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Advanced Orthopedics > Shoulder Exam and Intervention > Flashcards

Shoulder Exam and Intervention Flashcards

1
Q

Define differentiation

A
  • The action or process of differentiating
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2
Q

Cervical Myelopathy CPR

A
  • Abnormal gait
  • Hoffman’s test
  • Inverted supinator sign
  • Babinski sign
  • Age ≥45 years
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3
Q

Illness script for proximal humerus fractures

A
  • Elderly females with osteoporosis
  • Low energy ground level fall (FOOSH) typical in elderly or high energy in younger
  • Presets like soft tissue swelling, contusion, reduced AROM
  • Management: referral, imaging, if non-displaced & stable begin progressive ROM
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4
Q

GHJ dislocation illness script

A
  • Younger & contact sports or collagen disorders
  • MOI: trauma in anterior direction to the shoulder at end range ABD+ER
  • Anterior is more frequent dislocation direction
  • Acute dislocation check neurovascular
  • Traumatic associated conditions: Hill-Sachs lesion (humerus), labral tears
  • Generalized instability in 2 planes of movement and age 20-30 years
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5
Q

AC fracture illness script

A
  • Clavicle Fx is most common shoulder complex type Fx
  • Middle 3rd more common than distal 3rd
  • MOI: fall onto lateral shoulder or direct impact
  • Coracoclaviccula ligament are key for displacement
  • Conoid (medial) & trapezoid (lateral) provide primary resistance to superior displacement of the lateral clavicle depending on fracture location
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6
Q

Screening for clavicle dislocation

A
  • Movement screen: rotates 40-50º posteriorly with shoulder elevation
  • Coracoclavicular ligs: controls vertical motion & superior inferior stability
  • Acromioclavicular ligs: controls horizontal motion & anterior posterior stability
  • AC D/L: disrupts AC & possible CC ligs
  • SC D/L: collision contact sports; atraumatic if ligamentous laxity
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7
Q

Types of AC dislocations

A
  • I = sprain, non-displaced
  • II = <25% clavicle elevation, AC ruptured
  • III = clavicle elevation, AC, CC ligs & joint capsule ruptured, deltoid & trap detached
  • All ruptured/detached
  • IV = clavicle displaced posterior into trap
  • V = elevated space >25mm
  • VI = clavicle displaced behind coracobrachialis & biceps tendons
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8
Q

Exam flow for a shoulder examination

A
  • Interview
  • Observation
  • Screening
  • Movement scripts/testing
  • Palpation & joint mobility testing
  • MMT
  • Shoulder special Tess
  • Performance tests if needed
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9
Q

Describe the scapulohumeral rhythm

A
  • GHJ allows 120º and scapulothoracic allows 60º
  • For every 2º humeral elevation the scapula should elevate by 1º
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10
Q

Scapular motions

A
  • 60º of upward rotation
  • 40-60º of IR/ER
  • 30-40º of anterior/posterior tipping
  • Elevation/depression or protraction/retraction
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11
Q

How do you bring out scapular dyskinesia

A
  • Add a low weight with arm elevation
  • Dumping: downward rotation with return from elevation
  • Winging: medial border not stays close along the thoracic cage
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12
Q

Scapular specific mobilizations test

A
  • Scapular retraction test
  • Modified scapular assistance test
  • Scapular reposition test
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13
Q

Closed packed position of shoulder joint

A
  • 90º ABD & full ER or full ABD & ER
  • End range throwing position
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14
Q

Open packed position of shoulder joint

A
  • 55º ABD & 30º horizontal ABD
  • Scaption
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15
Q

Describe the shoulder ligaments and their purpose

A
  • Coracoclavicualr: anchor the clavicle to the scapula
  • Coracoacromial: prevents superior displacement of humeral head
  • Coracohumeral: strengthens superior glenohumeral joint capsule
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16
Q

What is the GHJ capsular pattern

A
  • ER > ABD > IR limited
  • ER limited more than ABD and ABD limited more than IR
  • Occurs in a 3-2-1 ratio
17
Q

When are the anterior GH ligaments under tension

A
  • Shoulder extension, ABD, and/or ER
18
Q

When are the poster GH ligaments under tension

A
  • Shoulder flexion and ER
19
Q

When are the inferior GH ligaments under tension

A
  • Shoulder ABD, extension, and/or ER
  • Primary restraint against anterior/posterior dislocation of humeral head
20
Q

Where does the supraspinatus refer for myofacial pain

A
  • Spine of scapula
  • Hot spot on lateral shoulder/deltoid insertion
  • Down the arm laterally to the wrist
  • Hot spot on lateral elbow/olecranon
21
Q

Where does the infraspinatus refer for myofacial pain

A
  • Unilateral suboccipital neck area
  • Hot spot on lateral shoulder/deltoid insertion
  • Hot spot on anterior shoulder down middle of bicep muscle belly
  • Down lateral arm across back and palm side of hand
22
Q

Where does the latissimus dorsi refer for myofacial pain

A
  • Hot spot on unilateral back at inferior angle of scapula
  • Across scapula into the axilla and down medial arm across the 4th/5th digits front/back
23
Q

Where does the Subsacpularis refer for myofacial pain

A
  • Across whole scapula
  • Hot spot on poster deltoid area/axilla but not in axilla
  • Down arm along triceps muscle belly
  • Across middle deltoid
  • Hot spot on back of wrist and across carpal bones
24
Q

Partial thickness RTC tear illness script

A
  • Anterior lateral pain
  • Pain w/overhead motion/painful arc
  • Night pain
25
Q

Full thickness RTC tear illness script

A
  • Anterior lateral pain, constant ashiness, night pain, pain that wakes
  • Compensatory shoulder shrugging w/overhead motion
  • Gross functional disabilities
  • Age >40
26
Q

Partial RTC tear cluster

A
  • Hawkins Kennedy
  • Painful arc
  • Infraspinatus muscle test
27
Q

Full RTC tear cluster

A
  • Drop arm test
  • Painful arc
  • Infraspinatus muscle test
28
Q

Describe SNout and SPIN

A
  • Sensitivity is a true positive rate
  • Snout = when Neg. it rules it OUT
  • Specificity is a true negative rate
  • Spin = when Pos. it rules it IN
29
Q

Describe the IRRST (internal rotation resisted strength test)

A
  • Used to assist with clinical reasoning
  • Can help differentiate between rotator cuff, extra-articular, and intra-articular
30
Q

Mobility differences based on rotator cuff, extra-articular, and intra-articular issues

A
  • RTC: IR is stronger than ER
  • Extra-articular: IR and ER are relatively equal in strength
  • Intra-articular: IR is weaker than ER

Advanced Orthopedics (29 decks)

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