Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Musculoskeletal I > Shoulder Pathology > Flashcards

Shoulder Pathology Flashcards

1
Q

What structures of the shoulder are affected in adhesive capsulitis?

A

Contractures of:

  • Anterioinferior capsule
  • Rotator Interval (space between supraspinatus and subscapularis tendons)
  • Coracohumeral ligament
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the 2 types of adhesive capsulitis?

A
  • Idiopathic/ primary

- Secondary/ Result of trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

In what gender is adhesive capsulitis more frequent?

A
  • Female.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

At what age does adhesive capsulitis typically onset?

A

Between 40 - 60 yo.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What health condition can lead to adhesive capsulitis?

A
  • Diabetes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the 4 stages of adhesive capsulitis?

A

1: Acute
2: Freezing
3: Frozen
4: Thawing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How long does adhesive capsulitis typically take to run its course?

A

1 - 3 years.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What pathology is associated with the acute stage of adhesive capsulitis?

A

Acute synovitis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What time frame does adhesive capsulitis typically occur over?

A

0 - 3 months.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How are AROM and PROM affected in the acute stage of adhesive capsulitis?

A
  • Pain on AROM (patient reluctant to move)

- PROM has empty endfeel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

If a patient is put under anesthesia in the acute stage of AC, how is the patient’s ROM affected?

A

It is normal.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What pathology is associated with the freezing stage of AC?

A

Hypertrophic hypervascular synovitis; proliferation of scar tissue.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Over what time frame does the freezing stage of AC typically occur?

A

Between 3 - 9 months.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How are AROM and PROM affected during the freezing stage of AC?

A

Pain on AROM and empty endfeel PROM.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How is ROM affected overall in the freezing stage?

A
  • ROM severely limited
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the freezing and acute stages of AC referred to as together, and what do they determine?

A

They make up the inflammatory stage of AC, and determine the overall duration of the condition.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What pathology is associated with the frozen stage of adhesive capsulitis?

A
  • Dense mature scar tissue
  • Decreased capsular volume (reduced redundant fold in capsule)
    Contractures of:
  • Subscapularis
  • Subacromial bursa
  • Coracohumeral ligament
  • Sarcomeres are lost
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How are AROM and PROM affected during the frozen stage of AC?

A
  • No pain in either AROM or PROM, and a firm endfeel, but range is extremely limited.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the time frame of the frozen stage of adhesive capsulitis typically?

A
  • 5 - 9 months
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What pathology is associated with the thawing stage of AC?

A
  • Restoration of capsular volume
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How are AROM and PROM affected by the thawing stage of AC?

A
  • No pain on AROM or PROM, and range gradually improves.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the time frame of the thawing stage of AC?

A

15 - 24 months.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is a capsular pattern?

A
  • Specific type of limitation in joint movement
  • ER most limited
  • Abduction moderately limited
  • IR least limited
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What joint’s kinematics will be altered by Adhesive Capsulitis?

A
  • Glenohumeral.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the goal of treatment during the acute phase of AC?

A
  • Interrupt pain and inflammation

- Promote relaxation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How can the therapist educate the patient during the acute phase of AC?

A
  • Pathogenesis
  • Posture
  • Activity modification
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

How are modalities used in the acute phase of AC?

A
  • Controls pain, inflammation

- Promotes relaxation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What type of exercising and manual therapy may be performed in the acute stage?

A
  • Early closed chain (wall slides)
  • AAROM (pain free)
  • Aquatic exercise
  • Conservative ROM
  • Pendulum exercise
  • Grade 1 and 2 mobs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is the goal of treatment in the freezing stage of AC?

A
  • Minimize pain, inflammation, adhesions, ROM restriction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

How can the therapist educate the patient during stages 2 - 4?

A
  • Posture

- Necessity of HEP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

How may modalities be used in the freezing stage of AC?

A
  • Decrease pain
  • Decrease inflammaiton
  • Improve tissue extensibility
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What exercises and manual therapy should be performed in the freezing stage of AC?

