PHTH 7232 Ortho > Shoulder algorithm > Flashcards

Shoulder algorithm Flashcards

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1
Q

What special tests might you use for Superior Capsule Instability? (1)

A

Sulcus sign at 0, norm ~11mm (tests rotator interval, SGHL, superior capsule)

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2
Q

What preliminary instability tests would you perform to assess overall shoulder stability?

And what patients would you do this on?

A
  1. Sulcus sign at 0 (~11mm, superior structures)
  2. Sulcus sign at 90 (no norm, inferior structures)
  3. Anterior load and shift (~8mm, anterior structures)
  4. Posterior load and shift (~9mm, posterior structures)

All patients

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3
Q

What Tests could you perform to test for SLAP? (6)

A
  1. Compression-Rotation Test
  2. Speed’s Test
  3. O’Brien’s Test
  4. Anterior Slide test
  5. Posterior Slide
  6. Crank Test
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4
Q

What special tests could you perform to assess anterior instability? (3)

A
  1. Anterior Load & Shift (anterior capsule and ligaments)
  2. Jobe sublux/reloc test (microtrauma, anterior synovial lining & capsule and IGHL)
  3. Apprehension test (macrotrauma)
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5
Q

What special tests could you perform to assess posterior instability? (4)

A
  1. Posterior Load & shift (post. capsule, norm ~9mm)
  2. Posterior Glide I, [tight capsule] (post. capsule)
  3. Jerk Test (Post. capsule, if + only 14% recover with PT alone)
  4. Posterior Glide II, [lax capsule] (post capsule)
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6
Q

What special test could you perform to assess inferior capsule and SGHL instability? (1)

A

Sulcus sign at 90 (no norm data)

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7
Q

When comparing sides, do you test the involved or uninvolved side first?

A

Uninvolved

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8
Q

MDI definition

A

Multi-directional instability

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9
Q

If pt tests positive (for instability) in initial 4 instability tests, and positive during impingement tests, would you classify them as primary or secondary impingement?

A

secondary impingement

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10
Q

If pt tests negative (for instability) in initial 4 instability tests, and positive during impingement tests, would you classify them as primary or secondary impingement?

A

Primary impingement

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11
Q

What is the special term that refers to the way the joint returns to resting position after pressure on it is released?

A

Hysteresis

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12
Q

Hysteresis

A

The way the joint tissue springs back after being compressed/stretched

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13
Q

For special tests, how many times should do a non-resisted test and what is the purpose of each time?

A

3 times:

  1. get general idea
  2. implicate tissues
  3. corroborate finding
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14
Q

what is the term for when you have pushed a joint to its furthest and tightest position during stability testing?

A

Capsular end feel

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15
Q

Is springy rebound compliance/hystoresis or capsular end feel more important (in Dr. Davies opinion)?

A
  • springy rebound compliance/hystoresis
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16
Q

How hard should you push when doing load and shift tests (and maybe its for any manual tests??)

A

9.5 lbs

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17
Q

What does SLAP stand for?

A

Superior Labrum, Anterior to Posterior

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18
Q

Where is a peel back mechanism SLAP found and why?

A

On the superior posterior labrum (between 10-12 on right) because greater tubersosity rubs against the labrum there

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19
Q

Where is an eccentric deceleration SLAP tear found?

A

anterior superior part of labrum, 12-2 on right side

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20
Q

Bankhart tears occur where?

A

Below “equator” of the glenoid on the superior anterior portion of the labrum.

Left Bankart is from 6-9, Right Bankart is from 3-6.

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21
Q

Draw the Clock Face diagram (probably have to specify if it is for Right or Left for the SLAP part)

A

https://classconnection.s3.amazonaws.com/297/flashcards/2750297/png/clock_face-1482D4CF2A93064AF79.png

(link is to picture that is attached)

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22
Q

What three things could indicate a positive SLAP test?

A
  1. deep pain
  2. clicking/clunking
  3. pseudo-locking/locking especially clicking & clunking must be consistent; a few clicks and clunks here and there is not positive in and of itself. remember “one test is no test”
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23
Q

how many pain generators are in the sub-acromial space?

A

11!

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24
Q

In order from best to worst what are the top three SLAP tests?

