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  /Title (6002-shoulder.pdf)
  /Creator (Cheatography)
  /Author (bee.f (bee.f))
  /Subject (6002 Shoulder Cheat Sheet)
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    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{6002 Shoulder Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{bee.f (bee.f)} via \textcolor{DarkBackground}{\uline{cheatography.com/180201/cs/42079/}}}
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}bee.f (bee.f) \\
  \uline{cheatography.com/bee-f} \\
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Published 14th April, 2024.\\
   Updated 14th April, 2024.\\
   Page {\thepage} of \pageref{LastPage}.
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  Measure your website readability!\\
  www.readability-score.com
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\begin{document}
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\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Causes of px arising from shoulder:}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{• Rotator cuff disorder} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{• Frozen shoulder} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{• Instability disorder} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{• AC joint disorder} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{• GH joint osteoarthritis} \tn 
% Row Count 5 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{• Inflammatory arthritis} \tn 
% Row Count 6 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{• Septic arthritis} \tn 
% Row Count 7 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Causes of px which arise from elsewhere:}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{• Malignancy} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{• Referred pain from the neck, heart, or lungs} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{• Polymyalgia rheumatica} \tn 
% Row Count 3 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Red flags on Hx or examination:}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{• Trauma, pain \& weakness, or sudden loss of ability to actively raise the arm (with or without trauma){\bf{:}} suspect acute rotator cuff tear} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{• Any shoulder mass or swelling{\bf{:}} suspect malignancy} \tn 
% Row Count 5 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{• Red skin, painful joint, fever, or the person is systemically unwell{\bf{:}} suspect septic arthritis} \tn 
% Row Count 8 (+ 3)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{• Trauma leading to loss of rotation \& abnormal shape{\bf{:}} possible shoulder dislocation} \tn 
% Row Count 10 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{• New Ssx of inflammation in several joint{\bf{:}} suspect inflammatory arthritis} \tn 
% Row Count 12 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Further investigations:}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{• {\bf{Blood tests:}} if malignancy, poly myalgia rheumatica, or inflammatory arthritis are suspected} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{• Testing for {\bf{diabetes}} considered if pt with frozen shoulder} \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{• {\bf{X-rays:}} if Hx of trauma; little improvement with conservative care; Ssx last more than 4 weeks; severe pain or restriction of movement; arthritis suspected} \tn 
% Row Count 8 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Treatments:}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{• Initial management: explanation \& education on diagnosis; analgesia if appropriate; MSK treatment} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{• Corticosteroid injections may be considered, depending on the suspected cause \& Ssx severity} \tn 
% Row Count 5 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{• If orthopaedic referral is indicated (suspected septic arthritis / dislocation), should not be delayed} \tn 
% Row Count 8 (+ 3)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{• Referral to 2° care considered if pain \& function are not improving following conservative treatment for 3 months} \tn 
% Row Count 11 (+ 3)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{• Earlier referral considered if: pain is having significant impact on ADLs; recurrent shoulder instability; severe post-traumatic pain} \tn 
