The Shoulder Lecture Powerpoint Flashcards
4 articulations of the shoulder
- glenohumeral
- scapulothoracic
- acromioclavicular
- sternoclavicular
Glenoid labrum function
Improve the stability of the head of the humerus that sits in the glenoid fossa
Painful arc
Painful range of motion from 60 to 120 degrees of abduction of the shoulder that often indicates rotator cuff tear or subacromial impingement symptoms
Scapular outlet “y” view
Diagnostic radiograph for the shoulder directed from behind to see how narrowed the subacromial space is or detect osteophytes indicative of impingement
Rotator cuff strain, tentinitis/tendinosis, impingement definition
Disorder often resulting from repetitive use injury or anatomical predisposition, possible to present at any age, shoulder pain most often present when attempting to abduct the shoulder as well as inability to lay on affected shoulder, locking sensation occasionally, loss of ROM especially external rotation, most often due to supraspinatous muscle being pinched by decreased subacromial space as it is responsble for allowing that abduction, subacromial bursa attached to supraspinatous becomes inflamed and irritated
Acromial types (3)
Flat (type 1)
Curved (type 2)
Hooked (type 3)
Rotator cuff strain, tentinitis/tendinosis, impingement treatment options (5)
- rest, NSAIDS
- maintain ROM to prevent adhesive capsulitis
- local steroid injection
- PT
- surgery in severe cases
Tear/rupture of rotator cuff definition
Typically from FOOSH, heavy lifting, repetitive throwing, trauma, etc, uncommon prior to 40 years of age, supraspinatous muscle most common**, snap or popping sensation may have been felt, inability to abduct or flex shoulder, night pain in deltoid region,
What is the most common muscle torn in rotator cuff injury?
Supraspinatous
Drop arm test
Placing shoulder into abduction passively and suddenly letting go seeing it drop immediately indicative of rotator cuff tear
Studies for rotator cuff tear (2)
- plain films
- MRI with an arthrogram (to assess capsule integrity)
Individuals with a torn rotator cuff, when asked to abduct their shoulder, will often do what?
Shrug their shoulders up and lean to one side in order to try to compensate for the weakness to elevate the shoulder
Rotator cuff tear treatment options (2)
- rest, rehab, PT, NSAIDS for minor tears
- surgical repair in selected patients
Calcific tendonitis definition
Degenerative changes often with advanced age of supraspinatous tendon, see gradual or acute onset of shoulder stiffness and severe pain, aggrivated by any motion of shoulder, active at night, pain radiates to deltoid and down arm, x rays display the calcium deposits
Calcific tendonitis treatment options (5)
- local steroid injection
- NSAIDS or analgesics/sedatives
- aspiration
- PT
- surgery
Biceps tenosynovitis definition
Repetitive strain injury seeing pain over anterolateral shoulder down anterior arm with limited ROM, tenderness over bicipital groove, positive yergsons or speeds test
Most common cause of shoulder pain age >40 years
Biceps tenosynovitis
Biceps tenosynovitis treatment options (2)
- avoid immobilization (adhesive capsulitis will occur)
- rest, NSAIDS, PT
Adhesive capsulitis (frozen shoulder) definition what are the two most common presenting symptoms?
Etiology unknown, usually follows period of inactivity or minor injury, insidious onset, usually in 5th decade, pain localized to rotator cuff and anterior arm and interferes with sleep, see pain and decreased range of motion***
Adhesive capsulitis diagnosis (2) and treatment (2)
- shoulder series x ray
- rule out posterior shoulder dislocation
- physical therapy do not wait!
- manipulation under anesthesia
Glenohumeral dislocations (anterior vs posterior) causes
Anterior most often fall on externally rotated abducted arm, posterior most often force against internally rotated arm such as seizure or convulsive disorders
Hill sachs lesion
Indentation of superolateral humeral head in recurrent anterior shoulder dislocations (chip of bone taken out of head oof humerus)
Bankart lesion
Tear of lesion or possibly bone most often in anterior in shoulder dislocations from glenoid fossa
Glenohumeral dislocations treatment options (3)
- primary manipulative reduction often with IV sedation
- open reduction in recurrent cases
- immobilization of shoulder
Most glenohumeral dislocations are… (anterior or posterior)
anterior
Acromioclavicular separation
Usually from a fall on shoulder or direct blow to top of shoulder, sees tenderness and swelling of AC joint, elevation of distal clavicle, painful/limited ROM of shoulder
Studies for acromioclavicular separation (2)
- plain x rays
- AP x rays with weighted arm differentiates complete and incomplete separations
What type of clavicle fracture has higher likelihood of needing ORIF?
Distal end fractures (proximal portion sticks up distal portion held together by coracoclavicular ligament)
Humeral shaft fractures and ORIF treatment place what nerve at high risk for injury?
Radial nerve
Radial nerve pathway in the upper extremity
Exits the subclavicular region and travels posteriorally down the back of the humerus before wrapping around laterally and then anteriorally by the time it hits the elbow joint
If a patient has shoulder pain not aggrivated by neeck or shoulder motion but has positive GI history, be concerned for….
…referred pain to top of shoulder via phrenic nerve (C345 innervate diaphragm) could be abdominal cause
