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Orthopedics > Shoulder (Exam 4) > Flashcards

Shoulder (Exam 4) Flashcards

1
Q

____ joint has a lot of mobility and is unstable.

A

Glenohumeral

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2
Q

Repetitive overhead lifting. Stress and friction result from crowding and compression of RTC tendons under the subacromial arch.

A

Subacromical Rotator Cuff (RTC) Impingement

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3
Q

Compression primarily of supraspinatus tendon as pass under coracoacromial ligament between acromion and coracoid process.

A

Primary Impingement

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4
Q

GH instability creates reduced subacromial space because humeral head elevates.

A

Secondary Impingement

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5
Q

Degenerative changes decrease subacromial space. Bony osteophyte formation occupy space under anteroinferior surface of the acromion decreases space.

A

Other causes of Subacromial Rotator Cuff (RTC) Impingement

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6
Q

___ most commonly affected tendon in impingement. Just proximal to insertion on greater tuberosity is hypo vascular with repeated overhead arm motions, which compromise blood supply. “Critical Zone”.

A

Supraspinatus

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7
Q

Decrease overhead activity. Control pain and swelling (ice massage). Stretching (Posterior Shoulder Capsule). Strengthening (External Rotators, Scapular Stabilizers). Strengthen, Stabilize Scapulothoracic Musculature First. Address RTC Weakness Next (External Rotators).

A

Rehab of Primary and Secondary RTC Impingement

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8
Q

Performed in conjunction with RTC repair. Increases space and subacromial space.

A

Subacromial Depression for Impingement

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9
Q

Small RTC Tear

A

Less than 1 cm.

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10
Q

Medium RTC Tear

A

Less than 3 cm.

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11
Q

Large RTC Tear

A

Greater than 5 cm.

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12
Q

Active motion and pain-free exercise can begin as soon as patient tolerates.

A

Small Cuff Tears Rehab

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13
Q

Tissue protection must be longer to allow for healing. Splint 4-6 weeks.

A

Medium and Large Tears Rehab

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14
Q

If _____ allowed too early, healing compromised due to stress on repaired tissue.

A

Full ROM

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15
Q

Anterior Deltoid Fibers Resected

A

Open Procedure

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16
Q

Lateral Deltoid Fibers Splitting and Arthroscopic Decompression

A

Mini-Open Procedure

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17
Q

Longer To Heal

A

Larger Cuff Tears

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18
Q

Early or Acute Phase. 6 weeks. Codman’s (Pendulum) Exercises within first weeks to restore mobility and stimulate mechanoreceptors. With small tears - submax isometrics as tolerated. PROM - pulleys.

A

RTC Repair Rehab Phase 1

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19
Q

Intermediate Phase. 7-12 weeks. Progressive ROM with caution of repetitive shoulder abduction and forward flex above 90 degrees. Scapular stabilization exercises. Resistive theraband for progressive strengthening of RTC below 90 degrees.

A

RTC Repair Rehab Phase II

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20
Q

Minimum Protection Phase. Begins when increased motion without signs and improved strength. 13-21 weeks. Gradual return to normal activities.

A

RTC Repair Rehab Phase III

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21
Q

No AROM or active strengthening for 3-4 months. Immobilization is key. PROM with restrictions. Codman’s pendulum exercises and gentle AAROM may begin 3 months post op. Submax isometrics and scapular stabilization may be added cautiously 2-4 months after surgery. Full function and recovery may take 10 months.

A

Massive RTC Tears

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22
Q

____ most commonly dislocated joint. Men greater than women. Anterior greater than posterior. Result of indirect trauma.

A

Shoulder

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23
Q

With shoulder in Abd, Ext, ER.

A

Anterior

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24
Q

With shoulder in Abd, Flex, IR.

A

Posterior

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25
Q

Dislocations can be accompanied by.

A

RTC Tear, Glenoid Labrum Tear (Bankart Lesion), Compression or Impaction Fx (Hill-Sachs Lesion)

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26
Q

Avulsion of the capsule and glenoid labrum off anterior rim of glenoid resulting from traumatic anterior dislocation.

A

Glenoid Labrum Tear (Bankart Lesion)

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27
Q

Injury to posterolateral humeral head due to anterior shoulder instability. Does not cause the instability.

A

Compression or Impaction Fx (Hill-Sachs Lesion)

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28
Q

Immobilization avoid positions that may reproduce dislocation.

A

Non-Operative Managment

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29
Q

For anterior dislocation avoid.

A

Abduction, External Rotation

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30
Q

Reattach and tighten capsule using staple, suture, or thermal repair.

A

Anterior Shoulder Capsulorrhaphy

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31
Q

Move subscapularis from lesser to greater tuberosity.

A

Magnuson-Stack Procedure

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32
Q

Surgical repositioning of coracoid process, coracobrachialis, and short head biceps to GH neck.