% Row Count 14 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Adhesive capsulitis}}  \tn
% Row 0
\SetRowColor{LightBackground}
• {\bf{GREEN or YELLOW}} & - Condition gradually develops \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
• {\bf{Intro:}} & - Also known as {\emph{Frozen shoulder}}\{\{nl\}\}- Inflammatory condition causing stiffness \& px in the shoulder joint\{\{nl\}\}- Dx emphasises the gradual development of global limitation of shoulder motion\{\{nl\}\}- Significant radiographic findings may not be present\{\{nl\}\}- Assessing passive ROM crucial for Dx \tn 
% Row Count 16 (+ 14)
% Row 2
\SetRowColor{LightBackground}
• {\bf{Aetiology (risk factors):}} & - Prevalence 2-5\% in general pop\{\{nl\}\}- Common in people starting 55yrs\{\{nl\}\}- F\textgreater{}M (1.4:1)\{\{nl\}\}- Non-dominant hand often affected\{\{nl\}\}- Associated w/ autoimmune comorbidities: thyroid disorders, DM (poorer treatment outcomes)\{\{nl\}\}{\bf{Form classification:}}\{\{nl\}\}- {\bf{1°:}} idiopathic, gradual onset, associated w/ other conditions (e.g. DM, thyroid disease, drugs, hypertriglyceridemia, or Cx spondylosis)\{\{nl\}\}- {\bf{2°:}} result of shoulder trauma (e.g. rotator cuff tears, \#, surgery, or prolonged immobilisation) \tn 
% Row Count 40 (+ 24)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Adhesive capsulitis (cont)}}  \tn
% Row 3
\SetRowColor{LightBackground}
• {\bf{Pathophysiology:}} & - Not fully understood\{\{nl\}\}- Leading hypothesis: inflammation begins in joint capsule \& synovial fluid\{\{nl\}\}- Subsequent reactive fibrosis \& adhesions in synovial lining\{\{nl\}\}- Initial inflammation causes px\{\{nl\}\}- Fibrosis \& adhesions limit ROM \tn 
% Row Count 12 (+ 12)
% Row 4
\SetRowColor{white}
• {\bf{Clinical presentation:}} & - Gradual onset of shoulder px\{\{nl\}\}- Worsens over weeks - months\{\{nl\}\}- Followed w/ significant limitation in shoulder ROM \tn 
% Row Count 18 (+ 6)
% Row 5
\SetRowColor{LightBackground}
• {\bf{Physical examination:}} & - Reduced AROM \& PROM\{\{nl\}\}- Specifically affected movements: EXT rotation → ABD → INT rotation → forward FX\{\{nl\}\}- Severe cases may loose natural arm swing during walking \& muscular dystrophy\{\{nl\}\}- TTP around the joint\{\{nl\}\}- Distal neurology MUST remain intact\{\{nl\}\}- RROM elicits px \& marked limitation, resembling rotator cuff tear\{\{nl\}\}- Apley scratch test: measure INT rotation\{\{nl\}\}- +ve special tests: Need, Hawkins, \& Speed's (indicating impingement or biceps tendinopathy) \tn 
% Row Count 41 (+ 23)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Adhesive capsulitis (cont)}}  \tn
% Row 6
\SetRowColor{LightBackground}
• {\bf{Diagnosis:}} & - Dx based mainly on clinical \& physical findings\{\{nl\}\}- X-rays considered for alternative Dx or underlying pathology\{\{nl\}\}- Injection test can help differentiate adhesive capsulitis from other shoulder pathologies\{\{nl\}\}- MRI may reveal characteristic findings: rotator interval synovitis, coracohumeral lig hypertrophy, loss of subcoracoid fat triangle, \& thickening of the GH capsule (they're not specific) \tn 
% Row Count 19 (+ 19)
% Row 7
\SetRowColor{white}
• {\bf{Staging:}} & {\bf{3 clinical phases:}}\{\{nl\}\}- {\bf{Phase 1:}} painful phase is characterised by diffuse \& disabling shoulder px, initially worse at night, along w/ increasing stiffness, can last 2-9 months\{\{nl\}\}- {\bf{Phase 2:}} frozen or adhesive phase involves a progressive limitation in ROM in all shoulder planes, the intensity of px gradually diminishes during this phase, typically lasts from 4-12 months\{\{nl\}\}- {\bf{Phase 3:}} thawing or regression phase is marked by gradual return of the ROM, recovery of ROM may take 12-24 months for complete restoration \tn 
% Row Count 44 (+ 25)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Adhesive capsulitis (cont)}}  \tn
% Row 8
\SetRowColor{LightBackground}
• {\bf{Complications:}} & - Residual shoulder px \&/or stiffness\{\{nl\}\}- Humeral fracture\{\{nl\}\}- Rupture of the biceps \& subscapularis tendons\{\{nl\}\}- Labral tears\{\{nl\}\}- GH dislocation\{\{nl\}\}- Rotator cuff tear \tn 
% Row Count 9 (+ 9)
% Row 9
\SetRowColor{white}
