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OCS Exam > Shoulder McGee > Flashcards

Shoulder McGee Flashcards

1
Q

AMBRI

A

Atraumatic Multidirectional Bilateral Rehabilitation (as appropriate) and rarely Inferior capsular shift surgery - Not typically recommended for surgery & May be a primary instability factor for Secondary Impingement

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2
Q

TUBS

A

Traumatic Unilateral anterior with a Bankart lesion responding to Surgery

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3
Q

Empty can vs full can which is better for testing supraspinatus?

A

Full Can position tests supraspinatus strength better than Empty Can - Empty can position: strength tends to be limited by pain

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4
Q

Rotator Cuff avascular zone

A

Glenohumeral 0°: poor vascularity to RC tendons & 30-45° Abduction: vascularity to RC tendons optimized

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5
Q

Primary Anterior Stabilizers of Glenohumeral Joint

A

GH 0°: Subscapularis, GH 45°: Subscapularis & Middle Glenohumeral Ligament, GH >90°: Inferior Glenohumeral Ligament & Biceps Brachii

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6
Q

Primary mechanism of anterior Glenohumeral dislocation

A

Trauma; indirect blow with shoulder in abduction, extension, & ER

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7
Q

Primary mechanism of posterior Glenohumeral dislocation

A

Axial loading of arm with shoulder in adduction, flexion, & IR, trauma to front of the shoulder, FOOSH

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8
Q

Traumatic dislocations can be associated with what nerve injuries

A

Axillary

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9
Q

Humeral shaft fractures can be associated with what nerve injuries

A

radial

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10
Q

What RTC repair has a slower progression due to weaker fixation of repair

A

Arthroscopic

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11
Q

What RTC repair has a vertical split between anterior and middle deltoid, but allows early initiation of deltoid AROM

A

Mini-Open

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12
Q

What RTC repair has a Deltoid detachment/release from clavicle or acromion, and has no deltoid AROM for 6-8 weeks

A

Open

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13
Q

RTC describe small, medium, and large tears:

A

5cm (large)

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14
Q

Describe basic guidelines for miniopen repair for RTC for sling, ROM, and istonic exercise for a small tear

A

Sling 7-10 days; Full ROM 4-6 weeks, 2-3 wks for isotonic ex

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15
Q

Describe basic guidelines for miniopen repair for RTC for sling, ROM, and istonic exercise for a medium tear

A

Sling 2-3 weeks; Full ROM 8-10 weeks, 3-4 weeks for isotonic ex

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16
Q

Describe basic guidelines for miniopen repair for RTC for sling, ROM, and istonic exercise for a larger tear

A

Sling 2-3 weeks; Full ROM 10-14 weeks, 3-4 weeks for isotonic ex

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17
Q

Which has a lower reoccurrance rate for instability surgery open or arthoscopic?

A

Open: standard procedure (recurrence rate <5%) vs Arthroscopic: slower rehab (recurrence rate 8-17%)

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18
Q

What type of surgery is used for instability?

A

Bankart and capsular shift (which spends more time in a immobilizer)

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19
Q

What directions can shoulder instability exist?

A

Ant, post, and multidirectional

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20
Q

Describe a Type I SLAP injury:

A

Degenerative fraying of superior labrum, Biceps attachment intact, Biceps anchor intact

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21
Q

Describe a Type I SLAP surgery

A

Superior labrum is debrided

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22
Q

Describe a Type I SLAP rehab

A

Pendulum after 1 week NO ER > neutral/extension of arm behind body x 4 weeks No stressful biceps activity x 3 months

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23
Q

Describe a Type II SLAP injury:

A

Biceps anchor pulled away from glenoid

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24
Q

Describe a Type II SLAP surgery

A

Lesion repaired with tacks, staples, or suture anchors

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25
Q

Describe a Type II SLAP rehab

A

More conservative than type I - Sling x 3 weeks

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26
Q

Describe a Type III SLAP injury:

A

Bucket-handle tear of superior labrum, Biceps anchor intact

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27
Q

Describe a Type III SLAP surgery

A

Torn fragment is resected

28
Q

Describe a Type III SLAP rehab

A

Same as Type 1

29
Q

Describe a Type IV SLAP injury:

A

Similar to Type 3- Tear extends to biceps tendon & Torn biceps tendon and labrum displaced into joint

30
Q

Describe a Type IV SLAP surgery

A

30% tendon torn Older patient: labrum debrided, tendon tenodesis Young patient: arthroscopic suture repair

31
Q

Describe a Type IV SLAP rehab

A

More conservative - Sling x 3 weeks

32
Q

AC seperation MOI

A

Trauma to superior shoulder

33
Q

AC seperation physical exam

A

Step deformity at AC (possible) (+) AC shear test Tenderness to AC joint Pain with shoulder elevation and/or abduction (+) xray findings

34
Q

AC seperation differential Dx

A

Chronic conditions can increase stress to RC Concomitant clavicle fracture RC tear

35
Q

AC seperation Tx

A

varies on grade, typically grade I, II, and usually III do not require surgery - grades higher than III do require surgery

36
Q

Acute Bursitis/Calcific Tendonitis Hx and demographic

A

Idiopathic; can result from Tendonosis or viral infection Women > men Middle age > older > younger

