Shared Flashcard Set

Details

Shoulder Exam - Lindsey
Shoulder Exam from Lindsey
77
Anatomy
Graduate
03/20/2012

Additional Anatomy Flashcards

 


 

Cards

Term
what is the shoulder examination sequence
Definition
history/interview, observation, UQS, AROM, PROM, accessory motion, MMT, palpation, special tests
Term
what should be taken into consideration in examination sequence
Definition
patient position: do everything in sitting at one time, do everything in supine at one time, etc
Term
what things to look for in patient interview
Definition
acute or chronic?; event?; prior treatment for this injury?; PMHx/PSHx/medications; radiographs; overall health; best pain -> can it get to 0?; worst pain; aggs/eases;
Term
Name 4 commonly used outcome measures
Definition
SF-12, Quick DASH, Patient Specific Functional Scale, Upper Extremity Functional scale
Term
why do we need outcome measures
Definition
goal writing; health care reform; research
Term
describe Quick DASH
Definition
outcome measure of difficulty of ADLs. 11 questions with optional sports and work module
Term
describe Patient Specific Functional Scale
Definition
Identify 5 functional activities with impairment and rate on 1-10 scale
Term
describe Upper Extremity Functional Scale
Definition
occupational
Term
describe SF-12
Definition
Quality of Life
Term
what to look for in posture
Definition
forward head, rounded shoulders, kyphosis
Term
what to look for in observation of scapular position
Definition
elevated/depressed; protracted/retracted
Term
what to look for in scapulohumeral rhythm
Definition
head position, cervical asymmetry, clavicular poise, scapular position, gross thoracic asymmetry, scars, muscle wasting, swelling
Term
what are the steps of the upper quarter screen
Definition
upper quarter AROM with overpressure and resistance; compression/traction; myotomes; dermatomes; reflexes
Term
what are pathologies that refer pain to the shoulder
Definition
lung CA, gall bladder, cardiac
Term
what are necessities for full elevatoin
Definition
scapular stabilization; inferior glide of the humerus; ER of the humerus; rotation of the clavicle at SC joint; scapular abduction and lateral rotation of AC joint; straightening of thoracic kyphosis
Term
how to test scapular stabilization
Definition
MMT rhomboids, lower trap, middle trap; look for inhibition from levator scapulae
Term
what would prevent inferior glide of humeral head in elevation
Definition
weak muscles, joint capsule restriction in inferior direction
Term
what would prevent ER
Definition
joint capsule restriction in posterior direction, weak muscles
Term
check affected or unaffected side first in PROM
Definition
unaffected first
Term
what to do if ROM asymmetries exist
Definition
take goniometric measurements
Term
what are the 4 classifications in the Cyriax muscle performance scale
Definition
Strong and Pain Free; Strong and Painful; Weak and Painful; Weak and Pain Free
Term
what is the definition of Cyriax Strong and Pain Free
Definition
normal tendon, muscle, attachments
Term
what is the definition of Cyriax Strong and Painful
Definition
1st degree strain - minor lesion
Term
what is the definition of Cyriax Weak and Painful
Definition
2nd degree strain - gross lesion
Term
what is the definition of Cyriax Weak and Pain Free
Definition
3rd degree strain - complete rupture or neurological
Term
is it important to look at scapular stabilizers in shoulder eval?
Definition
yes
Term
what are the scapular stabilizers
Definition
rhomboids, middle trap, upper trap
Term
what change in muscular performance is seen in overhead athletes with impingement
Definition
decreased middle and lower trap firing, latency
Term
when would you want to check other joints instead of just shoulder?
Definition
when patient isn't progressing
Term
what accessory motions/mobilizations can you do at the shoulder
Definition
inferior mobilization, posterior mobilization, aggressive posterior mobilization, anterior mobilization
Term
what should be palpated posteriorly
Definition
upper trap, supraspinatus, AC joint, acromion, scapular spine, superior angle to inferior angle, levator, rhomboids, infraspinatus, teres minor
Term
what should be palpated laterally
Definition
AC - acromion joint space, deltoid, subscapularis, serratus
Term
what should be palpated anteriorly
Definition
SC joint, clavicle, AC - acromion, coracoid process, coracoacromial/coracoclavicular ligaments, pec major/minor/short head, subacromial structures, bicipital groove
