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Fall Semester PM Exam 1 > Surgical Shoulder Injuries > Flashcards

Surgical Shoulder Injuries Flashcards

1
Q

3 scapular stabilizers

A

SA, rhomboids, levator scap

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2
Q

quadrilateral space syndrome

A

axillary nerve gets compressed between muscles, causing shoulder pain

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3
Q

damage to which nerve can cause scapular winging?

A

long thoracic nerve

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4
Q

___ nerve lesion is a common cause of RTC atrophy/tear in young adults?

A

suprascapular nerve

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5
Q

impingment sign

A

pain with lifting arm above head

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6
Q

MRI scans are good to see which structures?

A

soft tissue

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7
Q

CT scans are good to see which structures?

A

boney anatomy

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8
Q

rotator cuff disease involves which 3 pathologies?

A

acute strains, impingement, and cuff tears

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9
Q

rotator cuff disease can be ___ or ___

A

due to intrinsic or extrinsic factors

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10
Q

Intrinsic pathogenesis of cuff disease

A

vascular

- critical zone involves area of supraspinatus that does not receive much blood supply.

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11
Q

Extrinsic pathogenesis of cuff disease

A

compression of cuff due to acromial shape

  • flat (good)
  • curved
  • hooked (very bad, affects 5-10% of pop) - bursa/supraspinatus gets pinched against the acromion with overhead activities
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12
Q

3 stages of NEER (RTC disease)

A

inflammation
fibrosis
tearing

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13
Q

T/F rotator cuff tears become “normal” with age

A

true – up to 30% of pop over age 60 has some sort of RTC tear

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14
Q

non operative treatment for RTC disease

A
  • activity modification
  • NSAIDs
  • capsular stretching!!!! espc posterior capsule
  • cuff strengthing
  • treat for 3 months before considering surgery
  • cortisone injections
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15
Q

what is the most important aspect of non operative treatment for RTC disease

A

capsular stretching, especially to the posterior capsule

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16
Q

operative treatment for impingement

A

arthroscopic decompression to convert tye 2 or 3 acromion to type 1

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17
Q

operative treatment for cuff repair

A

acute tear: repair within 3-4 weeks

chronic: repair if not better within 3 months

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18
Q

T/F all RTC surgeries are arthroscopic

A

true

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19
Q

4 key elements to RTC surgery

A
  1. acute vs chronic tear
  2. extent of tear
  3. bony abnormalities
  4. patient expectations and activity level
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20
Q

When do you suspect larger RTC tears?

A
  • insidious onset
  • substantial atrophy
  • loss of aROM
  • loss of subacromial space
  • older pt
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21
Q

surgical outcomes with traditional open repair

A

good for small to medium tears. positive outcomes decrease for larger tears

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22
Q

standard of care for RTC surgeries?

A

arthroscopic. avoids damage to deltoid but does not mean shorter healing problems. also allows for ability to evaluate other problems.

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23
Q

how long does it take before tissue regains normal tensile strength following RTC surgery?

A

6 months

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24
Q

4 Goals of all techniques for RTC repair surgery

A
  1. eliminate impingement
  2. close the defect
  3. preserve deltoid fxn
  4. prevent post-op adhesions
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25
When is open approach used for RTC repair?
- large tear in older adults - obese - re-do's - subscap tear
26
When is scope used for RTC repair?
- small to moderate tears - younger and more active - massive tears in older pts???
27
Phase 1 of post op rehab for RTC repair
- regain motion via pendulums and PROM - be careful in impingement zone (70-120) - long sustained stretches - ice
28
phase 2 of post op rehab for RTC repair
- AAROM - therabands - no abduction until trap and SA strong enough to rotate scapula - shrugs, push ups
29
how long does phase 1 of post op rehab for RTC repair last?
first 6-8 weeks
30
phase 3 of post op rehab for RTC repair
- progressive strengthening - tensile strength at 3 months is only 50% - total rehab time is 4-6 months
31
when is a patient at phase 3 of post op rehab for RTC repair?
3 months post op
32
Shoulder Instability exam
- apprehension - sulcus sign - ligamentous laxity - relocation test
33
classification of shoulder instability
direction, cause, degree, and control
34
95% of shoulder instability occurs i nwhich direction?
anterior
35
associated injuries with shoulder instability (2)
1. vascular (rare) | 2. neurologic
36
neurologic injuries associated with shoulder instability
1. axillary nerve palsy: numbness over lateral deltoid. resolves in 4-6 months 2. musculocutaneous: weak biceps and forearm numbness
37
conservative treatment for shoulder instability
- Immboilize for 3-6 wks - PT for 6-12 wks many re-dislocate!!!! regardless of PT or time spent in immobilization immobilize in ER! not IR! - less likely to re-dislocate
38
when is open surgery done for shoulder instability?
- poor tissue or capsular laxity - collision athletes - bone defects highest success rates with open surgery!
39
when is arthroscopic surgery done for shoulder instability?
- no bony defects - non-collision athlete - no capsular defects - few dislocations - high demand throwers does not heal faster!
40
risk of developing severe arthritis is ___ times greater for those who have dislocated1
10-20
41
____ is where ligaments attach to the socket ? (??)
labrum ?
42
what does SLAP stand for?
superior labral tear from anterior to posterior
43
average age of SLAP tear and location
age = 37 location = near biceps origin true slap tear occurs from biceps pulling on labrum
44
etiology of SLAP tear
contraction of biceps creates shear force perpendicular to labrum
45
3 mechanisms of injury for labral tear
1. fall onto outstretched hand 2. deceleration wearinga seat belt 3. cumulative throwing injury
46
best test for diagnosing labral tear
biceps load test (MRI's also good)
47
Type 1 SLAP tear
- degenerative - older pt (over age 40) - trtmt = debridement
48
type 2 SLAP tear
- most common (>50%) - traumatic - throwers - trtmt = repair
49
most common type of SLAP tear
type 2!
50
3 subtypes of type 2 SLAP tear
1. anterior 2. posterior 3. combined
51
describe an anterior type 2 SLAP tear
traumatic
52
describe a posterior type 2 SLAP tear
- instability | - usually throwing athletes
53
arthroscpoic findings of labral tears: drive through
means shoulder is loose/lax if shoulder is not loose once under anesthesia, it is not a labral tear. everything must add up. (history, emchanis of injury, etc)
54
how do you treat a type 3 slap tear
debride
55
how do you treat a type 4 slap tear
debride and repair
56
Labral tear rehab: 0-8 weeks
- avoid last 15 degrees of ER in abduction - encourage IR in abduction - no lifting more than 1 pound with biceps - will pull on repair - goal is 45 degrees of ER by 3 weeks
57
what is the goal of Labral tear rehab: 0-8 weeks?
45 degrees ER by 3 weeks
58
main point of Labral tear rehab: 0-8 weeks
avoid ER, encourge IR
59
labral tear rehab: 8-12 weeks
- cuff PREs | - arm cocking
60
labral tear rehab: 3-4 months
interval throwing
61
labral tear rehab: 4-6 months
throw off mound
62
labral tear rehab: 7 months
return to full throwing
63
which aspect of the capulse is often tight in overhead throwing athletes
posterior capsule. can have GIRD -- glenohumeral IR deficiency. risk of SLAP tears can be almost completely eliminated by stretching the posterior capsule
64
Keys to labral tears
- make sure hx fits dx - allow adequate time for rehab and healing - may be preventable in throwers via stretching - prepare pt that will not know if labrum is actually torn until surgery

Fall Semester PM Exam 1 (5 decks)

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