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MS shoulder
Clinical Medicine II
| Question | Answer |
|---|---|
| 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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