Shoulder Dysfunction

Question 1

How are rotator cuff diseases classified?

Answer 1

Neer Classification of Rotator Cuff Disease: Stage I -III

Question 2

Tendonopathy with repeated insult that causes decreased integrity of soft tissues resulting in partial or full tendon tear can be classified as:

Answer 2

stage III

Question 3

Theories of RC injury?

Answer 3

avascularity
mechanical wear
micro/macro trauma

Question 4

Explain the avascular component of RC injury

Answer 4

“wringing out” occurs with prolongued/repetitive overhead activities resulting in loss of blood flow

Question 5

What is tendonosis?

Answer 5

intra-tendon degeneration

Question 6

What is sprengels deformity?

Answer 6

failure of scapula to defend

Question 7

What is erb’s palsy?

Answer 7

obstetrical brachial plexus traction injury

Question 8

Describe stage II RC disease.

Answer 8

fibrosis of the cuff, permanent and irreversible changes, 25-40 years

Question 9

Where is pain typically present with subacromial/subdeltoid bursitis:

Answer 9

pain near end of ROM

Question 10

Adhesion or shortening of GH capsule may lead to

Answer 10

adhesive capsulitis “frozen shoulder”

Question 11

What are the two causes of adhesive capsulitis?

Answer 11

trauma or idiopathic

Question 12

How long does it take for idiopathic adhesive causalitis to resolve?

Answer 12

12-18 months

Question 13

Describe Freezing Idiopathic Adhesive Capsulitis

Answer 13

First 4-6 months
very painful
losing ROM

Question 14

Describe Frozen Idiopathic Adhesive Capsulitis

Answer 14

Second 4-6 months
pain decreases
very stiff

Question 15

Describe Thawing Idiopathic Adhesive Capsulitis

Answer 15

Third 4-6 months
less pain
increasing motion

Question 16

How is adhesive capsulitis managed?

Answer 16

priority: pain control

maintain ROM as much as possible (consider phase)

Question 17

Describe GH dislocation presentation

Answer 17

o 95% Anterior: cannot touch opposite shoulder

o 5% Posterior: cannot ER arm

Question 18

What is bankart lesion arthrogram?

Answer 18

Glenoid labral tear assiated with GH dislocation

Question 19

What is SLAP lesion?

Answer 19

a forceful tearing of the labrum near the insertion of the biceps tendon that usually occurs with dislocation of shoulder

Question 20

Hill-Sachs Lesion

Answer 20

Posterolateral indentation fx of humeral head associated with anterior GH dislocation

Question 21

What is the incidence of hill sachs lesion with recurrent dislocations?

Answer 21

80% incidence in recurrent dislocations

Question 22

What is the conservative treatment for shoulder dislocations?

Answer 22

Reduction
Immobilization in slip (up to 3 wks)
Progressive mobilization
shoulder strengthening (RC especially)

Question 23

What does the Bankart surgery repair?

Answer 23

Repair by suturing the leabrum and capsule

Question 24

Do you get full ROM back with a Bankart Arthroscopic surgery?

Answer 24

YEs

Question 25

What is a capsular shift surgery?

Answer 25

Tightening of the anterior capsule

Question 26

What is a method used for a capsular shift?

Answer 26

Electrothermally assisted capsular shift

Question 27

Do you get full ROM back with a capsular shift surgery?

Answer 27

May loose a little ROM

Question 28

What is done with a bristow Arthrotomy?

Answer 28

For recurrent dislocations, the coracoid is moved to the anterior glenoid

Question 29

What is a grade 1 AC sprain?

Answer 29

Tender at AC, sprain of AC ligaments, NO deformity

Question 30

What is a Grade 2 AC sprain?

Answer 30

Increased displacement of clavicle. Tear of both superior and inferior AC

Question 31

What is a grade 3 AC sprain?

Answer 31

Complete disruption, marked deformity, complete tear of AC ligaments and CC ligaments (trapezoid and conoid

Question 32

What is a piano key sign?

Answer 32

Push down on the distal clavicle and it springs back up like a piano key

Question 33

What is a conservative management of an AC sprain/dislocation ?

Answer 33

Immobilize in a kenny-howard sling for 3-6 weeks

Question 34

What is a surgical management of an AC sprain/dislocation?

Answer 34

ORIF with a rockwood screw only if severe

Question 35

What movement precautions should you take post AC dislocation?

Answer 35

Horizontal Adduction | Abduction above 90 degrees

Question 36

| What are SC joint sprains/dislocations usually secondary to?

Answer 36

| Trauma (MVA), direct blow to sternum, or FOOSH(or A)

Question 37

What situation would a SC joint dislocation be a medical emergency?

Answer 37

If it translates posteriorly due to the proximity of the trachea and subclavian artery/nerve

Question 38

What are two of the most common fxs of the proximal humerus?

Answer 38

Nondisplaced greater tuberosity fx | Clavicular Fx

Question 39

What are proximal humeral fxs and clavicular fxs usually caused by?

Answer 39

FOOSH's

Question 40

What is the female:male ratio for proximal humeral fxs?

Answer 40

2:1 female to male ratio

Question 41

How does Neer classify Shoulder fractures?

Answer 41

``` 4 part system based on the relationship of the following bone parts and the amt of displacement: Articular fragment of the head lesser tuberosity Greater Tuberosity Shaft ```

Question 42

What would a two part fx consist of?

Answer 42

Displacement between any two of the 4 parts of Neers shoulder fx classification (i.e. greater tuberosity and shaft)

Question 43

What is the conservative management of a proximal humeral fracture?

Answer 43

sling for 10-21 days IF non-displaced. THEN gradual mobility

Question 44

When do use a sling for a proximal humoral fx post-op?

Answer 44

If displaced by >1 cm, or if in 45 deg. angulation, you will be in a sling several weeks post op

Question 45

What is lipohemarthrosis?

Answer 45

the mixture of fat and blood in a joint cavity following trauma

Question 46

WHat are some considerations post humeral fracture?

Answer 46

potential for post-immobilization adhesive capsulitis Stability of fx Potential for CRPS (formerly shoulder-hand syndrome)

Question 47

How long are you in a sling post clavicular fx?

Answer 47

2-3 week

Question 48

How and when are clavicular fxs surgically repaired?

Answer 48

Only for severe fxs, they use a plate and screw fixation

Question 49

How does erb's palsy present?

Answer 49

shoulder adducted/IR forearm pronated wrist flexed absent biceps reflex