ATTR 222 Ch 22 The Shoulder Complex: Recognition and Management of Specific Injuries

Identify the factors that contribute to scapular dyskinesis. (Check all that apply.)

Coracoid tenderness Scapular malposition

In the context of specific shoulder injuries, match the grades of acromioclavicular sprains with their symptoms.

Grade 1: In the context of specific shoulder injuries, match the grades of acromioclavicular sprains (in the left column) with their symptoms (in the right column). Grade 2: Partial displacement and prominence of the lateral end of the clavicle when compared with the unaffected side Grade 4: Complete disruption of the acromioclavicular ligament, with the coracoclavicular ligaments remaining intact in some cases Grade 5: Complete loss of both the acromioclavicular and the coracoclavicular ligaments Grade 6: Displacement of the clavicle inferior to the coracoid behind the coracobrachialis tendon

In the context of specific shoulder injuries, match the grades of acromioclavicular sprains with their characteristics.

Grade 1: Point tenderness and discomfort during movement at the junction between the acromion process and the outer end of the clavicle Grade 2: Tearing or rupture of acromioclavicular ligaments, with associated stretching of the coracoclavicular ligament Tearing or rupture of acromioclavicular ligaments, with associated stretching of the coracoclavicular ligament Grade 3: Complete rupture of the acromioclavicular and coracoclavicular ligaments Grade 4: Posterior separation of the clavicle Grade 5: acromion Tearing of the trapezius and deltoid attachment to the clavicle and acromion

What should be done immediately after a sternoclavicular sprain?

POLICE should be used.

_____ paralysis leads to wrist drop and an inability to perform forearm supination.

Radial nerve

Match the progressive stages of shoulder impingement as described by Neer with their characteristics.

Stage I: Choice, It involves point tenderness over the supraspinatus or biceps tendons and pain during abduction that becomes worse at 90 degrees. It involves point tenderness over the supraspinatus or biceps tendons and pain during abduction that becomes worse at 90 degrees. Stage II: It involves a permanent thickening and fibrosis of the supraspinatus and biceps tendons and at times the subacromial bursa. Stage III: Choice, It involves a possible partial muscle tear and permanent thickening of the rotator cuff and the acromial bursa with scar tissue. It involves a possible partial muscle tear and permanent thickening of the rotator cuff and the acromial bursa with scar tissue.

True or false: A fracture of the lesser tuberosity may occur as the subscapularis tendon avulses its attachment in posterior glenohumeral dislocation.

This is true. A fracture of the lesser tuberosity may occur as the subscapularis tendon avulses its attachment in posterior glenohumeral dislocation. The mechanism of injury is usually forced adduction and internal rotation of the shoulder or a fall on an extended and internally rotated arm.

True or false: Older individuals may not require surgical repair in case of biceps brachii rupture because the brachialis muscle is the primary flexor of the elbow joint.

This is true. Older individuals may not require surgical repair in case of biceps brachii rupture because the brachialis muscle is the primary flexor of the elbow joint, and the majority of patients are able to function without their biceps.

Jim, a basketball player, experiences excruciating pain while making overhead passes. Later, he reports pain in all directions of shoulder movement. After a while, he complains of shoulder stiffness. Additional diagnosis reveals paucity of synovial fluid around the humeral head and contraction and lack of elasticity of rotator cuff muscles. In this scenario, Jim probably has _____.

adhesive capsulitis

Susanna is a gymnast. While practicing a spinning move, she loses balance and injures her right shoulder. She experiences moderate pain and disability and is unable to touch the left shoulder with her right hand. She carries her right arm in external rotation and slight abduction. In this scenario, Susanna has _____.

an anterior glenohumeral dislocation

Recurrent _____ instability may cause the athlete who throws to complain of pain or clicking or to experience what is described as a dead arm syndrome in the cocking phase of the overhead throwing motion.

anterior

The biceps brachii rupture commonly occurs near the origin of the muscle in the _____.

bicipital groove

In case of bicipital tenosynovitis, a constant inflammation may result in _____.

degenerative scarring

During initial inspection, shoulder pointers may be mistaken for a _____.

grade 1 AC sprain

In the context of the causes of shoulder instabilities, increased laxity of the supportive capsular and tendinous structures leads to _____.

more instability

Myositis ossificans is a condition in which calcifications, or bone fragments, occur in a(n) _____ adjacent to bone.

muscle

Nerve injury must be considered when there is _____.

muscle atrophy

Referral to a physician is essential in case of peripheral nerve injuries if _____.

muscle weakness persists

In the context of the progressive stages of shoulder impingement as described by Neer, stage IV involves _____.

possible degeneration of the clavicle

Management of stages I and II of shoulder impingement involves _____.

restoring normal biomechanics

In the context of posterior glenohumeral dislocation, a _____ defect can occur on the anteromedial portion of the humeral head following a posterior shoulder dislocation.

reverse Hill-Sachs lesion

The pathological process of a sprain to the glenohumeral joint often involves the _____ muscles.

rotator cuff

Sarah, a discus thrower, experiences a stiff shoulder and pain in all directions of shoulder movement. After evaluation, the physician informs Sarah that she has adhesive capsulitis. In this scenario, the physician could arrive at this conclusion because _____.

there is less synovial fluid around Sarah's humeral head

Leo is an athletic trainer. During a match, an athlete falls on her outstretched arm and sustains an injury. Leo can positively assert that the injured athlete has a clavicular fracture if she _____.

tilts her head toward the injured side

Rhea, a basketball player, falls on the tip of her right shoulder and fractures her clavicle. In this scenario, she will _____.

turn her chin toward her left side

In adhesive capsulitis, _____ is useful in providing penetrating heat to the affected area.

ultrasound

A grade 1 acromioclavicular sprain requires use of a sling for _____.

