- a combined compression of extrinsin joint space and intrinsic degeneration
- its an impingment of the bursa which overtime can create tendinitis and lead to a full tear & rotator cuff tear
- inflammatory process which is most commonly occuring at the supraspinatus
Risk Factors
- anatomic variants
- scapular dyskinesis
- older age
- overhead activities
Rotator Cuff Tendonitis
Symptoms
Diagnosis
Treatment
Symptoms
- overuse and repetitive activity results in
- shoulder pain which is worse with overhead lifting
- pain radiates to the deltoid
- pain when palaped, but normal ROM
- weakness due to pain (abduction is painful)
- + Hawkins (90degree rotation) & Neers (stable scapular & move upwards)
Diagnosis (no gold standard)
X-ray: AP, Lateral & Y view (for shoudler)
- osetophytes & calcification/cystic changes
MRI: tendionpathy & atrophy
US: see bursitis and hypoechogenicity
Treatment
- conservative: NSAIDS (topical too), ICE, modifiy activity
- PT to help stregthen
- subacromial corticosteroid injection
- DO NOT SLING A TENDONITIS: risk of frozen shoulder
Rotator Cuff Tear
Etiology
Risk Factors
Etiology
- full thickness tear of the rotator cuff tendons
- due to degeneration of teh tendon, chronic impingment (tendonitis) and overlaod
- starts partial but can go full thickness
older pts: see supr and infraspinatus tears : due to degeneration and stress
younger pts: see subscapular tear due to a fall
Risk Factors
- older age
- smoking
- hypercholesteremia
- family history
- gait disturbances (liekly to fall)
Rotator Cuff Tear
Symptoms/Signs
Diagnosis
Treatment
Symptoms
- recent trauma: pain anteroir/lateral shoulder
- progressive weakness
- NIGHTTIME PAIN!!!!
- progressive pseuoweakness
Signs
- limited AROM, preserved passive ROM
- + Neer/Hawkins
- + drop arm (cant hold out)
- + empty can (supra)
- + weakness with external rotation (infra)
- + lift off (subscap)
Diagnosis
- MRI: gold standard : to eval. muscle quality
- X-ray: AP, lateral & Y : cystic changes, migration of head
- US: can help
Treatment : depends on size
inital treatment: PT, rest, NSAIDS (dont do steroids)
full thickness: artherscopic repair of tendon + PT
untreated: need full shoulder replacement
Shoulder Dislocations
Etiology
symptoms
Etiology
- anterior dilocation is most common
- anterior: fall on outstretched arm
- posterior: fall from height, tonic-clonic seizure and electric shocks
- atraumatic: overhead sports/swimming (those who are hyperflexible)
Symptoms
- recent trauma, prior dislocation, nighttime dislocation
- weakness, pain
- inability to move arm
- cannot open doors with push (posterior sign)
Signs
anterior: abducted and externally rotated
posterior: internally rotated, + apprehension and load shift
Should Dislocation
Diagnosis
Treatment
Diagnosis
- X-ray: gold standard: AP, lateral & Y view (orthogonal will show forward or back) (need all 3 to r/o posterior)
- MRI/CT: after reduction to see labrum tear or boney chip
Treatment
immediate reduction of the joint back into place stimson is least trauam
- sling them 2-4 weeks with pendulum exercises
- early PT and ortho
- surgery if unstable and boney involvement
Proximal Biceps Tendon Rupture
Etiology
Risk Factors
Etiology
- older athletes
- the long head of the biceps ruptures from the attachment point of the coricoid process
- due to chronic degeneration
- boney variations
- rotator cuff changes
- a sudden load during eccentric: lengthening contraction
Risk Factors
- florquinolone use
- glucocorticoid use
- smoking
- increased BMI
Proximal Biceps Tendon Rupture
symptoms
Signs
Diagnosis
Treatment
Symptoms
- sudden pop
- brusing, swelling
- hx. of chronic tendiopahty
- pain with doorknob turning (supination : pulls bicep)
Signs
- tender at the bicepial groove
- brusing
- popeye deformity
- pain with flexion and supination Yergasons test
Diagnosis
diagnostic arthroscopy: gold standard : surgery to directly see it
US: empty groove
MIR: see shoulder issues
Treatment
- urgent referral NOT needed
Initial: rest, ice, sling and NSAIDS
Surgery: for younger active pts.
no big changes in strength of muslce because they have other head
