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Semester 4 PM Exam 1 > Shoulder Pathology > Flashcards

Shoulder Pathology Flashcards

1
Q

Types of shoulder pathology

A

Traumatic

Cumulative

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2
Q

Stages of Healing - Acute and Chronic Inflammation

A

Vasodilation and homeostasis mediated by histamine and prostaglandins
Inc in fluid pressure around nerve ending can result in pain, loss of motion and muscle inhibition
Lasts 1 day to 2 weeks

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3
Q

Stages of Healing - Fibroplasia

A

Formation of functional scar
Start laying down new tissue
Can last up to 6 wks

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4
Q

Stages of Healing - Maturation

A

Can occur for a year post op
Tissue regains muscle strength
Restoration of normal functioning

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5
Q

Referred pain - Visceral

A

GALL BLADDER - ask if they notice symptoms after eating
Cardiac
Pulmonary

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6
Q

Rotator Cuff Disease includes

A

Impingement
Tendonitis
Bursitis
Tendinopathy

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7
Q

Define impingement

A

Compression of subacromial contents due to encroachment of humerus into coracoacromial arch

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8
Q

Subacromial space is formed by the

A

Coracoacromial arch and humeral head

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9
Q

Contents of subacromial space

A

Tendons of rotator cuff
Long head of biceps
Subacromial bursa

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10
Q

Subacromial space = normal

pathologic

A 
Norm = 9-10mm
Path = less than 6mm
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11
Q

Causal factors of impingement

A

Intrinsic

Extrinsic - primary and secondary

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12
Q

Intrinsic factors of impingement

A

Specific to that muscle

  • Changes in vascularity (critical zone)
  • Cuff degeneration
  • Muscle dysfunction
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13
Q

Extrinsic factors of impingement - primary

A
  • acromion types
  • osteophytes
  • tight post capsule
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14
Q

Extrinsic factors of impingement - secondary

Caused by:

A
  • poor force couples
  • postural deviations
  • poor motor control
    Caused by instability
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15
Q

Stages of Impingement - Neer and Jobe - Stage 1

A

Edema and hemorrhage

Younger age

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16
Q

Stages of impingement - Neer and Jobe - Stage 2

A 
Fibrosis and Tendonitis 
Middle aged (25-40)
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17
Q

Stages of impingement - Neer and Jobe- Stage 3

A

Neer - degeneration of tendon (over 40)

Jobe - bone spurs and tendon rupture (small tear)

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18
Q

Stages of impingement - Jobe - Stage 4

A

Complete thickness RTC tear (over 40)

Large tear

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19
Q

Etiology of tendinitis

A 
Repetitive stress (overuse, eccentric contraction)
Primarily RTC, biceps (supra and long head)
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20
Q

Presentation of tendinitis

A

Pain on palpation
Pain with motion
Dec ROM and strength

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21
Q

Etiology of bursitis

A

compression and/or irritation of the bursa

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22
Q

Acute and chronic bursitis

A

Acute - very painful

Chronic - same symptoms as tendonitis

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23
Q

Most common bursitis

A

subacromial

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24
Q

Presentation of bursitis

A

pain with movement
decreased ROM
decreased strength
tenderness to palpation

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25
Q

RTC tear etiology

A

mechanical wear and tear causing degeneration, fall (FOOSH)

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26
Q

RTC tear presentation

A

may or may not have pain, weak, mm substitutions

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27
Q

Adhesive Capsulitis - etiology

A

often idiopathic, primarily females, ages 40-60

can also be traumatic, post surgical stiffness or neuropathic

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28
Q

Stages of freezing

A

Preadhesive
Freezing
Frozen
Thawing

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29
Q

Pre-adhesive stage

A

pain with motion, often patient ignores or misdiagnosis

30
Q

Freezing stage

A

pain with use, dec motion, difficult, sleeping, very painful

31
Q

Frozen stage

A

less pain, capsular end feel

32
Q

Thawing stage

A

less pain beginning to move easier

33
Q

AC joint separation - etiology

A

FOOSH

Fall on point of shoulder

34
Q

Type 1 AC joint separation

A

AC ligament sprain

Joints remain intact

35
Q

Type 2 AC joint separation

A

AC ligament sprain
Coracoclavicular ligament sprain
Intact but unstable joint

36
Q

Type 3 AC joint separation

A

AC and coracoclavicular ligaments torn
Joint unstable
Deltoid/Trapezius disruption

