Shoulder Injuries

Question 1

MOA of humeral fx in young vs elderly

Answer 1

High energy trauma in younger pts

Simple fall in elderly

Question 2

What is the presentation of humerus fx?

Answer 2

Severe pain
Limited ROM
Swelling
Ecchymosis

Question 3

What classification do you use for humerus fx?

Answer 3

Neer classification (location, fx parts, displacement)

Question 4

What are the 3 fx patterns of the humerus?

Answer 4

Transverse
Oblique
Spiral

Question 5

What is the most frequent cause of shoulder pain?

Answer 5

Subacromial impingement syndrome (SAIS)

decreased space –> increased compression

Question 6

What is the mechanism of impingement syndrome?

Answer 6

Repetitive microtrauma

• supraspinatus tendon
• subacromial bursa
• long head of biceps

Question 7

Compression due to impingement can cause…

Answer 7

Tendon degeneration –> inflammation, reduction in stress tolerance

Question 8

What anatomical shape of the acromion increases one’s risk of SAIS?

Answer 8

Hooked acromion (Type III)
- due to decreased space, more contact w/ RC tendons

Question 9

What type of impingement is driven by degenerative changes & is typically seen > 35 yo?

Answer 9

Primary

Question 10

What type of impingement is caused by repetitive overhead movement & typically seen < 35yo?

Answer 10

Secondary

- Involves faulty scapular posture

Question 11

What are contributing factors of faulty scapular posture?

Answer 11

Forward head

Increased kyphosis

Question 12

What does faulty scapular posture lead to?

Answer 12

Adaptive muscle imbalances

Question 13

What are s/s of SAIS?

Answer 13

exacerbated by overhead activity

night pain & difficulty sleeping on affected side

tenderness to palpation over greater tuberosity, subacromial bursa, & biceps tendon

Question 14

What tests are used for SAIS?

Answer 14

Strength test (ER/infraspinatus)
Empty can test (supraspinatus)
Lift off test (subscapularis)

Question 15

What are interventions for SAIS?

Answer 15

• X-ray (eval for fx, bone spur, calcification)
• NSAIDs
• If no improvement in 6wks –> corticosteroid injection
• Failure w/ meds –> surgery (SA decompression)

Question 16

What is the MOA of rotator cuff tears?

Answer 16

MC = overuse

Traumatic

Question 17

Where do rotator cuff tears most often originate?

Answer 17

In the supraspinatus tendon

Question 18

What age group is at increased risk for a “full-thickness” rotator cuff tear?

Answer 18

> 40yo (esp. > 60yo)

Question 19

What is the presentation of a rotator cuff tear?

Answer 19

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

Question 20

What does a rotator cuff tear look like on PE?

Answer 20

Tenderness at SA space
AROM decreased (shoulder shrug w/ abduction)
PROM nl (+ drop arm test)
Pain, weakness w/ isolation

Question 21

What imaging is used for a rotator cuff tear? What is gold standard?

Answer 21

X-ray (r/o fx, bone spur, calcification)

MRI *Gold standard

Question 22

What are nonsurgical options for a rotator cuff tear?

Answer 22

If < 50% thickness tear:

• NSAIDs, PT
• Steroid injections (no more than 3/yr)

Question 23

Who are candidates for surgical tx of a rotator cuff tear?

Answer 23

• Significant sx & failed rehab > 3-6mos

- Acute traumatic cuff tear

Question 24

What is adhesive capsulitis? What is the #1 RF?

Answer 24

1 RF = DM

Idiopathic loss of both active & passive movement
Inflammatory process involving the glenohumeral capsule

Question 25

How does adhesive capsulitis present?

Answer 25

At least 50% reduction in active & passive ROM
Pain: aches at rest, sharp w/ movement
Diffuse shoulder tenderness

Question 26

What imaging is used for adhesive capsulitis? What is seen?

Answer 26

Radiographs

MRI: contracted capsule & loss of inferior pouch

Question 27

What are the phases of adhesive capsulitis?

Answer 27

“Freezing”: pain & progressive loss of motion

“Thawing”: decreasing discomfort a/w improvement in ROM

Question 28

How do you treat adhesive capsulitis?

Answer 28

Consider steroid intra-articular injection
PT
If no improvement within 9-12 mos –> consider surgery