A
  • Scapular training
  • Specific rotator cuff strengthening
  • AROM
  • PROM
  • Grade II and III mobilizations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is the goal of treatment in the frozen and thawing stages of AC?

A
  • Increase ROM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

How may modalities be used in the frozen and thawing stages of AC?

A
  • Promote relaxation
  • Improve tissue extensibility
  • Reduce treatment discomfort
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What exercises and manual therapies should be used in the frozen and thawing stages of AC?

A
  • More specific scapular training
  • Reestablish force couples
  • Continued rotator cuff strengthening
  • AROM that reestablishes scapular and GH mechanics
  • Aggresive stretching (PNF, STM, Low load prolonged stretch)
  • Grades III and IV.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What are intrinsic or primary causes of rotator cuff tears?

A
  • Subacromial space issues such as:
    Hooked acromion or rough undersurface
    Degenerative changes in AC/ subscapularis
    Decreased vascularity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What are extrinsic/ secondary causes of rotator cuff tears?

A 
- Strength/ Environmental
    G-H force couple dyskinesia
    S-T force couple dyskinesia
    Posture
    Excessive overhead use of arm
    Posterior capsule shortening
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

In what decades does the incidence of partial RC tears peak?

A

5th and 6th decades.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

How many over the age of 60 have evidence of a full thickness RC tear?

A

5 - 40 %.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What type of RC tear is prevalent in 25 - 40 year olds?

A
  • Partial thickness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What are 3 examples of diagnostic imaging results that confirm a tear of the RC?

A
  • Calcific deposits in subacromial space on plain film’
  • Absent axillary fold with contrast medium in plain film or seen in MRI
  • Ultrasound showing an absence of tendon
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What forces make up the deltoid force couple of the rotator cuff?

A
  • Deltoid elevates the arm, and superiorly translates the humeral head
  • RC off sets deltoid with inferior and medial forces (esp. infraspinatus, teres minor and subscap), and limit anterior and posterior translation of the humeral head .
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What forces make up the scapular force couple?

A
  • Upper, middle, and lower trapezius, and the serratus anterior work in concert to rotate the scapula.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What scapular forces are required to maximize the subacromial space?

A
  • Upward rotation
  • Posterior tilt
  • External rotation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

How does scapular position affect the force production capabilities of the RC muscles?

A

By changing the length-tension relationships.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

How can RC impingement be caused by a lack of scapular rotation?

A

Humerus translates superiorly into acromion.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

How can RC impingement be caused by a failure of scapular adduction?

A
  • The head of the humerus translates anteriorly.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Describe neer stage 1 rotator cuff tears.

A
  • Edema and hemmorage
  • Minimal weakness
  • Excessive overhead use
  • Traumatic change, etc….
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What age group is usually affected by stage 1 RC tears?

A
  • < 25 y/o
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Describe neer stage 2 RC tears.

A
  • Fibrosis and tendonitis of cuff and bursa following repeated mechanical inflammation.
  • chronic changes due to repeated trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What age ranges are usually affected by neer stage 2 RC tears?

A

25 - 40 y/o

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Describe neer stage 3 RC tears.

A
  • Bone spurs
  • Incomplete and complete tears of cuff and biceps tendon
  • Degeneration of remaining tendons
  • Degeneration of skeletal structure
  • OA of joint
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What age ranges are typically affected by neer stage 3 RC tears?

A

40 < y/o

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What is PT treatment protocol for an acute RC tear?

A
  • Ice
  • Meds
  • Rest
  • Correct joint mechanics
  • Stabilize scap
  • Strengthen RC
  • Correct posture/ instability
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

How long should conservative treatment of RC tears be provided before surgery is considered?

A
  • At least 6 months
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What type of RC problems may require surgery?

A
  • Complete RC tears
  • Impingement (acromioplasty/ subacromial decompression)
  • Capsular repair for instability
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What is the procedure for post-op RC PT management?

