Orthopedics: Clavicle to Humeral Shaft

PA Study Sesh

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,