A
  1. O’Brien’s Test
  2. Crank Test
  3. Speed’s Test
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25
What special tests could you perform to test the Long Head of the Biceps (LHB)? (6)
1. Yergason's Test (also tests THL) 2. Speed's Test 3. Neer Test 4. Coracoid Impingement (+ is pain at Ant./Med.) 5. Cross-over test (+ is pain at Med.) 6. O'Brien's Test (davies mentioned in lecture I think)
26
What special tests could you perform to check AC joint? (3)
1. O'Brien's Test 2. AC Anterior-Posterior Sheer test 3. Cross-over (hug) test (+ sup. pain)
27
What special tests could you use to evaluate supraspinatus impingement? (4)
1. Neer Test 2. Kawkins-Kennedy Test (only test that isolates supraspinatus) 3. Coracoid Impingement test (+ lat. pain) 4. Cross-over (hug) test (+ lat. pain)
28
What special test could you do to evaluate rotator cuff tear in the supraspinatus? (2)
1. ERLS II (External rotation Lag Sign II) 2. 90/90 Lag sign II
29
What special tests could you do to evaluate subscapularis impingement?
1. Coracoid Impingement test (+ Ant. Med. Pain) 2. Cross-Over (hug) test (+ med. pain)
30
What special test could you do to assess subscapularis rotator cuff tear? (1)
IRLS (internal rotation lag sigin)
31
What special tests could you perform to asses Internal Impingement? (2)
1. Jobe sublux/reloc test (+ post. pain for Int. Imp. Synd.) 2. Cross-over (hug) test (+ posterior pain, not precise so could also be a lot of other stuff)
32
What special tests could you do to assess Infraspinatus rotator cuff tear? (2)
1. ERLS I (external rotation lag sign I) 2. 90/90 Lag Sign I
33
What special test could you do to assess infraspinatus/teres minor and posterior capsule imprecisely? (1)
1. Cross-over (hug) test (+ post. pain)
34
What special tests could you do to test for Bankart lesions? (3)
1. Clunk Test I 2. Clunk Test II (see-saw test) 3. Crank Test
35
Which special tests do you want to do on all patients? (4)
1. Suclus sign at 0 (~11 mm norm, tests superior structures) 2. Sulcus sign at 90 (no norm, tests inferior structures) 3. Anterior load and shift (~8mm norm, tests anterior structures) 4. Posterior Load and shift (~9mm norm, tests posterior structures)
36
What should you consider testing if pt presents with the following symptoms: * MOI = macrotraumatic, * MOI = eccentric deceleration history of activities, * deep shoulder pain, * locking/pseudo-locking, * repetitive clicks/clunks
Check for SLAP 1. Compression-rotation 2. Anterior slide test 3. Posterior slide test 4. Speed's test
37
CKC stands for
Closed Kinetic Chain
38
What is the most common CKC MOI for a slap tear?
A a FOOSH (falling on an outstretched hand) CKC = closed kinetic chain)
39
Define FOOSH
Falling On an Out-Stretched Hand
40
What Tests to Consider for Symptom(s): All Patients. (4)
Overall Instabilities 1. Sulcus Sign at 0 (norm ~11mm) [sup. Cap., SGHL, Rot. Interval] 2. Sulcus Sign at 90 (no norm) [inf. Cap., IGHL] 3. Anterior Load & Shift (norm ~8mm) [Ant. Cap. & ligaments] 4. Posterior Load & Shift (norm ~9mm) [Post. Cap.]
41
What Tests to Consider for Symptom(s): MOI = Macrotrauma, generally as its own condition . (4)
Four SLAP Tests 1. Compression-rotation (+ deep pain, clicking/clunking, pseudo-locking/locking) 2. Anterior slide test [ant. Sup. Acc. Dec.] (+ deep pain, clicking/clunking, pseudo-locking/locking) 3. Posterior slide test [post. Sup. Peel back] (+ deep pain, clicking/clunking, pseudo-locking/locking) 4. Speed’s Test (+ deep pain)
42
What Tests to Consider for Symptom(s): MOI = Macrotrauma with functional disability (5)
Five Rotator Cuff Tests 1. ERLS I [Infr.] (+ lag) 2. ERLS II [Supra.] (+ lag) 3. 90/90 Lag Sign I [Infr.] (+ lag) 4. 90/90 Lag Sign II [Supra.] (+ lag) 5. IRLS [Subscap.] (+ lag)
43
What Tests to Consider for Symptom(s): MOI = Macrotrauma with ant/inf injury (1)
