Shoulder Pathology Flashcards
2 kinds Labral lesions
1) SLAP
2) Bankart
Labral lesion Sx
1) dull/throbbing
2) difficulty sleeping on shoulder
3) loss of strength
4) **instability
5) popping/clicking/catching
What is the most common cause of Labral tears
*impact injury (not age)
What is a Labral lesion
Tearing of glenoid labrum
What is SLAP Labral lesion
“Superior labrum anterior posterior”
-injury to anterior/posterior attachment of bicep tendon
SLAP Labral lesion Sx
1) impingement/catching with overhead force/pushing
2) pain with movement (above head/throwing)
cause of SLAP Labral lesion
1) fall outstretched arm
2) forceful pulling arm (catching heavy object)
3) rapid/forceful movement above shoulder level
Risks for SLAP
1) overuse (weightlifting, throwing)
2) shoulder dislocation
3) MVA
On a clock where do SLAP lesion occur
10 and 2
On a clock where do Bankart lesion occur
3 and 6
What is a Bankart lesion
-anterior (inferior) glenoid labrum
2 kinds of Bankart lesions
1) soft- labrum
2) bony- anteroinferior glenoid rim bone
SX of Bankart lesion
1) pain worse with arm behind back
2) hill-Sachs lesion- posterolateral humeral head compression fracture= promotes future dislocation
Cause of Bankart lesion
Anterior shoulder dislocation
What other pathologies to differentiate for Labral lesions
1) ALPSA (anterior Labral posterior sleeve avulsion)
2) cuff fraying
3) rotator cuff tears
4) SLAP lesion
5) impingement
What is bursitis
Inflammation of the bursa
Etiology of bursitis
Inflammation-> increase synovial cells-> increase collagen/fluid production in bursa-> decrease lubrication outside bursa
Cause of bursitis
1) repetitive trauma/friction (micro-trauma)
2) impact
3) rheumatoid arthritis
4) infection
Sx of bursitis
Impingement syndrome
What are other names for impingement syndrome
“Sub criminal impingement, painful arc syndrome, supraspinatus syndrome, swimmers shoulder, throwers shoulder”
Etiology of impingement syndrome
Decreased sub acromial space= impingement (of supraspinatus tendon, subacromial bursa, long head bicep tendon)
Cause of bursitis
1) intrinsic/primary- rotator cuff degeneration/weakness
- subacromial bursitis
2) extrinsic/secondary- subacromial bone spurs
- osteoarthiritic Spurs from AC joint
- variation of acromion shape
- thickening coracoacromial ligament
- poor posture (anteriorly)
- weak scapular stabilizers (rhomboids/traps)
- tight mm (pecs, serrated anterior)
Predisposing factors for impingement syndrome
Overhead activities
Sx of impingement syndrome
1) pain front/side shoulder
2) onset- sudden (trauma) OR gradual (micro trauma)
3) increase pain- overhead activity/lying on shoulder
4) decrease strength with pain
5) decreased ROM
6) painful arc movement- forward elevation (60-120)
7) crepitus
Differential for impingement syn
1) rotator cuff tear (pain resolves, weakness persists)
2) supra scapular nerve entrapment
Diagnosis for impingement syn
1) Hawkins-Kennedy test
2) painful arc sign
3) weakness in external rotation with arm at side
What is adhesive capsulitis
“Frozen shoulder”
Types of adhesive capsulitis
1) idiopathic
2) trauma
3) post surgery
4) vaccine related
Etiology of adhesive capsulitis
Decrease synovial fluid-> thickening shoulder capsule-> adhesions within capsule/connective tissue
Cause of adhesive capsulitis
Trauma with autoimmune component
Risks for adhesive capsulitits
1) tonic seizures
2) diabete mellitus
3) stroke
4) LU Dz
5) connective tissue Dz
6) thyroid Dz
7) HT Dz
Sx for adhesive capsulitis
1) constant pain
2) pain increases at night/cold
3) progressive loss AROM/PROM
4) provoked by certain movements (pain and cramping)
Normal course of healing of adhesive capsulitis
1) stage 1 (freezing/painful)- 6week-9 month
- slow onset
- increase pain= decreased ROM (vice versa)
2) stage 2 (frozen/adhesive)- 4-9 month
- pain= slow improvement
- stiffness
3) stage 3 (thawing/recovery)- 5-26 months
- motion slowly returns to normal
2 kinds of rotator cuff tears
1) partial (fraying)/ 1-2 degree
2) full thickness/ 3 degree
What is included in 3 degree
1) small pinpoint tear
2) large buttons hole tear
3) majority of tendon, tendon still attached to humeral head
4) complete detachment of tendon from humeral head
Etiology of rotator cuff tear
1) injury (acute)- varying amts of stress
- supraspinatus tendon/rotator interval
- severe pain radiates thru arm
- limited ROM- abduction
2) degeneration (chronic)
- extended use and poor biomechanics/mm imbalance
Sx of rotator cuff tear
1) sporadic worsening of pain
2) debilitating mm atrpohy
3) pain during rest
4) crepitus
5) ROM (abduction/flexion)
Risks for rotator cuff tear
1) repetitive stress
2) decrease blood (supraspinatus) ***CUPPING
3) impingement syndrome
What is a rotator interval
Triangular space between suprascapularis/supraspinatus, coracohumeral/superior glenhumeral ligaments, long head bicep tendon, anterior joint capsule
What is VOMIT
“Victims of medical imaging technology”
- MRI studies
- 20% partial rotator cuff tear
- 15% full thickness tear
- 50% rotator cuff tear of ppl over 60- no pain/injury
- 40% pro baseball players- partial/full thickness, no pain, even after 5 years
