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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
Q

When is open approach used for RTC repair?

A
  • large tear in older adults
  • obese
  • re-do’s
  • subscap tear
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26
Q

When is scope used for RTC repair?

A
  • small to moderate tears
  • younger and more active
  • massive tears in older pts???
27
Q

Phase 1 of post op rehab for RTC repair

A
  • regain motion via pendulums and PROM
  • be careful in impingement zone (70-120)
  • long sustained stretches
  • ice
28
Q

phase 2 of post op rehab for RTC repair

A
  • AAROM
  • therabands
  • no abduction until trap and SA strong enough to rotate scapula
  • shrugs, push ups
29
Q

how long does phase 1 of post op rehab for RTC repair last?

A

first 6-8 weeks

30
Q

phase 3 of post op rehab for RTC repair

A
  • progressive strengthening
  • tensile strength at 3 months is only 50%
  • total rehab time is 4-6 months
31
Q

when is a patient at phase 3 of post op rehab for RTC repair?

A

3 months post op

32
Q

Shoulder Instability exam

A
  • apprehension
  • sulcus sign
  • ligamentous laxity
  • relocation test
33
Q

classification of shoulder instability

A

direction, cause, degree, and control

34
Q

95% of shoulder instability occurs i nwhich direction?

A

anterior

35
Q

associated injuries with shoulder instability (2)

A
  1. vascular (rare)

2. neurologic

36
Q

neurologic injuries associated with shoulder instability

A
  1. axillary nerve palsy: numbness over lateral deltoid. resolves in 4-6 months
  2. musculocutaneous: weak biceps and forearm numbness
37
Q

conservative treatment for shoulder instability

A
  • 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
Q

when is open surgery done for shoulder instability?

A
  • poor tissue or capsular laxity
  • collision athletes
  • bone defects
    highest success rates with open surgery!
39
Q

when is arthroscopic surgery done for shoulder instability?

A
  • no bony defects
  • non-collision athlete
  • no capsular defects
  • few dislocations
  • high demand throwers
    does not heal faster!
40
Q

risk of developing severe arthritis is ___ times greater for those who have dislocated1

A

10-20

41
Q

____ is where ligaments attach to the socket ? (??)

A

labrum ?

42
Q

what does SLAP stand for?

A

superior labral tear from anterior to posterior

43
Q

average age of SLAP tear and location

A

age = 37
location = near biceps origin
true slap tear occurs from biceps pulling on labrum

44
Q

etiology of SLAP tear

A

contraction of biceps creates shear force perpendicular to labrum

45
Q

3 mechanisms of injury for labral tear

A
  1. fall onto outstretched hand
  2. deceleration wearinga seat belt
  3. cumulative throwing injury
46
Q

best test for diagnosing labral tear

A

biceps load test (MRI’s also good)

47
Q

Type 1 SLAP tear

A
  • degenerative
  • older pt (over age 40)
  • trtmt = debridement
48
Q

type 2 SLAP tear

A
  • most common (>50%)
  • traumatic
  • throwers
  • trtmt = repair
49
Q

most common type of SLAP tear

A

type 2!

50
Q

3 subtypes of type 2 SLAP tear

A
  1. anterior
  2. posterior
  3. combined
51
Q

describe an anterior type 2 SLAP tear

A

traumatic

52
Q

describe a posterior type 2 SLAP tear

A
  • instability

- usually throwing athletes

53
Q

arthroscpoic findings of labral tears: drive through

A

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
Q

how do you treat a type 3 slap tear

A

debride

55
Q

how do you treat a type 4 slap tear

A

debride and repair

56
Q

Labral tear rehab: 0-8 weeks

A
  • 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
Q

what is the goal of Labral tear rehab: 0-8 weeks?

A

45 degrees ER by 3 weeks

58
Q

main point of Labral tear rehab: 0-8 weeks

A

avoid ER, encourge IR

59
Q

labral tear rehab: 8-12 weeks

A
  • cuff PREs

- arm cocking

60
Q

labral tear rehab: 3-4 months

A

interval throwing

61
Q

labral tear rehab: 4-6 months

A

throw off mound

62
Q

labral tear rehab: 7 months

A

return to full throwing

63
Q

which aspect of the capulse is often tight in overhead throwing athletes

A

posterior capsule. can have GIRD – glenohumeral IR deficiency. risk of SLAP tears can be almost completely eliminated by stretching the posterior capsule

64
Q

Keys to labral tears

A
  • 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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