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Ortho Test 4 > Shoulder Pathos > Flashcards

Shoulder Pathos Flashcards

1
Q

what is the most common MOI for ACJ injuries?

A

medial/inferior force to the ACJ - football or fall

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2
Q

what is the order of structures injured in an ACJ injury?

A

AC ligament > CC ligament > delt/trap attachments

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3
Q

what is a type 1 ACJ injury?

A

AC ligament sprain

CC ligament intact

delt/trap intact

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4
Q

what is a type 2 ACJ injury?

A

AC ligaments disrupted

CC ligaments sprained

delt/trap intact

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5
Q

what is a type 3 ACJ injury?

A

AC ligaments disrupted

CC ligaments disrupted (25-100% larger space)

delt/traps detached

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6
Q

what is the major difference between a type 3 and type 4 ACJ injury?

A

the clavicle is posteriorly displaced in a type 4 injury

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7
Q

what is the major difference between a type 3 and type 5 ACJ injury?

A

ACJ grossly displaced 100-300% requiring surgery

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8
Q

what is the major difference between a type 3 and a type 6 ACJ injury?

A

the clavicle is displaced inferiorly

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9
Q

although the most common ACJ MOI is a direct blow, what are three other MOIS?

A
  1. FOOSH
  2. elbow jammed upward
  3. traction
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10
Q

what are the two sports most commonly associated with ACJ arthrosis

A

baseball and weightlifting

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11
Q

which three items clue you in to an ACJ pathology?

A
  1. MOI
  2. focal pain at ACJ w radiation proximally
  3. delt is round, but depressed
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12
Q

what are the four major special tests you should use to dx an ACJ pathology

A
  1. o’brien’s active compression
  2. cross body adduction
  3. ACJ TTP
  4. end range painful arc
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13
Q

what three classifications can be made for impingement?

A

internal, external subacromial, external subcoracoid

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14
Q

describe internal impingement

A

infra/supraspinatus impinges between labrum/glenoid and greater tuberosity causing tendon fraying and pain

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15
Q

what is the typical patient profile for internal impingement? when does the majority of pain occur?

A

young overhead throwers during the late cocking phase

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16
Q

what is tight in internal impingement?

A

posterior IGHL

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17
Q

what is the most common structure of acromion associated with impingement?

A

type 3 hooked in 70% of cadaveric shoulders

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18
Q

where do we observe external impingement pain in the painful arc test?

A

60-120 abd > flexion

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19
Q

what is GIRD? who has it?

A

loss of GH IR due to bone changes, posterior capsule tightness, or RTC tightness

throwing athletes

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20
Q

What is the CPG to rule in shoulder pain from muscle power deficits? (4)

A
  1. symptoms worsen with repetitive overhead mvmts
  2. midrange catching
  3. midrange resistance flx/abd pain
  4. weak RTC
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21
Q

what is the CPG to rule out shoulder pain from muscle power deficits? (4)

A
  1. resistive tests pain-free
  2. supra/infra/biceps normal strength
  3. loss of PROM
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22
Q

define multidirectional instability of the GHJ

A

MDI: symptomatic laxity in two or more directions, one of which is always inferior

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23
Q

differentiate between laxity and instability

A

laxity - extent to which the humeral head can be translated on the glenoid

instability - abnormal increase in GH translation causing symptoms related to sublux/dislocation

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24
Q

what are the two classifications of instability?

A

AMBRI and TUBS

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25
Q

what is AMBRI

A

atraumatic, multidirectional, bilateral, rehab effective, inferior capsule shift

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26
Q

what is TUBS

A

traumatic dislocation, unidirectional, bankhart, surgery

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27
Q

what is the most common pathology seen in anterior shoulder dislocations?

A

bankart lesion

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28
Q

what is a bankart lesion?

A

(aka Perthes lesion) avulsion of the glenoid labrum in the anterior inferior quadrant

29
Q

what is are typical MOIs for Bankart lesions?

A

QB blocked throw, blocked dunk (abd, ext, ER)

30
Q

what is a hill-sachs lesion? what causes it?

A

compression fx of the post/lat humeral head occuring over time with anterior dislocations

31
Q

what do you find on examination of an anterior dislocation?

A
  1. FLATTENED DELTOID
  2. increased acromial prominence
  3. arm in a protected position, acute
32
Q

during a fx or complete tear (severe trauma) which nerve are we worried about and what does it supply

A

axillary - deltoid and teres minor

33
Q

in what pt demographic are recurrence rates of anterior dislocation highest? (90%)

A

< 20 after traumatic dislocation

34
Q

what exam findings do you expect in this patient?

A
  1. ER < 0
  2. elevation < 90
  3. IR and horiz add cause pain
35
Q

what causes posterior dislocations? what two anatomical changes can occur?

A

FOOSH; reverse bankhart and reverse hill sachs

36
Q

what is a type 1 SLAP tear

A

labral degeneration (frayed edges), but no avulsion

37
Q

what is a type 2 slap tear?

A

most commonly reported - complete labral detachment from ant/sup to post sup, thus causing biceps tendon instability

38
Q

what is a type 3 SLAP tear?

