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Orthopedics: Clavicle to Humeral Shaft
MP3•Episode home
Manage episode 199946118 series 2108787
Content provided by PA Study Sesh. All podcast content including episodes, graphics, and podcast descriptions are uploaded and provided directly by PA Study Sesh or their podcast platform partner. If you believe someone is using your copyrighted work without your permission, you can follow the process outlined here https://staging.podcastplayer.com/legal.
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,
…
continue reading
* 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,
22 episodes
MP3•Episode home
Manage episode 199946118 series 2108787
Content provided by PA Study Sesh. All podcast content including episodes, graphics, and podcast descriptions are uploaded and provided directly by PA Study Sesh or their podcast platform partner. If you believe someone is using your copyrighted work without your permission, you can follow the process outlined here https://staging.podcastplayer.com/legal.
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,
…
continue reading
* 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,
22 episodes
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