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,

What to expect from PA Study Sesh.