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MSK Redemption Arc > Shoulder MDT > Flashcards

Shoulder MDT Flashcards

1
Q

Pt presents with:

Fall on tip of shoulder resulting in ligamentous disruption

A

AC Injury/Separation

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2
Q

Type I AC Separation

A

-AC ligaments = disrupted
-CC ligaments = intact

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3
Q

Type II AC Separation

A

AC ligaments = torn
CC ligaments = intact

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4
Q

Type III AC separation

A

AC ligaments = completely disrupted
CC ligaments = completely disrupted
Complete separation of clavicle from acromion

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5
Q

Type IV AC separation

A

AC ligaments = completely disrupted
CC ligaments = completely disrupted
Superior and prominently posterior displacement

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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

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7
Q

Type VI AC separation

A

Uncommon
Muscles are torn resulting in wide displacement
Clavicle lies in either subacromial space or subcoracoid space

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8
Q

Pt presents with:
- Pain over AC joint
- Pain on lifting affected arm
- supporting arm in adducted position

A

AC Separation

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9
Q

Which types of AC separation present with obvious deformity

A

Type III-VI

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10
Q

Plain films show:
-AC joint widening

A

Type III AC separation

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11
Q

Treatment of type I and Type II AC Separation

A
  • Sling
  • Ice
  • Analgesics
  • HEP
  • Light Duty within 4 weeks
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12
Q

Type III AC separation treatment

A
  • Orthopedic consultation
  • Sling
  • Ice
  • Analgesics
  • HEP
  • Light duty until ortho eval
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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
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14
Q

Pt presents with:
- falling on shoulder
- struck on clavicle
- pain over clavicle
- pain with arm motion

A

Clavicle fracture

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15
Q

What is the most common bony injury

A

Clavicle fracture

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16
Q

Where is the most common location for clavicle fracture

A

Middle third portion of clavicle

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17
Q

What special test is positive for Clavicle fracture

A

Cross-body test

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18
Q

What radiology test confirms clavicle fracture

A

Plain films

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19
Q

Treatment of clavicle fracture

A
  • Figure of 8 strap
  • Ice
  • Analgesics
  • Orthopedic consult
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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
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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

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22
Q

What special tests should be done to evaluate for shoulder impingement

A

Neers and Hawkins

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23
Q

Treatment of shoulder impingement syndrome

A
  • NSAIDS
  • Ice
  • Light duty and avoid offending activities
  • HEP and PT
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24
Q

When should shoulder impingement be referred?

A

Ortho consult if failed conservative management after 2-3 months

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25
Q

Rotator cuff tears generally originate where?

A

Supraspinatus and may progress anteriorly and posteriorly

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26
Q

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

A

Rotator Cuff Tear

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27
Q

Pt PE:
- Sunken in shoulder
- Tenderness over greater tuberosity
- Grating sensation at tip of shoulder
- Positive Drop Arm
- Positive Empty can test

A

Rotator Cuff tear

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28
Q

Radiological diagnostic tests for Rotator Cuff Tear

A
  • Plain films
  • MRI necessary to confirm dx
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29
Q

Treatment of rotator cuff tear

A
  • NSAIDS
  • Ice
  • No overhead activities
  • HEP
  • Physical therapy if failed conservative management
  • Ortho consult if failed rehab over 3-6 months
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30
Q

When should acute traumatic rotator cuff tears be surgically repaired

A

No later than within 6 weeks of injury

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31
Q

Biceps tendon injury occurs mostly along which head of biceps tendon

A

Along long head of biceps tendon

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32
Q

What activities commonly cause bicep tendon injury

A

People who pull, lift, reach or throw
- rock climbers, weight lifters

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33
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

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34
Q

When would a bicep tendon rupture be suspected?

A
  • single injury with a “pop”
  • Ecchymosis
  • Swelling
  • Popeye Deformity (in severe case)
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35
Q

Pt PE:
- TTP in bicipital groove
- Speeds test positive

A

Biceps tendon injury

36
Q

Treatment of biceps tendon injury

A
  • NSAIDS
  • Ice
  • Duty/activity mods
  • PT/HEP
37
Q

Who should be consulted if bicep rupture is suspected

A

Ortho

38
Q

Laxity, trauma or overuse can create disruption in the dynamic stabilization of the glenohumeral joint may result in?

A

Shoulder instability

39
Q

What is anterior, posterior, inferior or multidirectional glenohumeral laxity due to traumatic or atraumatic pathology

A

Shoulder instability

40
Q

What is humeral head partially slips out of socket with spontaneous reduction

A

Shoulder subluxation

41
Q

What is humeral head completely slips out of glenoid fossa with spontaneous reduction or sometimes requiring manual manipulation

A

Shoulder dislocation

42
Q

What are the 2 specific instability patterns of shoulder instability

A

TUBS
AMBRI

43
Q

What is TUBS

A

Traumatic unilateral dislocations with a 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 capsular shift (surgery)

45
Q

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

A

Anterior shoulder dislocation

46
Q

Pt presents with:
- force that is posteriorly directed on shoulder

A

Posterior dislocation

47
Q

Which shoulder dislocation has vague sx but is usually related to activity

A

Multidirectional instability

48
Q

Ability to voluntarily dislocated shoulder is associated with what?

