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name the four joints at articulate within the shoulder girdle
- sternoclavicular joint
- acromioclavicular joint
- glenohumeral joint
- scapulothoracic joint
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how many muscles are associated with the shoulder joint
30
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what are some of the things that should be determined when taking a history
- nature of injury – acute or chronic, combination
- duration of injury
- activities affected or affecting activities
- associated symptoms – neck, numbness, vascular
- treatments tried
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what are some basic principles to remember when doing an exam
- shirt off
- symmetry
- bony and muscle contours
- palpation
- manual muscle testing
- laxity/stability – sulcus, hyper laxity, schucking
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how many degrees of flexion is there in the shoulder
180
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how many degrees of extension is there in the shoulder
50
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how many degrees of abduction is there in the shoulder
180
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how many degrees of a adduction is there in the shoulder
50
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how many degrees of internal rotation is there in the shoulder
90
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how many degrees of external rotation is there in the shoulder
90
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Speed's Test assesses what conditions
- SLAP Lesions
- labral pathology
- biceps tendon
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Sulcus Sign assesses what conditions
- multidirectional instability
- laxity
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what are the characteristics of scapular dysfunction
- tightness anteriorly
- forward had
- overdeveloped pectoralis major and minor
- smaller window of the shoulder
- "like firing a cannon out of the canoe"
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what are the radiographic evaluations of the shoulder
- Xrays 3 views
- arthrogram
- MRI
- MRI with arthrogram
- CT
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true or false – arthrography were used prominently prior to MRIs
true
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Arthrograms are good for what populations
patients with pacemakers and patients who are claustrophobic
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true or false – MRIs are the most informative method of viewing the shoulder
true – however only as good as interpretation and quality of the scan
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AC Joint injuries are also called
shoulder separations
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AC joint injuries are usually caused by
force applied to the acromiom -fall on the superior aspect
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what is the treatment for AC joint injuries; grade 1 and 2
- nonoperative
- sling
- ice, NSAIDs
- one – two weeks start range of motion
- progressive strengthening when pain free
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what is the treatment for AC joint injuries; grade 3
- controversial
- sling 3 - 6 weeks
- surgery – screws, tape, suture, allographs reinforcement
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what is the treatment for AC joint injuries grade 4, 5, and 6
surgery
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true or false – impingement injuries, it is hard to determine between impingement or rotator cuff lesion
true
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what is the primary cause of most cuff tears and biceps lesions
outlet impingement
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what is the ideology of impingement and rotator cuff tears
- anatomic and mechanical - Spurs, overuse, often in painters
- overuse
- vascular – smokers
- tramatic
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what percentage of the population has type I, type II, and type III acromions?
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what is the percentage for rotator cuff tears in type I, type II, and type III acromions
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what percentage of patients with confirmed rotator cuff tears had AC Spurs
51%
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true or false – 10 to 14% of normal AC joints have osteophytes
true
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what are the characteristics of primary impingement
- repetitious micro trauma - Cuff
- tendinitis and bursitis - impingement
- tendinitis and bursitis is mostly caused by overhead motion
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what are the characteristics of secondary impingement: theory 1
- rotator cuff weakness
- scapular stabilizer weakness
- rotator cuff fatigue
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what are the characteristics of secondary impingement: theory 2
- clinical or sub clinical instability leads to intrinsic tension overload and/or superior humeral head migration which leads to impingement
- often seen in throwing athletes
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what are the stages of impingement syndrome
- Stage I - edema and hemorrhage
- Stage II -- Fibrosis and Tendonitis
- Stage III- Bone Spurs and tendon rapture
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what are the characteristics of impingement stage I
- < 25 years of age
- overuse etiology
- Reversible
- conservative treatment
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what are the characteristics of impingement stage II
- 25 – 40 years of age
- recurrent pain with activity
- bursectomy or CA ligament resection
- Subacromial decompression
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what are the characteristics of impingement stage III
- > 40 years of age
- progressive disability
- partial or complete tears
- subacromial decompression and rotator cuff repair
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W ahat is the non-operative treatment of impingment syndrome
- Relative rest
- NSAID's
- steroid injections - in sub acromial space
- physical therapy
- surgery if not improved with time
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what are the three types of rotator cuff tears
- bursal surface
- undersurface
- full thickness
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what are the advantages of acromioplast arthroscopicy
- improved cosmesis
- decreased deltoid opening
- shortens hospital stay
- earlier active motion and more aggressive with a RROM
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true or false – pain is related to the size of the tear
false – pain is not related to tire size
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true or false – small tears in the rotator cuff will not usually enlarge with time
false – small tears usually will enlarge with time
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true or false – surgery is better earlier than later when it concerns the rotator cuff
true
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what does TUBS stand for
- traumatic
- unidirectional
- Bankart
- Surgery
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what does AMBRII stand for
- a traumatic/acquired
- multidirectional
- bilateral
- rehab
- inferior capsular shift
- interval closure
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true or false – the shoulder is usually instable anteriorly and inferiorly
true
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dislocation
the joint surfaces are no longer in contact and the joint requires reduction to reassociate the articular surfaces
-
subluxation
the joint does not frankly dislocate. His slips or translates greater than normal. The joint surface may lose contact however they self reduce
-
hill sachs lesion
defect on posterior aspect of humeral head
-
reverse hill sachs
well defect on anterior aspect of humeral head
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SLAP Lesion
type I – ?
type II - ?
type III -
type IV -
- degen tearing, but intact biceps
- detachment from glenoid
- buckethandle tear
- care extends into biceps tendon
-
what kind of surgery is done for type I SLAP lesions
Debride
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what kind of surgeries done for type II, III, and IV
surgical repair
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how much strength is lost a patient suffers from bicep tendon rupture
- 20% decrease in flexion strength
- popeye muscle
- cosmetic deformity
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adhesive capsulitis is also called
frozen shoulder
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adhesive capsulitis is associated with
hyperthyroidism, diabetes, breast surgery, autoimmune
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