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Common Problems in the Shoulder Complex
Musculo Exam 2 Common Shoulder Problems
98
Anatomy
Graduate
03/20/2012

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Cards

Term
define adhesive capsulitis
Definition
fibrosis of GHJ capsule with a chronic inflammatory response
Term
is adhesive capsulitis more common in men or women
Definition
women
Term
patient's experience with adhesive capsulitis
Definition
pain, limited ROM, disability
Term
how long does adhesive capsulitis last
Definition
3 months - 3 years
Term
capsular pattern in shoulder as seen in adhesive capsulitis
Definition
ER>Abd>IR
Term
what is primary adhesive capsulitis
Definition
has no precipitating event. Probably from chronic inflammatory response with fibroblast proliferation
Term
what is secondary adhesive capsulitis
Definition
occurs after surgery or injury. May be associated with diabetes, RC injury, CVA, cardiovascular disease, thyroid
Term
what is chronic regional pain syndrome
Definition
autonomic pain syndrome that can be a differential diagnosis for adhesive capsulitis.
Term
what to look for in chronic regional pain syndrome
Definition
autonomic changes in affected arm: sweating, goosebumps. Also shoulder girdle tumors
Term
what are the 3 stages of adhesive capsulitis
Definition
painful, stiffness, recovery
Term
describe painful stage of adhesive capsulitis
Definition
limited ROM, irritability and pain following treatment
Term
describe stiffness stage of adhesive capsulitis
Definition
longest stage. Still not comfortable when you stretch them, but not as uncomfortable for as long.
Term
pathologies with adhesive capsulitis
Definition
shrug sign with GH elevation; PROM limitations; elevated and anterior humeral head; shortening/fibrosis of joint capsule; contracture of shoulder ligaments decreases capsule volume; fascial restrictions, muscle tightness, trigger points all come from joint disuse
Term
patient presentation with adhesive capsulitis
Definition
constant dull ache in shoulder with gradual onset; posture changes; gradual limitations in motion; painful to lie on affected side; limited accessory motion; capsular pattern ER>Abd>IR
Term
non-operative treatments for adhesive capsulitis
Definition
benign neglect; NSAIDs; oral corticosteroids; GH intraarticular steroid injection; PT
Term
what PT treatments are good for phase 1 adhesive capsulitis
Definition
ultrasound, pain-free motion, light stretching, grade 1/2 mobilizations, postural positioning, manual techniques to relieve muscle involvement; maintain existing ROM
Term
what PT treatments are good for phase 2 adhesive capsulitis
Definition
more stretching, AAROM, capsular stretching, aggressive ROM as tolerated, home exercise program throughout the day
Term
what PT treatments are good for phase 3 adhesive capsulitis
Definition
stretch, strength
Term
what are operative options for adhesive capsulitis
Definition
manipulation under anesthesia; arthroscopic capsular release; open surgical release
Term
at what age are proximal humeral fractures more common
Definition
over 40
Term
what is a hemi arthroplasty
Definition
half a shoulder replacement (ball only)
Term
what is a humeral head depression defect
Definition
due to instability, the humeral head slides out and the rim of the glenoid has caused an indention on the humeral head
Term
what is a Hill-Sachs lesion
Definition
impression defect in the posterolateral humeral head from contact with the glenoid rim associated with anterior dislocation
Term
what is a reverse hill sachs
Definition
someone dislocated posteriorly. Intentation on anterior humeral head.
Term
how are hill sachs lesions treated
Definition
immobilizer, grafting, hemiarthroplasty
Term
PT for proximal humeral fractures?
Definition
per MD protocol; pain-motion-strength-control
Term
what static factors contribute to GH stability
Definition
GH congruence, glenoid labrum, GH ligaments (esp IGHL), joint capsule, negative intra-articular pressure
Term
what dynamic factors contribute to GH stability
Definition
rotator cuff, biceps long head tendon, scapular stabilizing muscles
Term
are men or women more likely to have GH instability
Definition
men
Term
what are the 2 types of GH instability
Definition
traumatic, atraumatic
Term
what is TUBS
Definition
traumatic unilateral instability caused by Bankart lesion usually needing Surgery
Term
what is AMBRII
Definition
Atraumatic, Multidirectional unstable patient with Bilateral involvement in whom Rehab is first treatment, may need Inferior capsular shift and tightening of rotator Interval
Term
what is a bankart lesin
Definition
damage to labrum. Usually needs surgery
Term
what is the usual direction of force in traumatic GH instability
Definition
GH Abd/ER
Term
what are some MOI's for traumatic GH instability
Definition
31% from seizure, fall from a height, MVA
Term
what are risk factors for traumatic GH instability
Definition
ligamentous laxity, inadequate glenoid concavity, glenoid hypoplasia, muscular imbalance, poor neuromuscular control
Term
what is glenoid hypoplasia
Definition
posterior sloping of glenoid rim
Term
do you do special tests for glenohumeral instability post-op?