• {\bf{Management:}} & - SMT \& STW\{\{nl\}\}- IASTM/TFM\{\{nl\}\}- Spencer technique\{\{nl\}\}- NSAIDs\{\{nl\}\}- Corticosteroids / steroid injections\{\{nl\}\}- Arthroscopic capsular release\{\{nl\}\}- Exercises phase 1: Codman pendulum, Cane - FX \& ABD, Cross body stretch, Shoulder INT rotation - towel, EXT rotation doorway stretch\{\{nl\}\}- Exercises phase 2: Side lying horizontal ABD, resisted shoulder EXT prone, Resisted shoulder FX\{\{nl\}\}{\bf{Indication for surgery:}}\{\{nl\}\}- Pt fails a trial of steroids or NSAIDs\{\{nl\}\}- No response to GH or SC injections\{\{nl\}\}- No response respond to PT\{\{nl\}\}{\bf{Contraindications for surgery:}}\{\{nl\}\}- Pt has had an inadequate course of steroids or NSAIDs\{\{nl\}\}- Pt has not had any attempt at conservative therapy\{\{nl\}\}- Acute infection\{\{nl\}\}- Pt has a concomitant malignancy in the shoulder\{\{nl\}\}- Pt has a neurological deficit or nerve complaint originating from the Cx spine \tn 
% Row Count 49 (+ 40)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Adhesive capsulitis (cont)}}  \tn
% Row 10
\SetRowColor{LightBackground}
• {\bf{Ddx:}} & - Cx radiculopathy\{\{nl\}\}- AC arthrosis\{\{nl\}\}- Bicep tendinopathy\{\{nl\}\}- GH arthritis\{\{nl\}\}- Fracture\{\{nl\}\}- Calcifying tendinitis/synovitis\{\{nl\}\}- Malignancy\{\{nl\}\}- Polymyalgia rheumatica\{\{nl\}\}- Shoulder impingement s. \tn 
% Row Count 10 (+ 10)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{\{\{popup="https://www.ncbi.nlm.nih.gov/books/NBK532955/"\}\}link text\{\{/popup\}\}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{AC joint injury}}  \tn
% Row 0
\SetRowColor{LightBackground}
• {\bf{GREEN to RED}} & - Sprain degree to torn degree \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
• {\bf{Intro:}} & - Common among athletes \& adolescents\{\{nl\}\}- Around 40\% of all shoulder injuries\{\{nl\}\}- Mild injuries usually don't cause significant morbidity\{\{nl\}\}- Severe injuries can result in substantial strength loss \& function of shoulder\{\{nl\}\}- AC injuries may be linked to clavicular \#\{\{nl\}\}- They can lead to impingement s.\{\{nl\}\}- Neurovascular insults are a rare complication associated w/ AC injuries \tn 
% Row Count 20 (+ 18)
% Row 2
\SetRowColor{LightBackground}
• {\bf{Aetiology (risk factors):}} & - Commonly occur after sporting events, car accidents, \& falls\{\{nl\}\}- Make up about 40\% of all shoulder injuries\{\{nl\}\}- Up to 10\% of all injuries in collision sports (e.g. football, lacrosse, \& ice hockey)\{\{nl\}\}- AC joint: lateral process of clavicle meets the acromion process projecting off the scapula\{\{nl\}\}- Stabilised by AC lig (anterior, posterior, superior, \& inferior portion), where superior portion crucial for stability\{\{nl\}\}- Mild injuries don't cause significant issues, but severe can lead to substantial strength \& function loss\{\{nl\}\}- Linked to clavicular \#, impingement s., \& occasionally neurovascular problems \tn 
% Row Count 49 (+ 29)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{AC joint injury (cont)}}  \tn
% Row 3
\SetRowColor{LightBackground}
• {\bf{Pathophysiology:}} & - Most common: direct trauma to lateral aspect of the shoulder or acromion process w/ the arm in ADD\{\{nl\}\}- Falling on an outstretched hand or elbow may also lead to AC separation \tn 
% Row Count 9 (+ 9)
% Row 4
\SetRowColor{white}
• {\bf{Clinical presentation:}} & - Antero-superior shoulder px\{\{nl\}\}{\bf{Mechanism of injury:}}\{\{nl\}\}- Blunt trauma to ABD shoulder\{\{nl\}\}- Landing on outstretched arm\{\{nl\}\}{\bf{Px description:}}\{\{nl\}\}- Radiating to neck or shoulder\{\{nl\}\}- Aggravated by movement\{\{nl\}\}- Worse when sleeping on affected shoulder \tn 
% Row Count 22 (+ 13)
% Row 5
\SetRowColor{LightBackground}
• {\bf{Physical examination:}} & - Swelling, bruising, or deformity of AC\{\{nl\}\}- TTP\{\{nl\}\}- Restricted A\&PROM due to px\{\{nl\}\}- "Piano key sign": palpation of the distal clavicle demonstrates a feeling of "giving way"\{\{nl\}\}- Cross-body ADD test\{\{nl\}\}- BvR test\{\{nl\}\}- Paxino's test\{\{nl\}\}- AC differential test \tn 
% Row Count 35 (+ 13)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{AC joint injury (cont)}}  \tn
% Row 6
\SetRowColor{LightBackground}
• {\bf{Diagnosis:}} & - X-rays are 1° for Dx\{\{nl\}\}- US \& MRI may be considered if Dx remains uncertain \tn 
% Row Count 4 (+ 4)
% Row 7
\SetRowColor{white}