A

Bristow Procedure

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33
Q

Slack in capsule is reduced. For patients with anterior instability.

A

Capsular Shift

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34
Q

Pain, decreased ROM, capsular inflammation, fibrous synovial adhesions. Females more than males. Typical 40-60 years old. Many are diabetic.

A

Adhesive Capsulitis “Frozen Shoulder”

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35
Q

Idiopathic and spontaneous. Most common.

A

Primary Adhesive Capsulitis

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36
Q

Post trauma or immobilization. In older patients, 1-2 days may be enough immobilization to cause adhesive capsulitis.

A

Secondary Adhesive Capsulitis

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37
Q

Slow onset of pain and decreased ROM. 6 weeks to 9 months.

A

Stage 1 Freezing Stage

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38
Q

Slow improvement in pain, but the stiffness remains. 4 months to 9 months.

A

Stage 2 Frozen Stage

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39
Q

Shoulder motion slowly returns to normal. 5 months to 24 months.

A

Stage 3 Thawing Stage

40
Q

Frozen shoulder will generally get better on its own. Takes ___ to ____ years.

A

2-3

41
Q

Pain control, restoring motion, function.

A

Treatment Adhesive Capsulitis

42
Q

Pain free ROM, Codman’s (Pendulum), Wand and Pulley’s, Joint Mobs, Strengthening Scapular ROM, Stabilization, Submax Isometrics.

A

Treatment (Freezing Stage) Adhesive Capsulitis

43
Q

Same as freezing stage, more aggressive stretching. Painful. Pulley’s, Wand, Dowel, Grade III, IV Joint Mobs, Strengthening.

A

Treatment (Later Stages) Adhesive Capsulitis

44
Q

Partial tear of acromioclavicular ligaments. Joint tenderness. No joint instability or laxity. Minimal loss of function.

A

First Degree AC Sprain

45
Q

Complete rupture acromioclavicular ligaments with partial tear coracoclavicular ligament. Moderate pain. Some dysfunction reduced shoulder abduction. Palpable gap between acromion and clavicle.

A

Second Degree AC Sprain

46
Q

Dislocation between acromion and clavicle. Both AC and coracoclavicular ligaments ruptured. Distal clavicle displaced superiorly. Significant pain. Severe ROM limitation.

A

Third Degree AC Sprain

47
Q

Shoulder harness or sling to approximate ligament for healing of torn ligaments. 3 - 6 weeks.

A

AC Sprain Treatment

48
Q

Pins through AC to stabilize and approximate joint. Sutures around distal clavicle and coracoid process to stabilize. Screw between clavicle and coracoid. Excision of distal clavicle.

A

Severe Surgical Repair

49
Q

Direct severe trauma. Significant injuries including humerus fx, pneumothorax, neuromuscular injuries.

A

Scapular Fractures

50
Q

Treatment in conservative. Most common area of scapula to be fx. Immobilization with sling 2-3 weeks. Hand, wrist, elbow exercises allowed. PROM when pain and swelling subsides.

A

Scapular Body Fracture

51
Q

Conservative symptomatic care with healing in 6 weeks

A

Extraarticular Glenoid Neck Fracture

52
Q

Fx extends through glenoid fossa. Treatment depends on presence of GH instability as a result of the fx. No stability, immobilized in sling. Instability, surgical repair with screw inserted into fx fragments followed by immobilization.

A

Interarticular Glenoid Neck Fracture

53
Q

Direct or indirect trauma. Generally men less than 25 years old.

A

Clavicle Fractures

54
Q

Reduce fracture, maintain reduction minimized immobilization of GH joint.

A

Treatment for Clavicle Fractures

55
Q

AROM for flexion. Limited to 40 degrees initially 4-6 weeks. Fx on distal end. Commonly fixated with ORIF because tend to be unstable and may have malunion.

A

Clavicle Fracture Treatment

56
Q

AVN, OA, RA, Osteoporosis, Four Part Fracture of Proximal Humerus. If torn RTC needs repair as well, immobilization may last 6-8 weeks.

A

Total Shoulder Arthroplasty (TSA)

57
Q

Deltoid contractions contraindicated when RTC repaired. No abduction. Gentle AAROM 1-2 days post op. Week 1 post op, active exercises elbow, wrist, hand. Pendulum exercises.

A

TSA Rehab Program

58
Q

Traumatic onset.
Unidirectional anterior.
Bankart lesion, anterior inferior labral tear.
Surgery.

A

TUBS

59
Q

Recurrent episodes of apprehension and/or anterior dislocations. Patient feels apprehension when UE is near position of subluxation/dislocation. Decreased abduction and ER. Muscle guarding in these positions.

A

TUBS

60
Q

Stabilization exercise is beneficial in older patients. Surgery is indicated in younger patients.

