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MSK 2 > Unit 2 Weeks 6-7 Shoulder > Flashcards

Unit 2 Weeks 6-7 Shoulder Flashcards

1
Q

what muscles are considered the humeral stabilizers?

A

supraspinatus, infraspinatus, subscapularis, teres minor (Rotator Cuff)

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2
Q

what muscles are considered the prime movers of the shoulder?

A

pectoralis major, latissimuss dorsi, teres major, deltoid (LH of biceps, triceps)

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3
Q

what muscles are considered the scapular stabilizers?

A

serratus anterior, latissimus dorsi, trapezius, rhomboids, levator scapulae, pectoralis minor

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4
Q

what is the scapulohumeral rhythm?

A

2:1 ratio of glenohumeral motion to scapulothoracic motion

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5
Q

what are the force couples of the shoulder?

A

deltoid-rotator cuff
upper trap-serratus anterior

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6
Q

what are you looking for when looking at joint motion?

A

quality, quantity, provocation, where in range symptoms produced
scapulo-humeral rhythm: anterior and posterior

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7
Q

what functional motions should be looked at in a shoulder evaluation?

A

hand behind head: combined abd/ER
hand behind back: combined ext, add, IR

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8
Q

what are the SA pain tests?

A

neer’s: shoulder flexion with arm in IR+ over pressure
hawkins-kennedy: 90 degrees flexion with IR

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9
Q

what makes up the rotator cuff?

A

supraspinatus, infraspinatus, teres minor, subscapularis

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10
Q

what are the ACJ provocation tests?

A

cross body adduction
resisted horizontal ext/abd

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11
Q

what tests are for the biceps tendon and ACJ/labrum?

A

speeds test: long head of the biceps/bicipital tendonitis
active compression test: ACJ/labral pathology

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12
Q

what are the common locations of tenderness in the shoulder?

A

subacromial space, supraspin tendon, greater tuberosity, bicipital groove, ACJ line, upper trap and levator scap

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13
Q

what does the wall push up test?

A

serratus anterior weakness
a (+) test = scapular winging

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14
Q

what are the scapular alleviation tests?

A

scapular assistance test
scapular repositioning test

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15
Q

what degree of FROM is needed for combing hair, perineal care, washing the contralateral UE, and overhead shelf?

A

combing: abd 105-120, ER 90, add 30-70
perineal: abd 30-45, IR 90+, abd 75-90
washing: flex 60-90, IR 90, add 60-120
overhead: flex 70-80, ER 45, add 70-80

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16
Q

what are some contributing factors to internal rotation loss?

A

bony adaptation, scapular posture, posterior musculotendinous tightness, shoulder fatigue, posterior capsular tightness (anterior pseudolaxity, superior and anterior/posterior migration

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17
Q

what is the kibler classification or scapular posture?

A

type 1: prominent inferior angle - RTC tendinopathy
type 2: prominent medial border - GH instability
type 3: superior migration of medial border - RTC weakness

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18
Q

what is thrower’s sick scapula?

A

Scapular malposition
Inferior medial border prominence
Coracoid pain and malposition
dysKinesis: labral (inferior/medial border), rotator cuff (superomedial border)

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19
Q

what does spinal accessory nerve palsy present as in relation to scapular posture?

A

upper trap atrophy and scapular depression
(+) flip sign
no medial winging with flexion or abd

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20
Q

what does long thoracic nerve palsy present as in relation to scapular posture?

A

medial winging with active flexion

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21
Q

what are the common faults of scapular dyskinesia? what interventions should be done?

A

increased anterior tilt: stretch UT, pec minor, levator and rhomboids. strengthen serratus and LT
increased IR: stretch pec minor. strengthen serratus and LT
decreased upward rotation: stretch pec minor and pec major. strengthen mid and low trap, rhomboids, serratus

22
Q

what are the shoulder unilateral ratios?

A

ER to IR: 66-75%
s/p RTC repair ER to abd: >58%

23
Q

what subjective complaints are common with rotator cuff tendinopathy?

A

anterolateral shoulder pain/tenderness
pain with overhead activities
reports of painful arc of motion
pain with reaching behind back
symptoms lifting or sleeping on affected side
gradual onset

24
Q

what are the contributing factors for rotator cuff pathology?

A

intrinsic theory: consequence of overuse and/or overload; degeneration
extrinsic theory: bony/articular compression

25
Q

what is tendinopathy? what must be present for diagnosis?

A

thickened, non-ruptured tendon
tendon pathology, pain system changes, motor system impairments

26
Q

what are the modifiable risk factors for RTC pathology?

A

force couple imbalance/weakness
scapular dysfunction
ROM loss
quickness to fatigue
posterior impingement
humeral head superior translation

27
Q

what are the non-modifiable risk factors for RTC pathology?

