Term
| little league shoulder- characterized by what? seen frequently in what age? etiology?? |
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Definition
| characterized by upper arm pain with throwing. usually seen between 11-14. exact etiology unknown; conceptually a salter harris type I fx |
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Term
| treatment for little league shoulder |
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Definition
| activity modification; instruction in proper throwing technique |
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Term
| Mechanism for AC seperation |
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Definition
| direct blow to shoulder or indirectly by FOOSH |
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Term
| Rockwood Classification- Type I |
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Definition
| I- The acromioclavicular ligament is sprained with an intact coracoclavicular ligament. The acromioclavicular joint remains stable and symptoms resolve in 7-10 days. This injury has an excellent prognosis |
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Term
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Definition
| The coracoclavicular ligaments are sprained; however, the acromioclavicular ligaments are ruptured |
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Term
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Definition
| The acromioclavicular joint capsule and coracoclavicular ligaments are completely disrupted. The coracoclavicular interspace is 25-100% greater than the normal shoulder. |
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Term
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Definition
| This is a type III injury with avulsion of the coracoclavicular ligament from the clavicle, with the distal clavicle displaced posteriorly into or through the trapezius |
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Term
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Definition
| This is type III but with exaggeration of the vertical displacement of the clavicle from the scapula-coracoclavicular interspace 100-300% greater than the normal side, with the clavicle in a subcutaneous position. |
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Term
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Definition
| This is a rare injury. This is type III with inferior dislocation of the lateral end of the clavicle below the coracoid |
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Term
| Signs and Sx of AC seperation |
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Definition
point tenderness
soft tissue swelling
pain with ROM (type I-II esp at end ranges)
LOM (Type III - VI)
Deformity (type III- VI) |
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Term
| Management of AC seperation |
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Definition
Type I and II- conservative
Type III- gray area
Type IV-VI surgically |
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Term
| what disorder is sometimes secondary to AC seperation |
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Definition
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Term
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Definition
Pain with palpation of ACJ
Pain with crossed-chest adduction
Radiographic evidence of osteophytes and joint space narrowing |
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Term
| Distal clavicle osteolysis is common with who? |
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Definition
| weight lifters and those with hand out traumatic injury |
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Term
| signs and sx of distal clavicle osteolysis |
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Definition
| pain, swelling, stiffness |
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Term
| treatment for distal clavicle osteolysis |
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Definition
NSAIDs
Corticosteroid injections
Activity modification
Distal clavicular resection |
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Term
| Mechanism of injury for SC sprains, dislocation, subluxation |
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Definition
FOOSH with shoulder flexion/adduction or extended adducted
Direct trauma
Side impact |
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Term
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Definition
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Term
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Definition
subluxation; partial tear of capsular ligaments.
type IIA- subluxation (anterior)
type IIb- subluxation (posterior) |
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Term
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Definition
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Term
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Definition
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Term
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Definition
| habitual dislocation (rare) |
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Term
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Definition
| habitual dislocation (rare) |
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Term
| Signs and Sx of SC sprain/ dislocation/ subluxation |
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Definition
Px over SC joint, worse in higher ranges of movement
Deformit |
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Term
| Treatment for SC sprain/dislocation/ subluxation |
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Definition
Conservative: dislocations 6 wks in sling
Guarded ROM
Rarely surgical stabilization |
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Term
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Definition
S- scapular malposition
I- inferior medial border prominence (protracted- type I scapula)
C- coracoid pain
K- dysKinesia of scapular movement |
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Term
| Scapular malposition of Sick scapula syndrome |
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Definition
| inferior- protracts initially, anterior inferior rotation |
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Term
| location of pain of SICK scapula |
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Definition
| anterior pain near coracoid. px may be anywhere around shoulder |
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Term
| what movement is usually lacking with SICK scapuls |
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Definition
| FF and have accentuated px of coracoid with attempts to max passive flex |
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Term
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Definition
| prominence of inferior medial border of scapula. tight pectorals and weak serratus anterior and inferior trap |
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Term
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Definition
| entire medial border protruding. tight anterior structures with weak upper and lower traps as well as rhomboids |
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Term
| "ultimate culprit" to initiate SLAP lesion |
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Definition
| tight posterior inferior capsule |
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Term
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Definition
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Term
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Definition
| fraying and stripping superior labrum and biceps tendon |
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Term
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Definition
| bucket handle tear superior labrum |
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Term
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Definition