• {\bf{Staging:}} & {\bf{Rockwood classification}} (gold standard){\bf{:}}\{\{nl\}\}{\bf{I:}} AC ligament sprain; CC ligament intact; no radiographic abnormalities\{\{nl\}\}{\bf{II:}} AC ligament is torn; CC ligament sprain; clavicle has elevated but is not superior to the border of the acromion, or exhibits a less than 25\% increase in the CC interspace compared to the contralateral\{\{nl\}\}{\bf{III:}} AC \& CC ligaments are torn; clavicle has elevated above the border of the acromion, or there is an increase of 25-100\% in the CC interspace compared to the contralateral\{\{nl\}\}{\bf{IV:}} AC \& CC ligaments are torn; posterior displacement of the distal clavicle into the trapezius\{\{nl\}\}{\bf{V:}} AC \& CC ligaments are torn; superior displacement of the distal clavicle by more than 100\% in the CC interspace compared to the contralateral\{\{nl\}\}{\bf{VI:}} AC \& CC ligaments are torn; inferolateral displacement in a subacromial or subcoracoid displacement behind the coracobrachialis or biceps tendon \tn 
% Row Count 48 (+ 44)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{AC joint injury (cont)}}  \tn
% Row 8
\SetRowColor{LightBackground}
• {\bf{Complications:}} & - Residual joint px (30-50\% of pts)\{\{nl\}\}- AC arthritis (more common in surgical management)\{\{nl\}\}- Following fixation: hardware irritation, infection, adhesive capsulitis, coracoid, \& clavicular \#\{\{nl\}\}- Hook plate: acromion irritation, subacromial impingement, \& osteolysis \tn 
% Row Count 13 (+ 13)
% Row 9
\SetRowColor{white}
• {\bf{Management:}} & - Generally favourable prognosis\{\{nl\}\}- Functional motion regain by 6 weeks \& return to normal activity by 12 weeks\{\{nl\}\}- Non-operative grade 1, 2 \& 3; 3 operative if athlete / \textgreater{} displacement\{\{nl\}\}- Acute (within 6 weeks): stabilisation \& reduction of Ssx\{\{nl\}\}- STW\{\{nl\}\}- SMT (not shoulder)\{\{nl\}\}- IASTM / TFM\{\{nl\}\}- Exercises phase 1: scapular clocks \& protraction / retraction\{\{nl\}\}- Exercises phase 2: resisted shoulder EXT rotation, cane - FX, low row \tn 
% Row Count 34 (+ 21)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{AC joint injury (cont)}}  \tn
% Row 10
\SetRowColor{LightBackground}
• {\bf{Ddx:}} & - AC distal clavicle osteolysis\{\{nl\}\}- AC arthritis\{\{nl\}\}- Acromion \#\{\{nl\}\}- Adhesive capsulitis\{\{nl\}\}- Anterior humerus subluxation\{\{nl\}\}- Complex pain s.\{\{nl\}\}- Erb-Duchenne injury\{\{nl\}\}- Glenoid labrum tear\{\{nl\}\}- Os acromiale\{\{nl\}\}- Rotator cuff injury\{\{nl\}\}- Superior tabral tear\{\{nl\}\}- Septic arthritis\{\{nl\}\}- Shoulder dislocation \tn 
% Row Count 16 (+ 16)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{\{\{popup="https://www.ncbi.nlm.nih.gov/books/NBK493188/"\}\}link text\{\{/popup\}\}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{AC osteoarthritis}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{• {\bf{GREEN}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
• {\bf{Intro:}} & - Common (spec. in 40 \& older) \& causes anterior / superior shoulder px\{\{nl\}\}- Px exacerbated during overhead \& cross-body activities\{\{nl\}\}- 1° affects middle-aged pts due to degeneration of the fibrocartilaginous disc\{\{nl\}\}- Many pts are asymptomatic, w/ findings often discovered incidentally on shoulder x-ray / MRI \tn 
% Row Count 16 (+ 15)
% Row 2
\SetRowColor{LightBackground}
• {\bf{Aetiology (risk factors):}} & - Less common than knee / hip OA, but more common than GH OA\{\{nl\}\}- Approx 54-57\% of elderly pts exhibit x-ray evidence of degenerative changes in AC, though clinically relevant AC OA is less common\{\{nl\}\}- Approx 20\% of all shoulder px\{\{nl\}\}- Common in 40 \& older pts\{\{nl\}\}{\bf{Types of AC arthritis:}}\{\{nl\}\}- {\bf{1° OA:}} articular degeneration w/o an apparent underlying cause, often occurring due to constant stress from repeated overhead lifting activities\{\{nl\}\}- {\bf{2° OA:}} resulting from associated causes such as post-trauma (prevalent) or underlying disease (e.g. RA)\{\{nl\}\}- Arthritic Ssx have been observed in Grade I \& II sprains of the AC \tn 
% Row Count 46 (+ 30)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{AC osteoarthritis (cont)}}  \tn
% Row 3
\SetRowColor{LightBackground}