A

secondary impingement
ligamentous laxity

28
Q

what grouping of objective findings are consistent with a rotator cuff tear?

A

weakness with ER
(+) drop arm test
(+) painful arc

29
Q

what are the 4 stages of adhesive capsulitis and their timelines?

A

1: synovial rxm w/out adhesion (up to 3 months)
2: painful/freezing; agressive synovitus (3-9 months)
3: frozen; progressive capsuligamentous fibrosis (9-15 months)
4: thawing (15-24 months)

30
Q

what are the adhesive capsulitis rehab irritability classifications?

A

high: >7/10, increase disability, AROM < PROM
moderate: 4-6/10, moderate disability, AROM = PROM
low: <3/10, minimal disability, AROM = PROM

31
Q

what are the signs and symptoms consistent with proximal biceps pathology?

A

localized anterior shoulder pain (bicipital groove)
provocative ROM
pain with resisted elbow flexion/wrist supination
Ludington’s sign

32
Q

what signs and symptoms are consistent with superior labral anterior-posterior tears (SLAP)?

A

deep shoulder pain at maximal ER with throwing
intermittent popping/catching during rotation
loss of external rotation strength with accompanying atrophy in infraspinous fossa
decreased velocity and control (dead arm)

33
Q

what signs and symptoms are consistent with anterior glenohumeral dislocation?

A

pain
flattened deltoid/head humerus near axilla
arm support and head abd/ER

34
Q

what is the MOI for anterior glenohumeral dislocation? posterior?

A

anterior: abduction and ER
posterior: adduction and IR

35
Q

what signs and symptoms are consistent with anterior glenohumeral dislocation?

A

pain
protect posture: add and IR
limited ER and elevation
flattened deltoid and prominent coracoid

36
Q

what are the common symptoms of shoulder instability?

A

pain
feeling of weakness
sensation abnormal mechanics (clicking, catching, clunking)
instability (subluxation/dislocation)
pain with WB (posterior)

37
Q

what is included in the shoulder instability cluster? which rule in/out?

A

apprehension: both
sulcus: spin
load-shift: spin
anterior release: both
relocation: both

38
Q

what is included in the labral tear cluster? which rule in/out?

A

crank: spin
obrien’s: snout
resisted supination/ER test: both

39
Q

what are the common symptoms of little league shoulder (proximal humeral epiphysiolysis)?

A

vague anterior shoulder pain
TTP superolateral shoulder
pain with resisted external rotation
reduction in rotator cuff strength and endurance
poor scapular control
increase in height velocity

40
Q

what rehab considerations are there for ACJ separations?

A

avoid stress through ROM (horizontal add, IR, end flex and ext)
minimize downward displacement (avoid sustained lifting)

41
Q

what is the cervical radiculopathy cluster?

A

(+) spurling’s test
(+) distraction test
(+) ULTT
cervical rot < 60 degrees involved UE

42
Q

what diagnoses fall under shoulder pain with mobility deficits?

A

adhesive capsulitis/frozen shoulder
fractures
arthrosis
(subacromial impingement, bicipital tendinitis)

43
Q

what are the 4 stages of progression for frozen shoulder/adhesive capsulitis?

A

Stage 1: looks like impingement, capsular pattern
Stage 2: progressive ROM loss all planes, significant, persistent pain, night pain
Stage 3: significant ROM loss, compensatory mvmts, severe pain passed
Stage 4: pain spontaneously resolved, steady gain of ROM, caps pattern, end-feel before pain

44
Q

what is the test cluster for impingement?

A

H-K, painful arc, infraspin (ER) resistance test

45
Q

what diagnoses fall under shoulder pain with muscle power deficits?

A

rotator cuff syndrome

46
Q

what diagnoses fall under shoulder pain with joint stability impairments?

A

labral tear
dislocation
instability/sprain: GH, ACJ

47
Q

what is a bankart lesion?

A

avulsion of the anterior inferior labrum from the glenoid rim

48
Q

what is a hill-sachs lesion?

A

compression fracture of the posterior humeral head at the side where the humeral head impacted the inferior glenoid rim

49
Q

how is shoulder instability classified?

A

frequency
etiology
volition (voluntary vs involuntary)
direction
degree (dislocation, subluxation, micro)

50
Q

what is the beighton’s scale?

A

(score 0-9, 1 point each, test bilateral)
1. passive dorsiflexion of the 5th finger beyond 90
2. passive thumb opposition to the forearm
3. active elbow hyperextension beyond 10
4. active knee hyperextension beyond 10
5. forward flexion of the trunk with knees fully extended so that the palms of the hands rest flat on the floor
>2 = 2.5x more likely to have episode of shoulder instability

51
Q

what diagnoses fall under shoulder pain with with movement coordination impairments?

A

SICK scapula syndrome
posterior impingement
(secondary impingement, nerve injuries)

52
Q
A

MSK 2 (8 decks)

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