| bucket handle tear of superior labrum and biceps tendon |
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Term
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Definition
37% anterior superior lesions
31% posterior superior lesions
31% combined |
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Term
| associated lesions with SLAP lesion |
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Definition
29-45% have partial thickness RC tears
11% complete RC tears
22% bankart lesions |
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Term
| shoulders at risk for SLAP lesion |
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Definition
| GIRD , SICK scapula, both combined is at higher risk |
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Term
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Definition
| "peel back" mechanisms, FOOSH, traction |
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Term
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Definition
try of more than 25 degrees; an absolute value of less than 25 deg; side-to-side loss of total arc of motion more than 25 deg
GIRD (glenohumeral internal rotation deficit)
Burkhart and Morgan have hypothesized a “peel back” mechanism that produces SLAP lesion in the overhead athlete. |
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Term
| anterior laxity is correlated with? |
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Definition
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Term
| posterior tightness is correlated with?? |
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Definition
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Term
| with anterior laxity and posterior tightness what is affect of humeral head |
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Definition
| posterior superior during cocking --> possible labral peel back. without tightness humeral head goes posterior inferior |
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Term
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Definition
| Pathogenesis probably involves inflammation, thickening and capsular fibrosis – capsule adheres to humeral head |
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Term
| who is affected most by adhesive capsulitis |
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Definition
women > men (70% female)
increased > 40 yrs old
greates frequency between 40-60 yo
diabetes and thyroid disease |
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Term
| Stage1- adhesive capsulitis- how longs it last? pain? limitations of motions?? pathological changes? |
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Definition
1-3 months
pain with AROM and PROM
limitations with flex, abd, IR, ER
exam shows limited LOM
diffuse GH synovitis
pathological changes- hypertrophic, hypervascular synovitis, rare inflammatory cell infiltrates, normal underlying capsule |
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Term
| secondary causes of adhesive capsulitis |
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Definition
| systemic, extrinsic, intrinsic |
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Term
| stage 2- adhesive capsulitis (freezing stage)- duration? pain? motion? pathological findings? |
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Definition
Duration of sx: 3 – 9 mos
Chronic px with A & PROM
Significant LOM of IR, ER, FF, abd
Pathological changes: hypertrophic, hypervascular synovitis with perivascular and subsynovial scar
ROM under anesthesia is essentially the same as when pt awake |
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Term
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Definition
Duration of sx: 9 – 15 mos
Minimal px except at end ROM
Significant LOM with rigid end-feel
ROM identical whether under anesthesia or awake
Significant hypertrophy & hypervascularity of synovium. Dense scarring of capsule |
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Term
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Definition
Duration of sx: 15 – 24 mos
Minimal px
Progressive improvement in ROM |
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Term
| treatment of adhesive capsulitis |
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Definition
Passive neglect
PT
Intra-articular corticosteroid injections
MUA (manipulation under anesthesia)
Arthroscopic lysis (sometimes with MUA)
Hydraulic distension
Capsulotomy (incision into capsule) |
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Term
| brachial plexus roots of suprascapular nerve |
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Definition
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Term
| proximal portion and distal portion of suprascapular nerve go through? |
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Definition
supraspinatos notch (SSN)- proximal
distal- supraglenoid notich (SGN) |
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Term
| sensory branches of suprascapular nerve go where? |
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Definition
| coracohumeral ligament, coracoacromial ligament, sub acromial bursa, AC and GH ligaments |
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Term
| mechanisms of injury to suprascapular nerve |
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Definition
| trauma, repetive overuse, mass lesion, iatrogenic cause |
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Term
| trauma of suprascapular nerve |
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Definition
scapular fx
clavicular fx
shoulder dislocation
penetrating trauma
Iatrogenic causes during surgery, esp surgery near posterior glenoid neck
SSN compression aggravated by depression, retraction or hyperabuction of shou |
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Term
| repetive overuse of suprascapular nerve |
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Definition
esp with compression of SGN
overhead activities |
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Term
| signs and sx with suprascapular lesion |
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Definition
1) px in posterior lateral shoulder (esp with SSN)
2) atrophy and weakness of supra/infra (SSN), just infra (SGN)
3) Changes in GH biomechanics with ↑ scapula elevation occurring during arm elevation
4) Full ER & passive HADD may be painful (esp with lesion at SSN) |
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Term
| differential dx of suprascapular nerve lesion |
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Definition
Cervical spine disease
Brachial plexopathy
RC pathology
Intra-articular G-H pathology |
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Term
| borders of quadrilateral space |
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Definition
teres minor (superiorly)
teres major (inferiorly)
long head of triceps (medially)
humeral shaft (laterally) |
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Term
| contents of quadrilateral space |
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Definition
| Axillary nerve, posterior humeral circumflex artery. |
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Term
| quadrilateral space syndrome |
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Definition
| compression of axillary nerve and / or posterior circumflex artery by fibrous bands in space |
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Term
| pts with quadrilateral space system usually present with what? |
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Definition
| typically presenting with anterior shoulder pain and paresthesia, radiating down the arm and forearm in a non-dermatomal distribution |
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Term
| when is quadrilateral space syndrom often seen?? |
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Definition
| in throwing athletes and is associated with late cocking and acceleration |
