WEEK 8 Shoulder NOT ON MIDTERM

Question 1

Which 4 muscles are the primary scap stabilizers?

Answer 1

Serratus anterior (SA), rhomboids, trapezius (trap), levator scapulae

Question 2

Which 2 muscles are the secondary scap stabilizers?

Answer 2

Latissimus dorsi, pectoralis minor

Question 3

What is the generalized term for compression and resultant damage to soft tissue structures within the shoulder region?

Answer 3

Shoulder impingement

Question 4

What is the most common site of impingement?

Answer 4

Subacromial space between the inferior acromion and superior humeral head

Question 5

The subacromial space is narrowed during which glenohumeral motion?

Answer 5

Abduction

Question 6

Impingement results from extrinsic compression from abnormalities of acromion or as humeral head moves superiorly to entrap tendons of rotator cuff (RC). Which direction does this occur?

Answer 6

Superiorly and inferiorly

Question 7

Which 3 tendons are most commonly entrapped?

Answer 7

Supraspinatus, infraspinatus, long head of biceps

Question 8

Are these mechanisms of injury primary or secondary external? Abnormalities of superior structures, diminished subacromial space, congenital (os acromiale), osteophytes, & thickening of subacromial arch, patients older than 35.

Answer 8

Primary

Question 9

Are these mechanisms of injury primary or secondary external? Excessive downward angulation of acromion secondary to inadequate muscle stabilization of scap, anterior & inferior movement of acromion encroaches into subacromial space, patients younger than 35 (especially athletes).

Answer 9

Secondary

Question 10

In internal impingement, increased joint instability results in which type of impingement of RC against the posterior & superior aspect of glenoid labrum & posterior humeral head?

Answer 10

Posterior

Question 11

Which type of athletes is internal impingement seen in?

Answer 11

Overhead athletes (baseball pitchers or tennis players)

Question 12

What pathology are the following contributing factors associated with? Impaired scap stability, thickened subacromial bursa, forward shoulder posture, excessive anterior thoracic musculature shortness/tightness, structural anomalies (type II, III acromion), calcific coracoacromial ligament, AC arthritis, os acromiale, unfused acromial apophysis.

Answer 12

Shoulder impingement

Question 13

True or False: There’s posterior & lateral pain for external impingement & anterior pain for internal.

Answer 13

False (switch posterior and anterior)

Question 14

Which 2 motions would be painful with external impingement?

Answer 14

Flexion and abduction

Question 15

True or False: For internal impingement, there’s increased external rotation & decreased internal rotation when range is tested at 90 degrees abduction.

Answer 15

True

Question 16

What motion would be painful with coracoid impingement?

Answer 16

Horizontal adduction (HADD)

Question 17

Which pathology is aggravated by lying on either involved or uninvolved upper extremity?

Answer 17

Shoulder impingement

Question 18

RC exercises for shoulder impingement should start from isometric to what?

Answer 18

Concentric

Question 19

True or False: Band resistance is preferred for shoulder impingement rehab.

Answer 19

False (fixed weight & free weight)

Question 20

Which grade of impingement is characterized by local pain, mild swelling, ecchymosis, tenderness, mild tightness or spasm locally, and minimal loss of ROM & strength?

Answer 20

Grade 1 (subacromial bursitis/tendonitis)

Question 21

Which grade of impingement is characterized by severe loss of ROM & strength and significant swelling & ecchymosis?

Answer 21

Grade 3 (full thickness tear of RC)

Question 22

True or False: Diminished blood supply to RC is an intrinsic factor.

Answer 22

True

Question 23

True or False: Acromion morphology, posture, & behavior are intrinsic factors.

Answer 23

False (extrinsic)

Question 24

Where would pain be felt with RC tear?

Answer 24

Lateral deltoid/arm, greater tuberosity, upper trapezius, thoracic/interscapular region

Question 25

Prolonged activities that promote which shoulder position will facilitate subacromial impingement?