One Anterior Instability Test - macrotrauma * Apprehension Test [Ant. Cap. & IGHL] (+ fear, pain is not positive)
44
What Tests to Consider for Symptom(s): MOI = Macrotrauma to cause post. Trauma (3)
Three Posterior Instability Tests 1. Posterior Glide I (tight capsule) [Post. Capsule] (+ pain?) 2. Jerk Test [post. Capsule] (+ pain & subluxation) 3. Posterior Glide II (lax capsule) [Post. Capsule] (+ pain?)
45
Hx of Macrotrauma indicates which special tests? (3)
Three Bankart Lesion Tests 1. Clunk Test I [Ant/inf. Labrum] (+ deep pain, clicking/clunking, pseudo-locking/locking) 2. Clunk Test II (see-saw test) [Ant/inf. Labrum] (+ deep pain, clicking/clunking, pseudo-locking/locking) 3. Crank Test (also tests for SLAP) [Ant/inf. Labrum] (+ deep pain, clicking/clunking, pseudo-locking/locking)
46
* MOI = macrotrauma to superior shoulder, * MOI CKC (closed kinetic chain) position, * c/o Pain with Overhead Activities, * Pain “on Top” of Shoulder, * Pain with AC Palpation, * Pain with Cross-Over Activities, & * Asymmetrical Deformities of AC. Indicates which special test? (1)
One AC Test * AC Anterior-Posterior Shear test (+ pain)
47
MOI = Eccentric Deceleration history of activities indicates which special tests? (5)
The Four Main SLAP Tests 1. Compression-rotation (+ deep pain, clicking/clunking, pseudo-locking/locking) 2. Anterior slide test [ant. Sup. Acc. Dec.] (+ deep pain, clicking/clunking, pseudo-locking/locking) 3. Posterior slide test [post. Sup. Peel back] (+ deep pain, clicking/clunking, pseudo-locking/locking) 4. Speed’s Test (+ deep pain) One LHB Test 1. Yergasuon’s Test [LHB, THL] (+ pain or abnl. palpation)
48
Repetitive Overhead Activities indicate which special tests? (5)
Four RTC Impingement Tests 1. Neer Test [Supra. LHB] (+ pain) 2. Hawkins-Kennedy Test [isolates supra] (+ pain) 3. Coracoid Impingement [Ant./Med: LHB & Subscap, Lat: Supra] (+ pain) 4. Cross-Over (hug)Test [Med: LHB & subsap, Lat: Supra, Sup: AC, Post: Inf/Teres m or post cap. & Inf. Impin] (+ pain) One Anterior Instability Test - macrotrauma 1. Apprehension Test [Ant. Cap. & IGHL] (+ fear)
49
c/o Painful Palpation of LHB indicates which special test? (1)
One LHB Test * Yergasuon’s Test [LHB, THL] (+ pain or abnormal palpation)
50
c/o Pain-Anterior Shoulder indicates which special tests? (4)
One LHB Test 1. Yergasuon’s Test [LHB, THL] (+ pain or abnl palp) Three Bankart Lesion Tests ( all + deep pain, clicking/clunking, pseudo-locking/locking) 1. Clunk Test I [Ant/inf. Labrum] 2. Clunk Test II (see-saw test) [Ant/inf. Labrum] 3. Crank Test (also SLAP) [Ant/inf. Labrum]
51
c/o Constant Dull Ache in Shoulder would suggest you do which special tests? (5)
Five Rotator Cuff Tests 1. ERLS I [Infr.] (+ lag) 2. ERLS II [Supra.] (+ lag) 3. 90/90 Lag Sign I [Infr.] (+ lag) 4. 90/90 Lag Sign II [Supra.] (+ lag) 5. IRLS [Subscap.] (+ lag)
52
c/o Posterior shoulder pain would suggest you do which special tests? (4)
One Internal Impingement Syndrome Test 1. Jobe Subluxation/Relocation test [Artic. sides Supra & Infra hit on post. Sup. Lab.] (+ post. Pain in sublux, red. in reloc.) Three Posterior Instability Tests 1. Posterior Glide I (tight capsule) [Post. Cap] (+ pain?) 2. Jerk Test [post. Capsule] (+ pain & subluxation) 3. Posterior Glide II (lax cap) [Post. Capsule] (+ pain?)
53
* c/o Pain “Deep” or “in” Shoulder, & * Locking/Pseudo-Locking suggests you do which special tests? (7)
Four SLAP Tests 1. Compression-rotation 2. Anterior slide test 3. Posterior slide test 4. Speed’s Test Three Bankart Lesion Tests 1. Clunk Test I 2. Clunk Test II (see-saw test) 3. Crank Test (also tests for SLAP)
54
* c/o Pain in Lateral Aspect of Shoulder/Arm, * Night Pain, & * Compensatory Shoulder Shrug Sign suggests you do which special tests? (9)
