Unit 2 Weeks 6-7 Review

Question 1

Which of the following choices** will lead you to a diagnosis of secondary subacromial impingement as opposed to primary subacromial impingement?

**pick to answer that is pathognomonic of secondary subacromial impingement

Answer 1

Pronounced scapular dyskinesia and anterior glenohumeral arthrokinematic hypoermobility

Question 2

Which of the following exercises would best isolate the external rotator musculature while minimizing recruitment of the lateral delts and upper trapezius?

Answer 2

Sidelying external rotation

Question 3

Which of the following is true?
-When performing standing shoulder external rotation with arm at side it is best to use a towel roll between elbow and side to increase circulation to the conjoin tendon and also is best to cue patient to retract and depress scapula to improve lower trapezius recruitment
-Posterior impingement is associated with compression of the subscapularis tendon against the glenoid rim
-A full thickness rotator cuff tear is at least 3cm in diameter and if repaired would requires passive ROM only for at least 10 weeks
-The cross body test is used for assessing posterior impingement impingement whereas the drop arm test has excellent sensitivity for a partial rotator cuff tears

Answer 3

When performing standing shoulder external rotation with arm at side it is best to use a towel roll between elbow and side to increase circulation to the conjoin tendon and also is best to cue patient to retract and depress scapula to improve lower trapezius recruitment

Question 4

Adhesive capsulitis is associated with which of the following clinical patterns?

Answer 4

Arthrokinematic hypomobility at the GH joint with global PROM loss and kinesiophobia

Question 5

Which of the following is true?
-AN inferior glide to the medial clavicle would serve to improve shoulder depression
-The long thoracic nerve is often injured in anterior dislocations of the GH joint
-The cluster of the apprehension test, relocation and surprise test of the GH joint have a low specificity.
-A reverse shoulder arthroplasty often requires restriction of unhand to back movements for at least 10-12 weeks or longer

Answer 5

A reverse shoulder arthroplasty often requires restriction of unhand to back movements for at least 10-12 weeks or longer

Question 6

A subacromial decompression surgery would require the following restrictions

Answer 6

No precautions other than preventing kinesiophobia

Question 7

Which of the following is true?
-A type 3 AC separation can NOT be seen on a standard AP view radiograph
-An acute RTC tear would be seen as a high intensity zone on a T1 weighted MRI image and a hypointensity on a T2 weighted image
-A protracted scapular position restricts upward scapular rotation due to the rhomboids being taut and promoting downward rotation
-Soft tissue mobilization of the scapula and ultrasound are efficacious treatments for adhesive capsultitis

Answer 7

A protracted scapular position restricts upward scapular rotation due to the rhomboids being taut and promoting downward rotation

Question 8

Which of the following exercises has the best lower trap isolation while minimizing upper trapezius and deltoid recruitment?

Answer 8

modified prone cobra

Question 9

Which of the following anatomical structures is likely to refer pain the the sub -clavicular region and medial arm?

Answer 9

Heart

Question 10

Patients with adhesive capsulitis are also known to have scapular dyskinesia. What specific difference would you expect to see with this type of patient when compared to a patient with subacromial impingement?

Answer 10

Adhesive capsulitis would be associated with increased upward rotation, whereas subacromial impingement syndrome would be associated with decreased upward rotation

Question 11

A posterior SLAP lesion is most commonly associated with which of the following movements and impairments/diagnosis?

Answer 11

Abduction with external rotation in the presence of posterior shoulder tightness

Question 12

A patient presents to physical therapy 3-weeks following a massive rotator cuff repair. Patient is wearing a sling and swath. Not wearing an abduction pillow. Rates pain 0/10 at rest and 6/10 at worse. QuickDASH is scored a 65%.

What is the appropriate intervention at this time?

Answer 12

PROM only shoulder, wrist, and elbow, wear sling when not in therapy.

Question 13

A patient presents to physical therapy 3-weeks following a rotator cuff repair. Patient is wearing a sling and swath. Not wearing an abduction pillow. The operative report states patient had a full thickness tear that covered a diameter (length) of 4 cm. Patient reports tear was not due to specific trauma. Rates pain 0/10 at rest and 6/10 at worse. QuickDASH is scored a 65%.