Answer 25

Forward

Question 26

Shoulder adducted/IR is what type of packed position?

Answer 26

Loose

Question 27

True or False: Nonsurgical treatment for RC tears are related to patients with weakness.

Answer 27

False (pain)

Question 28

RC repairs are typically immobilized with no active range of motion for how many weeks?

Answer 28

4-6 weeks

Question 29

Therapy for RC repair will consist of passive range of motion especially flexion & which type of rotation for 1-4 weeks?

Answer 29

External rotation

Question 30

What is the term for accumulation of microtrauma that leads to degenerative changes in tendon?

Answer 30

Tendinosis

Question 31

What is the term for injury of biceps tendon as it runs in the intertubercular groove?

Answer 31

Biceps tendinopathy

Question 32

Which head of biceps does tendon rupture usually occur at?

Answer 32

Long head

Question 33

True or False: Biceps tendinopathy is usually seen in isolation.

Answer 33

False (with RC pathology, subdeltoid bursitis, GH instability)

Question 34

What kind of bicipital groove leads to subluxation of biceps tendon?

Answer 34

Flattened & shallow

Question 35

True or False: Biceps tendon is usually injured by repetitive overhead activity.

Answer 35

True

Question 36

Full recovery is anticipated in how many weeks for tendonitis?

Answer 36

6-8 weeks

Question 37

True or False: Exercises that promote circulation such as pulleys or pendulum are used for subacute tendonitis.

Answer 37

False (acute)

Question 38

True or False: Closed chain exercises are started first for biceps tendonitis.

Answer 38

True

Question 39

Which labral tear involves the anterior or inferior portion of labrum (2-6 o'clock) & anterior shoulder dislocations?

Answer 39

Bankart tear

Question 40

What is the term for bone divots in the humeral head caused by blunt trauma from dislocation of humeral head of glenoid fossa associated with Bankart?

Answer 40

Hill-Sachs lesions

Question 41

Which type of labral tears are associated with internal impingement of shoulder with external rotation & supraspinatus?

Answer 41

Posterior labral tears

Question 42

True or False: Scapular retraction is easing for labral tears.

Answer 42

True

Question 43

90/90 shoulder position should be minimized with what type of labral tear for prehab?

Answer 43

Bankart tear

Question 44

Repair of which labral tear requires no external rotation & no resisted biceps for 4 weeks?

Answer 44

SLAP tear

Question 45

Repair of which labral tear requires no external rotation for 4 weeks?

Answer 45

Bankart tear

Question 46

Which ages are dislocations most common in?

Answer 46

11-30 and over 50

Question 47

What type of instability does trauma lead to?

Answer 47

Unidirectional

Question 48

Which 2 structures are released to decrease humeral head displacement?

Answer 48

Pectoralis minor and scapula

Question 49

In which decades does adhesive capsulitis occur more frequently and in which gender?

Answer 49

4th & 6th decades, more common in women

Question 50

Which 3 diseases/conditions are associated with elevated risk for adhesive capsulitis?

Answer 50

Type 2 diabetes mellitus (T2DM), hyperthyroidism, hypertriglyceridemia

Question 51

What is the hallmark sign of adhesive capsulitis?

Answer 51

Nocturnal pain

Question 52

Which phase of adhesive capsulitis is characterized by insidious, predominantly nocturnal pain, pain in deltoid, aggravated with movement to end-ranges, and minimal ROM restriction?

Answer 52

Phase 1 (painful)

Question 53

Which phase of adhesive capsulitis is characterized by diminished pain, progressive ROM limitations in capsular pattern, and ADLs affected?

Answer 53

Phase 2 (frozen/adhesive)

Question 54

Which phase of adhesive capsulitis is characterized by decreased pain, increased ROM over 12-24 months, and inability to lay on side?

Answer 54

Phase 3 (thawing or regressive)