WEEK 8 Shoulder NOT ON MIDTERM Flashcards
Which 4 muscles are the primary scap stabilizers?
Serratus anterior (SA), rhomboids, trapezius (trap), levator scapulae
Which 2 muscles are the secondary scap stabilizers?
Latissimus dorsi, pectoralis minor
What is the generalized term for compression and resultant damage to soft tissue structures within the shoulder region?
Shoulder impingement
What is the most common site of impingement?
Subacromial space between the inferior acromion and superior humeral head
The subacromial space is narrowed during which glenohumeral motion?
Abduction
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?
Superiorly and inferiorly
Which 3 tendons are most commonly entrapped?
Supraspinatus, infraspinatus, long head of biceps
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.
Primary
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).
Secondary
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?
Posterior
Which type of athletes is internal impingement seen in?
Overhead athletes (baseball pitchers or tennis players)
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.
Shoulder impingement
True or False: There’s posterior & lateral pain for external impingement & anterior pain for internal.
False (switch posterior and anterior)
Which 2 motions would be painful with external impingement?
Flexion and abduction
True or False: For internal impingement, there’s increased external rotation & decreased internal rotation when range is tested at 90 degrees abduction.
True
What motion would be painful with coracoid impingement?
Horizontal adduction (HADD)
Which pathology is aggravated by lying on either involved or uninvolved upper extremity?
Shoulder impingement
RC exercises for shoulder impingement should start from isometric to what?
Concentric
True or False: Band resistance is preferred for shoulder impingement rehab.
False (fixed weight & free weight)
Which grade of impingement is characterized by local pain, mild swelling, ecchymosis, tenderness, mild tightness or spasm locally, and minimal loss of ROM & strength?
Grade 1 (subacromial bursitis/tendonitis)
Which grade of impingement is characterized by severe loss of ROM & strength and significant swelling & ecchymosis?
Grade 3 (full thickness tear of RC)
True or False: Diminished blood supply to RC is an intrinsic factor.
True
True or False: Acromion morphology, posture, & behavior are intrinsic factors.
False (extrinsic)
Where would pain be felt with RC tear?
Lateral deltoid/arm, greater tuberosity, upper trapezius, thoracic/interscapular region
Prolonged activities that promote which shoulder position will facilitate subacromial impingement?
Forward
Shoulder adducted/IR is what type of packed position?
Loose
True or False: Nonsurgical treatment for RC tears are related to patients with weakness.
False (pain)
RC repairs are typically immobilized with no active range of motion for how many weeks?
4-6 weeks
Therapy for RC repair will consist of passive range of motion especially flexion & which type of rotation for 1-4 weeks?
External rotation
What is the term for accumulation of microtrauma that leads to degenerative changes in tendon?
Tendinosis
What is the term for injury of biceps tendon as it runs in the intertubercular groove?
Biceps tendinopathy
Which head of biceps does tendon rupture usually occur at?
Long head
True or False: Biceps tendinopathy is usually seen in isolation.
False (with RC pathology, subdeltoid bursitis, GH instability)
What kind of bicipital groove leads to subluxation of biceps tendon?
Flattened & shallow
True or False: Biceps tendon is usually injured by repetitive overhead activity.
True
Full recovery is anticipated in how many weeks for tendonitis?
6-8 weeks
True or False: Exercises that promote circulation such as pulleys or pendulum are used for subacute tendonitis.
False (acute)
True or False: Closed chain exercises are started first for biceps tendonitis.
True
Which labral tear involves the anterior or inferior portion of labrum (2-6 o’clock) & anterior shoulder dislocations?
Bankart tear
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?
Hill-Sachs lesions
Which type of labral tears are associated with internal impingement of shoulder with external rotation & supraspinatus?
Posterior labral tears
True or False: Scapular retraction is easing for labral tears.
True
90/90 shoulder position should be minimized with what type of labral tear for prehab?
Bankart tear
Repair of which labral tear requires no external rotation & no resisted biceps for 4 weeks?
SLAP tear
Repair of which labral tear requires no external rotation for 4 weeks?
Bankart tear
Which ages are dislocations most common in?
11-30 and over 50
What type of instability does trauma lead to?
Unidirectional
Which 2 structures are released to decrease humeral head displacement?
Pectoralis minor and scapula
In which decades does adhesive capsulitis occur more frequently and in which gender?
4th & 6th decades, more common in women
Which 3 diseases/conditions are associated with elevated risk for adhesive capsulitis?
Type 2 diabetes mellitus (T2DM), hyperthyroidism, hypertriglyceridemia
What is the hallmark sign of adhesive capsulitis?
Nocturnal pain
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?
Phase 1 (painful)
Which phase of adhesive capsulitis is characterized by diminished pain, progressive ROM limitations in capsular pattern, and ADLs affected?
Phase 2 (frozen/adhesive)
Which phase of adhesive capsulitis is characterized by decreased pain, increased ROM over 12-24 months, and inability to lay on side?
Phase 3 (thawing or regressive)
