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Shoulder MDT Flashcards

1
Q

Type I AC Injury

A

AC ligaments partially disrupted and coracoclavicular ligaments are intact.
No separation of clavicle from acromion

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2
Q

Type II AC Injury

A

AC ligaments are torn and CC ligaments are intact resulting in partial separation of clavicle from acromion

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3
Q

Type III AC Injury

A

AC and CC ligaments completely disrupted resulting in complete separation of the clavicle from acromion

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4
Q

Type IV AC Injury

A

AC and CC ligaments are completely disrupted with superior and prominently posterior displacement

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5
Q

Type V AC Injury

A

AC and CC ligaments are completely disrupted with CC interspace more tan twice as large as opposite shoulder

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6
Q

Type VI AC Injury

A

Uncommon.
Clavicular periosteum and/or deltoid and trapezius muscle are torn resulting in wide displacement. Clavicle lies in either then subacromial space or subcoracoid space

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7
Q

Which types of AC separation present with obvious deformity

A

Type III-VI

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8
Q

Patient presents with:
Pain over AC joint
Pain on lifting affecting arm

A

AC separation

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9
Q

Rads for AC Injury

A

AP and axillary rads

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10
Q

Which type of AC injury can be seen on radiographs?

A

Type III
AC joint widening can be seen

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11
Q

Treatment of Type I AC and II AC injury

A

Sling x 24-48 hours
Ice, Analgesics, HEP
RTD within 4 weeks

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12
Q

Treatment of type III AC injury

A

Ortho consult
Ice, Analgesics, HEP
Light duty until evaluated by ortho

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13
Q

Treatment of Type IV-VI Injury

A

Ortho consult, WILL REQUIRE SURGERY
Ice, Analgesics, HEP
Light duty until evaluated by ortho

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14
Q

Causes of clavicle frature

A
  • Falling on shoulder
  • most common bony injury
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15
Q

How are clavicle fractures classified

A

Proximal
Middle
Distal

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16
Q

What is the most common anatomic location for clavicle fracture

A

Most common location is middle third

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17
Q

Pt presents with:
- Pain over clavicle
- Pain with arm motion
- Snapping or cracking with reported event
- Swelling

A

Clavicle Fracture

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18
Q

Special test for clavicle fracture

A

Cross body

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19
Q

Rads for clavicle fracture

A

AP and 10 degree cephalic tilt radiographs

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20
Q

Treatment of clavicle fracture

A

Ice, Analgesics, sling or figure 8 strap
Ortho consult

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21
Q

Red flags of fracture clavicle

A
  • MEDEVAC
  • Painful nonunion after 4 months of treatment
  • Widely displaced lateral or mid-shaft fractures or segmental fractures
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22
Q

What are the common structures impinged in the subacromial space?

A

Subacromial bursa
Tendon of supraspinatus
Tendon of infraspinatus
Long head of biceps tendon

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23
Q

Types of acromion morphology?
Which has greater association with Shoulder impingement?

A
  • Flat
  • Curved
  • Hooked, greatest association with shoulder impingement
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24
Q

Pt presents with:
- Gradual onset of anterior and lateral shoulder pain exacerbated by overhead activity
- Night pain and difficulty sleeping on affected side
- Pain worse between 90 and 120 degrees of abduction when lowering arm