A

TUBS Non-surgical Management

61
Q

Avulsion of the anteroinferior glenohumeral ligament-labral complex from the anterior glenoid rim and scapular neck.

A

Bankart Lesion

62
Q

The subscapularis insertion on the humeral head is detached to expose the glenohumeral ligaments. Glenohumeral ligaments are tightened. The labrum is reattached to the anterior glenoid with suture anchors. The capsule is tightened as subscapularis is reattached.

A

TUBS Surgical Procedure

63
Q

The subscapularis does not become detached instead the subscapularis is tagged and held back by a suture. This is done mostly with overhead athletes.

A

Bankart Procedure

64
Q 
Atraumatic. 
Multidirectional. 
Bilateral Shoulder Findings. 
Rehab Appropriate Rx. Rarely Surgery. 
Inferior Capsular Shift If Surgery Performed.
A

AMBRI

65
Q

Ligamentous laxity or muscle weakness. Chronic shoulder dislocations or subluxations with different motions. Abd/ER (Closed Pack) Flex, Add, IR (Posterior Humeral Head Translation)

A

AMBRI

66
Q

Complaints of pain, apprehension, slipping, catching, clunking without history of dislocation. Repetitive micro trauma due to work or sports with/without underlying hyper mobility. Instability may develop in any direction.

A

Functional Instability

67
Q

Pivotors

A

Scapular Stabilizers

68
Q

Protectors

A

Rotator Cuff

69
Q

Positioners

A

Deltoids, Latissimus Dorsi, Pectoralis Major, Pectoralis Minor

70
Q

During glenohumeral movements with at least 90 degrees elevation, the scapular stabilizers must be strong enough to position the scapula correctly. Weak, scapulohumeral rhythm can be disrupted, causing impingement or other problems.

A

Pivoters Scapular Stabilizers

71
Q

Serratus anterior, rhomboids, middle and lower trapezius. Serratus anterior and lower traps form important force couple that produces acromial elevation. Movement will be abnormal if the force couple is not working properly.

A

Lower Scapular Stabilizers

72
Q

Tendinous band formed. Supraspinatus, Infraspinatus, Teres Minor, Subscapularis.

A

Protectors Rotator Cuff

73
Q

Help keep the head of the humerus rotating against the glenoid fossa during joint motion. Compress and center the humeral head within the glenoid. Provide a counterforce to humeral head superior translation due to deltoid contraction.

A

Rotator Cuff

74
Q

Faulty kinematics and muscle activation. Increased superior humeral head translation. Subsequent decrease is subacromial space which can lead to impingement.

A

Rotator Cuff Weakness

75
Q

At 0 degrees abduction, IR assistance is given by pectoralis major, latissimus doors, and teres major. Less pectoralis major activity at 90 degrees abduction.

A

Subscapularis Exercises

76
Q

Deltoids, Pectoralis Minor, Pectoralis Major, Latissimus Dorsi, Teres Major

A

Positioners

77
Q

Provide dynamic stability within the scapular plane. Mid and post heads provide more stability by generating more compressive forces. During anterior shoulder instability, strengthen mid and post heads.

A

Deltoid

78
Q

Moseley et al. group of 4 exercises make up the core of a scapular strengthening program.

A

Scaption, Rowing, Push-up with a plus, Press-Up.

79
Q

Townsend et al. exercises considered challengeing.

A

Scaption with IR, Flexion, Horizontal Abd with ER, Press-Up.

80
Q

Rowing

A

Trapezius, Levator Scapulae, Rhomboids

81
Q

Horizontal Abd with ER

A

Trapezius, Levator Scapulae, Infraspinatus, Posterior/Medial Deltoid

82
Q

Prone Arm Lift

A

Trapezius, Levator Scapulae, Infraspinatus, Posterior/Medial Deltoid, Supraspinatus

83
Q

Dynamic Hug

A

Serratus Anterior, Subscapularis

84
Q

Shoulder Shrug

A

Levator Scapulae, Upper Trapezius

85
Q

Wall Slide

A

Upper Trapezius

86
Q

Towel Slide

A

Rhomboids, Lower Trapezius

87
Q

Press-Up

A

Pectoralis Major, Minor, Lat Dorsi

88
Q

Push-Up with a Plus

A

Serratus Anterior

89
Q

Ball Stability

A

Multi - RTC

Planar - Stabilizers

90
Q

Inferior Glide

A

Serratus Anterior, Lower Trapezius

91
Q

Low Row

A

Serratus Anterior, Lower Trapezius

92
Q

Lawnmower

A

Serratus Anterior, Lower Trapezius

93
Q

Robbery Exercise

A

Multi-Joint

94
Q

CKC Exercises

A

Step-ups, Push-up, Stair-master, Slide board

95
Q

RTC Muscles

A

Supraspinatus, Infraspinatus, Subscapularis, Teres Minor

Orthopedics (17 decks)

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