Shoulder

Question 1

Rotator cuff tear size classifcations

Answer 1

s < 1 cm; m- 1-3 cm; L 3-5; massive > 5 cm

Question 2

RTC tear depth (average cuff depth 9-12m)

Answer 2

grade 1 <3mm; 2- < 6mm, 3- +6mm

Question 3

Characteristics for unfavorable RTC tear outcomes

Answer 3

1. pain > 1 year, cuff tear > 1 cm squared, 3. poor functional impairment at eval (+ emptycan test)

Question 4

Indications for RTC sx

Answer 4

1. failed 3 months conservative treatment, with 6 weeks PT, subacromial injection, oral NASAIDs; 2. significant pain and or weakness, 3. worsening function

Question 5

MOI for AC jt injury

Answer 5

Trauma, direct pressure; inferior force on superior acromion on fixed clavicle (supported by SC ligaments)

Question 6

TUBS

Answer 6

Shoulder dislocations “ Traumatic, unidirectional, bankart lesion usually present, Surgery (PT <20% effective)

Question 7

Primary vs Secondary adhesive capsulitis

Answer 7

Primary- insidious, Secondary- known cause

Question 8

Inferior GH ligament

Answer 8

restrics anterior, inferior and posterior translation of humerus at higher levels of abd. STRONGEST

Question 9

Middle GH ligament

Answer 9

restrics ant translation in lower ranges of motion

Question 10

anterior GH ligament

Answer 10

restrics anterior/inferior translation

Question 11

Passive GH stabilizers

Answer 11

1. labrum 2. GH ligaments 3. Capsule

Question 12

Dynamic GH stabilizers

Answer 12

1. RTC 2. Biceps 3. Scapulothoracic muscles and propricceptors ( Pacinian and ruffinian)

Question 13

GH jt dysfunction

Answer 13

painful arc from 60-120

Question 14

AC jt dysfunction

Answer 14

painful arc from 120-160 shoulder flexion

Question 15

Which type of AC joint injuries are operative?

Answer 15

Type 4,5,6 recommend Op. Type 1,2,3 recommend non-op. Type 3 injury in pitcher/athlere could be op

Question 16

Type 1 AC joint Seaparation

Answer 16

mild trauma, TTP. AC jt stable. no dislocation AC and CC ligaments intact. No deformity

Question 17

Type 2 AC joint Separation

Answer 17

mod TTP. Distal clavicle unstable, CC ligament intact. Pain with shoulder AROM

Question 18

Type 3 AC joint Separation

Answer 18

Disruption of CC and AC ligaments. Can be less painful than type 2. Shoulder abd causes most pain. manual reduction technique possible.

Question 19

Type 4 AC joint Separation

Answer 19

AC and CC ligament disruption+ distal clavicle displaced posteriorly. Manual reduction technique not possible.

Question 20

Type 5 AC joint Separation

Answer 20

AC and CC ligament disruption + detachment of deltoid and UT muscle attachments from distal 1/3 of clavicle. Entire UE drops inferiorly.

Question 21

Type 6 AC joint Separation

Answer 21

AC and CC ligament disruption. Distal clavicle displaced posteriorly under coracoid process. RARE. Due to traumatic abd force to UE.

Question 22

Upward rotation force couple

Answer 22

UT and SA

1. allows for rotation of the scap
2. maintains LT relationship for deltoid
3. prevents SA impingment
4. provides stable scapular base

Question 23

Scapular upward rotators

Answer 23

SA and Lower trap

Question 24

scapular downward rotators

Answer 24

rhomboids, levator scap, pec minor

Question 25

Bankart Lesion

Answer 25

anterior inferior labral detachment

Question 26

SLAP lesion

Answer 26

Superior labral detachment from A-P | - increases anterior band of inferior GH ligament by 100-120%

Question 27

Hill Sachs lesion

Answer 27

dent in posteriorlateral humeral head due to trauma with anterior labrum during dislocation

Question 28

Primary Impingment

Answer 28

Impingment due to abnormal relationship between coracoacromial arch - sub acromial irritation to tendon b/w humeral head, ant 1/3 of clavicle, Coracoacromial ligament coracoid or AC joint

Question 29

Secondary Impingement

Answer 29

due to underlying Glenohumeral instability and tendon wear. Because of increased anterior humeral head translation (think upper crossed syndrome), biceps tendon and RTC can become impinged

Question 30

Posterior impingement

Answer 30

90/90 abd/er position cause tendons of supra and infra to contact postero-superior glenoid lip (tight posterior capsule)

Question 31

RTC guidelines (medium tear)

Answer 31

weeks 1-2: PROM, submax isometrics*, joint mobs Week 6: isotonics week 8: begin closed chain step up/qped rhythmic stab, UE plyo week 10: initiation of submax isokinetic IR/ER week 12: begin interval return programs, max isokinetics

Question 32

Best view for hill sachs lesion

Answer 32

Stryker notch view

Question 33

best view for west point modified axillary view

Answer 33

avulsion of IGHL bony bankart Anterior inferior glenoid deficiency

Question 34

Humeral fx

Answer 34

- early access to PT important - jt mobs as early as 2 weeks - normal flexion ROM by 24 days - immobilization 3 weeks no benefit