Shoulder Evaluation 3

Question 1

(%) of sport related shoulder injuries involve the ACJ

Answer 1

40%

Question 2

ACJ dysfunction: How is the dx made?

Answer 2

clinically

radiographic imaging

Question 3

ACJ dysfunction: radiographs (view) can rule out fx of ___

Answer 3

Stryker view

coracoid process

Question 4

ACJ dysfunction: 6 different classifications

Answer 4

1. ligament stretched
2. partial rupture of AC ligaments
3. complete rupture AC and CC ligaments
4. clavicle displaced posteriorly over acromion
5. clavicle displaced just under skin
6. clavicle underneath coracoid (very rare)

Question 5

Which ACJ dysfunction types are conservatively managed?

Answer 5

Type I - III

Question 6

Which ACJ dysfunction types require surgical management?

Answer 6

Type IV - VI

Question 7

Why do most surgeons delay ACJ repairs?

Answer 7

no evidence to support early surgical intervention

Question 8

ACJ repair: how long in a sling post-op?

Answer 8

6-8 weeks

Question 9

ACJ repair: post-op

be cautious with these movements

Answer 9

AAROM

• horizontal adduction
• internal rotation behind the back
• forward elevation

Question 10

Most commonly injured nerve during anterior dislocations

Has been involved in up to (%) of dislocations

Answer 10

axillary nerve

30%

Question 11

Acute shoulder instability:

presentation

Answer 11

• visibly deformed shoulder
• swelling/bruising
• intense pain
• inability to move the arm

Question 12

Acute shoulder instability:

treatment

Answer 12

• PT
• NSAIDs, injections
• surgery

Question 13

Acute shoulder instability:

assess

Answer 13

• ROM
• strength
• neuro function
• palpate pulses
• GHJ ‘joint play’

Question 14

Acute shoulder instability:

special testing

Answer 14

• apprehension
• relocation
• sulcus
• AP translation testing

Question 15

Acute shoulder instability:

imaging

Answer 15

XR
MRI
MRA

Question 16

TUBS =

Answer 16

Traumatic
Unilateral (anterior)
Bankart lesion
Surgery (low non-operative success rate)

Question 17

AMBRI =

Answer 17

• Atraumatic
• Multidirectional
• Bilateral (commonly)
• Rehab (high success with nonoperative management)
• Inferior capsular shift

Question 18

Apprehension test:

interpretation - anterior pain

Answer 18

secondary GH joint impingement

Question 19

Apprehension test:

interpretation - posterior pain

Answer 19

posterior or internal impingement

Question 20

What is the procedure used for shoulder instability?

Answer 20

capsular plication

Question 21

Capsular plication:

expect full ROM at

Answer 21

10-12 weeks

Question 22

Capsular plication:

Be cautious to avoid this early post-surgery

Answer 22

excessive ROM

Question 23

Capsular plication: perform exercises in this plane to minimize stress across the repair and to maximize joint congruency

Answer 23

scapular plane

Question 24

Adhesive capsulitis: generally, these ROM losses define the dx

Answer 24

> 25% loss in at least 2 planes

PROM ER loss > 50% of uninvolved shoulder or less than 30˚

Question 25

What is the hallmark finding for clinical dx of adhesive capsulitis?

Answer 25

limited PROM ER of 50% or less than 30˚ with the arm at the side

Question 26

Adhesive capsulitis: which direction of mobilizations are most effective?

Answer 26

posterior mobs

Question 27

Adhesive capsulitis: strong evidence supports the use of these to improve pain and function in pts with frozen shoulder within 3-6 weeks of the intervention

Answer 27

corticosteroid injection + exercise

Question 28

osteonecrosis =

Answer 28

bone death

Question 29

osteonecrosis aka

Answer 29

avascular or aseptic necrosis

Question 30

Osteonecrosis of the humerus often occurs when?

Answer 30

after fractures to proximal humerus (esp if there is a wider segment of articular segment from the shaft)

Question 31

Osteonecrosis: associated with

Answer 31

- systemic steroid use - Cushing's disease - alcohol consumption