3 or 4 days

Match the grades of sprain to their characteristics.

Grade 1 sprain: Little pain and disability, with some point tenderness but no joint deformity Grade 2 sprain: Subluxation of the SC joint with visible deformity, pain, swelling and point tenderness Grade 3 sprain: Complete dislocation with gross displacement of the clavicle at its sternal junction, swelling and disability

In the context of the lesions that can be caused by shoulder dislocation, a _____ lesion is caused by the compression of the cancellous bone of the head of the humerus against the anterior glenoid rim that creates a divot in the humeral head.

Hill-Sachs

In the context of the lesions that can be caused by shoulder dislocation, which of the following is true of the superior labrum anterior/posterior lesion?

It is caused by an injury to the superior aspect of the labrum that begins posteriorly

The term _____ describes several factors that contribute to scapular dyskinesis.

SICK scapula

During a baseball tournament, a player accidentally hits Paul's left shoulder. He is immediately rushed to the hospital where the physician conducts several preliminary tests on him. He has pain when he is asked to flex, adduct, and internally rotate his arms. He experiences tenderness when the physician palpates the subacromial space. Moreover, the impingement test exhibits a positive result. In this scenario, Paul has _____.

Shoulder bursitis

Contusions to the distal end of the clavicle are called _____.

Shoulder pointers

Identify the subacute and chronic conditions that result due to any traumatic injury to the shoulder joint. (Check all that apply.)

Synovitis Bursitis

Identify the parts that have to be surgically removed if conservative treatment for thoracic outlet compression syndromes fails. (Check all that apply.)

The anterior scalene muscle The first rib

A soccer player falls on the tip of his shoulder while tackling the ball. He experiences excruciating pain when he tries to move his shoulder. The pain enhances when he attempts to flex, adduct, or internally rotate his arm. He complains of tenderness in the affected area when the physician palpates the subacromial space. The impingement test conducted on him exhibits a positive result. In this scenario, the player probably has _____.

shoulder bursitis

_____ is a brief, transient occurrence in which the humeral head quickly returns to its normal position relative to the glenoid

subluxation

A patient who wants to continue activity during stages III and IV of shoulder impingement may require _____.

surgical intervention

A symptom of bicipital tenosynovitis is _____.

tenderness in the anterior upper arm over the bicipital groove

Winging of the entire medial border of the scapula at rest is caused by fatigue of the _____.

trapezius

Select all that apply Identify the characteristics of the fractures of the humeral shaft.

They are communited. They are transverse.

True or false: In the context of the trauma resulting in a sprain to the sternoclavicular joint, the complete rupture of the sternoclavicular and costoclavicular ligaments is a characteristic of grade 2 stage.

This is false. A grade 3 sprain, which is the most severe, presents a picture of complete dislocation with gross displacement of the clavicle at its sternal junction, swelling, and disability, indicating complete rupture of the sternoclavicular and costoclavicular ligaments. A grade 2 sprain displays subluxation of the sternoclavicular joint with visible deformity, pain, swelling, and point tenderness.

True or false: With all grades of acromioclavicular sprain, an aggressive rehabilitation program involving joint mobilization, flexibility exercises, and strengthening exercises should begin immediately after the recommended period of protection

This is true. With all grades of acromioclavicular sprain, an aggressive rehabilitation program involving joint mobilization, flexibility exercises, and strengthening exercises should begin immediately after the recommended period of protection. Progression should be as rapid as the patient can tolerate without increased pain or swelling. The joint should also be protected with appropriate padding until a pain-free, full range of motion returns.

Match the episodes of shoulder instabilities to their causes.

Traumatic episodes: They occur from one or more situations that cause a complete or partial joint displacement. Atraumatic Episodes: They occur in patients who voluntarily or involuntarily displace the shoulder joint because of inherent ligamentous laxity. Microtraumatic episodes: They are created by repetitive use of the shoulder, usually involving some faulty biomechanics, that leads to soft-tissue laxity.

In a(n) _____ dislocation, the head of the humerus is forced out of its articular capsule in an anterior direction past the glenoid labrum and then downward to rest under the coracoid process.

anterior/inferior glenohumeral

The most common mechanism in an anterior/inferior glenohumeral dislocation is _____.

forced abduction

Adhesivs capsulitis is also known as a(n) ____ ____.

frozen shoulder

With _____, there is excessive translation of the humeral head without complete separation of the joint surfaces.

glenohumeral subluxations

During the management of the sternoclavicular sprain, _____ is usually maintained for 3 to 5 weeks, followed by graded reconditioning exercises.

immobilization

Winging of the superior medial border of the scapula is likely due to _____.

impingement

A characteristic of the recurrent anterior instability of the shoulder joint is that it may _____.

lead to a positive apprehension test

The _____ test can be used to determine thoracic outlet compression syndromes.

military brace position

Jim falls from bicycle and lands on his left shoulder. After the injury, he is unable to externally rotate and elevate his left arm. X-ray of the shoulder reveals that the anterior deltoid muscle is flattened and the acromion and coracoid processes are prominent. These are symptoms of _____.

posterior glenohumeral dislocation