Shoulder Injuries Flashcards
inflammation associated with repetitive trauma during every day shoulder movement.
Risk factor: repetitive overhead activity
tendonitis
chronic degeneration of the muscles w/ age
pain despite lack of inflammation
tendonosis
pain that comes on gradually, deep ache in the lateral shoulder that radiates to the deltoid- point tenderness. Painful ROM, improves w/ analgesics
tendonitis
what can be the result of tendonitis progression, impingement, & degeneration?
Chronic tear of the rotator cuff
Shoulder pain that is worse at night. Worsening pain with gradual weakness. Weakness does not improve with analgesics. Decreased ROM, especially abduction
Chronic rotator cuff tear
what is the specialized exam for a chronic rotator cuff tear?
drop arm sign
acute shoulder pain w/ negative radiographs
acute tear
etiologies of acute tear (2)
trauma, pathology
What are the specialized exams for rotator cuff injuries? (6)
Apley’s scratch test, empty can test, lift off test, Hawkin’s test, Neer’s impingement sign
what is the most commonly involved muscle in rotator cuff injuries?
Supraspinatus
Treatment of a rotator cuff injury? (5)
ice anterolaterally, NSAIDs if appropriate
weighted pendulum stretching for 5 min to maintain ROM
restrict overhead motions
shoulder immobilizer for very short duration- PT afterwards
subacromial steroid injection- rest afterwards
stiffened glenohumeral joint
Frozen Shoulder/Adhesive Capsulitis
Chronic shoulder pain w/ decreased ROM, rigid immobility
Frozen shoulder/adhesive capsulitis
frozen shoulder tx (2)
intense PT to stretch the joint lining & restore ROM
some will require surgery to remove adhesions
shoulder pain w/ abduction, flexion, & internal rotation. Subacromial tenderness. Normal glenohumeral ROM, preserved strength
Shoulder impingement syndrome
shoulder impingement syndrome etiology
compression of the rotator cuff tendons & the subacromial bursa between the humeral head and lateral edge of acromion process
shoulder impingement syndrome complications? (3)
bursitis
rotator cuff tendonitis
degenerative changes
hallmark sign of shoulder impingement syndrome?
pain reproduced by the painful arc of flexion-internal rotation manuevers
tests for shoulder impingement syndrome? (3)
Neer’s, Hawkin’s impingement tests
MRI to r/o cuff tear
Shoulder impingement syndrome treatments (4)
ice, activity changes
NSAIDs
PT
possible corticosteroid injections
bump on the shoulder that is worse at bedtime, AC joint tenderness, pain increases w/ downward traction
Acromioclavicular Injury
injured in fall onto the tip of the shoulder w/ arm tucked into side
AC joint
AC joint intact, capsular distension, ligament stretch (sprain)
Grade I AC Injury
AC ligament is torn, coracoclavicular ligament intact. Unstable AC joint, decreased ROM
Grade II AC injury
separation of superior and inferior AC ligaments & coracoclavicular ligaments. Clinical deformity, instability, pain, decreased ROM.
Grade III AC injury
Acromioclavicular injury treatment (4)
Shoulder immobilizer for 3-4 weeks to allow ligaments to reattach
Ice, rest, NSAIDs
activity restrictions
corticosteroid injections if not improving after 2-4 weeks
what is the usual clavicle fracture?
middle 1/3, displaces superiorly, & may be comminuted
concern w/ distal clavicle fx?
brachial plexus involvement
concern w/ proximal clavicle fx?
evaluate internal organs
clavicle fx tx? (4)
conservative for nondisplaced or minimally displaced fxs in adults, nearly all peds
Sling/swatch, analgesics, muscle relaxers, sleeping upright
clavicle fx healing?
most within 4-6 weeks, some 8-10 weeks
clavicle fx ortho referral? (2)
displaced midclavicle fxs
all proximal and distal fxs
inflammation, possible degeneration of bursa. Associated w/ repetitive movement or acute injury. May result from systemic disease
Subacromial bursitis
inflammation, pain w/ ROM & rest, decreased ROM due to pain, localized tenderness to palpation
Subacromial bursitis
subacromial bursitis treatment (3)
ice & NSAIDs
restriction of overuse
aspiration & corticosteroid injection
inflammation of the long head of the biceps tendon as it passes through the bicipital groove, associated w/ repetitive lifting
Biceps tendonitis
pain in the anterior shoulder w/ abduction and external rotation. Maximal point of tenderness along bicipital groove. Popping sensation, weakness
Biceps tendonitis
specialized exams for biceps tendonitis? (2)
Yergason’s sign, Speed’s test
Biceps tendonitis treatment? (4)
NSAIDs
rest
PT
Surgery for younger pts who are active
shoulder instability, arm guarded, sulcus sign
glenohumeral subluxation/dislocation
detachment of anterior inferior labrum from glenoid rim
Bankart lesion
depression of the posterolateral humeral head when its impacted by anterior rim of glenoid
Hill Sachs lesion
Apley scratch test? and what conditions it evaluates?
touch the opposite scapula to test shoulder ROM
frozen shoulder, rotator cuff
Empty can test? and what conditions it evaluates?
resistance against forward flexion in hyperpronation (thumbs down), elbow extension, & abduction
rotator cuff: supraspinatus injury/tear
lift off test? and what conditions it evaluates?
hand on back, shoulder internally rotated. Push against resistance
Rotator cuff: subscapularis injury
Hawkin’s test? and what conditions it evaluates?
passive flexion to 90* & forceful internal rotation of the shoulder.
pain –> impingement –> rotator cuff concerns
rotator cuff, shoulder impingement syndrome
Neer’s impingement sign? and what conditions it evaluates?
passive flexion w/ arm pronated & scapula stabilized. Empty can w/ assist to full ROM
pain –> subacromial impingement –> rotator cuff concerns
rotator cuff, shoulder impingement syndrome
gradation of Neer’s test for shoulder impingement syndrome?
Pain at 90* = mild impingement
Pain at 60-70* = moderate impingement
Pain at 45* or below = severe impingement
Cross over test? and what conditions it evaluates?
passive cross body adduction
AC injury
Yergason test? and what conditions it evaluates?
elbow flex at 90* w/ forearm pronated. Supinate forearm & externally rotate humerus against resistance
Bicipital tendon assessment
Speed’s test? and what conditions it evaluates?
arm extended in full supination w/ shoulder flexed. Elevate arm against resistance
bicipital tendon
Apprehension & Relocation test? and what conditions it evaluates?
elbow flexed at 90, arm abducted at 90. Apply external rotation at the shoulder & note apprehension, pain
glenohumeral dislocation/subluxation
Sulcus sign
arm in neutral, relaxed position. Provider will pull the arm downward, resulting in a depression or “sulcus” in the shoulder near the acromion.
Pt may show this voluntarily
glenohumeral instability