• {\bf{Pathophysiology:}} & - AC is a synovial joint connecting the axial skeleton \& scapula\{\{nl\}\}- Limited ROM characterises the AC \{\{nl\}\}- Articular connection involves the distal clavicle's convex surface \& the acromial facet's slight convex surface \{\{nl\}\}- Fibrocartilage disc exists between the hyaline cartilage covered facets (akin to knee meniscus)\{\{nl\}\}- Degenerative changes are part of the natural process\{\{nl\}\}- In early adulthood, the fibrocartilage disc undergoes degeneration, leaving behind fibrous remnants \tn 
% Row Count 23 (+ 23)
% Row 4
\SetRowColor{white}
• {\bf{Clinical presentation:}} & - Hx of trauma, e.g. direct impact on the joint or a FOOSH injury\{\{nl\}\}- Occupational Hx, e.g. occupation that requires repeated overhead lifting activities\{\{nl\}\}- Participation in sports that stress / injure AC, e.g. weightlifting, rugby\{\{nl\}\}- Complaints of px at night during sleeping on affected shoulder\{\{nl\}\}- Pt may experience {\emph{popping}}, {\emph{clicking}}, {\emph{grinding}}, or {\emph{catching}} sensation w/ movement of the shoulder\{\{nl\}\}- Functional limitations ACJ px include difficulty w/ resisted-training activities that place the GH in an extended position, common in weightlifters AKA {\emph{Weightlifter's Shoulder}}\{\{nl\}\}- Damage to AC can be synchronous w/ damage to the supraspinatus tendon \& osteophytes from the arthritic AC joint may contribute to {\emph{subacromial impingement}} exacerbating \& producing further shoulder px \tn 
% Row Count 60 (+ 37)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{AC osteoarthritis (cont)}}  \tn
% Row 5
\SetRowColor{LightBackground}
• {\bf{Physical examination:}} & - Pts typically maintain intact ROM, EXCEPT for specific movements: \{\{popup="https://www.physio-pedia.com/Scarf\_Test"\}\}cross-body ADD\{\{/popup\}\}, behind the back (scratch back), \& overhead reaching, which exacerbate px\{\{nl\}\}- Localised superior shoulder px is common\{\{nl\}\}- TTP, possible accompanied w/ swelling due to distal clavicle osteolysis\{\{nl\}\}- Px can be induced in deltoid area through certain movements: forward FX to 90° w/ horizontal ADD (Cross-body test) or straight-ahead pushing (e.g. bench press)\{\{nl\}\}- Most sensitive tests: TTP over Acromioclavicular point \& \{\{popup="https://www.physio-pedia.com/Paxino's\_test?utm\_source=physiopedia\&utm\_medium=related\_articles\&utm\_campaign=ongoing\_internal"\}\}Paxino's test\{\{/popup\}\}, \& \{\{popup="https://www.physio-pedia.com/Resisted\_AC\_Joint\_Extension\_Test"\}\}AC resisted EXT test\{\{/popup\}\} \tn 
% Row Count 39 (+ 39)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{AC osteoarthritis (cont)}}  \tn
% Row 6
\SetRowColor{LightBackground}
• {\bf{Diagnosis:}} & - Dx relies on Hx, physical exam, imaging (x-ray, MRI), \& diagnostic local anaesthetic injection\{\{nl\}\}{\bf{Imaging:}}\{\{nl\}\}- Plain film \& Dx local anaesthetic local injections are essential Dx tools\{\{nl\}\}- X-ray \& MRI provide comprehensive imaging of AC joint pathology\{\{nl\}\}- US is effective in detecting signs of AC OA \& is commonly used for imaging\{\{nl\}\}- US-guided injections: +ve if Ssx reduction; -ve if persistent px post-injection suggesting alt shoulder pathologies (commonly rotator cuff injury) \tn 
% Row Count 23 (+ 23)
% Row 7
\SetRowColor{white}
• {\bf{Management:}} & - Activity modification (avoid repetitive \& overhead movements), NSAIDs, PT modalities, corticosteroid \& local anaesthetic injections\{\{nl\}\}- Surgery\{\{nl\}\}{\bf{Physical therapy:}}\{\{nl\}\}- Px management using electro-modalities, SMT/STW\{\{nl\}\}- Maintaining active ROM \& strengthening scapular stabiliser muscles\{\{nl\}\}- Rotator cuff strengthening exercises\{\{nl\}\}- Postural correction - pec muscle stretching \& retractors strengthening \tn 
% Row Count 43 (+ 20)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{AC osteoarthritis (cont)}}  \tn
% Row 8
\SetRowColor{LightBackground}
• {\bf{Ddx:}} & - Calcific tendonitis\{\{nl\}\}- GH arthritis\{\{nl\}\}- Adhesive capsulitis\{\{nl\}\}- Rotator cuff impingement s. \tn 
% Row Count 5 (+ 5)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{\{\{popup="https://www.physio-pedia.com/Acromioclavicular\_Arthritis"\}\}link text\{\{/popup\}\}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Tendinopathies*}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{"{\bf{Tendinopathy}} is an umbrella term to decribe the tendon px, w/ an unknown cause"} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{"{\bf{Tendinitis}} describes a tendon in which inflammatory processes are present. However, studies show that tendons are rather in a degenerative state than in an inflammatory state."} \tn 
