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Clinical Medicine PT-517 > Shoulder Pathophysiology > Flashcards

Shoulder Pathophysiology Flashcards

1
Q

Rotator Cuff Tendonitis

A

Inflammation of any of the 4 RC tendons
Supraspinatus most common
Common with overhead overuse

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2
Q

Rotator Cuff tendonitis Etiology

A

Impingement Syndrome
Repetitive eccentric overload
Watershed or hypovascular critical

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3
Q

Does GH instability lead to RC tendonitis?

A

It can. Leads to increased GH translation then RC tension overload then Rotator Cuff tendonitis

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4
Q

Rotator Cuff Watershed area

A

Compression on superior RC tendons at GH head leads to reduced blodflow. Adduction causes this.

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5
Q

External Impingement Syndrome

A

RC tendons/Subdeltoid bursa encroached by Acrom, AC joint, or CA ligament

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6
Q

External Impingement Syndrome Etiology

A 
Reduced RC Outlet
RC active insufficiency
Abnormal Scapulothoracic mechanics
Passive Capsuloligamentous insufficiency
Capsuloligamentous laxity
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7
Q

Reduced supraspinatus outlet causes

A 
Abnormal acromion
Hypertrophy CA ligament
AC joint DJD
Enlarged subacromial bursa
Spur formation
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8
Q

Type I abnormal acromion

A

Flat

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9
Q

Type II abnormal acromion

A

Smooth curve

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10
Q

Type III abnormal acromion

A

Anterior Hook

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11
Q

Can decreased RC contractility lead to external impingement?

A

Yes.
Leads to reduced GH compression; leads to increased superior translation; leads to compression; leads to impingement syndrome

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12
Q

Active insufficiency RC leads to External impingement by…..

A

Decreased inferior pull on GH during elevation

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13
Q

Abnormal ST mechanics

A

May place anterior acromion & CA ligament into an impinging position
Abnormal retroflexion also can create impingement

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14
Q

Passive capsuloligamentous insufficiency

A

Tight capsuloligamentous structure will contribute a hyper constraint mechanism
Excessive HH translation results
Direction of HH translation opposite of tight structure

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15
Q

Capsuloligamentous laxity

A

Anterior band of IGHL should restrain ER from 90 scaption
Laxity results in insufficient contraint
Results in excessive anterior HH translation

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16
Q

Neer’s Impingement Stage I

A

Age s and improve biomechanics

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17
Q

Neer’s Impingement Stage II

A

25-40
Bursa Thickening & tendon fibrosis
Pain recurrent
Add anti-inflamatory, consider surgery, subacromial decompression, bursectomy

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18
Q

Neer’s Impingement Stage III

A

> 40
HH & acromial bone spurs. Tendon tears. Progressive disability
Add acromioplasty and RC repair

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19
Q

Internal Impingement

A

Under surface of posterior RC being impinged
Inside-Out compression overload
Posterior HH and Glenoid incriminated

20
Q

Hyper Angulation

A

Horizontal Angulation beyond the POS

Scapular protraction and or winging beyond normal POS

21
Q

Internal Impingement capsuloligamentous laxity

A

Excessive Ant HH translation
IGHL laxity
GH apprehension and relocation tests

22
Q

Test Item cluster for shoulder impingement syndrome

A

Hawkins Kennedy: positive test with passive IR
Painful Arc 60-120
Resisted ER

23
Q

Calcific Tendonitis

A

Calcium deposit into substance of a tendon
May contribute to impingement
Often self limiting

24
Q

Bicipital Tendonitis

A

Bicipital groove or Glenoid origin of tendon

25
Q

Bicipital tendonitis intraarticular etiology

A

Repetitive overhead use
Eccentric overload
Typical with athletes attempting to decelerate elbow extension and radioulnar pronation during follow through

26
Q

Bicipital tendonitis extraarticular etiology

A

Impingement
Bicipital groove tendon subluxation
Spur
Tenosynovial sheath consideration

27
Q

Shoulder Bursitis

A

Not typically primary
Acompany rotator cuff disorder or systemic disorder
May become fibrotic or develop adhesions

28
Q

Rotator Cuff Tears

A

End result of a degenerative process

Impingement, eccentric overload, vascular or collagen disease process

29
Q

Small RC tear

A

<1 cm

30
Q

Medium RC tear

A

< 3 cm

31
Q

Large RC tear

A

< 5 cm

32
Q

Massive RC tear

A

> 5 cm

33
Q

Partial RC tears

A

Classification by location

  • Articular side
  • Mid substance
  • Bursal side
34
Q

RC tear progression

A

Starts at tendon, notch phenomenon moves outward, acute extension of chronic tear, advance to include infraspinatus, further progression to include other RC muscles

35
Q

RC poor healing

A

Retraction of muscle portion of tear

Tear is bathed in synovial fluid

36
Q

Test item cluster for RC tear

A

Drop arm sign: full slow active scaption
Painful arc: 60-120 degrees
Resisted ER in neutral

37
Q

Partial RC tear incidence

A

High middle aged

38
Q

Full RC tear incidence

A

Above 65

39
Q

GH dislocations

A

Complete dissociation of articular surfaces high recurrance rate

40
Q

Anterior GH dislocations

A

Subcoracoid
Subglenoid
Subclavicular

41
Q

Posterior GH dislocations

A

Subacromial
Subglenoid
Subspinous

42
Q

Inferior GH dislocations

A

Rare
Subglenoid
Luxatio Erecta: HH in contact with lateral chest wall

43
Q

Superior GH dislocations

A

Humeral head superior to acromion
Very rare
Extremene soft tissue damage, neuro comprones,fx

44
Q

GH subluxation

A

Excessive humeral head translation
May be traumatic or atraumatic
More difficult to diagnose

45
Q

GH instability across the lifetime

A

20 y/o atraumatic

30 traumatic

Clinical Medicine PT-517 (10 decks)

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