A
  • Gentle PROM/ AROM
  • Modalities
  • Light UE closed chain ex
  • Stabilizaiton ex
58
Q

What nerves are affected first in thoracic outlet syndrome?

A
  • Sensory before motor
59
Q

What is the characteristic symptom of thoracic outlet syndrome?

A
  • Poorly localized aching pain.
60
Q

What 3 pathologies must be ruled out when testing for thoracic outlet?

A
  • CTS
  • Radiculopathy
  • Distal nerve compression
61
Q

What 2 postures provoke symptoms of thoracic outlet?

A
  • Forward head

- Protracted shoulders

62
Q

What bony structures contribute to the incidence of thoracic outlet?

A
  • Cervical rib

- C7 transverse process

63
Q

What nerve distribution is disproportionately affected by thoracic outlet?

A
  • Ulnar nerve
64
Q

What muscles are involved in thoracic outlet?

A

Anterior and middle scalenes.

65
Q

What can cause impingement by the scalenes?

A
  • Forward head posture
  • Scalene hypertrophy/ tightness
  • Surgical positions
66
Q

What type of thoracic outlet is aggravated by overhead tasks and some cervical positions?

A

Scalene groove.

67
Q

What methods are used to treat thoracic outlet due to the scalene groove?

A
  • Soft tissue release

- Postural correction

68
Q

How are an elevation in the ribs related to thoracic outlet syndrome?

A

Neurovascular bundle can become compressed between the clavicle and 1st rib.

69
Q

What posture causes TO between the clavicle and 1st rib?

A
  • Depressed, retracted shoulders

- Carrying backpacks, and other heavy loads

70
Q

What test can be performed to determine TO at the clavicle and 1st rib?

A

Military posture will lead to increased pulse.

71
Q

What muscle is related to compressing the neurovascular bundle against the ribs causing TO?

A

Pec minor.

72
Q

What provokes TO symptoms when the bundle is compressed between the ribs and pec minor?

A
  • Overhead activity.
73
Q

What is the treatment for TO due to the clavicle and first rib?

A

Strengthen scap elevators.

74
Q

What is the treatment for TO due to pec minor and the rib cage?

A
  • Strengthen scap stabilizers

- Stretch pecs.

75
Q

What 4 elements contribute to glenohumeral joint stability?

A
  • Articular geometry
  • Static capsuloligamentous complex
  • Dynamic muscular stabilizers
  • NM control
76
Q

What are the 2 more common abnormal GH motions, and what muscle causes these?

A
  • Excessive anterior translation durin glateral rotation and abduction
  • Excessive anterior translation during medial rotation
  • Due to deltoid muscle
77
Q

What is the 4 step continuum of shoulder instability?

A
  • Normal
  • Lax/ hypermobile (joint congruent, but unloaded)
  • Subluxed (partially congruent)
  • Dislocated (no congruence)
78
Q

How does the RC contribute to GH stability?

A
  • Passive muscle tension
  • Compression from contraction
  • Motion blockage from contracted muscles
79
Q

How does the motion in the shoulder contribute to GH stability?

A

Tightening of the joint capsule due to motion.

80
Q

What 2 joints contribute to centering the humerus on the glenoid?

A
  • GH

- ST

81
Q

What causes most acute GH dislocations?

A

Trauma.

  • Bankart lesion
  • Hill-sachs deformity
82
Q

What amount of Bankart injuries are successfully rehabilitated without surgery?

A

> =20%

83
Q

What is a bankart lesion?

A

Avulsion of anterior, inferior GH ligament, and anterior labrum.
(soft tissue injury)

84
Q

What is a hill-sachs deformity?

A
  • Humeral head crushes into glenoid.
85
Q

What causes chronic GH dislocation?

A
  • Due to instability

- Instability –> Subluxation –> Dislocaiton

86
Q

What is the success rate of GH dislocation rehabilitation without surgery?