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Term
| treatment of Q space syndrom |
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Definition
| surgical release of bands |
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Term
| clavicular fx- how often? cause? |
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Definition
5% of all fx in ER
10-15% of all fx in children
usually from FOOSH |
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Term
|
Definition
| guarded, difficult elevating past 60 degrees. palpable and observable deformity of clavicle |
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Term
| when is PROM initiated after clavicle fx |
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Definition
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Term
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Definition
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Term
| population at risk for proximal humeral fx |
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Definition
elderly population
active adult |
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Term
| mechanism of injury of proximal humeral fx |
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Definition
direct blow
FOOSH
fall on shoulder |
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Term
| proximal humeral fx in elderly |
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Definition
low energy trauma
osteoporotic bone
85% of proximal humeral fx
minimally displaced |
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Term
| active adult proximal humeral fx |
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Definition
high energy trauma
15% of fx
displaced fx
surgical intervention
low energy= metastatic/metabolic |
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Term
| Neer classification for proximal humeral fx is based on what? |
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Definition
| displacement- one cm and 45 degree fragment granulation |
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Term
| percentage of one part fx |
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Definition
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Term
| displacement of one part fx |
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Definition
< one cm
< 45 degree angulation |
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Term
| two part fx of PHF displacement |
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Definition
> one cm
> 45 degree angulation |
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Term
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Definition
1) humeral head and surgical neck or
2) humeral head and greater tuberosity |
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Term
| involved segments of three part fx |
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Definition
greater tuberosity
lesser tuberosity
humeral head
(bloody supply at risk) |
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Term
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Definition
greater tuberosity
lesser tuberosity
humeral head
diaphysis |
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Term
| 4 part fx- articular surface involved |
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Definition
avascular necrosis
require hemiarthorplasty |
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Term
| LH bicep tendon rupture usually occurs in what population? |
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Definition
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Term
| surgery of LH bicep rupture |
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Definition
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Term
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Definition
- usually hear pop followed by moderate pain for few weeks
- positive popeye sign
- little loss of elbox flexion or supination strenth |
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Term
| traumatic arthritis- significant glenoid erosion usually causes what? |
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Definition
| static posterior subluxation of humeral head |
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Term
| age group of traumatic arthritis |
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Definition
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Term
| charaterisitics of traumatic arthritis |
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Definition
| px, progressive functional impairments, and reports of instability |
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Term
| treatment for traumatic arthritis |
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Definition
| Conservative rx rest, activity modification, NSAIDs |
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Term
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Definition
| upper trapezius and scapula |
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Term
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Definition
|
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Term
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Definition
| clavicle, coracoid, pectoralis minor, and deltopectoral fascia |
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Term
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Definition
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|
Term
| course of vessels thru TOS |
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Definition
| Blood vessels and brachial plexus course under clavicle, over first rib and posterior to pectoralis minor |
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Term
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Definition
1) true vascular
2) true neurological
3) disputed |
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Term
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Definition
Subclavian artery &/or vein damaged or thrombosed
Documented by arteriogram or venogram
Can be surgical emergency |
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Term
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Definition
Lower trunk of brachial plexus (C8, T1) compressed due to fibrous band or other structures
Documented by imaging and electrodiagnostic stud |
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Term
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Definition
Majority of cases
Sx of px and paresthesias,
No abnormality on electrodiagnostic studies
May have faulty posture |
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Term
| Sites of entrapment of TOS |
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Definition
1) interscalene triangle
2) costoclavicular space
3) axillary interval |
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Term
| interscalene triangle entrapment |
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Definition
| cervical rib/ adsons test |
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Term
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Definition
Entrapment between first rib and posterior aspect of clavicle may occur with clavicle depression, first rib elevation caused by scalene hypertonicity, repetitive shoulder abduction, or first rib-clavicular deformity
Postfracture callus formation of first rib or clavicle
Dutton states Wright’s test is best provocative test for this area |
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Term
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Definition
Usually position-sensitive and more or less intermittent
Pain
Paresthesia
Numbness |
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Term
|
Definition
Patient education – postural correction
Mobilize restricted nerve tissue
Increase flexibility of tight musculature
Train weak muscles
Correct faulty breathing pattern
Progress to functional independence |
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