Shoulder MDT Flashcards
1
Q
Pt presents with:
Fall on tip of shoulder resulting in ligamentous disruption
A
AC Injury/Separation
2
Q
Type I AC Separation
A
-AC ligaments = disrupted
-CC ligaments = intact
3
Q
Type II AC Separation
A
AC ligaments = torn
CC ligaments = intact
4
Q
Type III AC separation
A
AC ligaments = completely disrupted
CC ligaments = completely disrupted
Complete separation of clavicle from acromion
5
Q
Type IV AC separation
A
AC ligaments = completely disrupted
CC ligaments = completely disrupted
Superior and prominently posterior displacement
6
Q
Type V AC separation
A
AC ligaments = completely disrupted
CC ligaments = completely disrupted
CC interspace more than twice as large as opposite shoulder
7
Q
Type VI AC separation
A
Uncommon
Muscles are torn resulting in wide displacement
Clavicle lies in either subacromial space or subcoracoid space
8
Q
Pt presents with:
- Pain over AC joint
- Pain on lifting affected arm
- supporting arm in adducted position
A
AC Separation
9
Q
Which types of AC separation present with obvious deformity
A
Type III-VI
10
Q
Plain films show:
-AC joint widening
A
Type III AC separation
11
Q
Treatment of type I and Type II AC Separation
A
- Sling
- Ice
- Analgesics
- HEP
- Light Duty within 4 weeks
12
Q
Type III AC separation treatment
A
- Orthopedic consultation
- Sling
- Ice
- Analgesics
- HEP
- Light duty until ortho eval
13
Q
Type IV-VI AC separation treatment
A
- MEDEVAC
- Will require surgery, ortho consult
- Sling until eval by ortho
- ICe
- Analgesics
- Light duty until eval by ortho
14
Q
Pt presents with:
- falling on shoulder
- struck on clavicle
- pain over clavicle
- pain with arm motion
A
Clavicle fracture
15
Q
What is the most common bony injury
A
Clavicle fracture
16
Q
Where is the most common location for clavicle fracture
A
Middle third portion of clavicle
17
Q
What special test is positive for Clavicle fracture
A
Cross-body test
18
Q
What radiology test confirms clavicle fracture
A
Plain films
19
Q
Treatment of clavicle fracture
A
- Figure of 8 strap
- Ice
- Analgesics
- Orthopedic consult
20
Q
Red flags for clavicle fracture
A
- Painful nonunion after 4 months of treatment
- Widely displaced lateral or mid-shaft fractures or segmental fractures
21
Q
Pt presents with:
- Gradual onset of anterior and lateral shoulder pain exacerbated by overhead activity
- Night pain and difficulty sleeping on affected side
A
Shoulder impingement syndrome
22
Q
What special tests should be done to evaluate for shoulder impingement
A
Neers and Hawkins
23
Q
Treatment of shoulder impingement syndrome
A
- NSAIDS
- Ice
- Light duty and avoid offending activities
- HEP and PT
24
Q
When should shoulder impingement be referred?
A
Ortho consult if failed conservative management after 2-3 months
25
Rotator cuff tears generally originate where?
Supraspinatus and may progress anteriorly and posteriorly
26
Pt presents with:
- Chronic shoulder pain for several months
- Specific injury that triggered pain
- Night pain and difficulty sleeping on the affected side
- Complaints of weakness, catching and grating especially overhead activities
Rotator Cuff Tear
27
Pt PE:
- Sunken in shoulder
- Tenderness over greater tuberosity
- Grating sensation at tip of shoulder
- Positive Drop Arm
- Positive Empty can test
Rotator Cuff tear
28
Radiological diagnostic tests for Rotator Cuff Tear
- Plain films
- MRI necessary to confirm dx
29
Treatment of rotator cuff tear
- NSAIDS
- Ice
- No overhead activities
- HEP
- Physical therapy if failed conservative management
- Ortho consult if failed rehab over 3-6 months
30
When should acute traumatic rotator cuff tears be surgically repaired
No later than within 6 weeks of injury
31
Biceps tendon injury occurs mostly along which head of biceps tendon
Along long head of biceps tendon
32
What activities commonly cause bicep tendon injury
People who pull, lift, reach or throw
- rock climbers, weight lifters
33
Pt presents with:
- anterior shoulder pain that radiates distally down the arm over bicep muscle
- Aggravated by lifting, pulling, overhead activity
Biceps tendon injury
34
When would a bicep tendon rupture be suspected?
- single injury with a "pop"
- Ecchymosis
- Swelling
- Popeye Deformity (in severe case)
35
Pt PE:
- TTP in bicipital groove
- Speeds test positive
Biceps tendon injury
36
Treatment of biceps tendon injury
- NSAIDS
- Ice
- Duty/activity mods
- PT/HEP
37
Who should be consulted if bicep rupture is suspected
Ortho
38
Laxity, trauma or overuse can create disruption in the dynamic stabilization of the glenohumeral joint may result in?
