UE part 1 X3 Flashcards
Rotator cuff general presentation
-pain over ant and lateral aspects of the shoulder
> radiates into the deltoid
-ROM decreased
> in ability to abduct arm about shoulder
-may catch
+ drop arm, empty can, neers hawkins possible
Tendonosis
Chronic degeneration of the muscles with age
Tendonitis
inflamation ass with repetative trauma ass with everday movement
what is-Rotator Cuff Tears Chronic
Degeneration, impigment, and overload
- overhead occupation
- variation of shoulder structure leading to narrowing under outer edge
- typ start as partial tear of suprspin and may progress to full tear
Roator Cuff acute tear
acute radiographs with neg finding
- assosiated with sig amount of force usually <30yrs
- often seen with labral pathology
RC tendonitis/impingment
Risk: repeated overhead act
- pain comes on gradually
- complain deep ache on lat shoulder
- Point tenderness
- ROM pain>90degress
- neers and hawkins test*
Chronic rotator cuff tear pres.
accumulation of imp and degen - comon men >40yrs - pain worse with overhead act and at night and messes with sleep - worsening pain +gradual weakness - subacromial tenderness *drop arm, empty can* restriccted ADLS >90 degrees
Physical exam for RC tear
Muscle weakness**
- weakness to abduction and xternal rotation
- loss of smoothness over overhead reaching
- weakness does not improve with analgesics
RC diagnosis
Overall to distinguid between tendinopathy and tear
- inject lidocane then do neers
- rediographs: elevation of the humeral head over 1 cm
- MRI study of choice when full thickness tear is suspected or pt has failed conservative x
- MR arthrogram preferred to evaluate labral path
Shoulder impingment syndrome Present
Similar to rotaror cuff tendonitis
- subacromia tenderness
- normal gelnohymeral joint rainge of motion Pain>90
strength is preserved**
Test** pain repro by pain with neers and hawkins and painful arc
Should imingment imaging
Radiography- usually normal
MSK U/S
MRI- good for chronic symptoms to rule out tear
Impingment Tx
Ice, NSAIDs, Activity mod
- no sling PT REFERAL
- f/u in 3 weeks
- can do corticosteroid inject if pain persists
Labral teat MOI and present
MOI: acute or repetative overuse
Pres:
acute: pain
CHronic: clicking
Bankart lesion vs SLAP labral tear
Bankart: inferior tear of rim associated with dilocation
SLAP: superior labrum ant post
Labral Tear Physical Exam
Biceps tendon pain GH joint rest IR/ER scapula motion dysfunction * specialized: glide test, speeds , obriens Imaging MRA>MRI and arthroscopy Tx: NSAIDS or acetaminophin, PT
Adhesive capsulitis Etiology and presentation
Chronic choulder pain with gradual GLABAL limitation in ROM
- stiffen GH join and may develop adhesions
- unknown cause but can be secondary to trauma
Adhesive Capsulitis
ROM test confirmed reduced ROM in 2 or more plane
- severe pain and mechanical restriction
-Abduction and ER!!
Appley Scratch Test
Injection test: to discern dx from other subacromical condition
Adhesive Capsulitis Imaging
Xray - not super helpful but common
MRI maay be helpful
Adhesive capsulitis Tx
-tx any underlying process, strethch lining of the joint , try and restore ROM, consult PT
<10% require syrgical intervention
AC injury MOI
injured falling onto the tip of the shoulder
AC sprain
Insp: AC joint swelling/ deformity
Palp/ROM: AC joint tenderness, pain with downard traction
cross over test>pain
Grade ! AC
AC joint intact, capsular destention
-pain
- not a lot of laxity
normal Xray
Grade II
Partial Tear of AC
so the CA and CC joints are intact
X-ray- widenin and offset
Grade III
AC jonint and CC ligament are torn
large separtation on X-rad
* youll usually see this deformity in person
AC sprain dx/tx
Xray
Tx:
-shoulder immobilizer for 3-4 wks for comfort +resprtiction overhead
- Ice rest NSAIDS and possibly injection in 2-4 wks
- Surgical considerations after grade III possibly
Clavicule Fracture pres
- most often occur in the middle 1/3)
- visual deformity seen
-tenderness with palpation over the bone
-decreased ROM
Imaging: single AP X-ray
Clavicular fracture tx
Conservative tx for non dispaced and for most peds
- slig/swathe
-analgesics, muscle reaxlers
-sleep upright for comfort
Displaced mid clav fxs all proximal and distal 1/3fxs
possibly surgery
Subacromical Bursitis
Repetative movement injury or may represent a systemic disease
Pres: pain with ROM and rest and possible decreased ROM
localized tenderness
ass: with tendonitis or impingment
SA bursitis tx
Dx: clinical and possible fluid aspiration if rule out infection
Tx: Ice and NSAIDS and restiction of overuse
*often corticosteroid inj and aspiration
Biceps Tendsonitis
Pain ant shoulder with abduction and ER - main poin of tenderness along groove - popping sensations - weaness due to pain *yergasons and speeds* Popeye deformity seen with rupture
Biceps tednonitis Dx and Tx
Dx: maining clinical but can also use U/S
Tx: want to reduce inflam and increase strengthen and prevent rupture
NSAIDs, rest, PT, can do steroid injections