37
Q

Acute Bursitis/Calcific Tendonitis presentation

A

Capsular pattern: ER > ABD > IR Joint play restrictions in all directions, especially inferiorly: Histological changes in area of redundant fold Chronic cases can lead to secondary impingement

38
Q

Acute Bursitis/Calcific Tendonitis differential Dx

A

Impingement Subscapularis spasm/tightness

39
Q

Acute Bursitis/Calcific Tendonitis Tx

A

Regain motion at GH joint Regain ST rhythm Strengthen Typically self-limiting within 6-12 months Aquatic therapy should be considered

40
Q

Bicipital Tendonitis Hx

A

Overuse/overtraining Overhead sports with racquet/throwing Pain at anterior shoulder

41
Q

Bicipital Tendonitis presentation

A

Tenderness along Long Head of Biceps tendon (proximal portion) (+) Speeds test Pain with resisted shoulder flexion (typical); elbow flexion (occasional) (+) Horizontal Adduction with overpressure for symptom reproduction

42
Q

Bicipital Tendonitis differential Dx

A

Supraspinatus tendonitis Subscapularis tendonitis Impingement

43
Q

Bicipital Tendonitis Tx

A

Anti-inflammatory & rest Overhead activity modification Posterior capsule stretching Eccentric-specific strength training RC & ST strengthening

44
Q

Neer Stages of Impingement Stage 1

A

Age: < 25 Pathology: Edema Clinical Presentation: Subacromial pain/tenderness, Painful arc; (+) Neer test, RROM Abd/ER strong + pain

45
Q

Neer Stages of Impingement Stage 2

A

Age: 25-40 Pathology: Fibrosis, tendonitis/bursitis Clinical presentation: Subacromial pain/tenderness, Painful arc; (+) Neer test RROM Abd/ER strong + pain, Capsular pattern

46
Q

Neer Stages of Impingement Stage 3

A

Age: >40 Pathology: bone spurs, tendon disruption Clinical presentation: Subacromial pain/tenderness, Painful arc; (+) Neer test RROM Abd/ER weak + pain, Capsular pattern, “Squaring” of acromion (atrophy of deltoid and RC)

47
Q

Neer Stages of Impingement Stage 4

A

similar to stage 3

48
Q

Describe Primary Impingement

A

Abnormal mechanical relationship between rotator cuff and coracoacromial arch - Typically a “narrowing” of that arch

49
Q

Primary Impingement Hx

A

Typically > 40 years old c/o anterior shoulder and upper lateral arm pain unable to sleep on affected side

50
Q

Primary Impingement physical exam

A

Decreased ROM and strength (secondary to pain) (+) Hawkins-Kennedy & Neer Impingement signs Typically concomitant AC arthrosis exacerbated by: 1. internal rotation 2. abduction >90°

51
Q

Primary Impingement differential Dx

A

RC tears Calcific tendonitis AC joint arthrosis Glenohumeral instability SLAP lesions Bicepital tendonitis Early adhesive capsulitis Tumors

52
Q

Primary Impingement Tx

A

Surgical subacromial decompression (acromioplasty)

53
Q

Describe Secondary Impingement

A

Narrowing of the subacromial space due to glenohumeral or scapulothoracic instability. Attempts by RC to compensate for lack of ligamentous/capsular stabilization results in fatigue of RC and superior migration of humeral head

54
Q

Secondary Impingement Hx

A

Younger populations Typically participate in overhead sports: combinations of school and community league sports does not allow for “off-season” in pre/adolescent populations reports of “arm going dead”

55
Q

Secondary Impingement physical exam

A

Glenohumeral instability with (+) apprehension test +) Full can, Empty can tests Scapular dyskinesia, winging, or abnormal motion Tight posterior Glenohumeral capsule

56
Q

Secondary Impingement Tx

A

Addressing underlying impairment should resolve the problem

57
Q

Posterior (Internal) Impingement: population and Hx

A

Typically in overhead athletes (tennis players, swimmers, throwers) During ABD+ER (cocking phase) the supraspinatus and infraspinatus muscles get ‘pinched’ at superior/posterior glenoid Occurs on undersurface (instead of bursa side) of RC Typically associated with anterior instability

58
Q

Describe Neer

A

Maximal passive flexion of arm (overhead) compresses greater tuberosity against anteroinferior acromion

59
Q

Describe Hawkins-Kennedy

A

Flexion to 90°, max passive IR, compresses supraspinatus against anterior coracoacromial ligament

60
Q

Describe Cross-over

A

Stabilize superoposterior shoulder and maximally horizontal adduct patient’s arm across their body

61
Q

Describe Painful arc

A

ROM that is painful, Typically 60-120°

62
Q

Describe Lift-off

A

Dorsum of hand placed against back pocket, Patient lifts hand away from back, Inability to perform is (+)

63
Q

Describe Drop sign

A

Passively place arm in 90° elbow flexion and abduction & max ER. Release arm. Inability for patient to maintain position (+)

64
Q

Describe IR Lag

A

Same position as lift off, only examiner lifts arm away and asks patient to maintain position. (+) inability to maintain

65
Q

Describe ER Lag

A

Passively place arm in 20° scapular elevation and 90° elbow flexion. Maximally ER. (+) inability to maintain position

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