Shoulder Pathology Flashcards by Alex Stein

Types of shoulder pathology

Traumatic

Cumulative

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Stages of Healing - Acute and Chronic Inflammation

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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Stages of Healing - Fibroplasia

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

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Stages of Healing - Maturation

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

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Referred pain - Visceral

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

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Rotator Cuff Disease includes

Impingement
Tendonitis
Bursitis
Tendinopathy

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Define impingement

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

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Subacromial space is formed by the

Coracoacromial arch and humeral head

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Contents of subacromial space

Tendons of rotator cuff
Long head of biceps
Subacromial bursa

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Subacromial space = normal

pathologic

Norm = 9-10mm
Path = less than 6mm

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Causal factors of impingement

Intrinsic

Extrinsic - primary and secondary

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Intrinsic factors of impingement

Specific to that muscle

Changes in vascularity (critical zone)
Cuff degeneration
Muscle dysfunction

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Extrinsic factors of impingement - primary

acromion types
osteophytes
tight post capsule

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Extrinsic factors of impingement - secondary

Caused by:

poor force couples
postural deviations
poor motor control
Caused by instability

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Stages of Impingement - Neer and Jobe - Stage 1

Edema and hemorrhage

Younger age

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Stages of impingement - Neer and Jobe - Stage 2

Fibrosis and Tendonitis 
Middle aged (25-40)

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Stages of impingement - Neer and Jobe- Stage 3

Neer - degeneration of tendon (over 40)

Jobe - bone spurs and tendon rupture (small tear)

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Stages of impingement - Jobe - Stage 4

Complete thickness RTC tear (over 40)

Large tear

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Etiology of tendinitis

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

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Presentation of tendinitis

Pain on palpation
Pain with motion
Dec ROM and strength

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Etiology of bursitis

compression and/or irritation of the bursa

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Acute and chronic bursitis

Acute - very painful

Chronic - same symptoms as tendonitis

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Most common bursitis

subacromial

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Presentation of bursitis

pain with movement
decreased ROM
decreased strength
tenderness to palpation

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RTC tear etiology

mechanical wear and tear causing degeneration, fall (FOOSH)

RTC tear presentation

may or may not have pain, weak, mm substitutions

Adhesive Capsulitis - etiology

often idiopathic, primarily females, ages 40-60 | can also be traumatic, post surgical stiffness or neuropathic

Stages of freezing

Preadhesive Freezing Frozen Thawing

Pre-adhesive stage

pain with motion, often patient ignores or misdiagnosis

Freezing stage

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

Frozen stage

less pain, capsular end feel

Thawing stage

less pain beginning to move easier

AC joint separation - etiology

FOOSH | Fall on point of shoulder

Type 1 AC joint separation

AC ligament sprain | Joints remain intact

Type 2 AC joint separation

AC ligament sprain Coracoclavicular ligament sprain Intact but unstable joint

Type 3 AC joint separation

AC and coracoclavicular ligaments torn Joint unstable Deltoid/Trapezius disruption

Type 4 AC joint separation

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

Type 5 AC joint separation

AC joint dislocated with gross disruption of surfaces | Very unstable

Type 6 AC joint separate

clavicle dislocated inferior around coracoid

AC joint separation - presentation

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

Fractures - etiology

Usually falls

Fractures - considered displaced if

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

Presentation - fractures

seen 4 weeks and later pain limited ROM altered scapulohumeral rhythm

Labral tears - etiology

occurs primarily due to loss of control of GH arthrokinematics

Labral tears - presentation

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

SLAP lesions

superior labral ant to post

Most common type of slap lesion

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

Shoulder instabilities

ant, post, multidirectional

Most common type of shoulder instability

ant

Ant shoulder instability - etiology

forced abduction and ER, FOOSH, post blow to shoulder

Presentation for ant shoulder instability

subluxation, dislocation

Associated pathologies with an ant shoulder instability

Ant capsule lesion Bankart lesion Hill Sach lesion Brachial plexus injury

Hill Sach lesion

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

Post shoulder instability - percentage and etiology

less than 5% | FOOSH, bench press ant blow, electrocution

Post shoulder instability - presentation

ant shoulder hollowing, guarded UE with ROM loss

Post shoulder instability - associated pathology

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

Etiology of multidirectional instability

occupational or recreational (throwing/swimming) or congenital

Presentation of multidirectional instability

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

Associated pathologies with multidirectional instability

multi laxity in capsule and loose labrum

Etiology of snapping scapula

bursitis, boney alignment, muscle weakness, luschkas tubercles

Presentation of snapping scapula

pain crepitus possible scapula winging

Etiology of arthritis

RA or OA

Presentation of arthirits

pain joint deformity Dec ROM and strength Functional impairment

Thoracic outlet - define

compression of neurovascular bundle in thoracic outlet producing neurovascular compromise

Etiology of thoracic outlet

``` postural deviations compression/traction injury muscle hypertonicity cervical rib soft tissue abnormalities ```

Epidemiology of thoracic outlet syndrom

``` Female more 20-50 age Vascular hx of trauma previously Chronic pain syndromes personality ```

Presentation of thoracic outlet

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

Compression sites for thoracic outlet

Scalene triangle Costoclavicular space Pec minor and chest wall

Scapula dyskinesis - define

abnormal motion of scapula

Etiology or scapula dyskinesis

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

patterns of dyskinesis

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