Four RTC Impingement Tests 1. Neer Test [Supra. LHB] (+ pain) 2. Hawkins-Kennedy Test 3. Coracoid Impingement 4. Cross-Over (hug) Test Five Rotator Cuff Tests 1. ERLS I [Infr.] (+ lag) 2. ERLS II [Supra.] (+ lag) 3. 90/90 Lag Sign I [Infr.] (+ lag) 4. 90/90 Lag Sign II [Supra.] (+ lag) 5. IRLS [Subscap.] (+ lag)
55
* c/o Painful Arc Syndrome, * Painful Arc During AROM, or * Overuse of Arm in Unaccustomed Activities suggests you do which special tests? (4)
Four RTC Impingement Tests 1. Neer Test [Supra. LHB] (+ pain) 2. Hawkins-Kennedy Test [only test that isolates supra] (+ pain) 3. Coracoid Impingement [Ant./Med: LHB & Subscap, Lat: Supra] (+ pain) 4. Cross-Over (hug) Test [Med: LHB & subsap, Lat: Supra, Sup: AC, Post: Inf/Teres minor or post cap. & Inf. Impingement] (+ pain)
56
Pt Older than 40 suggest you do which special tests? (10)
One AC Test 1. AC Anterior-Posterior Shear test Four RTC Impingement Tests 1. Neer Test 2. Hawkins-Kennedy Test 3. Coracoid Impingement 4. Cross-Over (hug) Test Five Rotator Cuff Tests 1. ERLS I , 2. ERLS II, 3. 90/90 Lag Sign I, 4. 90/90 Lag Sign II, 5. IRLS
57
* Pt Age Younger Than 30, * Sensation of Shoulder Weakness, & * No Overt Signs of Instability suggest you do which special tests? (1)
One Anterior Instability Test – Microtrauma 1. Jobe Subluxation/Relocation test [Ant. Synovial lining, Ant. Cap., IGHL.] (+ ant. Pain upon sublux, red. in reloc.)
58
History of Recurrent Subluxations suggests you should perform which special tests? (4)
One Anterior Instability Test – 1. macrotrauma Apprehension Test [Ant. Cap. & IGHL] (+ fear, pain is not positive) Three Bankart Lesion Tests 1. Clunk Test I [Ant/inf. Labrum] (+ deep pain, clicking/clunking, pseudo-locking/locking) 2. Clunk Test II (see-saw test) [Ant/inf. Labrum] (+ deep pain, clicking/clunking, pseudo-locking/locking) 3. Crank Test (also tests for SLAP) [Ant/inf. Labrum] (+ deep pain, clicking/clunking, pseudo-locking/locking)
59
Volitional Subluxations (history or current) indicate you should perform which special tests? (3)
Three Posterior Instability Tests 1. Posterior Glide I (tight capsule) [Post. Capsule] (+ pain?) 2. Jerk Test [post. Capsule] (+ pain & subluxation) 3. Posterior Glide II (lax capsule) [Post. Capsule] (+ pain?)
60
Lots of c/o Clunking/Clicking suggests you should perform what special tests? (11)
The Four Main SLAP Tests The One Main Anterior Instability Test - macrotrauma The Three Main Posterior Instability Tests The Three Main Bankart Lesion Tests
61
Functional Disability suggests you should perform which special tests? (5)
Five Rotator Cuff Tests 1. ERLS I [Infr.] (+ lag) 2. ERLS II [Supra.] (+ lag) 3. 90/90 Lag Sign I [Infr.] (+ lag) 4. 90/90 Lag Sign II [Supra.] (+ lag) 5. IRLS [Subscap.] (+ lag)
62
Horizontal Extension Motion suggests which special test should be performed? (1)
One Internal Impingement Syndrome Test 1. Jobe Subluxation/Relocation test [Artic. sides Supra & Infra hit on post. Sup. Lab.] (+ post. Pain in sublux, red. in reloc.)
63
* c/o Dead Arm Syndrome, & * Positive Apprehension Test suggests which special test should be performed? (1)
One Anterior Instability Test – macrotrauma 1. Apprehension Test [Ant. Cap. & IGHL] (+ fear, pain is not positive)
64
What are the indications for the following group of special tests? (1) Overall Instabilities: * Sulcus Sign at 0 * Sulcus Sign at 90 * Anterior Load & * Shift Posterior Load & Shift
All Patients
65
What are the indications for the following group of special tests? (5 things) Four SLAP Tests * Compression-rotation * Anterior slide test * Posterior slide test * Speed’s Test
1. MOI = macrotraumatic injury 2. MOI = eccentric deceleration history of activities 3. c/o pain "deep" or "in" shoulder 4. Sensations of locking/pseudo-locking 5. Repetitive clicking/clunking
66
What are the indications for the following group of special tests? (3) One LHB Test * Yergasuon’s Test [LHB, THL] (+ pain or abnormal palpation)
