shoulder pain

Question 1

rotator cuff disorders

Answer 1

tendinopathy
partial tear
complete tear

Question 2

progressive fibrosis of joint capsule → painful loss of shoulder ROM
later on: reduction in pain, then return to near normal ROM
*loss of active + passive ROM

Answer 2

adhesive capsulitis

Question 3

osteoarthritis: degeneration of articular cartilage with associated synovitis, effusion, osteophyte formation

Answer 3

glenohumeral (trauma, dislocation hx, autoimmune arthritis, loss of active + passive ROM)
acromioclavicular (most common, overhead activities, heavy weight lifting, may have prominent AC joint)

Question 4

shoulder instability

Answer 4

subluxation

dislocation

Question 5

shoulder anatomy

Answer 5

humerus
clavicle
scapula: acromion, coronoid, glenoid

Question 6

shoulder joint articulations

Answer 6

sternoclavicular
acromioclavicular
glenohumoral
scapulothoracic

Question 7

soft tissue stabilizers of shoulder joint

Answer 7

static: bony support, joint capsule, glemohumeral ligaments, glenoid labrum
dynamic stabilizers (keep humerus centered in glenoid during movement): rotator cuff muscles, long head of biceps tendon

Question 8

rotator cuff muscles

Answer 8

loss of active ROM ONLY
"painful arc": pain with active ROM between 60-120 deg
supraspinatous
infraspinatous
teres minor
subscapularis

Question 9

if weak static or dynamic stabilizers

Answer 9

risk for shoulder subluxation (transient dislocation) or frank dislocation

Question 10

most common shoulder subluxation/dislocation

Answer 10

anterior

fall with arm abducted and externally rotated

Question 11

complication of subluxation/dislocation

Answer 11

damage to labrum - lead to chronic instability/dislocations

Question 12

repetitive overhead activities
recurrent impingement of rotator cuff between humerus and acromion
tendinopathy (inflammation) → partial tear → complete tear of rotator cuff tendon

Answer 12

impingement syndrome

Question 13

occurs secondary to primary rotator cuff injury

Answer 13

subacromial bursitis

Question 14

abduction strength tests (arm at 90)

Answer 14

supraspinatous

Question 15

internal rotation strength tests

Answer 15

subscapularis

Question 16

external rotation

Answer 16

infraspinatous/teres minor

Question 17

hawkins impingement test: passively forward flex arm to 90, internally rotate arm to end point

Answer 17

rotator cuff injury:
trap rotator cuff tendon (often supraspinatous) between bony head of humerus and undersurface of acromion
positive: pain

Question 18

empty can test: abduct to 90, forward flex the arm 30 deg

Answer 18

supraspinatous injury (more effective than abduction strength test)
positive: pain + weakness

Question 19

subscapularis lift oft=F test: dorsum of hand against low back - pt lifts hand off and examiner resists

Answer 19

subscapularis

positive: pain and/or weakness

Question 20

drop arm test: passively abduct to 160 degrees, ask pt to slowly lower arm to side

Answer 20

large rotator cuff tear needing surgery:

positive: arm not lowered in controlled fashion

Question 21

AC joint test

Answer 21

bring patients arm across contralateral shoulder (adduction)

positive: pain in AC joint

Question 22

apprehension test: lie supine, abduct to 90 deg with elbow flexed to 90 deg, examiner applies external rotation

Answer 22

anterior shoulder instability/DISLOCATION

positive: apprehensive

Question 23

sulcus sign: examiner applies inferior force down on wrist

Answer 23

multidirectional instability

positive: suclus or indentation is created between acromion and proximal humeral head

Question 24

acute injury, arthritis, calcific tendinosis - imaging

Answer 24

xray

Question 25

if fail conservative management for 6-8 wks

Answer 25

MRI and suspect rotator cuff tear