Shoulder Injuries Flashcards by Sarah Moore

What are the muscles of the rotator cuff?

Supraspinatus, Infraspinatus, teres minor, subscapularis

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What tests are included in the PE of a shoulder complaint?

Neer, Hawkins-Kennedy, Empty can test, Drop arm test, Cross arm test, Speed’s, O’brien’s, Apprehension test, Sulcus sign, Load and shift test, Yergason’s test

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Who is shoulder impingement common in?

Middle-aged people
A. Repetitive lifting or overhead activities
Athletes
A. Swimmers, baseball, tennis

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What are the sxs of shoulder impingement?

Pain w/ activity and @ rest
A. Pain worsens w/ lifting or certain movements
Anterior shoulder pain radiating to deltoid/upper arm
Pain at night
Loss of motion and strength
Difficulty reaching behind back

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What types of xrays are needed for a shoulder disorder?

Plain radiographs
AP, oblique
Outlet view

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How is shoulder impingement treated?

1. Activity modification
A. Avoid overhead reaching/lifting
2. NSAIDs
3. PT
A. Rotator cuff strengthening exercises
4. Subacromial cortisone injection

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What type of acromion structures are predisposed to shoulder impingement?

Type 2 and 3

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What is adhesive capsulitis?

aka “frozen shoulder”
Painful inflammation of the GHJ -> eventual fibrosis of the joint capsule -> restriction of shoulder motion
Cause of shoulder pain & dec glenohumeral movement

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What are the risk factors for adhesive capsulitis?

DM
Thyroid Disease
Autoimmune disease
Prolonged immobilization
A. Trauma
B. Stroke
C. Inflammatory shoulder conditions
-Biceps / rotator cuff tendonitis

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What are the sxs of adhesive capsulitis?

Diffuse aching pain that is poorly localized
A. Pain worse @ night
Shoulder stiffness
Dec active and passive ROM: pathognomonic

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What dx studies are used for adhesive capsulitis?

X-ray shoulder
A. AP, oblique and outlet views
-Usually normal
B. To exclude post. shoulder dislocation and GH arthritis

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What is stage 1 of adhesive capsulitis?

Stage 1 (first 2-3 mos)

2. Synovial inflammation & limited ROM

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What is stage 2 of adhesive capsulitis?

Stage 2 (3-9 mos after onset of sxs/ freezing stage)

2. Dec shoulder motion and chronic pain

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What is stage 3 of adhesive capsulitis?

Stage 3 (9-15 mos)
Less pain
Inc fibrosis w/ significantly dec ROM

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What is stage 4 of adhesive capsulitis?

Stage 4 (thawing stage)

2. After 15 months, minimal pain & improved ROM

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How is adhesive capsulitis treated?

1. Pain control
A. NSAIDs, analgesics, sleep aid
2. Physical Therapy is essential
A. pendulum exercises, wall-walking
3. +/- corticosteroid injection
4. MUA (manipulation under anesthesia)

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Define shoulder osteoarthritis

Clinical examination is very similar to pts w/ adhesive capsulitis
Not as common as knee or hip OA
Anterior shoulder pain and stiffness over months to years
Pain worse w/ movement, better w/ rest, below shoulder level movements

What are the sxs of shoulder OA?

Local GH jt line tenderness & swelling anteriorly
Joint crepitus
Atrophy of rotator cuff muscles over scapula
Loss of ROM of ER and Abduction

What are the general characteristics of an anterior shoulder dislocation?

95% of shoulder dislocations are in anterior direction

2. Caused by fall on an outstretched & abducted arm

What are the general characteristics of a posterior shoulder dislocation?

Posterior dislocations are usually caused by:
A. Falls from height
B. Grand mal seizure
C. Electrical shock
Arm held internally rotated & slightly abducted
Pt unable to externally rotate shoulder

Define dislocated shoulder

Traumatic shoulder dislocation can lead to instability of shoulder joint
Atraumatic shoulder dislocations are usually caused by
A. Intrinsic ligament laxity
B. Repetitive microtrauma leading to joint instability

What are the sxs of acute traumatic dislocations?

Pt usually presents supporting affected extremity w/ contralateral arm
A. Arm adducted & internally rotated
Acute pain
Obvious deformity with humeral head dislocated anteriorly

What are the sxs of atraumatic or recurrent dislocations?

Less pain

What dx studies do you want to order for a shoulder dislocation?

1. X-ray shoulder
A. AP and “Y” view (outlet)
2. +/- MRI (usually not in the acute stage)
A. Shows soft tissue injuries to labrum
B. Visualizes asst rotator cuff tears

What nerves may be affected by a shoulder dilocation?

1. Axillary nerve A. Freq. affected w/ anterior shoulder dislocations 2. Musculocutaneous nerve A. Freq. affected w/ ant. shoulder dislocations 3. Brachial plexus

How is an acute shoulder dislocation treated?

1. Need shoulder reduction ASAP 2. Stimson procedure least traumatic 3. Then sling immobilization for 2-4 weeks along with pendulum exercises 4. Before and after shoulder reduction neurovascular checks are essential

How is a chronic shoulder dislocation treated?

PT | Modified activities

What is Kocher's Maneuver and what is it used for?

1. Slow external reduction and downward traction of affected arm 2. ANTERIOR SHOULDER DISLOCATION REDUCTION TECHNIQUE

What shoulder deformities may be complications of shoulder dislocations?

1. Hill-Sachs Deformity | 2. Bankart Lesion

What is a bankart lesion?

Bankart lesion is an injury of the anterior (inferior) glenoid labrum of the shoulder due to anterior shoulder dislocation.[1] When this happens, a pocket at the front of the glenoid forms that allows the humeral head to dislocate into it.

What is Hill-sachs deformity?

is a cortical depression in the posterolateral head of the humerus. It results from forceful impaction of the humeral head against the anteroinferior glenoid rim when the shoulder is dislocated anteriorly.

What are common characteristics of a clavicular fracture?

1. Most common fracture in children and adolescents Usually caused by fall on outstretched arm 2. It can be found in up to 3% live births

What are the sxs of a clavicular fracture?

1. Visible deformity usually present 2. Arm is supported by contralateral extremity 3. Check for brachial plexus injuries A. Pain B. Weakness C. Sensory abnormalities 4. Proximal portion may be displaced superiorly because of attachment to SCM

What dx studies are used for clavicular fractures?

X-ray clavicle Confirms dx A. May see bayonette

What is the treatment for a clavicular fracture?

``` 1. Children A. Figure of 8 sling 2. Adults A. Sling 3. Conservative treatment A. Majority of time 4. Open Reduction internal fixation (ORIF) ```

What is a separated AC joint?

1. Aka “Separated shoulder” A. Stretch or Tear of acromioclavicular ligaments 2. Usually caused by fall or impact on tip of shoulder 3. Grades I-VI

What are the characteristics of the grades of a separated shoulder?

1. Grade I, II, III most common 2. Grade III: Refer for possible surgery 3. Grade IV-VI: NEED SURGERY A. Uncommon, high-energy injury as in MVA

What are the sxs of a separated shoulder?

Patients have clinically apparent step off at AC joint- (Grade III or higher)

What are the dx studies of a separated AC joint?

1. AP view both shoulders | 2. Mild separations may require stress films-> pt holds weighted object to reveal separation

What are the treatment options for AC joint separation?

1. Grade I-II injuries- Conservative treatment A. Sling B. Pain meds C. +/- PT 2. Grade III-VI A. Refer to Orthopedics for surgery consult