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Musculoskeletal Upper Limb > Shoulder Injuries > Flashcards

Shoulder Injuries Flashcards

1
Q

Special Diagnostic Tests for Rotator cuff tendinopathy

A

Hawkins Kennedy

Shoulder symptom modification procedure

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2
Q

Special Diagnostic Tests for Shoulder instability

A

apprehension relocation test
AP/PA glide
Sulcus sign

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3
Q

Special Diagnostic Tests for Full-thickness cuff tear

A

ER Lag

IR Lag

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4
Q

Special Diagnostic Tests for AC Joint Injury

A

Scarf test
Shear test
Accessory movements of the AC

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5
Q

SLAP (superior labrum anterior-posterior) lesion tests

A

Passive distraction
Active compression (O’briens)
Labral shear

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6
Q

Pathogenesis and pathophysiology of Rotator cuff tendinopathy

A

excessive load placed on tendon -> tissue breakdown -> tendinopathy

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7
Q

Symptoms of Rotator Cuff Tendinopathy

A

• Weak and painful shoulder
• Pain localised to shoulder (can refer into upper arm)
• Mechanical symptoms
• Sharp, catching and pinching with ‘impingement’
o E.g. lifting, reaching, sport, work
o Note sleeping as an issue
• Aches once aggravated

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8
Q

Diagnostic features of (clinical features) Rotator Cuff Tendinopathy

A
  • painful arc (or 60 deg to P2)
  • +ve palpation of SITS muscles and tendons
  • isometric ER +ve
  • isometric Abd +ve
  • reduced shoulder strength
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9
Q

Management for Rotator Cuff Tendinopathy

A

passive therapies: dry needling/massage of supra and infraspinatus & pec minor, joint mobilisation of costovertebral joints, thoracic spine

strengthening:
1. isometric for pain relief: abd + ER
2. isotonic loading (truncate range): flex -> elevation -> ER -> scap elevation -> IR
3. Functional loading

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10
Q

Pathogenesis of Shoulder Instability - Overuse

A

due to repetitive…

  1. joint strain
  2. tissue train
  3. microtrauma
  4. stretch
  5. damage
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11
Q

Symptoms of Shoulder Instability

A
  • apprehension

- fear, anxiety, avoidance

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12
Q

Diagnostic features (clinical features) of Shoulder Instability

A
  • increased/excessive movements active and passive
  • apprehension with ABERs
  • +ve apprehension relocation test
  • AP/PA glide +ve
  • Sulcus sign +ve if dislocation
  • decreased global shoulder strength
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13
Q

Management of Shoulder Instability

A

Surgery if young + trauma

Strengthening:

  1. isotonic loading - progress towards ABERs: IR -> scap elevation -> flex -> elevation -> ER
  2. functional loading
  3. closed chain loading
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14
Q

Reason for/effects of using closed chain loading in rehab of shoulder instability

A
  • enhances co-activation of muscles around the shoulder

- increases feelings of security

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15
Q

Risk Factors for Frozen shoulder

A

systemic: diabetes, CV disease, genetics
extrinsic: general trauma, cervical radiculopathy, stroke
intrinsic: shoulder trauma, shoulder surgery, RC tendinopathy, vaccination
epidemiology: female 3 x more common

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16
Q

Stages of Frozen shoulder inc. features

A

i. freezing - extreme pain
ii. frozen - extreme stiffness but reducing pain
iii. thawing - resolving stiffness with negligible pain

17
Q

Duration of Frozen shoulder

A 
18 months (6 months per stage)
1-4 years total
18
Q

Pathophysiology of Frozen shoulder

A

Vascular ingrowth into the capsule

Collagen proliferation and contracture

19
Q

Diagnostic features of Frozen shoulder

A

Passive elevation decreased
Passive ER decreased (- crepitus)
Isometric ER and Abd clear

only test ER, everything else hurts too much

reduced global strength

20
Q

Symptoms of Frozen Shoulder (for each stage)

A

Stiff and painful shoulder

0-6 months:

  • pain localised to the shoulder, may refer into upper arm
  • constant severe unrelenting pain
  • excruciating pain with movement

6-12 months:
- decreasing pain but no change in mobility

12-18 months:
- gradual improvement in mobility

21
Q

Management of Frozen Shoulder (not exercises)

A
  1. clarify diagnosis: surgical review
  2. reduce pain and promote tissue healing: medication, intra-articular steroid injections, taping, heat, general movement, lifestyle
  3. rectify impairments: exercise (strengthening), as mobility returns make sure the patient uses the shoulder to its full ability. ROM exercises - wand exercises
22
Q

Rehab (strength) of Frozen Shoulder

A
  1. isotonic loading: elevation, ER, scap elevation, horizontal ext, IR, ext.
  2. functional loading
23
Q

Pathophysiology of Glenohumeral OA

A

Degeneration of articular cartilage and subchondral bone -> narrowing of GH joint (due to osteophyte development)

  1. synovitis (nociception)
  2. articular cartilage degradation
  3. subchondral bone degradation
24
Q

Symptoms of Glenohumeral OA

A
  • stiff and painful shoulder
  • pain localised to the shoulder
  • ‘hurts all the time’
  • ‘sharp pain’ on movement
  • ‘GRINDING’ ‘CRUNCHING’
25
Q

Diagnostic features of Glenohumeral OA

A

decreased passive elevation
decreased external rotation (+crepitus)

decreased global shoulder strength

26
Q

Management of Glenohumeral OA

A
  1. clarify diagnosis
    - imaging Xray
    - 2nd opinions - surgical review -> TSR
  2. reduce pain and promote tissue healing
    - medications: NSAIDS, analgesics
    - taping
  3. rectify impairment
    - exercise (strengthening) - limit range to avoid provocation, dont push it around R2
27
Q

Rehab of Glenohumeral OA

A

Shoulder ROM exercises - wand exercises

  1. isotonic loading
    - elevation
    - external rotation
    - scap elevation
    - horizontal ext
    - internal rotation
    - extension
  2. functional loading
28
Q

AC joint sprain Type 1 - pathology/description and clinical features

A

synovitis

pain at the AC joint

29
Q

AC joint sprain Type 2 - pathology/description and clinical features

A

complete AC ligament tear

mild step deformity

30
Q

AC joint sprain Type 3 - pathology/description and clinical features

A

complete tear of coracoclavicular, conoid and trapezoid ligaments

marked step deformity

31
Q

AC joint sprain Type 4 - pathology/description and clinical features

A

significant injury associated soft tissue injury

additional deformity

32
Q

Management of AC joint sprain Type 1 (inc. acute time period)

A

conservative

Acute: 1-3 weeks

33
Q

Management of AC joint sprain Type 2 (inc. acute time period)

A

conservative

acute: 4-6 weeks

34
Q

Management of AC joint sprain Type 3 (inc. acute time period)

A

trial conservative management

<12 weeks

surgical review

35
Q

Management of AC joint sprain Type 4

A

Surgery

Musculoskeletal Upper Limb (5 decks)

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