1. MOI - Eccentric deceleration history 2. Pain to palpation of LHB 3. c/o Pain in anterior shoulder
67
What are the indications for the following group of special tests? (8) One AC Test * AC Anterior-Posterior Shear test (+ pain)
1. Age \> 40 2. MOI = macrotrauma to superior shoulder 3. MOI = CKC position 4. c/o pain "on top" of shoulder 5. c/o pain to AC palpation 6. c/o pain with cross-over activities 7. c/o pain with overhead activities 8. Asymmetrical deformities of AC
68
What are the indications for the following group of special tests? (7) Four RTC Impingement Tests * Neer Test * Hawkins-Kennedy Test * Coracoid Impingement * Cross-Over (hug) Test
1. Age \> 40 2. 2. Repetitive overhead activities 3. Overuse of arm in unaccustomed activities 4. c/o pain in lateral aspect of shoulder 5. c/o night pain 6. c/o painful arc syndrome 7. Painful arc during AROM 8. Compensatory Shoulder shrug sign
69
What are the indications for the following group of special tests? (8) Five Rotator Cuff Tear Tests * ERLS I [Infr.] (+ lag) * ERLS II [Supra.] (+ lag) * 90/90 Lag Sign I [Infr.] (+ lag) * 90/90 Lag Sign II [Supra.] (+ lag) * IRLS [Subscap.] (+ lag)
1. Age \> 40 2. Macrotraumatic injury with functional disability 3. Idiopathic onset of functional disability of shoulder 4. c/o pain in lateral aspect of arm 5. c/o dull constant ache in shoulder 6. c/o night pain; often wakes patient 7. compensatory shoulder shrug sign 8. functional disability
70
What are the four rules/steps for interpreting/executing the RTC Tear special tests?
1. AAOM to predetermined position 2. Isometric hold at position successful = normal Muscle-tendon unit 3. \< 5-10 degree lag = partial RTC tear 4. \> 10 degree lag = full RTC tear
71
What are the indications for the following group of special tests? (4) One Anterior Instability Test – macrotrauma * Apprehension Test [Ant. Cap. & IGHL] (+ fear, pain is not positive)
1. Macrotrauma with ant/inf injury 2. history of recurrent subluxations 3. c/o "dead arm syndrome" 4. Positive apprehension test
72
"Dead Arm Syndrome"
paralyzing pain and weakness in shoulder, that may be transient. Means athlete is NOT OK suggests anterior shoulder instability
73
What are the indications for the following group of special tests? (6) One Anterior Instability Test – Microtrauma * Jobe Subluxation/Relocation test [Ant. Synovial lining, Ant. Cap., IGHL.] (+ ant. Pain upon sublux, red. in reloc.)
1. Age \< 30 2. Repetitive Overhead Activities 3. c/o pain with overhead activities 4. no overt signs of instability 5. c/o click/clunk in shoulder 6. Sensations of shoulder weakness
74
What are the indications for the following group of special tests? (2) One Internal Impingement Syndrome Test * Jobe Subluxation/Relocation test [Artic. sides Supra & Infra hit on post. Sup. Lab.] (+ post. Pain in sublux, red. in reloc.)
1. Specific c/o pain in the posterior shoulder inferior to the postero-lateral acromion 2. Horizontal extension motion
75
What are the indications for the following group of special tests? (5) Three Posterior Instability Tests * Posterior Glide I (tight capsule) [Post. Capsule] (+ pain?) * Jerk Test [post. Capsule] (+ pain & subluxation) * Posterior Glide II (lax capsule) [Post. Capsule] (+ pain?)
1. MOI: macrotrauma to cause posterior trauma 2. History of volitional subluxation 3. c/o posterior shoulder pain 4. Patient can volitionally sublux shoulder 5. c/o click/clunk
76
What are the indications for the following group of special tests? (5) Three Bankart Lesion Tests * Clunk Test I * Clunk Test II (see-saw test) * Crank Test (also tests for SLAP)
1. History of macrotrauma 2. history of recurrent subluxations 3. c/o pain anterior or "deep" in shoulder 4. c/o click/clunk 5. sensation of pseudo-locking
77
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