Shoulder instability
39
What is anterior, posterior, inferior or multidirectional glenohumeral laxity due to traumatic or atraumatic pathology
Shoulder instability
40
What is humeral head partially slips out of socket with spontaneous reduction
Shoulder subluxation
41
What is humeral head completely slips out of glenoid fossa with spontaneous reduction or sometimes requiring manual manipulation
Shoulder dislocation
42
What are the 2 specific instability patterns of shoulder instability
TUBS
AMBRI
43
What is TUBS
Traumatic unilateral dislocations with a 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 capsular shift (surgery)
45
Pt presents with:
- anterior instability
- sensation of the shoulder slipping out of joint when arm is abducted and externally rotated
- associated with trauma from a fall or forceful throwing motion
Anterior shoulder dislocation
46
Pt presents with:
- force that is posteriorly directed on shoulder
Posterior dislocation
47
Which shoulder dislocation has vague sx but is usually related to activity
Multidirectional instability
48
Ability to voluntarily dislocated shoulder is associated with what?
Multidirectional instability
49
What is the prognosis for surgical treatment if the patient can voluntarily dislocate shoulder
Poor prognosis
50
What is the most common direction of shoulder dislocation?
Anetrior dislocation
51
What shoulder dislocation does a patient support arm in neutral position?
Anterior dislocation
52
What shoulder dislocation does a patient hold arm in adduction and internal rotation
Posterior dislocation
53
Humeral "clunking" noted with flexion and abduction/adduction is a sign of?
Multidirectional instability
54
How would you check neurovascular status of shoulder dislocation?
- assess nerve functions
- asses radial pulse and cap refill
55
What tests would be positive for shoulder dislocation?
-Positive Sulcus test with inferior laxity
- Positive apprehension tests with anterior instability
- Positive anterior/posterior drawer
- Jerk test for posterior instability
56
Plain film radiographs should r/o what with anterior dislocations
Hill-sachs lesions
57
What radiologic diagnostic tests should be done for posterior shoulder dislocation?
Plain film
58
What radiologic study is needed to evaluate health or rotator cuff tendons, labrum(bankart lesion) and other soft tissue structures?
MRI
59
What is stimson technique for shoulder reduction
gravity assisted with patient lying on stomach
60
What is the longitudinal traction technique for shoulder reduction
elbow at 90 degree flexion will longitudinal traction is applied to humerous. Gently rotate arm.
61
What medication may be required to relax muscle structures to allow for shoulder reduction
Valium
62
What should be re-evaluated after shoulder reduction
Axillary nerve functions
63
Treatment of shoulder dislocation
- Reduce acute dislocations
- Sling in neutral position
- Light duty, no active use of arm for 2-3 weeks
- Rotator cuff strengthening 2-3 weeks post reduction
- PT consult
64
When should ortho be consulted/MEDEVAC for shoulder dislocation
- First time dislocation
- Neurovascular compromise
65
What structure is a Fibrocartilaginous ring attached to outer surface of glenoid
Labrum
66
Which part of the shoulder does the following:
- Give depth to the shoulder joint
- Increases area of contact between humeral head and glenoid
- Also serves as point of contact for several ligaments and tendons
Labrum
67
Injury of to the superior glenoid labrum and bicep anchor complex is called?
Superior labrum anterior posterior (SLAP) lesion
68
What injury is difficult to dx and is often a diagnosis of exclusion, confirmed during surgery?
SLAP lesion
69
The following MOIs can cause what injury:
- Falling back onto an outstretched arm
- Tries to prevent falling by grabbing hold of an object
- Suddenly tries to lift a heavy object
- Forceful throwing, excessive overhead activity
- Chronic overuse vs acute injury
SLAP lesion
70
Pt presents with:
- Anterior shoulder pain (in overuse injury)
- Clicking/clunking of the shoulder in certain positions
- Swelling, parasthesias, severe night pain uncommon
SLAP lesion
71
While no single test can reliably dx SLAP lesions, what spcial tests are recomended?
Obrien's and Speeds
72
Adhesive capsulitis is also called?
Frozen shoulder
73
What age range is adhesive capsulitis more common in?
50-60s
74
The following conditions are associated with what shoulder injury:
- DM
- Thyroid disease
- Autoimmune disorders
- stroke
-Parkinsons
- HIV medication use
Adhesive capsulitis
75
When does adhesive capsulitis typically affect active duty personnel?
After shoulder injuries
76
What phase of adhesive capsulitis is characterized by the following?
- Diffuse, severe, and disabling shoulder pain
- Increasing stiffness
- Last 2-9 months
First phase
77
What phase of adhesive capsulitis is characterized by the following?
- Stiffness and severe loss of shoulder motion with pain less pronounced
- Lasts for 4 to 12 months
Second phase
78
How long does the recovery phase of adhesive capsulitis take?
5-24 months
79
Pt presents with:
- Severe pain that is worse at night
“nagging pain”
- Decreasing ROM in the shoulder
- Issues with work or activities of daily living
- Varying degrees of impaired function
- Often with history of shoulder injury and immobilization
Adhesive capsulitis
80
Why would you obtain plain films for adhesive capsulitis
Exclude other etiologies
81
When would you obtain and MRI for adhesive capsulitis?
- MRI for more challenging cases
- Not necessary to make diagnosis
- Often shows thickening of joint capsule
82
Is an ultrasound useful for adhesive capsulitis?
Ultrasound also useful in diagnosing the dynamic changes that occur in the shoulder
83
Treatment of adhesive capsulitis
- Evidence lacking in treatment
- Early mobilization for those with shoulder injuries
- Avoid slings when possible
- Shoulder motion exercises
- Physical therapy consult
- NSAIDs
- Tylenol
- Consider referral for steroid injection
84
When should a patient with adhesive capsulitis be referred?
- not responding to conservative management
85
Who should patients with adhesive capsulitis be referred to?
- Sports medicine for steroid injection
- Ortho for surgery (likely does not improve)