A

> 80 %

87
Q

What does AMBRI mean?

A
  • Atraumatic
  • Multidirectional
  • Bilateral
  • Requiring Rehabilitation
  • Inferior Capsular Shift (rare)
88
Q

How are acute and chronic GH dislocation related?

A
  • Traumatic generally linked to future chronic dislocation
89
Q

What are 4 typically methods of presentation of GH dislocation?

A
  • Positive apprehension sign with anterior tenderness
  • RC weakness (due to tear)
  • Deltoid weakness/ lateral shoulder sensory loss if axillary nerve is damaged
  • UE in ER with anterior prominence of humeral head (acute)
90
Q

What is conservative treatment for a GH dislocation?

A
  • Improve dynamic stability/ proprioception of GH joint
  • Immobilize for up to 3 weeks (IR or ER)
  • Avoid forceful ER
  • No PROM/ stretching
  • Focus on neuromuscular coordination/ re-education
91
Q

What are surgical interventions for GH dislocation?

A
  • Anterior capsular shift

- Anterior capsulolabral reconstruction if bankart present

92
Q

How do patients <20 y/o typically respond to treatment for GH dislocation?

A
  • High rate of recurrence
93
Q

How should patients >40y/o be monitored during treatment?

A
  • Minimize immobilization

- If no change after 2 weeks, check for RC tear.

94
Q

What are 2 common mechanisms of AC injury?

A
  • FOOSH driving humerus into acromion

- Direct blow to lateral shoulder

95
Q

What 3 tests may be used to rule in AC joint injury?

A
  • Cross-over sign
  • Active compression
  • Resisted extension test
96
Q

How can an AC joint injury be ruled out?

A
  • Negative cross-over sign

- No tenderness

97
Q

Describe 1st, 2nd, and 3rd degree AC ligament disruptions.

A

1: No instability
2: A-P instability
3: Gross instability with distal clavicle riding high

98
Q

What muscles can be trained to stabilize the AC joint?

A

None. No muscles cross the AC joint.

99
Q

What surgical maneuver is performed with extreme degradation of the AC joint?

A
  • Portion of clavicle removed, and muscles hold arm on body.
100
Q

How is a 1st degree AC joint sprain treated?

A
  • Treat pain
  • Joint protection
  • Progressive return to activity
101
Q

How is a 2nd degree AC joint sprain treated?

A
  • Sling
  • Pain control
  • Progress from passive to active exercise as tolerated (2 - 3 weeks)
102
Q

How is a 3rd degree AC joint sprain treated?

A
  • Longer immobilization
  • Pain control
  • Progress from passive to active exercise
103
Q

What is the progression of exercise for an AC joint injury?

A
  • Stregthening
  • Dynamic strengthening
  • Sport/occupation specific ex
104
Q

What position should be avoided when performing exercises for AC rehabilitation?

A
  • Supine due to scapula being trapped, and limited causing greater clavicle movement
105
Q

What are 2 common mechanisms of SC joint injury?

A
  • Blunt force to sternum or clavicle

- Lateral compression from clavicle

106
Q

In what direction does the SC joint usually dislocate?

A
  • Anterior/ inferior
107
Q

What problems can arise from a posterior SC joint dislocation?

A
  • NV compromise

- Breathing/ swallowing problems

108
Q

What percentage of shoulder injuries occur at the SC joint?

A

3 %.

109
Q

What are 3 common mechanisms of labral tears?

A
  • FOOSH
  • Dislocation
  • Strong bicep contraction
110
Q

What is a stable labral tear?

A
  • Pain without locking or clicking
111
Q

What is an unstable labral tear?

A
  • Pain with locking or clicking
112
Q

Which joint injury does a labral tear produce similar symptoms to?

A
  • Similar to AC joint.
113
Q

What are the 4 types of SLAP lesions, and which is most common?