Term
when do you consider impingement
Definition
when you're pretty certain there isn't a massive rotator cuff or labral tear
Term
what is the prevalence of impingement
Definition
1/3 of all physician visits for shoulder pain
Term
prevalence of impingement in occupations with repetitive motions
Definition
16-40%
Term
most common patient age for impingement
Definition
<60 years
Term
most common history of patients with impingement
Definition
occupational or athletic activity with overhead use of arm
Term
most common age for primary impingement
Definition
>40 years
Term
what usually causes primary impingement
Definition
stress overload, degenerative changes
Term
degenerative changes in what structures lead to impingement
Definition
rotator cuff, acromion process, coracoid process, anterior tissues
Term
most common age for secondary impingement
Definition
15-39 years
Term
what are the muscle dynamics of secondary impingement
Definition
force couple disturbance linked to instability
Term
what is anatomical instability
Definition
loosening or tearing of the capsule.
Term
what causes anatomical instability
Definition
Someone has a trauma to their arm. OR someone has a tear and never gets treatment.
Term
what is translational instability
Definition
muscles controlling the joint are weak
Term
why is secondary impingement called secondary impingement
Definition
scapular stabilizers aren't working as they should, and this leads to secondary problem of impingement.
Term
what is outlet impingement
Definition
impingement occurs at supraspinatus outlet. Anterior impingement
Term
how is impingement graded
Definition
I-IV
Term
what is grade I impingement
Definition
pure impingement, no instability
Term
what is grade II impingement
Definition
secondary impingement and instability caused by chronic capsular and labral microtrauma
Term
what is grade 3 impingement
Definition
secondary impingement and instability caused by generalized hypermobility or laxity
Term
what is grade 4 impinement
Definition
primary instability with no impingement
Term
who usually gets nonoutlet impingement
Definition
overhead athletes
Term
what is the location of nonoutlet impingement
Definition
internal, posterior
Term
what happens in nonoutlet impingement
Definition
contact between undersurface of rotator cuff with posterior superior glenoid labrum when the arm is abducted to 90 deg and full ER
Term
how many Neer clinical stages are there
Definition
3
Term
what is Neer Clinical Stage I
Definition
a benign, self-limiting, overuse syndrome
Term
what is Neer Clinical Stage II
Definition
thickening and fibrosis
Term
what is Neer clinical Stage III
Definition
bony changes lead to increased contact pressure, which then lead to rotator cuff damage/tears
Term
what can you do to prevent fibrosis in the shoulder
Definition
MICE (movement). Need to know how to move correctly and safely.
Term
what is the cycle of barriers to healing
Definition
initial injury/decreased blood supply - disuse - weakening of rotator cuff - faulty biomechanics with elevation - continued stress - decreased blood supply
Term
what is sensitivity
Definition
true positive rate: proportion of subjects who have the test that the test finds positive. Snout
Term
what is specificity
Definition
true negative rate: proportion of subjects who do not have the test that the test findes negative. Spin
Term
do you want a high or low positive likelihood ratio
Definition
high
Term
do you want a high or low negative likelihood ratio
Definition
low
Term
what are special tests for impingement
Definition
Neer, Hawkins-Kennedy, IRRST,
Term
what does IRRST stand for
Definition
internal rotation resistance strength test
Term
what is a positive Neer test
Definition
pain
Term
can you use one test to diagnose impingement
Definition
no. best to determine impingement using a cluster of tests, such as Hawkins-Kennedy + painful arc sign + infraspinatus test
Term
State how the following things are for the typical impingement patient
Definition
ok
Term
PROM with overpressure in elevation and IR
Definition
painful
Term
posterior joint mobilization
Definition
painful
Term
posture
Definition
flexed thoracic spine. Forward head. Rounded shoulders
Term
scapular stabilizers
Definition
weak
Term
supraspinatus
Definition
weak and/or damaged
Term
flexibility of upper trap
Definition
less on affected side than unaffected
Supporting users have an ad free experience!