Shoulder Injuries Flashcards
MOA of humeral fx in young vs elderly
High energy trauma in younger pts
Simple fall in elderly
What is the presentation of humerus fx?
Severe pain
Limited ROM
Swelling
Ecchymosis
What classification do you use for humerus fx?
Neer classification (location, fx parts, displacement)
What are the 3 fx patterns of the humerus?
Transverse
Oblique
Spiral
What is the most frequent cause of shoulder pain?
Subacromial impingement syndrome (SAIS)
decreased space –> increased compression
What is the mechanism of impingement syndrome?
Repetitive microtrauma
- supraspinatus tendon
- subacromial bursa
- long head of biceps
Compression due to impingement can cause…
Tendon degeneration –> inflammation, reduction in stress tolerance
What anatomical shape of the acromion increases one’s risk of SAIS?
Hooked acromion (Type III) - due to decreased space, more contact w/ RC tendons
What type of impingement is driven by degenerative changes & is typically seen > 35 yo?
Primary
What type of impingement is caused by repetitive overhead movement & typically seen < 35yo?
Secondary
- Involves faulty scapular posture
What are contributing factors of faulty scapular posture?
Forward head
Increased kyphosis
What does faulty scapular posture lead to?
Adaptive muscle imbalances
What are s/s of SAIS?
exacerbated by overhead activity
night pain & difficulty sleeping on affected side
tenderness to palpation over greater tuberosity, subacromial bursa, & biceps tendon
What tests are used for SAIS?
Strength test (ER/infraspinatus)
Empty can test (supraspinatus)
Lift off test (subscapularis)
What are interventions for SAIS?
- X-ray (eval for fx, bone spur, calcification)
- NSAIDs
- If no improvement in 6wks –> corticosteroid injection
- Failure w/ meds –> surgery (SA decompression)
What is the MOA of rotator cuff tears?
MC = overuse
Traumatic
Where do rotator cuff tears most often originate?
In the supraspinatus tendon
What age group is at increased risk for a “full-thickness” rotator cuff tear?
> 40yo (esp. > 60yo)
What is the presentation of a rotator cuff tear?
Recurrent shoulder pain for several mos
Specific injury –> onset of pain
Subacromial pain & localized to deltoid tuberosity
Night pain, difficulty sleeping on affected side
Weakness, catching, grating
What does a rotator cuff tear look like on PE?
Tenderness at SA space
AROM decreased (shoulder shrug w/ abduction)
PROM nl (+ drop arm test)
Pain, weakness w/ isolation
What imaging is used for a rotator cuff tear? What is gold standard?
X-ray (r/o fx, bone spur, calcification)
MRI *Gold standard
What are nonsurgical options for a rotator cuff tear?
If < 50% thickness tear:
- NSAIDs, PT
- Steroid injections (no more than 3/yr)
Who are candidates for surgical tx of a rotator cuff tear?
- Significant sx & failed rehab > 3-6mos
- Acute traumatic cuff tear
What is adhesive capsulitis? What is the #1 RF?
1 RF = DM
Idiopathic loss of both active & passive movement
Inflammatory process involving the glenohumeral capsule
How does adhesive capsulitis present?
At least 50% reduction in active & passive ROM
Pain: aches at rest, sharp w/ movement
Diffuse shoulder tenderness
What imaging is used for adhesive capsulitis? What is seen?
Radiographs
MRI: contracted capsule & loss of inferior pouch
What are the phases of adhesive capsulitis?
“Freezing”: pain & progressive loss of motion
“Thawing”: decreasing discomfort a/w improvement in ROM
How do you treat adhesive capsulitis?
Consider steroid intra-articular injection
PT
If no improvement within 9-12 mos –> consider surgery
