Term
Gleno-humeral joint muscles
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Definition
»Stabilizers (rotator cuff)
•Supraspinatus (abduction)
•Infraspinatus (external rotation)
•Subscapularis (internal rotation)
•Teres minor (external rotation)
»Motion
•Deltoid (abduction, flexion, extension)
•Pectoralis major (adductor, internal rotator
•Latissimus dorsi (abduction , internal rotation)
»Other muscles
•Biceps brachii (supination/flexion of elbow)
•Triceps brachii (extension of arm and forearm)
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Term
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Definition
•AP shoulder
»Routine
»True
•Y-scapula lateral
•Axillary lateral
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Term
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Definition
•Result from fall on shoulder
•Classified based on degree of separation of clavicle relative to acromion
•Treatment
»Type I & II – sling for comfort
»Type III – controversial (surg vs non-surg)
»Type IV, V, VI - surgical
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Term
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Definition
•Destruction of joint cartilage with loss of joint space
»Usually > 50 years of age
»Numerous causes
•OA
•RA
•Trauma
•Rotator cuff pathology
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Term
Arthritis of Shoulder Treatment |
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Definition
•Treatment
»Non-operative
•NSAIDS
•Heat/ice
•Stretching
•Corticosteriod injection
»Operative
•Total Joint Replacement
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Term
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Definition
•Among most common bony injuries
•Rarely needs surgery
•May damage over-riding skin, great vessels, lung or brachial plexus
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Term
Fracture of the Proximal Humerus |
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Definition
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•Most in older age population with osteoporosis
•80% minimally displaced
•Look for bone pathology
»Cysts
»Tumor
•Physical Findings
»Severe pain
»Swelling
»Discoloration around upper arm & shoulder
»Possible brachial plexus injury
»Check pulses (axillary artery injury)
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Term
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Definition
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•Results from high-energy trauma
•90% of patients with scapula fractures will have associated injuries (often life threatening)
»Lung
»Spinal cord
»Head
•Physical Findings
»Easily missed as associated injuries are focused on
»Pain about the back of shoulder
»Skin abrasions & swelling
»Tenderness of palpation
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Term
Fracture of the Scapula Diagnostics |
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Definition
•Diagnostics
»AP shoulder radiograph
»AP chest radiograph
»CT scan
»Axillary view – look at acromion
•Treatment
»Non-operative
•Sling
•Early range of motion (ROM)
»Glenoid (> 2MM displaced) surgical management
»Scapular body fractures – ? hospitalization for pulmonary contusions
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Term
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Definition
•Insidious onset and decreased active and passive range of motion
•Cause unknown
»Most likely an inflammatory process
•Diagnositics
»Radiographs of Shoulder
»r/o tumor
»MRI if not improved in 3 months
»Arthrography – decreased volume
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Term
Frozen Shoulder Physical Findings |
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Definition
•Physical Findings
»Pain & loss of motion
»Female/non-dominant arm/40-65 years
»Associated medical conditions
•Insulin dependent diabetes
•Hypothyroidism
•Recent neurosurgical procedure
•Parkinson’s
•Recent myocardial infarction
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Term
Frozen Shoulder Treatment |
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Definition
•Treatment
»NSAIDs
»Physical therapy – home exercise program
»Examination under anesthesia if not improved in 12 weeks
»Associated with IDDM – arthroscopic surgical release
»2 – 2.5 year recovery period
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Term
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Definition
•Inability to keep humeral head centered in the glenoid socket
»No bony stability
»Remember anatomy
•Reduced – humeral head located on glenoid
•Subluxed – head partially off glenoid
•Dislocated – head completely off glenoid
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Term
Glenohumeral Instability (Types of Instability) |
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Definition
»TUBS
•Traumatic
•Unilateral
•Bankart lesions (tear in glenoid labrum)
•Surgery
•(patients >40 years may have rotator cuff tear)
»AMBRI
•Atraumatic
•Multi-directional
•Bilateral
•Rehabilitation
•Inferior capsule repair
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Term
Glenohumeral Instability Physical Findings and Treatment |
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Definition
•Physical Findings
»Apprehension sign – abduction/external rotation
•Pain
•Apprehension
»Sulcus sign
•Indentation between acromion & humeral head when arm pulled down
»Laxity exam
»Sensation – deltoid area for axillary N. injury
Treatment
»Acute dislocations
•Reduction
•Immobilization then Physical therapy
•Think about associated fractures and rotator cuff tears
»Atraumatic
•Physical therapy
•If voluntary (ie party trick) – psychiatric evaluation
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Term
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Definition
•Impingement of acromion, coracoacrionail ligament, acromioclavicular joint & coracoid process of the underlying bursa, biceps tendon and rotator cuff
•Treatment
»NSAIDS
»Physical therapy
»Steroid injection
»Surgical arthroscopy
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Term
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Definition
•Four muscles form a cover around the head of the humerus
•Tears primarily in supraspinatus tendon
»Injury
»Poor blood supply
»Subacromial impingement
»Usually > 40 years of age
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Term
Rotator Cuff Tear Physical Findings and Treatment |
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Definition
•Physical Findings
»Pain, especially at night
»Weakness, catching, grating
»Atrophy of supra & infraspinatus
»Passive ROM – full
»Active ROM – barely hike the shoulder
•Treatment
»NSAIDS
»Physical therapy
»Corticosteroids (controversial)
»Surgery
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Term
Rupture of the Biceps Tendon |
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Definition
•Tear of the proximal tendon
•> 40 years of age
•Long standing impingement
•Often associated with rotator cuff tear
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Term
Rupture of Biceps Tendon Physical Findings and Treatment |
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Definition
•Physical Findings
»Sudden sharp pain
»Bulge in lower arm (“Popeye”)
»Weakness of elbow flexion and supination
•Treatment
»Non-operative treatment for most
»Physical therapy for strength
»Younger patients – surgical repair
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