UE part 1 trigger Flashcards
what rotator cuff muscles do external rotation
teres minor and infraspinatus
hornblower tests what muscles
infraspinatus and teres minor
gerber lift off tests what muscle
subscapularis
stabilizing the scapula, flexing the shoulder to 90 degrees and applying posterior force should assess for what muscle weakness if winging is present?
serratus anterior
what test compresses the rotator cuff tendons between greater tuberosity & anterior acromion?
what does a positive test suggest?
neer impingement test
+ = rotator cuff tear or impingement syndrome
what test assesses for impingement of the supraspinatus tendon specifically
hawkins kennedy
what test assesses for AC joint pathology or arthritis
crossover test
90d flexion + max internal rotation + elbow flex 90d
Adduct arm across horizontal while pushing humerus in posterior position
what test is this and what does it assess for
jerk test -> posterior shoulder instability
pain presenting at 60-120 degrees of abduction is indicative of what
shoulder impingement
gradual onset of shoulder pain anteriorly and laterally. night pain and difficulty sleeping on the affected side. pain worsened by overhead activity.
impingement syndrome
PE shows tenderness over greater tuberosity and subacromial bursa. pain w abduction between 90-120 as well as when lowering arm back down. crepitus w movement.
shoulder impingement
when do you use anesthetic injection for diagnosis?
differentiating between impingement and tear.
improvement of empty can after injection = impingement
when do you consider corticosteroid injections and PT in impingement disorder
Steroid injections - if no imporvemnet in 4-6 wks
PT if no improvement in 3-4 weeks
OT only if PT fails
caused by repetitive overhead moevement
rotator cuff tendonitis
risk factors include increased BMI, DM, and HLD
rotator cuff tendonitis
also pitching (repetitive movements duh)
presents with aching/soreness w throwing. decreased accuracy and performance. pain w ADLs. improvement w rest
stage 1 tendonitis
posterior shoulder pain with activity and at night. loss of ROM abduction and ext rotation. does not improve w rest
stage 2 tendonitis
Passive ROM>Active ROM. pain above 90d abduction. tenderness along affected muscles. + empty can, neers, and hawkins
rotator cuff tendonitis
MSK US shows hypoechogenicity, hyperechogenicity, and thickening by >5-6mm
Rotator cuff tendonitis
what radiograph view should you obtain for shoulder dislocation, proximal humerus or scapula fx
scapular Y view
what radiograph view should you recieve for humeral head and glenoid problems
axillary
Rest and no training for 10 days. Intermittent activity after 10 days is tx for what
stage 1 rotator cuff tendonitis
stage 2 = refer to PT (no activity)
pain worse with activity and at night with weakness, catching, and crepitus when lifting. inability to perform overhead ADLs
rotator cuff tear
PE shows + drop arm with full PROM and limited/painful AROM
rotator cuff tear
a shallow space between acromion and humerus on Xray is indicative of what
chronic rotator cuff tear
risk factors include T1DM, parkiinsons, hypothyroidism, and cerebral hemorrhage
adhesive capsulitis
cervical disc dz, dupuytrens
MRI shows contracted capsule and loss of inferior pouch
adhesive capsulitis
tx includes moist heat compression, stretching, PT with TENS unit, and intraarticular steroid injections (3-6 max)
adhesive capsulitis
when do you do an arthroscopic capsular release
in adhesive capsulitis if theres no improvement in s/s after 3 consistent months of rehab
pt presents with arm slightly abducted and in external rotation. Acromion is very prominent. what type of dislocation is this
anterior
pt presents with adducted and internally rotate shoulder. coracoid process is prominent. what type of dislocation is this?
posterior
presents with fully abducted arm and inability to adduct arm. what dislocation type is this
inferior
Depression fx of humeral head 2/2 dislocation is called what
hills sach lesion
glenoid labrum disruption, common in patients <30y/o. what is this also known as?
bankart lesion
can be reduced with stimson technique or with longitudinal traction
anterior shoulder dislocation
can be reduced with axial traction
inferior shoulder dislocation
can be reduced with traction-countertraction
posterior shoulder dislocation
Falling directly on an ADducted shoulder can cause what injury
acromioclavicular injury
pt presents supporting arm in an adducted position and reports pain in anterior shoulder over AC joint when abducting.
AC joint injury
when are Zanca X Rays used in UE
good for viewing AC injuries and clavicle fractures
sling with rest for 2-3 days but ROM started within 7-10 days. expected full recovery in 2-4 weeks
grade 1 and 2 AC injuries
use sling for 2-3 weeks. start ROM exercises as soon as tolerated. Expected recovery is 6-12 weeks. only do surgery if injury affects career!
AC grade 3 injury
severe pain over central chest with swelling and ecchymosis. medial clavicle is prominent
anterior sternoclavicular dislocation
severe pain in central chest with swelling and ecchymosis. pt is hoarse and reports dysphagia and UE paresthesias
posterior sternoclavicular dislocation
when do you jump straight to CT as first line imaging due to Xray not being sensitive to these injuries
sternoclavicular injuries
reduce w posterior traction and then apply a sling/figure 8 harness
anterior sternoclavicular dislocation
where do we see skin tenting
clavicular fractures
if medial clavicular fracture is suspected, what imaging should be used
CT chest w con
Pain reported in the anterior shoulder radiating to the elbow. it is worsened by activity and also at night. symptoms do relieve w rest & ice
biceps tendinopathy
What is yergason’s test and who is it positive in?
pain with supination when stabilizing the elbow at 90d.
present in biceps tendinopathy
64 yo pt reports carrying heavy groceries inside when he had a sudden onset of pain in his upper arm. he heard an audible snap and soon after developed ecchymosis and severe isolated swelling and protruding deformity in the mid-anterior portion of his proximal upper extremity. what is the dx and tx
rupture of the LHBT
conservative. will lose about 10% of strength. surgery only for young athlete/laborer
When is ORIF indicated for a proximal humeral fx?
- Displacement of > 1 cm or > 45deg angulation
- Displacement of greater tuberosity > 0.5 cm (rotator cuff involved)
what tx is indicated in a 4-part fx of the humerus due to risk of blood supply disruption to humeral head
prosthetic humerus
Splinting with U-shaped coaptation splint for 2 weeks, then humeral fx brace for 6 weeks
encourage ROM of distal upper extremity
humeral shaft fx with angulation <20 d