% Row Count 6 (+ 4)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{"{\bf{Tendinosis}} describes the degenerative state of tendons \& therefore, this term is more applicable"\{\{nl\}\}• Eccentric exercises major role in treatment\{\{nl\}\}- Promote cross-linking of collagen fibres\{\{nl\}\}- Promote tendon remodelling\{\{nl\}\}• Tendinosis can be described on a continuum} \tn 
% Row Count 12 (+ 6)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Calcific tendonitis}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{• {\bf{GREEN}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
• {\bf{Intro:}} & - Self-limiting disorder, identified by calcium deposits in rotator cuff tendons (esp. infra \& supraspinatus)\{\{nl\}\}- Common \& painful condition, that decreases ROM\{\{nl\}\}- Visible signs of calcium deposits overlying rotator cuff insertion on shoulder x-rays \tn 
% Row Count 13 (+ 12)
% Row 2
\SetRowColor{LightBackground}
• {\bf{Aetiology (risk factors):}} & - Up to 20\% of pts are asymptomatic\{\{nl\}\}- 40-60\% of shoulder pts\{\{nl\}\}- 30-60yrs\{\{nl\}\}- F\textgreater{}M\{\{nl\}\}{\bf{Localisation:}}\{\{nl\}\}- Supraspinatus tendon (80\%): critical zone (most common)\{\{nl\}\}- Infraspinatus tendon (15\%): lower 1/3\{\{nl\}\}- Subscapularis tendon (5\%): pre-insertional fibres \tn 
% Row Count 26 (+ 13)
% Row 3
\SetRowColor{white}
• {\bf{Pathophysiology:}} & - Unclear\{\{nl\}\}{\bf{Hypothesis include:}}\{\{nl\}\}- Repetitive trauma of tendon → tendon degeneration → calcification\{\{nl\}\}- Tendon necrosis → intracellular calcium accumulation\{\{nl\}\}- Active process mediated by chondrocytes arising from metaplasia → calcium deposition\{\{nl\}\}- Phagocytosis of metaplastic areas reforms normal tendon \tn 
% Row Count 42 (+ 16)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Calcific tendonitis (cont)}}  \tn
% Row 4
\SetRowColor{LightBackground}
• {\bf{Clinical presentation:}} & - Night px, causing loss of sleep\{\{nl\}\}- Constant dull ache\{\{nl\}\}- Px increases considerably w/ AROM\{\{nl\}\}- Decrease in ROM, or complaint of stiffness\{\{nl\}\}- Radiating px up into suboccipital region, or down into the fingers \tn 
% Row Count 11 (+ 11)
% Row 5
\SetRowColor{white}
• {\bf{Physical examination:}} & {\bf{Cluster (+ve):}}\{\{nl\}\}- Neer's test\{\{nl\}\}- Hawkins-Kennedy test\{\{nl\}\}- Drop arm test\{\{nl\}\}- Jobe's test \tn 
% Row Count 16 (+ 5)
% Row 6
\SetRowColor{LightBackground}
• {\bf{Staging:}} & {\bf{Chronic (silent) phase:}} presence of the calcific deposit is asymptomatic \& may be so for years\{\{nl\}\}{\bf{Acute painful phase:}} severe px, disability, \& frequently nocturnal discomfort\{\{nl\}\}{\bf{Mechanical phase:}} tendon impingement being a prominent finding; px of less severe nature than the acute phase \tn 
% Row Count 30 (+ 14)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Calcific tendonitis (cont)}}  \tn
% Row 7
\SetRowColor{LightBackground}
• {\bf{Diagnosis:}} & - Diagnosed through x-rays \tn 
% Row Count 2 (+ 2)
% Row 8
\SetRowColor{white}
• {\bf{Complications:}} & - Adhesive capsulitis\{\{nl\}\}- Rotator cuff tear\{\{nl\}\}- Ossifying tendinitis \tn 
% Row Count 6 (+ 4)
% Row 9
\SetRowColor{LightBackground}
• {\bf{Management:}} & - NSAIDs, PT, stretching \& strengthening, steroid injections\{\{nl\}\}- ESWT (most useful in refractory calcific tendonitis in the formative \& resting phase)\{\{nl\}\}- US-guided needle lavage\{\{nl\}\}- Surgery (surgical decompression of calcium deposit)\{\{nl\}\}{\bf{Physical therapy:}}\{\{nl\}\}- Mobs / drops\{\{nl\}\}- ROM exercises to avoid articular stiffness\{\{nl\}\}- Strength exercises to restore normal mechanics\{\{nl\}\}- Commonly scapular dyskinesia needs to be treated at the same time \tn 
% Row Count 28 (+ 22)
% Row 10
\SetRowColor{white}
• {\bf{Ddx:}} & - Incidental calcification: found in 2.5-20\% of 'normal' healthy shoulders\{\{nl\}\}- Degenerative calcification: found tendons w/ tear Hx; generally smaller; slightly older individuals\{\{nl\}\}- Loose bodies: associated chondral defect; associated 2° OA \tn 