A

Multidirectional instability

49
Q

What is the prognosis for surgical treatment if the patient can voluntarily dislocate shoulder

A

Poor prognosis

50
Q

What is the most common direction of shoulder dislocation?

A

Anetrior dislocation

51
Q

What shoulder dislocation does a patient support arm in neutral position?

A

Anterior dislocation

52
Q

What shoulder dislocation does a patient hold arm in adduction and internal rotation

A

Posterior dislocation

53
Q

Humeral “clunking” noted with flexion and abduction/adduction is a sign of?

A

Multidirectional instability

54
Q

How would you check neurovascular status of shoulder dislocation?

A
  • assess nerve functions
  • asses radial pulse and cap refill
55
Q

What tests would be positive for shoulder dislocation?

A

-Positive Sulcus test with inferior laxity
- Positive apprehension tests with anterior instability
- Positive anterior/posterior drawer
- Jerk test for posterior instability

56
Q

Plain film radiographs should r/o what with anterior dislocations

A

Hill-sachs lesions

57
Q

What radiologic diagnostic tests should be done for posterior shoulder dislocation?

A

Plain film

58
Q

What radiologic study is needed to evaluate health or rotator cuff tendons, labrum(bankart lesion) and other soft tissue structures?

A

MRI

59
Q

What is stimson technique for shoulder reduction

A

gravity assisted with patient lying on stomach

60
Q

What is the longitudinal traction technique for shoulder reduction

A

elbow at 90 degree flexion will longitudinal traction is applied to humerous. Gently rotate arm.

61
Q

What medication may be required to relax muscle structures to allow for shoulder reduction

A

Valium

62
Q

What should be re-evaluated after shoulder reduction

A

Axillary nerve functions

63
Q

Treatment of shoulder dislocation

A
  • 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
Q

When should ortho be consulted/MEDEVAC for shoulder dislocation

A
  • First time dislocation
  • Neurovascular compromise
65
Q

What structure is a Fibrocartilaginous ring attached to outer surface of glenoid

A

Labrum

66
Q

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

A

Labrum

67
Q

Injury of to the superior glenoid labrum and bicep anchor complex is called?

A

Superior labrum anterior posterior (SLAP) lesion

68
Q

What injury is difficult to dx and is often a diagnosis of exclusion, confirmed during surgery?

A

SLAP lesion

69
Q

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

A

SLAP lesion

70
Q

Pt presents with:
- Anterior shoulder pain (in overuse injury)
- Clicking/clunking of the shoulder in certain positions
- Swelling, parasthesias, severe night pain uncommon

A

SLAP lesion

71
Q

While no single test can reliably dx SLAP lesions, what spcial tests are recomended?

A

Obrien’s and Speeds

72
Q

Adhesive capsulitis is also called?

A

Frozen shoulder

73
Q

What age range is adhesive capsulitis more common in?

A

50-60s

74
Q

The following conditions are associated with what shoulder injury:
- DM
- Thyroid disease
- Autoimmune disorders
- stroke
-Parkinsons
- HIV medication use

A

Adhesive capsulitis

75
Q

When does adhesive capsulitis typically affect active duty personnel?

A

After shoulder injuries

76
Q

What phase of adhesive capsulitis is characterized by the following?
- Diffuse, severe, and disabling shoulder pain
- Increasing stiffness
- Last 2-9 months

A

First phase

77
Q

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

A

Second phase

78
Q

How long does the recovery phase of adhesive capsulitis take?

A

5-24 months

79
Q

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

A

Adhesive capsulitis

80
Q

Why would you obtain plain films for adhesive capsulitis

A

Exclude other etiologies

81
Q

When would you obtain and MRI for adhesive capsulitis?

A
  • MRI for more challenging cases
  • Not necessary to make diagnosis
  • Often shows thickening of joint capsule
82
Q

Is an ultrasound useful for adhesive capsulitis?

A

Ultrasound also useful in diagnosing the dynamic changes that occur in the shoulder

83
Q

Treatment of adhesive capsulitis

A
  • 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
Q

When should a patient with adhesive capsulitis be referred?

A
  • not responding to conservative management
85
Q

Who should patients with adhesive capsulitis be referred to?

A
  • Sports medicine for steroid injection
  • Ortho for surgery (likely does not improve)

MSK Redemption Arc (14 decks)

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