Shoulder Pathophysiology

Question 1

Rotator Cuff Tendonitis

Answer 1

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

Question 2

Rotator Cuff tendonitis Etiology

Answer 2

Impingement Syndrome
Repetitive eccentric overload
Watershed or hypovascular critical

Question 3

Does GH instability lead to RC tendonitis?

Answer 3

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

Question 4

Rotator Cuff Watershed area

Answer 4

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

Question 5

External Impingement Syndrome

Answer 5

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

Question 6

External Impingement Syndrome Etiology

Answer 6

Reduced RC Outlet
RC active insufficiency
Abnormal Scapulothoracic mechanics
Passive Capsuloligamentous insufficiency
Capsuloligamentous laxity

Question 7

Reduced supraspinatus outlet causes

Answer 7

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

Question 8

Type I abnormal acromion

Answer 8

Flat

Question 9

Type II abnormal acromion

Answer 9

Smooth curve

Question 10

Type III abnormal acromion

Answer 10

Anterior Hook

Question 11

Can decreased RC contractility lead to external impingement?

Answer 11

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

Question 12

Active insufficiency RC leads to External impingement by…..

Answer 12

Decreased inferior pull on GH during elevation

Question 13

Abnormal ST mechanics

Answer 13

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

Question 14

Passive capsuloligamentous insufficiency

Answer 14

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

Question 15

Capsuloligamentous laxity

Answer 15

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

Question 16

Neer’s Impingement Stage I

Answer 16

Age s and improve biomechanics

Question 17

Neer’s Impingement Stage II

Answer 17

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

Question 18

Neer’s Impingement Stage III

Answer 18

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

Question 19

Internal Impingement

Answer 19

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

Question 20

Hyper Angulation

Answer 20

Horizontal Angulation beyond the POS

Scapular protraction and or winging beyond normal POS

Question 21

Internal Impingement capsuloligamentous laxity

Answer 21

Excessive Ant HH translation
IGHL laxity
GH apprehension and relocation tests

Question 22

Test Item cluster for shoulder impingement syndrome

Answer 22

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

Question 23

Calcific Tendonitis

Answer 23

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

Question 24

Bicipital Tendonitis

Answer 24

Bicipital groove or Glenoid origin of tendon

Question 25

Bicipital tendonitis intraarticular etiology

Answer 25

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

Question 26

Bicipital tendonitis extraarticular etiology

Answer 26

Impingement Bicipital groove tendon subluxation Spur Tenosynovial sheath consideration

Question 27

Shoulder Bursitis

Answer 27

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

Question 28

Rotator Cuff Tears

Answer 28

End result of a degenerative process | Impingement, eccentric overload, vascular or collagen disease process

Question 29

Small RC tear

Answer 29

<1 cm

Question 30

Medium RC tear

Answer 30

< 3 cm

Question 31

Large RC tear

Answer 31

< 5 cm

Question 32

Massive RC tear

Answer 32

> 5 cm

Question 33

Partial RC tears

Answer 33

Classification by location - Articular side - Mid substance - Bursal side

Question 34

RC tear progression

Answer 34

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

Question 35

RC poor healing

Answer 35

Retraction of muscle portion of tear | Tear is bathed in synovial fluid

Question 36

Test item cluster for RC tear

Answer 36

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

Question 37

Partial RC tear incidence

Answer 37

High middle aged

Question 38

Full RC tear incidence

Answer 38

Above 65

Question 39

GH dislocations

Answer 39

Complete dissociation of articular surfaces high recurrance rate

Question 40

Anterior GH dislocations

Answer 40

Subcoracoid Subglenoid Subclavicular

Question 41

Posterior GH dislocations

Answer 41

Subacromial Subglenoid Subspinous

Question 42

Inferior GH dislocations

Answer 42

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

Question 43

Superior GH dislocations

Answer 43

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

Question 44

GH subluxation

Answer 44

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

Question 45

GH instability across the lifetime

Answer 45

20 y/o atraumatic | 30 traumatic