37
Q

Type 4 AC joint separation

A

AC and coracoclavicular ligaments torn
Clavicle dislocates post
Delt and trap disruption

38
Q

Type 5 AC joint separation

A

AC joint dislocated with gross disruption of surfaces

Very unstable

39
Q

Type 6 AC joint separate

A

clavicle dislocated inferior around coracoid

40
Q

AC joint separation - presentation

A 
Painful ROM (esp hor abd/add and flex)
Tenderness
Possible deformity
Possible dec in functional use of arm
41
Q

Fractures - etiology

A

Usually falls

42
Q

Fractures - considered displaced if

A

segment is separated more than 1cm and if there is more than 45 degrees of angulation

43
Q

Presentation - fractures

A

seen 4 weeks and later
pain
limited ROM
altered scapulohumeral rhythm

44
Q

Labral tears - etiology

A

occurs primarily due to loss of control of GH arthrokinematics

45
Q

Labral tears - presentation

A

catching, popping, impingement like symptoms, instability, scapula dyskinesia, pain

46
Q

SLAP lesions

A

superior labral ant to post

47
Q

Most common type of slap lesion

A

type 2 - 55% = fraying labrum, unstable biceps and sup labrum

48
Q

Shoulder instabilities

A

ant, post, multidirectional

49
Q

Most common type of shoulder instability

A

ant

50
Q

Ant shoulder instability - etiology

A

forced abduction and ER, FOOSH, post blow to shoulder

51
Q

Presentation for ant shoulder instability

A

subluxation, dislocation

52
Q

Associated pathologies with an ant shoulder instability

A

Ant capsule lesion
Bankart lesion
Hill Sach lesion
Brachial plexus injury

53
Q

Hill Sach lesion

A

small compression fracture on post aspect of humeral head that occurs in an ant dislocation

54
Q

Post shoulder instability - percentage and etiology

A

less than 5%

FOOSH, bench press ant blow, electrocution

55
Q

Post shoulder instability - presentation

A

ant shoulder hollowing, guarded UE with ROM loss

56
Q

Post shoulder instability - associated pathology

A

compression fraction on ant aspect of humeral head (reverse hill sach), post glenoid fracture or labral tear

57
Q

Etiology of multidirectional instability

A

occupational or recreational (throwing/swimming) or congenital

58
Q

Presentation of multidirectional instability

A

similar to impingement, pain, may complain of shifting or subluxing

59
Q

Associated pathologies with multidirectional instability

A

multi laxity in capsule and loose labrum

60
Q

Etiology of snapping scapula

A

bursitis, boney alignment, muscle weakness, luschkas tubercles

61
Q

Presentation of snapping scapula

A

pain
crepitus
possible scapula winging

62
Q

Etiology of arthritis

A

RA or OA

63
Q

Presentation of arthirits

A

pain
joint deformity
Dec ROM and strength
Functional impairment

64
Q

Thoracic outlet - define

A

compression of neurovascular bundle in thoracic outlet producing neurovascular compromise

65
Q

Etiology of thoracic outlet

A 
postural deviations
compression/traction injury
muscle hypertonicity 
cervical rib
soft tissue abnormalities
66
Q

Epidemiology of thoracic outlet syndrom

A 
Female more
20-50 age
Vascular hx of trauma previously 
Chronic pain syndromes
personality
67
Q

Presentation of thoracic outlet

A 
diffuse pain radiating to arm that isnt dermatomal 
Fatigue and aching in UE
UE weakness and paresthesia
Vascular compromise
Costal breather
Postural deficits
68
Q

Compression sites for thoracic outlet

A

Scalene triangle
Costoclavicular space
Pec minor and chest wall

69
Q

Scapula dyskinesis - define

A

abnormal motion of scapula

70
Q

Etiology or scapula dyskinesis

A

mm weakness of trap and serratus
muscle imbalance - upper trap overrides lower trap
Nerve palsy
Mm tight - pec minor, lat

71
Q

patterns of dyskinesis

A

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Semester 4 PM Exam 1 (3 decks)

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