A
  • Rough edge (cracks and splits along central edge)
  • Labrum torn off glenoid (most common)
  • Bucket handle
  • Tear including bicep tendon
114
Q

What can PTs do to treat SLAP lesions?

A
  • Rebalance muscles
  • Correct dyskinesis
  • Improve mobility
  • But, cannot heal labrum
115
Q

What is the 3 step process to stable labral tear retraining?

A
  • NSAIDs/ cortisone injection
  • Scapular stabilization/ RTC retraining
  • Strengthen up to 90 %
116
Q

What type of treatment do unstable labral tears usually require?

A
  • Arthroscopic debridement and stabilization of unstable tears
  • Conservative treatment is rarely sucessful
117
Q

What are the 3 categories of LH biceps pathology?

A
  • Inflammatory/ degenerative
  • Instability
  • SLAP lesions/ biceps tendon anchor abnormalities
118
Q

What causes inflammatory/ degenerative pathology in the LH of the biceps?

A
  • Repetitive overhead motion causes impingement at coracoacromial arch
  • Tight posterior capsule
119
Q

What type of injury does biceps tendon instability typically occur in concert with?

A
  • RC injury
120
Q

What are 3 common causes of SLAP lesions/ biceps tendon anchor abnormalities?

A
  • Shearing from compression at superior glenoid rum
  • traction from eccentric contraction of LHB
  • Peel back from twisting of LHB with abduction and max ER.
121
Q

What is typical conservative treatment for LHB injury?

A
  • Pain management, PROM
  • Progress to AROM/ strengthening
  • RC training/ dynamic stability
122
Q

Why is conservative treatment for LHB injury often unsuccessful?

A

Involvement of RC.

123
Q

What are 4 surgical treatments for LHB treatment?

A
  • Decompression
  • Tenotomy
  • Tenodesis
  • SLAP repair
124
Q

What are 4 common causes of subacromial bursitis?

A
  • Trauma
  • Poor GH mechanics
  • Deconditioning
  • Inflammation due to RC impingement
125
Q

In what populations is subacromial bursitis more common?

A

Middle-aged to older patients.

126
Q

What are the characteristic symptoms of subacromial bursitis?

A
  • Acute onset of sever pain; painful arc

- Rotation not usually limited

127
Q

What is the normal treatment for subacromial bursitis?

A
  • Rest
  • Ice
  • Gentle, pain-free AROM
  • Improve GH and ST control/ conditioning
128
Q

What is subacromial bursitis a precursor to?

A

Rotator cuff problems

129
Q

When is joint arthroplasty indicated?

A
  • Conservative management fails

- No other options are available to restore relatively pain free joint function

130
Q

What are 3 types of pathologies that indicate joint arthroplasty?

A
  • Destructive arthidities (OA, RA, Ankylosing Spondylosis, Marfan’s, Lyme
  • Trauma/ fracture
  • Avascular necrosis
131
Q

What is a shoulder surface replacement?

A
  • surface of humerus replaced.
132
Q

What is a unipolar hemiarthroplasty?

A
  • Half of humeral head replaced
133
Q

What is a bipolar hemiarthroplasty?

A
  • Head moves inside of a shell which articulates with the glenoid
134
Q

What is a total shoulder replacement?

A

Glenoid and humerus replaced.

135
Q

What does it mean for a total shoulder replacement to be constrained?

A

Small humeral head in deep glenoid.

More stability, less mobility.

136
Q

What is a semiconstrained total shoulder replacement?

A
  • Concave humerus on convex glenoid “ball”
137
Q

What has better outcomes: TSR due to OA, RA, or TC?

A

OA > RA and RC

138
Q

How is a completely displaced humeral fracture treated?

A
  • Pins
  • Wires
  • Screws
  • Plates
139
Q

What damage is there is a completely displaced humeral fracture?

A
  • Soft tissue damage

- AVN

140
Q

How is an incomplete, non-displaced humeral fracture treated?

A
  • With a sling

Musculoskeletal I (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions