Msk System Shoulder Injuries Alasky

Front 1

What four muscles make up the rotator cuff?

Back 1

Supraspinatus
Infraspinatus
Teres Minor
Subscapularis

Front 2

3 parts to the physical exam?

Back 2

Inspection
Palpation
Motion

Front 3

Standard shoulder X-ray series

Back 3

AP - view of glenohumeral joint

Axillary - dislocations

Scapular Y - dislocations, acromion morphology

Front 4

Subacromial rotator cuff impingement

Back 4

RC fatigue, presents with lateral shoulder pain worse w/overhead activities and lying on affected side at night

Front 5

Internal RC impingement

Back 5

Seen in throwers, cuff contacts superior labrum, posterior superior deep shoulder pain

Front 6

Coricoid RC impingement

Back 6

from contact of RC with coricoid, anterior shoulder pain w/forward flexion and internal rotation activity

Front 7

Rotator Cuff Impingement Dx, Tx, RTP?

Back 7

Dx: + Neers, Hawkings, painful arc btw 60-120

Tx: NSAIDs, PT, injections, surgery - subacromial decompression

RTP - once pain resolved to allow near normal ROM and strength

Front 8

Rotator Cuff Tear

Back 8

Disruption of rotator cuff tendons, most commonly supraspinatus

Can be trauma or chronic tendonopathy

Presents similar to subacromial impingement (night pain) +/- weakness depending on size of tear

Atrophy of supraspinatus = chronic tear, pain or weakness with external rotation, empty can

Front 9

Tell btw rotator cuff tear/impingment?

Back 9

MRI needed but this can clue you in.

Impingement gets better, tear doesn't.

Front 10

Tx for rotator cuff tear:

Back 10

Individualized to pt, conservative tx less successful in pt w/symptoms > 1yr and significant weakness.

Surgery for acute traumatic tears and those who fail conservative tx

RTP: 6-12 mo for overhead throwing athletes

Front 11

Adhesive capsulitis

(frozen shoulder)

Back 11

Pain and gradual loss of active and passive ROM of shoulder caused by soft tissue contracture

Front 12

Who is adhesive capsulitis more commonly found in?

Back 12

Women and diabetics.

Can be idiopathic or post-traumatic

Front 13

Three stages of adhesive capsulitis?

Back 13

Painful

Adhesive

Recovery

Front 14

Adhesive capsulitis tx?

Back 14

Benign neglect and almost all will heal w/in 1 yr

PT, NSAIDs, steroid injections, manipulation under anesthesia

RTP: majority improve w/conservative tx.

May have residual deficits in motion and function.

Front 15

Anterior glenohumoral instability

Back 15

Pain, weakness, instability or recurrent dislocations

Younger Pt - Bankart lesion (labrum torn anteriorly)
>40 - rotator cuff tears

Loss of shoulder contour w/fullness ant., + apprehension test, check for axillary nerve function

Front 16

Anterior glenohumoral instability Tx

Back 16

Acute dislocations require reduction

PT beneficial

Surgical Tx for recurrent instability

Recurrence 90% under 20 y/o

RTP: after conservative tx - w/near normal ROM, strength and function; after sx 4-6 mo

Front 17

Posterior shoulder instability

Back 17

Rare, posterior tear from repetitive trauma (lineman jamming opponents)

Often after seizure or electric shock

Front 18

How does posterior shoulder instability present?

Back 18

Prominent coracoid, arm held in adductoin/int rotation. +jerk test

Imaging

Front 19

Posterior instability Tx

Back 19

Acute dislocation requires reduction

PT for recurrent dislocations

Sx if conservative tx fails, to repair reverse bankart lesions

RTP: Conservative tx when strength ROM returns, Sx - 4-6 mos

Front 20

Multidirectional instability

Back 20

Inferior instability w/either ant or post instability.

Caused by repetitive microtrauma (swimmers)

Often bilateral, pain and transient neurological symptoms

Generalized laxity, hyperextension, + sulcus sign

Imaging shows bankart lesions

Front 21

Multidirectional Tx/RTP?

Back 21

Responds well to PT, sx if PT fails

RTP: same as others

Front 22

Sulcus sign?

Back 22

Pull down on arm. + if sulcus widens

Front 23

Biceps tendonitis?

Back 23

Inflammation of long head of biceps, occurs w/ rotator cuff impingement

Pain ant. shoulder radiates down biceps, tenderness over bicipital groove, +speeds/Yergasons tests. Also may have +impingement signs

Xray normal or acromial spur, MRI-edema around tendon

Front 24

Biceps tendonitis tx?

Back 24

Rest, NSAIDs. ROM exercises, steroid injections. Sx if all else fails.

RTP: once pain resolved, near normal ROM and strength

Subluxation may occur w/ similar presentation

Sx is more appropriate tx in young, active pt

Front 25

Biceps rupture

Back 25

Rupture of long head, forceful elbow flexion against resistance

Pain and bruising ant. Older pt has degeneration and may be unaware

Popeye deformity

Sx for young, active pt if worried about cosmesis

RTP: when near normal function return or 4-6 mo after sx

Front 26

Superior Labrum Anterior to Posterior (SLAP) Lesion

Back 26

Injury to superior glenoid labrum. Traction, compression and direct blows. (Throwing)

Classified into 4 types

Front 27

SLAP lesion

Back 27

Pain w/overhead activities, popping or catching. similar to rotator cuff tear.

+ O'briens test

MRI - sup. paralabral cyst

Front 28

SLAP lesion Tx/RTP

Back 28

Tx - rest, NSAIDs, PT, specific Sx depending on type

RTP - throwing athletes 6-7 mo. to fully rehab, nonthrowers 4 mo

Front 29

Acromioclavicular injuries

Back 29

Fall onto shoulder w/arm adducted or on outstretched hand

Pain anterior superior shoulder over AC joint, +cross arm adduction test

Front 30

Acromioclavicular Tx/RTP

Back 30

Tx - types 1-2 immobilize in sling, ice, PT. Local anesthetic for in game tx. Type 3 controversial. Type 4-6 Sx.

RTP: 1-6 wks w/conservative tx. 4-6 mo after surgery

Front 31

Distal Clavical osteolysis

Back 31

Pain in AC joint caused by lysis of distal clavical, overuse injury leading to bone reabsorption. presents similar to AC sprains, prominence of distal clavical

Often bilateral - weight lifters, bench, push-ups

Xray - osteopenia, wide joint space.

Front 32

Distal clavical osteolysis Tx

Back 32

Modify activity, steroid injection, NSAIDs. Sx if pt fails nonoperative tx (distal clavical resection)

RTP: as tolerated, 4-6 wks after Sx

Front 33

Clavical Fractures occur where?

Back 33

80% occur in middle third of clavical, indirectly by fall on outstretched arm or point of direct trauma

Front 34

Clavical fracture presentation?

Back 34

Visible or palpable deformity w/swelling/bruising. Pt usually splinting the injured side

Always check neurovascular status of involved arm as well as for other injuries

Front 35

Clavicle Fracture Tx

Back 35

Sling immobilization and figure 8. High nonunion rate w/shortened clavical > 2 cm. Sx for open fracture and high level athletes

RTP: once radiographic healing achieved in noncontact sports and full painless active ROM. 2-3 mo for contact sports.

Front 36

Stinger

Back 36

Traction or compression of brachial plexus causes weakness and burning or stinging of shoulder and arm

Front 37

Thoracic Outlet Syndrome

Back 37

Compression of brachial plexus and subclavian vessels. Pain and paresthesis from neck to fingers

Front 38

Cervical Spine Injury

Back 38

Can refer pain to shoulder