Definition
no
Term
what is subluxation
Definition
pops out and comes back
Term
what is dislocation
Definition
comes out and it's out
Term
what are special tests for instability
Definition
sulcus, rockwood, anterior load and shift, apprehension/relocation, push-pull, jerk test
Term
what are treatments for glenohumeral instability
Definition
maintain motion, SH rhythm, RC strengthening, control exercises, strengthen for muscle balance, follow MD protocols, avoid stressing into direction of instability
Term
example of rhythmic stabilization exercises
Definition
perturbate the joint and see if they can stabilize
Term
examples of neuromuscular control exercises for GH instability
Definition
rhythmic stabilization, closed kinetic chain exercises
Term
do patients under 20 with traumatic GH instability injury have a good chance of recurrence
Definition
yes
Term
what to do for patients under 20 with traumatic dislocation/subluxation
Definition
educate on how to prevent
Term
do patients over 40 with traumatic GH instability injury have a good chance of recurrence
Definition
no. they have increased risk of RC pathology
Term
what is an engaging Hill Sachs lesion
Definition
large hh deficit causing hh to drop over glenoid rim with GH ER
Term
are hh depression defects common
Definition
yes
Term
what does SLAP stand for
Definition
Superior Labrum Anterior Posterior
Term
what is a Type I SLAP
Definition
fraying and degeneration, normal biceps
Term
what is a Type II SLAP
Definition
labrum and biceps detached
Term
what is a Type III SLAP
Definition
bucket handle tear of labrum (flops over)
Term
what is a type IV SLAP
Definition
bucket handle tear of labrum and biceps tendon (both flop over)
Term
what causes acute traumatic SLAP
Definition
FOOSH, GH traction injury
Term
what causes chronic repetitive SLAP
Definition
overhead throwing motion, high eccentric activity of biceps, "peel back" mechanism in late cocking phase of throwing (abductoin + max ER) due to torsional force on biceps tendon insertion
Term
what is lost in a SLAP lesion
Definition
vacuum pull of glenoid and hh
Term
what are SLAP special tests
Definition
O'Brien, Crank, SLAPrehension, Biceps load
Term
should you try conservative treatments for SLAP first?
Definition
yes
Term
what are conservative treatments for SLAP
Definition
protection, restore motion, scapular strengthening, RC/trunk/core strengthening, return to throwing after 3 months
Term
are conservative SLAP treatments usually successful
Definition
no, especially not with instability or RCT
Term
what is GIRD
Definition
glenohumeral internal rotation deficit (less than 70-90)
Term
what are surgical options for SLAP
Definition
depends on surgeon/patient: debride Types I/III, Repair Types II/IV
Term
what joint is injured in separated shoulder
Definition
AC
Term
what is the MOI for separated shoulder
Definition
trauma: FOOSH out to side; fall directly on shoulder; direct blow to top of shoulder with arm adducted
Term
how many types of AC joint separation are there
Definition
6
Term
which types of AC joint separation need surgery
Definition
III-VI
Term
for the next 6 questions, say what tye types of AC joint separation are
Definition
ok
Term
Type I
Definition
AC ligaments sprained
Term
Type II
Definition
AC ligament torn, CC ligaments intact
Term
Type III
Definition
both AC/CC ligaments torn
Term
Type IV
Definition
both AC/CC ligaments torn and posterior dislocation of clavicle
Term
Type V
Definition
both AC/CC ligaments torn and deltotrapezial fascia torn causing scapula to droop inferiorly
Term
Type VI
Definition
both AC/CC ligaments torn and clavicle dislocation inferior to coracoid
Term
how to manage Types 1 and 2
Definition
conservatively
Term
how to manage type 3
Definition
start conservatively. May need surgery
Term
how to manage types 4-6
Definition
surgically. After surgery, will get restrictions/protocol from MD
Term
what are the long thoracic nerve's roots and what muscle does it innervate
Definition
C5, C6, C7, serratus anterior
Term
what can injure the long thoracic nere
Definition
compression, distraction, laceration
Term
what is the most common injury to LTN
Definition
neuropraxia after blunt or stretch injury
Term
what are common MOI to LTN injury
Definition
falls from a height, MVA, athletics, sudden depression of the shoulder and twisting of neck, positioning during surgery
Term
what is evident in LTN injury
Definition
scapular winging
Term
how is abduction with LTN damage
Definition
good
Term
how to reduce scapular winging
Definition
stabilize lower trap, eccentric rhomboids, middle trap
Term
treatments for LTN damage
Definition
stabilize scapula, strengthen serratus anterior without over-fatigue, check for c-spine involvement
Term
what are the nerve roots for suprascapular nerve
Definition
C5 C6
Term
how to determine suprascapular nerve damage
Definition
look at patient's back for atrophy of rotator cuff muscles
Term
what causes injury to suprascapular nerve
Definition
compression or distraction
Term
what are common MOI to suprascapular nerve
Definition
overhead throwing overuse, entrapment at suprascapular notch from stenosis, compression from bone tumor
Term
symptoms of suprascapular nerve damage
Definition
pain and weakness in flexion and ER. May cause impingement. Alters SH rhythm
Term
how to assess suprascapular nerve damage
Definition
note muscle atrophy. Diagnosis of exclusion
Term
how to treat suprascapular nerve damage
Definition
strengthen, e-stim
Term
what are the nerve roots for axillary nerve
Definition
C5,6
Term
what does the axillary nerve innervate
Definition
teres minor and deltoid
Term
what are the nerve roots for radial nerve
Definition
56 or 567
Term
what does the radial nerve innervate
Definition
triceps and anconeus (56); brachioradialis and forearm extensors (567)
Term
what are the nerve roots of the subscapular nerve
Definition
C56
Term
what muscles does the subscapularis nerve innervate
Definition
subscapularis, teres major
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