Shoulder Evaluation 3 Flashcards
(%) of sport related shoulder injuries involve the ACJ
40%
ACJ dysfunction: How is the dx made?
clinically
radiographic imaging
ACJ dysfunction: radiographs (view) can rule out fx of ___
Stryker view
coracoid process
ACJ dysfunction: 6 different classifications
- ligament stretched
- partial rupture of AC ligaments
- complete rupture AC and CC ligaments
- clavicle displaced posteriorly over acromion
- clavicle displaced just under skin
- clavicle underneath coracoid (very rare)
Which ACJ dysfunction types are conservatively managed?
Type I - III
Which ACJ dysfunction types require surgical management?
Type IV - VI
Why do most surgeons delay ACJ repairs?
no evidence to support early surgical intervention
ACJ repair: how long in a sling post-op?
6-8 weeks
ACJ repair: post-op
be cautious with these movements
AAROM
- horizontal adduction
- internal rotation behind the back
- forward elevation
Most commonly injured nerve during anterior dislocations
Has been involved in up to (%) of dislocations
axillary nerve
30%
Acute shoulder instability:
presentation
- visibly deformed shoulder
- swelling/bruising
- intense pain
- inability to move the arm
Acute shoulder instability:
treatment
- PT
- NSAIDs, injections
- surgery
Acute shoulder instability:
assess
- ROM
- strength
- neuro function
- palpate pulses
- GHJ ‘joint play’
Acute shoulder instability:
special testing
- apprehension
- relocation
- sulcus
- AP translation testing
Acute shoulder instability:
imaging
XR
MRI
MRA
TUBS =
Traumatic
Unilateral (anterior)
Bankart lesion
Surgery (low non-operative success rate)
AMBRI =
- Atraumatic
- Multidirectional
- Bilateral (commonly)
- Rehab (high success with nonoperative management)
- Inferior capsular shift
Apprehension test:
interpretation - anterior pain
secondary GH joint impingement
Apprehension test:
interpretation - posterior pain
posterior or internal impingement
What is the procedure used for shoulder instability?
capsular plication
Capsular plication:
expect full ROM at
10-12 weeks
Capsular plication:
Be cautious to avoid this early post-surgery
excessive ROM
Capsular plication: perform exercises in this plane to minimize stress across the repair and to maximize joint congruency
scapular plane
Adhesive capsulitis: generally, these ROM losses define the dx
> 25% loss in at least 2 planes
PROM ER loss > 50% of uninvolved shoulder or less than 30˚
What is the hallmark finding for clinical dx of adhesive capsulitis?
limited PROM ER of 50% or less than 30˚ with the arm at the side
Adhesive capsulitis: which direction of mobilizations are most effective?
posterior mobs
Adhesive capsulitis: strong evidence supports the use of these to improve pain and function in pts with frozen shoulder within 3-6 weeks of the intervention
corticosteroid injection + exercise
osteonecrosis =
bone death
osteonecrosis aka
avascular or aseptic necrosis
Osteonecrosis of the humerus often occurs when?
after fractures to proximal humerus (esp if there is a wider segment of articular segment from the shaft)
Osteonecrosis: associated with
- systemic steroid use
- Cushing’s disease
- alcohol consumption