A

Shoulder impingement syndrome

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25
Special tests for shoulder impingement
Neers and Hawkins
26
Rads for shoulder impingement
AP and axillary radiographs MRI
27
Treatment of shoulder impingement
NSAIDS, ice, light duty HEP PT if failed local management
28
What should be done if shoulder impingement has failed conservative management
Orthopedic consult for 2-3 months
29
Pt presents with: - Chronic shoulder pain for several months - Specific injury that triggered pain - Night pain and difficulty sleeping on affected side - Complaints of weakness, catching and grating especially overhead activities
Rotator cuff tear
30
Which muscle do rotator cuff tears generally originate and where may it progress
Supraspinatus, may progress anteriorly or posteriorly
31
Special tests for rotator cuff tear
- Drop arm - Empty can test
32
Rads for rotator cuff tear
Radiographs and MRI
33
Treatment for rotator cuff tear
-NSAIDS, Ice, light duty -HEP -PT if failed conservative management - Ortho consult if failed rehab over 3-6 months
34
What activities is a common cause for biceps tendon injury?
People who pull, lift, reach or throw Rock climbers, weight lifters
35
Pt presents with: - Anterior shoulder pain that radiates distally down the arm over bicep muscle - aggravated by lifting, pulling, overhead activity
Biceps tendon injury
36
What deformity would be present if bicep tendon injury with a pop and ecchymosis and swelling
"Popeye" deformity
37
Special tests for bicep tendon injury
Speeds
38
Treatment of bicep tendon injury
NSAIDs, Ice Duty/activity mods Physical therapy/HEP If rupture is suspected, ortho consult
39
What is instability of shoulder?
Anterior, posterior, inferior or multidirectional glenohumeral laxity due to traumatic or atraumatic pathology
40
What is subluxation of shoulder?
Humeral head partially slips out of socket with spontaneous reduction
41
What is dislocation of shoulder?
Humeral completely slips out of socket with spontaneous reduction or sometimes required manual manipulation
42
What are the 2 specific instability patterns of the shoulder?
TUBS AMBRI
43
What is TUBS?
Traumatic unilateral dislocations with bankart lesion that can be treated with surgery
44
What is AMBRI?
Atraumatic multidirectional instability that is commonly bilateral and is often successfully treated with rehabilitation and occasionally an inferior capsule shift
45
Pt presents with: - Sensation of shoulder slipping out of joint when arm is abducted and externally rotated - Trauma from a fall or forceful throwing - recurrent dislocation by positioning arm overhead - supporting arm in neutral position
Anterior shoulder instability
46
Pt presents with: - force on shoulder that is posteriorly directed - holding arm in adduction and internal rotation
Posterior shoulder instability
47
Pt presents with: - vague shoulder instability related to activity
Multi directional instability
48
Special tests for shoulder instability
Sulcus Apprehension test Anterior/Posterior Drawer test Jerk test
49
Rads for shoulder instability
AP and axillary views MRI
50
What is the stimson technique for reducing shoulder dislocations
Gravity assisted with patient lying on stomach
51
What is the longitudinal traction technique for reducing shoulder dislocation?
Elbow at 90 degrees of flexion while longitudinal traction is applied to humerus, gently rotate arm
52
Treatment of shoulder dislocation
Reduce acute dislocations Immobilize arm in a sling Light duty, rotator cuff strengthening PT consult Ortho consult
53
When should you MEDEVAC a shoulder dislocation
First time dislocation or evidence of neurovascular compromise require ortho evaluation for possible surgery
54
What is a SLAP lesion?
Superior labrum anterior posterior lesions involve injury to the superior glenoid labrum and the biceps anchor complex
55
MOIs of SLAP lesions
FOOSH Heavy lift Forceful throw, excessive overhead
56
Special tests for SLAP lesion
Obrien’s and Speeds
57
What disease are associated with adhesive capsulitis
DM, thyroid disease, autoimmune disorders, parkinsons, HIV
58
When is adhesive capsulitis common in active duty population
After shoulder injuries
59
What is another name for adhesive capsulitis?
Frozen shoulder
60
What age is frozen shoulder common in?
50-60 y/os
61
3 phases of frozen shoulder
1. Diffuse, severe, and disabling shoulder pain - Increasing stiffness, 2-9 months 2. Stiffness and severe loss of shoulder motion with pain less pronounced - 4-12 months 3. Recovery phase with stiffness and gradual return of shoulder motion takes about 5-24 months
62
Rads for adhesive capsulitis
Plain films, MRI, US
63
Special tests for rotator cuff tear
- Drop arm - Empty can test

MSK (9 decks)

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