The Shoulder Lecture Powerpoint

Question 1

4 articulations of the shoulder

Answer 1

• glenohumeral
• scapulothoracic
• acromioclavicular
• sternoclavicular

Question 2

Glenoid labrum function

Answer 2

Improve the stability of the head of the humerus that sits in the glenoid fossa

Question 3

Painful arc

Answer 3

Painful range of motion from 60 to 120 degrees of abduction of the shoulder that often indicates rotator cuff tear or subacromial impingement symptoms

Question 4

Scapular outlet “y” view

Answer 4

Diagnostic radiograph for the shoulder directed from behind to see how narrowed the subacromial space is or detect osteophytes indicative of impingement

Question 5

Rotator cuff strain, tentinitis/tendinosis, impingement definition

Answer 5

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

Question 6

Acromial types (3)

Answer 6

Flat (type 1)
Curved (type 2)
Hooked (type 3)

Question 7

Rotator cuff strain, tentinitis/tendinosis, impingement treatment options (5)

Answer 7

• rest, NSAIDS
• maintain ROM to prevent adhesive capsulitis
• local steroid injection
• PT
• surgery in severe cases

Question 8

Tear/rupture of rotator cuff definition

Answer 8

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,

Question 9

What is the most common muscle torn in rotator cuff injury?

Answer 9

Supraspinatous

Question 10

Drop arm test

Answer 10

Placing shoulder into abduction passively and suddenly letting go seeing it drop immediately indicative of rotator cuff tear

Question 11

Studies for rotator cuff tear (2)

Answer 11

• plain films

- MRI with an arthrogram (to assess capsule integrity)

Question 12

Individuals with a torn rotator cuff, when asked to abduct their shoulder, will often do what?

Answer 12

Shrug their shoulders up and lean to one side in order to try to compensate for the weakness to elevate the shoulder

Question 13

Rotator cuff tear treatment options (2)

Answer 13

• rest, rehab, PT, NSAIDS for minor tears

- surgical repair in selected patients

Question 14

Calcific tendonitis definition

Answer 14

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

Question 15

Calcific tendonitis treatment options (5)

Answer 15

• local steroid injection
• NSAIDS or analgesics/sedatives
• aspiration
• PT
• surgery

Question 16

Biceps tenosynovitis definition

Answer 16

Repetitive strain injury seeing pain over anterolateral shoulder down anterior arm with limited ROM, tenderness over bicipital groove, positive yergsons or speeds test

Question 17

Most common cause of shoulder pain age >40 years

Answer 17

Biceps tenosynovitis

Question 18

Biceps tenosynovitis treatment options (2)

Answer 18

• avoid immobilization (adhesive capsulitis will occur)

- rest, NSAIDS, PT

Question 19

Adhesive capsulitis (frozen shoulder) definition what are the two most common presenting symptoms?

Answer 19

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***

Question 20

Adhesive capsulitis diagnosis (2) and treatment (2)

Answer 20

• shoulder series x ray
• rule out posterior shoulder dislocation
• physical therapy do not wait!
• manipulation under anesthesia

Question 21

Glenohumeral dislocations (anterior vs posterior) causes

Answer 21

Anterior most often fall on externally rotated abducted arm, posterior most often force against internally rotated arm such as seizure or convulsive disorders

Question 22

Hill sachs lesion

Answer 22

Indentation of superolateral humeral head in recurrent anterior shoulder dislocations (chip of bone taken out of head oof humerus)

Question 23

Bankart lesion

Answer 23

Tear of lesion or possibly bone most often in anterior in shoulder dislocations from glenoid fossa

Question 24

Glenohumeral dislocations treatment options (3)

Answer 24

• primary manipulative reduction often with IV sedation
• open reduction in recurrent cases
• immobilization of shoulder

Question 25

Most glenohumeral dislocations are… (anterior or posterior)

Answer 25

anterior

Question 26

Acromioclavicular separation

Answer 26

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

Question 27

Studies for acromioclavicular separation (2)

Answer 27

• plain x rays

- AP x rays with weighted arm differentiates complete and incomplete separations

Question 28

What type of clavicle fracture has higher likelihood of needing ORIF?

Answer 28

Distal end fractures (proximal portion sticks up distal portion held together by coracoclavicular ligament)

Question 29

Humeral shaft fractures and ORIF treatment place what nerve at high risk for injury?

Answer 29

Radial nerve

Question 30

Radial nerve pathway in the upper extremity

Answer 30

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

Question 31

If a patient has shoulder pain not aggrivated by neeck or shoulder motion but has positive GI history, be concerned for….

Answer 31

…referred pain to top of shoulder via phrenic nerve (C345 innervate diaphragm) could be abdominal cause