% Row Count 40 (+ 12)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{\{\{popup="https://www.physio-pedia.com/Calcific\_Tendinopathy\_of\_the\_Shoulder"\}\}link text\{\{/popup\}\}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{GH dislocation}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{• {\bf{RED}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
• {\bf{Intro:}} & - Separation of the humerus from glenoid of scapula at the GH joint\{\{nl\}\}- 50\% of all joint dislocations\{\{nl\}\}- Anterior dislocation most common\{\{nl\}\}- Shoulder is an unstable joint due to a shallow glenoid that only articulates w/ a small part of humeral head \tn 
% Row Count 13 (+ 12)
% Row 2
\SetRowColor{LightBackground}
• {\bf{Aetiology (risk factors):}} & - Directions: anterior, posterior, inferior, or anterior-superior\{\{nl\}\}- {\bf{Risk factors:}} Hx of shoulder dislocation, RC tear, Hx of glenoid fracture\{\{nl\}\}- M\textgreater{}F\{\{nl\}\}- Younger individuals, likely due to higher activity levels, more prone to redislocation\{\{nl\}\}- Dislocation occurs due to a strong force or extreme rotation, e.g. blow to the shoulder or trauma from contact sports, motor vehicle accidents, or falls\{\{nl\}\}- Fibrous tissue connecting the shoulder bones can be stretched or torn during dislocation, complicating injury \tn 
% Row Count 38 (+ 25)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{GH dislocation (cont)}}  \tn
% Row 3
\SetRowColor{LightBackground}
• {\bf{Pathophysiology:}} & {\bf{Anterior dislocation:}}\{\{nl\}\}- Up to 97\% of shoulder dislocations\{\{nl\}\}- Mechanism: typically a blow + ABD + EXT rot + EXT\{\{nl\}\}- Exam findings: ABD + EXT rot arm, prominent acromion\{\{nl\}\}- Associated injuries: nerve damage, labrum tears, glenoid fossa or humeral head fractures (up to 40\%)\{\{nl\}\}{\bf{Posterior dislocation:}}\{\{nl\}\}- 2-4\% of shoulder dislocations\{\{nl\}\}- Mechanism: hit to the anterior shoulder, axial loading of ADD + INT rot arm\{\{nl\}\}- Exam findings: arm held in ADD + INT rot, inability to EXT rot\{\{nl\}\}- Higher risk of associated injuries: surgical neck or tuberosity \#, \{\{popup="https://radiopaedia.org/articles/reverse-hill-sachs-defect\#:\textasciitilde{}:text=Reverse\%20Hill\%2DSachs\%20defect\%2C\%20also,correct\%20it\%20to\%20prevent\%20osteonecrosis."\}\}reverse Hill-Sachs lesions\{\{/popup\}\}, labrum or rotator cuff injuries\{\{nl\}\}{\bf{Inferior dislocation (laxation erecta):}}\{\{nl\}\}- Least common type (less than 1\%)\{\{nl\}\}- Mechanism: hyperABD or axial loading on the ABD arm\{\{nl\}\}- Exam findings: arm held above \& behind the head, inability to ADD the arm\{\{nl\}\}- Often associated w/: nerve injury, rotator cuff injury, tears in the internal capsule, highest incidence of axillary nerve \& artery injury among shoulder injuries \tn 
% Row Count 56 (+ 56)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{GH dislocation (cont)}}  \tn
% Row 4
\SetRowColor{LightBackground}
• {\bf{Clinical presentation:}} & - Pts may report: popping sensation, sudden onset of px w/ decreased ROM, sensation of joint rolling out of the socket\{\{nl\}\}- Ask about PREVIOUS dislocations\{\{nl\}\}- Nerves can get stretched out during shoulder dislocation, some pts may report {\emph{stinging}} \& {\emph{numbness}} in the arm at the time of dislocation \tn 
% Row Count 14 (+ 14)
% Row 5
\SetRowColor{white}
• {\bf{Physical examination:}} & - ROM diminished \& painfull\{\{nl\}\}- {\bf{Anterior dislocation:}} arm ABD \& EXT rot; in thin pts potentially prominent funeral head felt anteriorly, \& void can be seen posteriorly\{\{nl\}\}- {\bf{Posterior dislocation:}} easy to miss (pt appears to only guard the extremity) because arm is in INT rot \& ADD; in thin pts potentially prominent head can be palpated posteriorly\{\{nl\}\}- Neurovascular exam (IMPORTANT): axillary nerve injury (40\%)\{\{nl\}\}- {\bf{Special tests:}} apprehension test (anterior \& posterior), sulcus sign (inferior instability), load \& shift test (anterior \& posterior), anterior \& posterior drawer test \tn 
% Row Count 42 (+ 28)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{GH dislocation (cont)}}  \tn
% Row 6
\SetRowColor{LightBackground}
