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PCM Midterm > Shoulder ppt > Flashcards

Shoulder ppt Flashcards

1
Q

T/F the shoulder is the only joint in the body where tendons pass between bones.

A

True

rotator cuff tendons pass between acromion and humerus

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2
Q

What is the most sensitive indicator of joint disease?

A

evaluation of ROM

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3
Q

What are some traumatic extra-articular injuries of joints?

A

fracture, dislocation, soft tissue injury to ligaments, tendons, bursae, muscle, fascia, nerve

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4
Q

What are some traumatic intra-articular injuries of joints?

A

fracture, dislocation, soft tissue injury to joint capsule, articular cartilage, synovium, synovial fluid, intra-articular ligaments

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5
Q

What are some atraumatic extrinsic/referred causes of joint pain?

A

systemic disease, referred

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6
Q

What are some atraumatic intrinsic extra-articular causes of joint pain?

A

bone, soft tissue - myofascial injury, overuse injuries, bursitis, joint instability

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7
Q

What are some atraumatic intrinsic intra-articular causes of joint pain?

A

bone, soft tissue - arthritis, synovitis, capsulitis

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8
Q

What are traumatic causes of shoulder pain related to the bone?

A

fractures: clavicle, proximal humerus
dislocations: glenohumeral

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9
Q

What are traumatic causes of shoulder pain related to the soft tissue?

A

ligamentous injuries: acromial clavicular ligament
tendon injuries: rotator cuff
myofascial injuries
joint cartilage or capsule: labral tear

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10
Q

What age ranges are clavicle fractures most common?

A

kids and young adults

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11
Q

What age range is proximal humeral fracture most common?

A

elderly

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12
Q

What is scapular fracture associated with?

A

blunt trauma

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13
Q

What is the most common type of glenohumeral dislocation?

A

anterior

95-97 percent

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14
Q

What are the three types of glenohumeral dislocations?

A

anterior
posterior
inferior

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15
Q

What does acromioclavicular joint injury usually occur from?

A

direct trauma to the superior or lateral aspect of the acromion with the arm adducted
direct blow, falling onto shoudler

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16
Q

What are the types of AC injuries?

A

AC sprain, AC ligament rupture, sprain and rupture of coracoclavicular ligaments

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17
Q

What are PE findings for AC joint injuries?

A

tenderness directly over AC joint, possibly associated with deformity

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18
Q

Diagnostic testing for AC joint

A

single AP radiograph including both AC joints or US

19
Q

What is AC joint dislocation called?

A

shoulder separation

20
Q

What are the types of AC ligament injuries?

A

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)

21
Q

What are the rotator cuff muscles?

A

supraspinatus
infraspinatus
teres minor
subscapularis

22
Q

What rotator cuff muscle is most commonly injured?

A

supraspinatus

23
Q

What are risk factors for rotator cuff injury?

A

rotator cuff impingement, older age

repetitive overhead activity in sport or work

24
Q

What are the symptoms of rotator cuff injury?

A

shoulder pain, more prevelent with overhead activity

25
Q

What are PE findings of rotator cuff injuries?

A

tenderness over affected musculature or focal subacromial tenderness at the lateral or posterior lateral border of acromion

26
Q

What are specialty tests for rotator cuff?

A 
painful arc
neer impingement
hawkins test
yergason sign
empty can test
drop arm test
27
Q

Diagnostics for rotator cuff injury?

A

US or MRI

28
Q

treatment of rotator cuff injury?

A

rest, ice, NSAIDs, physical therapy

ortho referral if no improvement or suspect a tear

29
Q

impingement syndrome

A

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.

30
Q

tendon injury of the rotator cuff

A

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

31
Q

tendinopathy of rotator cuff

A

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

32
Q

extrinsic neurologic causes of shoulder pain

A 
cervical radiculopathy (C5-C6)
brachial plexus lesions
herpes zoster
spinal cord lesion
cervical spine DJD
thoracic outlet syndrome
33
Q

extrinsic abdominal causes of shoulder pain

A

hepatobiliary disease

diaphragmatic irritation

34
Q

extrinsic cardiovascular causes of shoulder pain

A

acute MI

axillary vein thrombosis

35
Q

extrinsic pulmonary causes of shoulder pain

A

upper lobe pneumonia
apical lung tumor
pulmonary embolism

36
Q

intrinsic causes of shoulder pain

A 
overuse injury
shoulder instability
rotator cuff tendinopathy or impingement syndrome
subacromial bursitis
synovitis
adhesive capsulitis
bicepital tendinitis
osteoarthritis
myofascial pain
septic arthritis
gout
37
Q

What are the top causes of acute shoulder pain?

A 
rotator cuff injury
fracture - clavicle and proximal humerus
dislocation GH joint
acromioclavicular sprain, tear
myofascial injury
38
Q

What are the top causes of chronic shoulder pain?

A

rotator cuff disorders
adhesive capsulitis
shoulder instability
shoulder arthritis

39
Q

What are the top causes of life threatening shoulder pain?

A

septic arthritis

referred pain - acute MI, intraperiotoneal hemorrhage, lung pathology

40
Q

What are the risk factors for septic arthritis?

A 
age > 80 yo
diabetes mellitus
rheumatoid arthritis
prosthetic joint
recent joint surgery
skin infection
IV drug abuse
alcoholism
prior intraarticular costicosteroid injection
41
Q

What are PE findings of septic arthritis?

A

erythema, swelling, warmth, pain

active and passive ROM limited

42
Q

What are signs of systemic disease in septic arthritis?

A

fever, tachycardia, hypotension

43
Q

Diagnosing septic arthritis

A

plain film XR - normal with effusion
Lab: elevated CBC, ESR, and CRP
Aspiration: synovial fluid with WBCs and bacteria

44
Q

Treatment of septic arthritis

A

Antibiotics: broad spectrum after aspiration and blood cultures
surgical washout of joint

PCM Midterm (9 decks)

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