During a re-evaluation what would be a reasonable QuickDASH score to plan for and document clinically important improvement in your goals?

Answer 13

54%

Question 14

Which of the following conditions would NOT be associated with osteophytes?

Answer 14

Anterior labral tear with secondary subacromial impingement syndrome

Question 15

Which of the following techniques should be performed for a patient with glenohumeral osteoarthrosis with a loss of sphericity and glenoid osteophytosis who has a torn rotator cuff with advanced fatty infiltration ( that has retracted and has led to a suprascapular nerve palsy)?

Answer 15

Reverse shoulder replacement

Question 16

A patient presenting with anterosuperior shoulder pain and popping has grade 1 tenderness of the long head biceps bilaterally. MMT is strong and pain-free at shoulder and elbow. Special tests include a positive crank test, positive speed test, positive O’Brien test, negative bicep load.

This patient most likely has which of the following diagnoses?

Answer 16

SLAP Lesion

Question 17

Which of the following diagnoses would be associated with a Hill-Sachs lesion?

Answer 17

Anterior dislocation

Question 18

A patient presents 8-weeks following an incomplete surgical neck fracture of the humerus. Patient was treated with a sling for 6 weeks. Recent CT scan shows healing sufficient to begin physical therapy without formal contraindications. Has type 2 acromion process with AC joint DJD.

AROM shows a loss of shoulder abduction, flexion & scaption (pain at end range on all 3 motions albeit less with scaption). PROM is comparable to AROM with capsular end-feels.
Significant scapular dyskinesia (winging and tipping) on the right shoulder.
Manual muscle testing is 5/5 all planes with exception of empty can which is strong and painful.
Pec minor test is 5 cm bilaterally.
Tenderness is palpated at AC joint with joint hypomobility.

What interventions would be reasonable based on aforementioned case? (select all that apply)

Answer 18

Ceiling punch
Inferior glides of the GH joint
Joint mobilization of the AC joint
Cross friction massage of the supraspinatus tendon
Prone cobra
Posterior glides of the GH joint
Pec minor stretching

Question 19

A tight pec minor would likely cause the following?

Answer 19

Scapular downward rotation, winging, anterior tilting & decreased external rotation of scapula

Question 20

A patient with a subscapularis tear (partial) would MOST likely have which test positive?

Answer 20

Bear Hug

Question 21

A test has a negative likelihood ratio of .8 when the test is negative. How could this be interpreted?

Answer 21

If test is negative it has a minimally important shift in probability that the person doesn’t have the condition; false negatives comprise more of the negatives than true negatives

Question 22

Which is correct regarding the scapular assistance test?

Answer 22

Used for secondary subacromial impingement to assess effect of scapular movement correction on pain; lacks diagnostic utility

Question 23

Which of the following conditions are most likely present in the image below?

Answer 23

Glenohumeral OA with a rotator cuff tear

Question 24

Which muscle’s tendon attaches to the supraglenoid tubercle by way of the superior labrum?

Answer 24

long head of biceps brachii

Question 25

Match the following clinical findings with its most likely diagnosis:
-pain-free weakness of the supraspinatus, infraspinatus, and teres minor
-pain-free weakness of the supraspinatus, infraspinatus, teres minor, deltoid, and bicep
-painful weakness of the supraspinatus and infraspinatus
-pain-free weakness of the supraspinatus and infraspinatus

Answer 25

-complete rotator cuff tear
-C5 nerve root lesion
-partial rotator cuff tear
-suprascapular nerve palsy

Question 26

What tendon is directly palpable between the lesser tuberosity and coracoid process when the arm is neutral or even external rotation?

Answer 26

subscapularis

Question 27

Which acromion type is associated with rotator cuff tears?

Answer 27

Type III

Question 28

Your patient presents is a highschool student with insidious onset of L shoulder pain that started after walking to and from school wearing a heavy backpack over the past 6 months. On evaluation you note the following findings.

Significant rounded shoulders and forward head
Significant L scapular winging
L serratus anterior MMT = 2/5 painfree
You suspect a possible injury to the following nerve.

Answer 28

long thoracic nerve

Question 29

This ligament is the primary restraint against both anterior and posterior dislocations of the humeral head at 90 deg abduction?

Answer 29

Inferior glenohumeral ligament