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Interventions II > Shoulder Pathology > Flashcards

Shoulder Pathology Flashcards

1
Q

Jobe’s Classification: Group 1

A

Pure impingement

Usually in an older recreational athlete with partial under surface rotator cuff tear and subacromial bursitis

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2
Q

Jobe’s Classification: Group 2

A

Impingement associated with labral and/or capsular injury, instability, and secondary impingement

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3
Q

Jobe’s Classification: Group 3

A

Hyper elastic soft tissue resulting in an anterior or multidirectional instability and impingement
Usually attenuated but intact labrum, undersurface rotator cuff tear

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4
Q

Jobe’s Classification: Group 4

A

Anterior instability without associated impingement
Result of trauma
Results in partial or complete dislocation

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5
Q

What type of posture might you expect with rotator cuff disease and tendinopathies

A

Thoracic kyphosis, forward head, and forward (anterior) tipped scapula with decreased thoracic mobility

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6
Q

When shoulder rotator cuff/tendinopathy is acute, where might pain be referred?

A

C5 and C6 reference zones

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7
Q

Rotator cuff mechanism of injury: end stage impingement

A

May cause tendon degeneration and progression to a complete tear
Due to compromise of subacromial space, decrease vascular and spur formation

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8
Q

Other conditions that may accompany rotator cuff tear

A
  • biceps tendons hypertrophy
  • increased EMG of biceps
  • biceps tendon rupture
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9
Q

Signs and symptoms of rotator cuff tear

A 
Pain/loss of function
\+ AROM
\+/- PROM findings
\+ weakness or pain
\+ special tests
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10
Q

Types of rotator cuff repairs

A
  • arthroscopic approach
  • mini open (arthroscopically assisted) approach
  • traditional open approach
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11
Q

What is the definition of impingement syndrome?

A
  • tendons of the rotator cuff and biceps and the sub-acromial bursa are subject to inflammation as a result of direct blows, excessive tensile forces and/or repetitive microtrauma
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12
Q

What do repetitive or sustained overhead activities frequently predispose?

A

Rotator cuff tendons to injury

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13
Q

Mechanical (primary) impingement of subacromial structures against the anterior acromion and coracoacromial ligament

A

Occurs when arm is lifted overhead, especially in abduction and flexion with arm internally rotated

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14
Q

What does secondary impingement frequently involve?

A

glenohumeral or functional scapular instability

Often on dominant side

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15
Q

Population of primary impingement

A

> 40 yo
Partly due to overall wear/tear
Could be related to aging process??

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16
Q

Population of secondary impingement

A

<35 years old

Typically athletic or overhead repetitive overhead activities

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17
Q

Associated pathologies of impingement syndrome

A

Bursitis, tendonitis, rotator cuff tears, and degenerative changes (osteophyte formation)

18
Q

Signs and symptoms of impingement syndrome

A 
Anterior pain
\+ difficulty with sleep position
\+ AROM
\+/- PROM
\+ weakness or pain
\+ tenderness
Primary impingement usually grade 3
\+ provocation with special tests
19
Q

Procedures associated with impingement syndrome

A

Subacromial decompression

Also knows as anterior acromioplasty or decompression acromioplasty

20
Q

Definition/MOI of instability

A

Excessive displacement anteriorly or posteriorly of the humeral head in relationship to the glenoid
Created by lack of active or passive stabilizers leading to increased likelihood of GH subluxation

21
Q

Population of instability

A

Younger male, athletic population
Frequently <35 yo
Repetitive overhead sport or occupation

22
Q

Types of GH instability

A

Anterior (common)
Posterior
Inferior
Multi-directional (anterior/inferior most common)

23
Q

Common progression of instability

A

Vague sense of shoulder dysfunction
Over time experiences repetitive microtraumas
Actually starting to sublux
Frank dislocation

24
Q

Signs and symptoms of instability

A 
Anterior pain
C/o clunk, click, pop
\+/- AROM
\+/- PROM
- weakness or pain
\+ accessory motion tests
- tenderness
25
Q

Potential procedures for shoulder instability

A
  • bankhart repair
  • capsularrhaphy
  • electrothermally assisted capsulorrhaphy
  • posterior capsulorrhaphy
  • repair or SLAP lesion
26
Q

Stability/ Impingement Relationship

A

Overuse —> microtrauma —> instability —> subluxation —> impingement —> rotator cuff tear

27
Q

Adhesive capsulitis onset characteristics

A 
Occurs in 3-4 consecutive stages
Gradual onset of pain (less than 3 mo)
Painful period (3-9 mo/freezing)
Stiff period (9-15 mo/frozen)
Recovery period (15-24+/thawing)
28
Q

What is the total duration of symptoms of adhesive capsulitis?

A

2 plus years

Self limiting

29
Q

Population of adhesive capsulitis

A

40-70 y/o (rare under 40)
Females&raquo_space; males
1/3 will develop contralateral problems in 5-7 years

30
Q

Primary adhesive capsulitis

A

Unknown etiology
Active and passive movements painful
Markedly restricted in all directions (greatest in ER)

31
Q

Secondary adhesive capsulitis

A

Identical clinical syndrome occurring in association with a particular disorder or event
Shoulder trauma, diabetes, thyroid disease, cardiac disease

32
Q

History pattern of complaints of adhesive capsulitis

A
  • insidious onset or some trauma
  • pain becoming severe, present at rest, vague, generalized, may refer to forearm
  • self-immobilization
  • inability to lay on involved side
33
Q

Tests and measures pattern for adhesive capsulitis

A
  • all active and passive motions passive/restricted
  • significant GH ER, moderate abduction limitation and some IR restriction
  • GH spasm endfeel, progressing to hard, capsular end-feel
  • may have + impingement test
  • accessory motion hypomobile
  • ?? + resisted tests
34
Q

Shoulder girdle treatment considerations for acute injury

A

Decrease/control inflammatory response
RICE
Maintain ROM
Cardiovascular training

35
Q

Shoulder girdle treatment considerations for sub acute injury

A

ROM/flexibility, strengthening, coordinated movement patterns, weight bearing, etc

36
Q

Shoulder girdle treatment considerations for chronic injury

A

More aggressive activities and Functional activities

37
Q

Mobility vs. stability shoulder girdle treatment injuries

A

Need to provide both

Order of priority depends on which problem is greater —> often will address simultaneously

38
Q

GH joint shoulder girdle treatment considerations

A

Joint restrictions

Muscle performance issues

39
Q

Scapula shoulder girdle treatment considerations

A

Muscle performance issues (motor control, endurance), scapular stabilization activities

40
Q

Shoulder girdle treatment considerations: trunk

A

Limited spine mobility will impact shoulder function

Restrictions in thoracic extension will limit achievement of full shoulder elevation

41
Q

Shoulder girdle treatment considerations: functional

A

Always need to be thinking about and including functional activities in the intervention plan

Interventions II (8 decks)

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