Shoulder Dysfunction Flashcards
Shoulder dsyfxn through hill-sacks lesion need to finish from dislocation management-end
How are rotator cuff diseases classified?
Neer Classification of Rotator Cuff Disease: Stage I -III
Tendonopathy with repeated insult that causes decreased integrity of soft tissues resulting in partial or full tendon tear can be classified as:
stage III
Theories of RC injury?
avascularity
mechanical wear
micro/macro trauma
Explain the avascular component of RC injury
“wringing out” occurs with prolongued/repetitive overhead activities resulting in loss of blood flow
What is tendonosis?
intra-tendon degeneration
What is sprengels deformity?
failure of scapula to defend
What is erb’s palsy?
obstetrical brachial plexus traction injury
Describe stage II RC disease.
fibrosis of the cuff, permanent and irreversible changes, 25-40 years
Where is pain typically present with subacromial/subdeltoid bursitis:
pain near end of ROM
Adhesion or shortening of GH capsule may lead to
adhesive capsulitis “frozen shoulder”
What are the two causes of adhesive capsulitis?
trauma or idiopathic
How long does it take for idiopathic adhesive causalitis to resolve?
12-18 months
Describe Freezing Idiopathic Adhesive Capsulitis
First 4-6 months
very painful
losing ROM
Describe Frozen Idiopathic Adhesive Capsulitis
Second 4-6 months
pain decreases
very stiff
Describe Thawing Idiopathic Adhesive Capsulitis
Third 4-6 months
less pain
increasing motion
How is adhesive capsulitis managed?
priority: pain control
maintain ROM as much as possible (consider phase)
Describe GH dislocation presentation
o 95% Anterior: cannot touch opposite shoulder
o 5% Posterior: cannot ER arm
What is bankart lesion arthrogram?
Glenoid labral tear assiated with GH dislocation
What is SLAP lesion?
a forceful tearing of the labrum near the insertion of the biceps tendon that usually occurs with dislocation of shoulder
Hill-Sachs Lesion
Posterolateral indentation fx of humeral head associated with anterior GH dislocation
What is the incidence of hill sachs lesion with recurrent dislocations?
80% incidence in recurrent dislocations
What is the conservative treatment for shoulder dislocations?
Reduction
Immobilization in slip (up to 3 wks)
Progressive mobilization
shoulder strengthening (RC especially)
What does the Bankart surgery repair?
Repair by suturing the leabrum and capsule
Do you get full ROM back with a Bankart Arthroscopic surgery?
YEs
What is a capsular shift surgery?
Tightening of the anterior capsule
What is a method used for a capsular shift?
Electrothermally assisted capsular shift
Do you get full ROM back with a capsular shift surgery?
May loose a little ROM
What is done with a bristow Arthrotomy?
For recurrent dislocations, the coracoid is moved to the anterior glenoid
What is a grade 1 AC sprain?
Tender at AC, sprain of AC ligaments, NO deformity
What is a Grade 2 AC sprain?
Increased displacement of clavicle. Tear of both superior and inferior AC
What is a grade 3 AC sprain?
Complete disruption, marked deformity, complete tear of AC ligaments and CC ligaments (trapezoid and conoid
What is a piano key sign?
Push down on the distal clavicle and it springs back up like a piano key
What is a conservative management of an AC sprain/dislocation
?
Immobilize in a kenny-howard sling for 3-6 weeks
What is a surgical management of an AC sprain/dislocation?
ORIF with a rockwood screw only if severe
What movement precautions should you take post AC dislocation?
Horizontal Adduction
Abduction above 90 degrees
<p>
| What are SC joint sprains/dislocations usually secondary to?</p>
<p>
| Trauma (MVA), direct blow to sternum, or FOOSH(or A)</p>
What situation would a SC joint dislocation be a medical emergency?
If it translates posteriorly due to the proximity of the trachea and subclavian artery/nerve
What are two of the most common fxs of the proximal humerus?
Nondisplaced greater tuberosity fx
Clavicular Fx
What are proximal humeral fxs and clavicular fxs usually caused by?
FOOSH’s
What is the female:male ratio for proximal humeral fxs?
2:1 female to male ratio
How does Neer classify Shoulder fractures?
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
What would a two part fx consist of?
Displacement between any two of the 4 parts of Neers shoulder fx classification (i.e. greater tuberosity and shaft)
What is the conservative management of a proximal humeral fracture?
sling for 10-21 days IF non-displaced. THEN gradual mobility
When do use a sling for a proximal humoral fx post-op?
If displaced by >1 cm, or if in 45 deg. angulation, you will be in a sling several weeks post op
What is lipohemarthrosis?
the mixture of fat and blood in a joint cavity following trauma
WHat are some considerations post humeral fracture?
potential for post-immobilization adhesive capsulitis
Stability of fx
Potential for CRPS (formerly shoulder-hand syndrome)
How long are you in a sling post clavicular fx?
2-3 week
How and when are clavicular fxs surgically repaired?
Only for severe fxs, they use a plate and screw fixation
How does erb’s palsy present?
shoulder adducted/IR
forearm pronated
wrist flexed
absent biceps reflex
