Week 8: Shoulder (Impingements, RC, SLAP, lesions, TSA)

Subacriomion impingement syndrome

greater tuberosity hits posteriorsuperior glenoid (under acromion), that entraps the rotator cuff

what 2 muscles are effected in impingement syndrome

supra and infraspinatus

causes of impingement syndrome

overhead/throwing athletes, inflamed subacromial bursa, anterior gh instability, tight posterior capsule, muscle imbalance

what motions are considred to cause impingment syndrome in athletes

Er and hyperabduction, late cocking and early acceleration

s/s of impingement syndrome

posterior sh pai, decreased throwing velocity, dead arm, mm imbalance, laxity, anterior instability, RC weakness, internal derangement, painful arc (60-120)

what is considered internal deranagement

popping, clicking, catching, sliding

special tests for impingement syndrome

hawkins-kennedy, neers test

hawkins kennedy test

flex shoulder and elbow to 90, force IR of shoulder, pain is positive

neers test

flex pt arm in scapular plane while stabilizing scapula, pain near end range flexion is positive

how many Neer stages of impingement syndrome

3

stage I

edema/hemorrhage, under 25yo, associated with overuse and is reversible

stage II

more advanced, 25-40 yo, show fibrosis, irreversible tendon changes

stage III

pts over 50, involves tendon rupture/tear

4 rotator cuff disorders

inflammation of tendon (tendinitis), impingement, calcium buildup, partial/complete tears

symptoms of RC disorders

pain that comes back, pain that prevents sleeping on that side, grating/cracking sound, limited motion, mm weakness

special tests for RC disorders

drop arm test, empty can test

drop arm test

supraspinatus mm, abd arm to 90 and slightly lower it, inability to control it indicates a tear

empty can test

supraspinatus, abd to 90, IR with thumb down, resistance is applied and any pain/weakness indicates a tear

SLAP 4 injury mechanisms

foosh, mva, overhead movements, shoulder dislocation

symptoms of slap lesions

similar to other shoulder sisues

special tests for slap

obriens(flex to 90 with ir, resist resistance), crank (elevate sh to 160 and rotates int/ext rot)

type I slap lesion

degenerative change in superior labrum

type II slap lesion

tear with biceps anchor detachment

type III slap lesion

bucket handle tear of superior labrum with intact biceps anchor

type IV slap lesion

bucket handle tear with involvement of biceps anchor and biceps tendon

type V-VII slap lesion

other involvements

bankhart lesion cause

repeated anterior shoulder sublux (anterior inferior labrum)

hill-sachs lesion cause

anterior shoulder dislocation, compression fracture or dent of superiorposteiror/lateral humeral head

reverse hill sachs lesion

anteromedial aspect, due to posterior shoulder dislocation

symptoms of bankhard lesion

instability, recurrent sublux/dislocation

hill sachs lesion symptoms

often asymptomatic, may worsen instability

what are pt considerations for bankhard lesions and hill sachs

build stability, avoid abd and er

what conditions lead to total shoulder arthroplasty(TSA)

OA, bone tumor, ra, pagets, osteonecrosis, fractures

indications for TSA

diffuse, achy, progressive pain, stiffness that limits rom, loss of sleep, limit function

what radiographic findings may lead to tsa

joint space narrowing, humeral head flat, osteophytes, cyst, humeral head enlargement, glenoid flat, posterior erosion of glenoid

components of TSA

humeral stem, humeral head, glenoid cup

post op conditions of TSA

talk to dr, er to neutral, full passive elevation immediately

expected outcomes of tsa

hand to head, hand to opp ear, hand to rear belt loop, allow sleep

what is a reverse TSA

glenoid is now a sphere, humerus now is flat

indications for reverse TSA

GH oA in pts with long term RCT, failed prior replacement

contraindications for reverse TSA

active infection, nerve injury of deltoit, yound pts

functions of reverse TSA

shifts biomechanics that rely on deltoid muscle.