Clavicle to Humeral Shaft


Episode Artwork
1.0x
0% played 00:00 00:00
Feb 18 2018 24 mins   6
Welcome to PA Study Sesh! We will be kicking off with orthopedics, starting with disorders of the shoulder and upper arm.

* Shoulder Dislocation

* Anterior #1
* Presents abducted, externally rotated. “Squared off” shoulder

* Opposite of a hip
* Light SABER

* Posterior: adducted internally rotated

* Usually associated with seizures or ECT

* Sulcus sign: sulcus near the acromion. May occur while patient rested, otherwise, can be elicited with pulling arm downward
* Apprehension Test: anterior pressure on humerus with external rotation

* += apprehensive (feel like it will dislocate)

* Relocation test: posterior pressure (hand on shoulder pushing back) while externally rotating)

* +relief of apprehension

* X-ray findings:

* Axillary:

* Normal: overlap between glenoid & humeral head
* Abnormal: humeral head anterior & inferior to glenoid

* Y view

* Determines anterior vs posterior
* Relative to spine of scapula

* Normal= in alignment

* Hill-sachs Lesion

* Groove on humeral head=compression fx

* Humerus hits the glenoid on a hill sachs

* Bankart Lesion

* Detachment of the anterior inferior labrum from glenoid
* NOT a SLAP tear
* Detected on MRI or MRI Arthrogram

* Check Axillary nerve

* Pinprick sensation over deltoid

* Tx: reduce, sling, PT. Consider surgery for recurrent dislocations.

* Rotator Cuff Tear

* #1 cause of shoulder pain over 40 y.o.
* trauma or overuse injury
* 4 muscles

* supraspinatus
* infraspinatus
* teres minor
* subscapularis
* SIT is responsible for ER & abduction
* Subscap helps with IR

* Pain over anterior & lateral shoulder

* Radiates to deltoid

* Increased pain with overhead activities
* Often disrupts sleep
* PROM>> AROM=WEAKNESS
* Chronic tear=atrophy & may lead to arthritis
* Empty can test

* Thumbs down, elbows extended, 45 degrees of abduction
* Resist against forward flexion
* Assesses supraspinatus

* First to tear

* Drop Arm Test

* Assesses for complete tear
* Passively abduct to 120 degrees
* + patient unable to slowly lower (arm DROPS)
* Pt may also have difficulty with full abduction

* Deltoids initiate, cuff completes

* Lift Off test

* Shoulder internally rotated behind back
* Push against resistance
* Tests subscapularis

* Imaging: MRI
* Tx: PT vs surgery

* Tendonitis/Impingement

* PAIN
* Inflammation: May be due to subacromial bursitis (point tenderness) or AC arthritis
* Hawkin’s Test

* Elbow flexed
* Passive shoulder flexion to 90
* Forcefully internally rotate
* += pain
* may also be positive with rotator cuff pathology

* Neer’s Impingement Test:

* Thumbs down
* Stabilize scapula
* Passively flex
* +=pain

* Impingement may also lead to chronic tear
* Tx: RICE, NSAIDs, injections, PT, surgery for AC arthritis

* AC injury

* MOI: fall onto tucked shoulder (football tackle)
* Grade 1: stretch without separation: normal xrays
* Grade 2: AC ruptured, CC intact: X rays, distal clavicle above inferior acromion,