Shoulder injuries Flashcards
What is the most commonly injured muscle of the rotator cuff and what tests do you use for it?
supraspinatous; empty can test and drop sign
What test do you use to check for subscapularis tear?
Lift off test
What are the two most common etiologies of tendonitis in the rotator cuff?
Degeneration of muscles and repetitive trauma
What are the causes of a chronic rotator cuff tear?
Occupational or old age
What are the causes of acute rotator cuff tear?
sudden, powerful raising of arm against resistance such as by a fall on the shoulder. Greater force is needed to cause an acute tear if the person is less than 30 y.o.
In what population is tendonitis more common?
Women age 35-50.
How is the pain of tendonitis described?
deep ache, point tenderness, pain comes on gradually and then becomes worse with lifting the arm
What other condition might tendonitis lead to?
A chronic tear
In what population is a chronic tear most likely to be found?
Men over 40
How is the pain of a chronic tear described?
Pain is usually worse at night and during sleep, worsening pain followed by gradual weakness
How is ROM reduced in a person with a chronic tear?
Inability to move arm out to the side, can’t lift injured arm as high or higher than the shoulder
How is the pain of an acute tear described?
Sudden tearing sensation, severe pain, limited motion plus muscle spasm, bleeding causes point tenderness
What is the apprehension test?
anterior pressure on arm in external rotation to check for anterior glenohumeral instability
What is the hallmark sign of a rotator cuff tear (acute or chronic)?
MUSCLE WEAKNESS that is not directly attributed to pain or atrophy, also shows weakness of external rotation
How do you diagnose a tear?
if a patient still can’t move their arm after lidocaine injection (i.e. with absence of pain)
How do you treat a tear conservatively?
ice anterolaterally, weighted pendulum stretch for 5 minutes, restrict overhead movement, DISCOURAGE ARM SLING
When do you start NSAIDs for a patient with a tear? What about subacromial injection?
after 2-4 weeks if not already started; NO steroids for tear!
What is the cause of frozen shoulder (aka adhesive capsulitis)?
idiopathic or secondary to injury, bursitis, or SLING USE
What is the clinical presentation of frozen shoulder?
chronic pain and limited ROM in all fields
What two actions can’t a person with adhesive capsulitis do?
scratch test and touchdown sign
How do you diagnose adhesive capsulitis?
ROM tests revealing reduced ROM @ GH joint, imaging is limited except with MRI and gadolinium to enhance the joint capsule
How do you treat frozen shoulder?
stretch, refer to PT, <10% need surgery, NO ARM SLING
What causes shoulder impingement syndrome?
Compression of rotator cuff and subacromial bursa b/w humeral head and lateral acromion
What may chronic impingement lead to?
bursitis, rotator cuff tendonitis, degenerative changes
What is the principle cause of rotator cuff tendonitis?
Shoulder impingement syndrome
What is the CP of SISyndome?
nearly identical to rotator cuff tendonitis: pain with abduction, flexion, and internal rotation with subacromial tenderness with NORMAL PASSIVE ROM AND STRENGTH
What is the hallmark of shoulder impingement syndrome (how to differentiate between this and tendonitis)?
Pain reproduced by elbow flexion-internal rotation
According to the Neer impingement test, what is considered mild impingement?
Pain at 90 degrees of external rotation
Neer impingement moderate:
Pain at 60-70 degrees of ext rot
Neer impingement severe:
Pain at 45 degrees of ext rot or below
What is the Hawkins impingement test and how is it used?
Try flexion and internal rotation to compress subacromial bursa and diagnose shoulder impingement syndrome
What kind of imaging is done to check for SISyndrome?
radiograph will be normal, do an MRI to r/o tear
What is the treatment for shoulder impingement syndrome?
ice, NSAIDs, NO ARM SLING, PT, steroid injections
What is the CC of an AC injury?
“bump on shoulder, worse @ bedtime”
What will PE of AC injury reveal?
Depending on severity, elevation of clavicle is a 3rd degree sprain. Pain is elicited with decreased traction or forced adduction
How do you diagnose an AC injury?
upon PE, degree of sprain is determined with radiograph
How do you classify a 1st degree AC separation?
AC/CC ligaments are uninvolved or slightly stretched, NO GROSS INSTABILITY, tenderness, possible swelling and pain with ROM
How do you classify a 2nd degree AC separation (aka partial dislocation)?
Complete tear of the AC AND partial tear of stretching of CC, pain w/ ROM, significant tenderness over AC, some joint laxity, and a moderately displaced clavicle
How do you classify a 3rd degree AC separation (aka complete dislocation)?
Complete disruption of AC and CC, tender, pain with ROM, significant laxity, and a prominent clavicle
What is the primary treatment for AC separation?
Reduce pressure to enhance reattachment of ligaments (USE A SLING, discourage overhead, PT), ice, rest, NSAIDs, try steroids after 2-4 weeks
Where do 80% of clavicle fractures occur? How would you treat them?
In the middle 1/3 (Class A); with a sling
Where do 15% of clavicle fractures occur? How would you treat them?
In the distal 1/3 (Class B); with a sling plus an ortho consult
Where do 5% of clavicle fractures occur? How would you treat them?
In the proximal 1/3 (Class C); with a sling plus swath plus ortho consult
How do you differentiate between subacromial bursitis and shoulder impingement syndrome?
SABursitis may be a result of systemic dx, more inflammation of the bursa with this than with SISyndrome. Pain will be at motion AND at rest with SAB. There will also be occasional regional loss of motion, unlike shoulder impingement.
When is the pain made worse in subacromial bursitis?
With abduction, internal and external rotation
How do you diagnose SABursitis?
Mostly clinical, fluid aspiration to check for sepsis, radiograph is limited
How do you treat SABursitis?
NSAIDs, restriction of overuse, steroids (there is no tear associated so steroids are okay)
What is the clinical presentation of biceps tendonitis?
Usually can point to one spot, follows strenuous lifting, pain is made worse by reaching overhead
What is the treatment for biceps tendonitis?
reduce inflammation, strengthen tendon and muscle to prevent rupture
When is surgery for biceps tendon rupture indicated?
for younger patients who are laborers or athletes