A

bucket handle displacement of labrum into the joint, BUT no instability of the biceps tendon

39
Q

what is a type 4 SLAP lesion?

A

similar to type 3 but the labrum AND biceps tendon are detached

40
Q

what is the CPG for ruling IN shoulder instability? (5)

A
  1. <40
  2. hx of dislocations
  3. excessive GHJ accessory motion in multiple planes
  4. apprehension at endrange
  5. deep ache intermittant pain (w or without click) worse with overhead
41
Q

what is the CPG to rule OUT shoulder instability

A
  1. no hx of dislocation
  2. globally limited ROM
  3. no apprehension
42
Q

how do you identify scapular dyskinesis

A

SICK for overhead athletes

S: scap malposition

I: inferior medial border prominent

C: coracoid pain

K: dysKinesis

43
Q

how does kibler classify scap diskinesis?

A

type 1 = inferior

type 2 = medial

type 3 = superior

named after whats visually prominent

44
Q

an inferior angle will become more prominent with which position cue?

A

hands on hips

45
Q

which muscle are weak in type 1 scap dyskinesis

A

LT, lats, SA

46
Q

which muscles are weak in type 2 scap dyskinesis?

A

rhomboids, all traps, and SA

47
Q

describe kiblers scap assistance test

A

for PAINFUL type 1 scap dyskinesis, stabilizing the inferior angle of the scap during movement will decrease pain

48
Q

describe kiblers scap retraction test

A

for PAINFUL type 2 scap dyskinesis, positive if stablizing the medial border during motion decreases pain

49
Q

what is flip sign?

A

resisted ER protrustion of scap signalling weak infraspin and teres minor

50
Q

what three things cause frozen shoulder?

A
  1. stiffening capsule, lig, tendon
  2. adhesions along RTC surface
  3. adhesions in biceps tendon
51
Q

what is the profile for frozen shoulder?

A
  1. 40-65 years
  2. female
  3. minor injuries
  4. non-shoulder surgeries
  5. immobility
  6. systemic diseases (esp diabetes)
52
Q

how long does frozen shoulder last?

A

self-limiting 1-3 years but mob deficits up to 10 years

53
Q

what is the recurrence for frozen shoulder? unilateral or bilateral?

A

recurrence and bilateral rare

54
Q

what are the three stages of frozen shoulder?

A
  1. painful freezing
  2. frozen
  3. thawing
55
Q

decribe stage 1 frozen shoulder

A

3-9 months

  • severe pain esp lying on side
  • sleep problems
  • absence of PROM limitation
  • synovitis upon arthroscopy
56
Q

describe stage 2 frozen shoulder

A

4-12 months

  • pain gradually diminishes
  • stiffness increases
  • PROM limited in all directions by 50% (ER most)
  • capsule hypertrophy/CHL contracture
57
Q

describe stage 3 frozen shoulder

A

12-42 months

  • pain beginning to resolve
  • persistent but resolving stiffness
58
Q

which three systemic diseases are majorly implicated in frozen shoulder

A
  • diabeetus
  • thyroid disease
  • autoimmune diseases
59
Q

what are the CPG criteria to rule in frozen shoulder?

A
  • 45-60 years
  • gradual onset of pain and stiffness
  • PROM limited in multiple directions (esp ER)
  • ER/IR decreases at 90 GH abd
60
Q

what are the CPG criteria to rule out frozen shoudler

A
  • PROM normal
  • ER/IR increases at 90 abd
  • TTP
  • ULTT repro of sxs
61
Q

how do you manage highly irritable frozen shoulder pts (4)

A
  1. heat/stim for pain
  2. positioning and act mods
  3. easy mobs
  4. pain free PROM to induce synovium mvmt
62
Q

how do you manage moderately irritable frozen shoulder patients

A

same as for irritable but mobilize to R1

63
Q

how do you manage nonirritable frozen shoulder pts

A

work em!

  1. high amplitude and long duration mobs
  2. stretching to pain tolerance
64
Q

which three outcomes would you use for frozen shoulder

A
  • DASH
  • SPADI (shoulder pain and disability)
  • ASES (american shoulder and elbow surgeons)
65
Q

where can the suprascapular nerve impinge? profile?

A

supraspinous fossa/suprascap notch

45% volleyball players or RTC full thickness tears

66
Q

how would you describe suprascapular nerve pain and what would be the major objective finding?

A

vague, dull, burning, diffuse ache posterolaterally; painless weakness to resisted abduction/ER

67
Q

what causes a spinal accessory nerve injury and what muscles can it affect?

A

stretch/whiplash, compression from backpack, lymph node surgery

SCM and UT

68
Q

what causes Parsonage Turner Syndrome (LTN injury) and what muscle does it affect?

A

prolonged arm traction with head turned away; SA

69
Q

quadrilateral space syndrome - low yield

A

humerus shaft, long head triceps, teres minor, teres major

contents: axillary n and post humeral circumflex artery

dead arm/vague pain and weakness overhead

Ortho Test 4 (7 decks)

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