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MSK > Shoulder MDT > Flashcards

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
Q

Special tests for shoulder impingement

A

Neers and Hawkins

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26
Q

Rads for shoulder impingement

A

AP and axillary radiographs
MRI

27
Q

Treatment of shoulder impingement

A

NSAIDS, ice, light duty
HEP
PT if failed local management

28
Q

What should be done if shoulder impingement has failed conservative management

A

Orthopedic consult for 2-3 months

29
Q

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

A

Rotator cuff tear

30
Q

Which muscle do rotator cuff tears generally originate and where may it progress

A

Supraspinatus, may progress anteriorly or posteriorly

31
Q

Special tests for rotator cuff tear

A
  • Drop arm
  • Empty can test
32
Q

Rads for rotator cuff tear

A

Radiographs and MRI

33
Q

Treatment for rotator cuff tear

A

-NSAIDS, Ice, light duty
-HEP
-PT if failed conservative management
- Ortho consult if failed rehab over 3-6 months

34
Q

What activities is a common cause for biceps tendon injury?

A

People who pull, lift, reach or throw
Rock climbers, weight lifters

35
Q

Pt presents with:
- Anterior shoulder pain that radiates distally down the arm over bicep muscle
- aggravated by lifting, pulling, overhead activity

A

Biceps tendon injury

36
Q

What deformity would be present if bicep tendon injury with a pop and ecchymosis and swelling

A

“Popeye” deformity

37
Q

Special tests for bicep tendon injury

A

Speeds

38
Q

Treatment of bicep tendon injury

A

NSAIDs, Ice
Duty/activity mods
Physical therapy/HEP
If rupture is suspected, ortho consult

39
Q

What is instability of shoulder?

A

Anterior, posterior, inferior or multidirectional glenohumeral laxity due to traumatic or atraumatic pathology

40
Q

What is subluxation of shoulder?

A

Humeral head partially slips out of socket with spontaneous reduction

41
Q

What is dislocation of shoulder?

A

Humeral completely slips out of socket with spontaneous reduction or sometimes required manual manipulation

42
Q

What are the 2 specific instability patterns of the shoulder?

A

TUBS
AMBRI

43
Q

What is TUBS?

A

Traumatic unilateral dislocations with bankart lesion that can be treated with surgery

44
Q

What is AMBRI?

A

Atraumatic multidirectional instability that is commonly bilateral and is often successfully treated with rehabilitation and occasionally an inferior capsule shift

45
Q

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

A

Anterior shoulder instability

46
Q

Pt presents with:
- force on shoulder that is posteriorly directed
- holding arm in adduction and internal rotation

A

Posterior shoulder instability

47
Q

Pt presents with:
- vague shoulder instability related to activity

A

Multi directional instability

48
Q

Special tests for shoulder instability

A

Sulcus
Apprehension test
Anterior/Posterior Drawer test
Jerk test

49
Q

Rads for shoulder instability

A

AP and axillary views
MRI

50
Q

What is the stimson technique for reducing shoulder dislocations

A

Gravity assisted with patient lying on stomach

51
Q

What is the longitudinal traction technique for reducing shoulder dislocation?

A

Elbow at 90 degrees of flexion while longitudinal traction is applied to humerus, gently rotate arm

52
Q

Treatment of shoulder dislocation

A

Reduce acute dislocations
Immobilize arm in a sling
Light duty, rotator cuff strengthening
PT consult
Ortho consult

53
Q

When should you MEDEVAC a shoulder dislocation

A

First time dislocation or evidence of neurovascular compromise require ortho evaluation for possible surgery

54
Q

What is a SLAP lesion?

A

Superior labrum anterior posterior lesions involve injury to the superior glenoid labrum and the biceps anchor complex

55
Q

MOIs of SLAP lesions

A

FOOSH
Heavy lift
Forceful throw, excessive overhead

56
Q

Special tests for SLAP lesion

A

Obrien’s and Speeds

57
Q

What disease are associated with adhesive capsulitis

A

DM, thyroid disease, autoimmune disorders, parkinsons, HIV

58
Q

When is adhesive capsulitis common in active duty population

A

After shoulder injuries

59
Q

What is another name for adhesive capsulitis?

A

Frozen shoulder

60
Q

What age is frozen shoulder common in?

A

50-60 y/os

61
Q

3 phases of frozen shoulder

A
  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
Q

Rads for adhesive capsulitis

A

Plain films, MRI, US

63
Q

Special tests for rotator cuff tear

A
  • Drop arm
  • Empty can test

MSK (9 decks)

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