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25 Cards in this Set
- Front
- Back
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If a pt comes in with shoulder pain or injury what should you ALWAYS check? |
the cervical spine (neck) |
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Shoulder pain PE: CROSS ARM ADDUCTION TEST= restricted forward flexion & active adduction
DX? |
AC joint sprain |
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What are the different grades of AC joint separation? |
1: sprained, but intact 2: slight disruption, intact 3: disrupted & superior displaced clavical 4: disrupted & post diplacement into trapezius 5: disrupted & extreme superior displacement 6: disrupted & inf to coracoid process, post to bicep (1-3 have similar pain levels) |
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AC joint sprain: Management |
rest splint
only surgery if young & necessary |
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Hx: FOOSH= Fall on outstretched hand Pt holding arm in ABDUCTION & EXT ROTATION PE: tenderness w/ ANTERIOR fullness
DX? |
Anterior Glenohumeral Dislocation
(Post GH dislocations are rare, due to direct trauma) |
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Anterior Glenohumeral Dislocation: Management |
Reduction- Hippocratic method: apply traction using wrist @ 45 deg angle & counteract w/ foot on chest (foot in armpit) Traction & Countertraction: wrap towel around chest & pull up, w another person pulling opposite wrist down Stimson's method: pt face down, arm off table w/ weight attached, pulls arm out of socket & gradually returns to position
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Shoulder pain Trauma to clavicle
DX? |
Clavicle Fracture
(80% are mid-shaft fractures) |
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Clavicle Fracture: Management |
**figure 8 strap or sling for 6-8 wks
surgery if open, 100% displaced or overlap (only is absolutely necessary) |
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PE: atrophy in affected supraspinatus fossa Affected arm weakness w/ resisted abduction pulses intact & no gross sensory deficits Tenderness of subacromial bursa + drop arm test + Hawkings & Neer's PROM: pain mid arc of abduction AROM: limited abduction
DX? |
Rotator cuff tear |
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Rotator cuff tears are usually due to a degenerative process that originates in the ________________ muscle |
supraspinatus muscle |
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Rotator cuff tear: Management |
if acute-> repair chronic-> tx symptoms & slow progression of degeration
(judges based on pts age, health, activity)
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Older pt, w/ chronic rotator cuff problems PE: some loss of SUPINATION strength mild tenderness in anterior shoulder & subacromial space & bicipital groove Bulge in mid arm Ecchymosis + Yergasons, + Speeds, + Hawkins & + Neers
DX? |
Proximal Biceps Tendon Rupture
(long head of bicep, from supraglenoid tubercle) |
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Proximal Biceps Tendon Rupture: Management |
3-4 months of rehab/PT
(unless young & loss of function, surgery) |
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PE: diffuse tenderness to shoulder both PROM & AROM restricted strenght preserved X-ray: rules out OA, posterior dislocation & mass
DX? |
Adhesive Capsulitis = "frozen shoulder"
-thickened fibrosis of capsule in axillary pouch
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Adhesive Capsulitis: Management |
OMM NSAIDs corticosteroid injections aggressive PT
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UNILATERAL shoulder/arm pain that burns/stings that pt can't "shake out" Hx: traumatic traction/compression to neck/shoulder PE: weakness of muscles effected
Dx? |
Brachial Plexus injury
(usually involves the upper trunk- suprascapular, dorsal scapular, long thoracic, or subclavius ns)
(*if bilateral= spinal cord= backboard to ER) |
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Brachial Plexus injury: Management |
1-2 hr rest for simple neuropraxia 4-6 wk rest for extensive
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Pt as acute, severe, intense shoulder pain, waking from sleep, radiates for 2-3 wks, followed by weakness Hx: past viral illness Exclusion of sprains, dislocations, etc
DX? |
Brachial plexus neuritis= Parsonage- Tuner Syndrome |
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Brachial plexus neuritis: Management |
Rest supervised rehab 3-4 months to recover strength |
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Hx: FOOSH in older or osteoperotic pt Possible axilary a. or nerve damage
Dx? |
Proximal Humerus Fracture |
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Proximal Humerus fracture: Management |
sling |
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Differential Dx for FOOSH |
Anterior dislocation of glenohumerol joint proximal humerus fracture |
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Differential Dx for chronic shoulder pain |
OA (glenohumeral or AC joint) Rotator Cuff impingement syndrome Rotator cuff Tendinosis Rotator Cuff Tear Adhesive Capsulitis Cervical Disk Disease Thoracic Outlet syndrome |
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Differential Dx for acute shoulder pain |
Fracture Brachial nerve injury Dislocation |
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Rotator Cuff muscles |
supraspinatus Infraspinatus Teres Minor Subscapularis |
