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MS shoulder

Clinical Medicine II

Forward flexion in sligh internal rotation causes pain + neer’s impingment sign
Internal rotation at 90 degrees forward flexion causes pain Hawkin – Kennedy impingement sign +
+ sign for impingement syndrome post corticosteroid injection, pain disappears with Neer’s and Hawkin’s tests
Presents w/ drooped forward shoulder posture, scapular winging or scapular dyskensis sick scapula
Tx sick scapula Conservative: PT, scapular stabilization program
Tx algorithm of sick scapula PT low oz, NSAIDS, stretching, injections at 6-12 weeks 2 max, MRI at 3-4m if no improvement
Tx for hx of pain, now acute weakness Cuff tear probably, MRI, CT w/ surgical referral
Tx for traumatic onset, nl ROM, nl strength, nl XR symptomatic rx-sling2-3 days, early AROM, 6-8wk resolution
Potential complications from traumatic rotator cuff pain adhesive capsulitis
Tx for nl PROM, poor AROM and weak ext/int rotation, FF, nl OR observe 2-4wks, MRI, refer if <60yo consider surgery> 60 at 12 wks
Tx of 50 yo RCT comes in 1st line Physical Therpy
Approx 80% pt’s respond to what tx for impingement syndrome conservative tx,
Tx’s for impingement syndrome Arthroscopic Subacromial or Coracoid decompression
Tx of RC arthropathy improve deltoid fx to compensate, use supine program to strengthen
What is adhesive capsulitis “frozen shoulder”: idiopathic loss of AROM and PROM (at least %50) Tx: PT, and injections
What are the phases of frozen shoulder Freezing ^ pain, thawing dec. pain
Surgical tx of frozen shoulder post 3m rehab: manipulation: sleep then physically loosen up, hydrotherapy: 60cc saline into capsule, usually same or not as good as PT, capsular release
Hallmark sign of frozen shoulder MRI reveals contracted capsule
What presents like frozen shoulder but is a progressive dz GH Joint DJD
Signs of DJD Dec ROM-progressive, dec. strength, crepitus
Signs sxs of Osteoarthritis after 40yo, progressive, affects specific joint, warm swelling rare, Am stiffness <30min, DIP/PIP involvement
Signs and sxs of RA Early onset, sudden, systemic sxs, affects many joints, warmth swelling common, am stiffness for hours, MCP involved
TX GH Joint DJD early detection to maintain ROM, PT, potential surgery >60yo, humeral resurfacing for <60
Sudden onset, EXTERMELY painful, XR shows crystals near joint Calcific Tendinitis
Tx for Calcific tendinitis Indomethicin for 7-10days, SA injection, Surgery?
Collarbone absorbs away from the acromion AC joint osteolysis d/t repetitive stress: AC joint pain
Tx for AC joint osteolysis PT, injections, surgery to create joint space
Compression of Brachial plexus and/or subclavian vessels Thoracic Outlet Syndrome (TOS)
MOI of TOS Ant. Scalene or pec minor tightness, costoclavicular approximation
Elbow flexed 90, abducted and rotated, head turned away: diminished pulse Allen’s Test for TOS
Rotate head to affect side and head tilts backward-diminished pulse Adson’s Test for TOS
Tx for TOS PT, shoulder stretching and strengthening, CT surgery?
Grade I AC joint separation XR nl, but + for joint pain
Grade II AC joint sep, Tx? 50% displacement, sling for pain, activity mod, full ROM and pain ~1wk, as tolerated to return
Grade II AC joint sep, tx? 100% displacement, Same as grade I
Grade IV AC joint sep tx? place finger at AC, will displace 100% backward into trap w/ adduction, tend toward nonoperative, accept deformatiy, operate young athletes or busy
Grade V AC joint sep stays sticking up 100% + displacement
Grade VI AC joint displacement Displacement downward w/ deltoid and trap muscles torn as well
How are AC joint injuries reproduced in PE, 2nd diagnosis cross-body adduction, plain XR
Tx for Grade IV-VI AC joint injuries surgical reconstruction, graphs,
Signs of SC joint separation Tenderness, deformity, assymety, post. Dislocation: difficulty breathing, parasthesia,
Tx SC joint separation immobilization, progressive return to activity, might be medical emergency
3 degress of GH joint instability Dislocation, subluxation, general laxity
MC 98% dislocations anterior dislocation
What are the two types of dislocations? TUBS and AMBRI
TUBS Trauma, Unidirectional, Bankart, Surgery
AMBRI Atraumatic, Multidirectional, Bilateral, Rehab used, Inferior capsular shift surgery is usually proceded
Bankart lesion a tear of the anterior glenoid labrum
Chronic GH tests apprehension or relocation signs (laying down) strength, general lax, motor and sensory exam
If dislocation occurs @ 40-50yo, what must we check RCT and surrounding n’s Axillary N. injury
Tx ant. GH dislocation Reduction, PT to ^RC strength, Bracing
Types of braces Duke Wyre, Sully
Stimson Technique Patient prone, arm hanging w/ 10-15lbs, thumb on acromion and fingers in front of humeral head, as muscles relax, press head caudally until reduction
Longitudinal Traction reduction Supine, sheet around pt’s chest, elbow at 90deg flex apply traction w/ gently rotation to reduce
When is surgery recommended for ant GH dislocation Soon, if axillary n. injured or is an above-ground athlete
Compression fracture of posterior humeral head Hill-Sachs lesion: w/ ant dislocation
MOI of GH post dislocation Forced along arm while in internal rotation w/ slight adduction
SLAP lesions, tx Superior Labrum tear from Anterior Posterior, Tx: conservative w/ surgical debridement when needed
PE of a proximal biceps tendon rupture tx: “Popeye” muscle, ecchymosis, dec. supination :accept deformity, asses RCT
PE of distal biceps tendon rupture, tx: pain Anticubital fossa and radial tuberosity, brusing, pain dec. flexion and supination, tx: conservative, surgical for active pt’s
MC fracture in the body Clavicle
Surgical tx for a clavicle break N/V injury, >2cm shortening, open fx
Must r/o what w/ midshaft humerus fracture? How? Radial N. entrapment or tear, by wrist extension
What is sometimes associated w/ proximal humorous fracture brachial plexus injury test: can’t feel deltoid
4 types of humerus fractures 2pt anatomical, 2 pt surgical, 3pt surgical neck, greater tuberosity, shaft, 4 pt, humeral head, gr. Tub, less tub, shaft
Tx humerus fractures surg. Neck 45 deg sling, 3 pt, ORIF young, prosthesis older, 4pt-prosthesis
4 anatomical joints of the shoulder sternoclavicular, acromioclavicular, glenohumeral, scapulothoracic
4 anatomical ligaments of the shoulder coracoacromial, coracoclavicular, glenohumeral, capsule
Nerves in the brachial plexus C5,6,7,8 and Ti
When there is humeral break, what must we be cautious of Radial N.
Muscles of the rotator cuff supraspinatus, infraspinatus, teres minor, subscapularis, long head of the biceps
What do we inspect on the shoulder? SADS, Swelling, Atrophy, Deformity, Skin Manifestation
What does external rotation test midcuff: infraspinatus, teres minor
What does ER/abduction test Mid cuff: infraspinatus, supraspinatus
What does forward flexion test superior cuff: supraspinatus
What does internal rotation test ant. Cuff: subscapularis
How do we evaluate the long head of the biceps? Speed’s test: arm flexed in prone positions,person resists supination and Yergason’s test
Subscapularis evaluation belly press, posterior lift off test
Created by: becker15
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