Shoulder ppt Flashcards
T/F the shoulder is the only joint in the body where tendons pass between bones.
True
rotator cuff tendons pass between acromion and humerus
What is the most sensitive indicator of joint disease?
evaluation of ROM
What are some traumatic extra-articular injuries of joints?
fracture, dislocation, soft tissue injury to ligaments, tendons, bursae, muscle, fascia, nerve
What are some traumatic intra-articular injuries of joints?
fracture, dislocation, soft tissue injury to joint capsule, articular cartilage, synovium, synovial fluid, intra-articular ligaments
What are some atraumatic extrinsic/referred causes of joint pain?
systemic disease, referred
What are some atraumatic intrinsic extra-articular causes of joint pain?
bone, soft tissue - myofascial injury, overuse injuries, bursitis, joint instability
What are some atraumatic intrinsic intra-articular causes of joint pain?
bone, soft tissue - arthritis, synovitis, capsulitis
What are traumatic causes of shoulder pain related to the bone?
fractures: clavicle, proximal humerus
dislocations: glenohumeral
What are traumatic causes of shoulder pain related to the soft tissue?
ligamentous injuries: acromial clavicular ligament
tendon injuries: rotator cuff
myofascial injuries
joint cartilage or capsule: labral tear
What age ranges are clavicle fractures most common?
kids and young adults
What age range is proximal humeral fracture most common?
elderly
What is scapular fracture associated with?
blunt trauma
What is the most common type of glenohumeral dislocation?
anterior
95-97 percent
What are the three types of glenohumeral dislocations?
anterior
posterior
inferior
What does acromioclavicular joint injury usually occur from?
direct trauma to the superior or lateral aspect of the acromion with the arm adducted
direct blow, falling onto shoudler
What are the types of AC injuries?
AC sprain, AC ligament rupture, sprain and rupture of coracoclavicular ligaments
What are PE findings for AC joint injuries?
tenderness directly over AC joint, possibly associated with deformity
Diagnostic testing for AC joint
single AP radiograph including both AC joints or US
What is AC joint dislocation called?
shoulder separation
What are the types of AC ligament injuries?
I - stretched
II - partial ligament rupture AC
III - complete rupture AC and CC ligaments
IV - clavicle displaced posterior over acromion
V - clavicle displaced just under skin
VI - clavicle underneath coracoid (very rare)
What are the rotator cuff muscles?
supraspinatus
infraspinatus
teres minor
subscapularis
What rotator cuff muscle is most commonly injured?
supraspinatus
What are risk factors for rotator cuff injury?
rotator cuff impingement, older age
repetitive overhead activity in sport or work
What are the symptoms of rotator cuff injury?
shoulder pain, more prevelent with overhead activity
What are PE findings of rotator cuff injuries?
tenderness over affected musculature or focal subacromial tenderness at the lateral or posterior lateral border of acromion
What are specialty tests for rotator cuff?
painful arc neer impingement hawkins test yergason sign empty can test drop arm test
Diagnostics for rotator cuff injury?
US or MRI
treatment of rotator cuff injury?
rest, ice, NSAIDs, physical therapy
ortho referral if no improvement or suspect a tear
impingement syndrome
symptoms resulting from compression of the rotator cuff tendons and the subacromial bursa between the greater tubercle of the humeral head and the lateral edge of the acromion process.
tendon injury of the rotator cuff
sprain or partial/complete tear
occur as the end result of chronic subacromial impingement, progressive tendon degeneration, traumatic injury, or combo of factors
most occur in suprapinatus tendon
tendinopathy of rotator cuff
chronic injury to the supraspinatus (abduction) and/or infraspinatus (external rotation) tendons
develops with repetitive activity, generally at or above shoulder height which leads to tendon degeneration and microvascular insult
extrinsic neurologic causes of shoulder pain
cervical radiculopathy (C5-C6) brachial plexus lesions herpes zoster spinal cord lesion cervical spine DJD thoracic outlet syndrome
extrinsic abdominal causes of shoulder pain
hepatobiliary disease
diaphragmatic irritation
extrinsic cardiovascular causes of shoulder pain
acute MI
axillary vein thrombosis
extrinsic pulmonary causes of shoulder pain
upper lobe pneumonia
apical lung tumor
pulmonary embolism
intrinsic causes of shoulder pain
overuse injury shoulder instability rotator cuff tendinopathy or impingement syndrome subacromial bursitis synovitis adhesive capsulitis bicepital tendinitis osteoarthritis myofascial pain septic arthritis gout
What are the top causes of acute shoulder pain?
rotator cuff injury fracture - clavicle and proximal humerus dislocation GH joint acromioclavicular sprain, tear myofascial injury
What are the top causes of chronic shoulder pain?
rotator cuff disorders
adhesive capsulitis
shoulder instability
shoulder arthritis
What are the top causes of life threatening shoulder pain?
septic arthritis
referred pain - acute MI, intraperiotoneal hemorrhage, lung pathology
What are the risk factors for septic arthritis?
age > 80 yo diabetes mellitus rheumatoid arthritis prosthetic joint recent joint surgery skin infection IV drug abuse alcoholism prior intraarticular costicosteroid injection
What are PE findings of septic arthritis?
erythema, swelling, warmth, pain
active and passive ROM limited
What are signs of systemic disease in septic arthritis?
fever, tachycardia, hypotension
Diagnosing septic arthritis
plain film XR - normal with effusion
Lab: elevated CBC, ESR, and CRP
Aspiration: synovial fluid with WBCs and bacteria
Treatment of septic arthritis
Antibiotics: broad spectrum after aspiration and blood cultures
surgical washout of joint