• {\bf{Diagnosis:}} & - Assess for axillary nerve injury: innervates deltoid \& teres minor, \& sensation to lateral shoulder\{\{nl\}\}- Fractures of tuberosity \& surgical neck may occur\{\{nl\}\}- {\emph{\{\{popup="https://radiopaedia.org/articles/bankart-lesion"\}\}Bankart lesion\{\{/popup\}\}:}} disruption of glenoid labrum, w/ or w/o avulsed bone fragment\{\{nl\}\}- {\emph{\{\{popup="https://www.google.com/search?client=safari\&rls=en\&q=Hill-Sachs+deformity\&ie=UTF-8\&oe=UTF-8"\}\}Hill-Sachs deformity\{\{/popup\}\}:}} compression \# of postern-lateral humeral head 1° w/ anterior dislocations\{\{nl\}\}- {\emph{\{\{popup="https://radiopaedia.org/articles/reverse-hill-sachs-defect\#:\textasciitilde{}:text=Reverse\%20Hill\%2DSachs\%20defect\%2C\%20also,correct\%20it\%20to\%20prevent\%20osteonecrosis."\}\}Reverse Hill-Sachs deformity\{\{/popup\}\}:}} impaction \# of antero-medial aspect of humeral head in posterior dislocations \tn 
% Row Count 38 (+ 38)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{GH dislocation (cont)}}  \tn
% Row 7
\SetRowColor{LightBackground}
• {\bf{Management:}} & - \{\{popup="https://www.msdmanuals.com/professional/injuries-poisoning/how-to-reduce-dislocations-and-subluxations/how-to-reduce-posterior-shoulder-dislocations"\}\}{\bf{Posterior shoulder reduction}}\{\{/popup\}\}\{\{nl\}\}{\bf{Anterior shoulder reduction:}}\{\{nl\}\}- \{\{popup="https://www.msdmanuals.com/professional/injuries-poisoning/how-to-reduce-dislocations-and-subluxations/how-to-reduce-anterior-shoulder-dislocations-using-the-stimson-technique"\}\}Scapular manipulation\{\{/popup\}\}: highest success rate\{\{nl\}\}- \{\{popup="https://www.msdmanuals.com/professional/injuries-poisoning/how-to-reduce-dislocations-and-subluxations/how-to-reduce-anterior-shoulder-dislocations-using-external-rotation-hennepin-technique"\}\}EXT rotation technique\{\{/popup\}\}\{\{nl\}\}- \{\{popup="https://www.medmastery.com/guides/emergency-procedures-clinical-guide/how-reduce-shoulder-cunningham-technique"\}\}Cunningham technique\{\{/popup\}\}\{\{nl\}\}- \{\{popup="https://www.mdedge.com/familymedicine/article/247600/musculoskeletal-disorders/step-step-evaluation-and-treatment-shoulder/page/0/1"\}\}Milch technique\{\{/popup\}\}\{\{nl\}\}- \{\{popup="https://www.msdmanuals.com/professional/injuries-poisoning/how-to-reduce-dislocations-and-subluxations/how-to-reduce-anterior-shoulder-dislocations-using-the-stimson-technique"\}\}Stimson technique\{\{/popup\}\}\{\{nl\}\}- \{\{popup="https://www.msdmanuals.com/professional/injuries-poisoning/how-to-reduce-dislocations-and-subluxations/how-to-reduce-anterior-shoulder-dislocations-using-traction-countertraction"\}\}Traction-countertraction technique\{\{/popup\}\}\{\{nl\}\}- \{\{popup="https://litfl.com/spaso-technique/"\}\}Spaso technique\{\{/popup\}\}\{\{nl\}\}- \{\{popup="https://www.msdmanuals.com/professional/injuries-poisoning/how-to-reduce-dislocations-and-subluxations/how-to-reduce-anterior-shoulder-dislocations-using-the-fares-method"\}\}FARES technique\{\{/popup\}\}\{\{nl\}\}- \{\{popup="https://www.sciencedirect.com/science/article/pii/S2452247316301637"\}\}Fulcrum technique\{\{/popup\}\} \tn 
% Row Count 89 (+ 89)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{GH dislocation (cont)}}  \tn
% Row 8
\SetRowColor{LightBackground}
• {\bf{Ddx:}} & - AC injury\{\{nl\}\}- Bicipital tendonitis\{\{nl\}\}- Clavicle fracture\{\{nl\}\}- RC injury\{\{nl\}\}- Shoulder dislocation\{\{nl\}\}- Swimmer's shoulder \tn 
% Row Count 7 (+ 7)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{\{\{popup="https://www.ncbi.nlm.nih.gov/books/NBK459125/"\}\}link text\{\{/popup\}\}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{GH instability*}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{• {\bf{YELLOW}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
• {\bf{Intro:}} & - Includes dislocation \& subluxation events\{\{nl\}\}- Approx 1-2\% of general population experience GH dislocation in their lifetime\{\{nl\}\}- Shoulder instability events are common among young, active, athletic population\{\{nl\}\}- Anterior shoulder instability accounts for over 95\% \tn 
% Row Count 14 (+ 13)
% Row 2
\SetRowColor{LightBackground}
• {\bf{Aetiology (risk factors):}} & {\bf{Classification criteria:}}\{\{nl\}\}- Uni- or multidirectional instability\{\{nl\}\}- Traumatic or atraumatic\{\{nl\}\}- Presence or absence of accompanying soft-tissue hyperlaxity\{\{nl\}\}- M\textgreater{}F\{\{nl\}\}- Rugby \& football have particularly high incidence rates\{\{nl\}\}- Anterior labral tears \& Hill-Sachs lesions are frequently observed \tn 
% Row Count 29 (+ 15)
% Row 3
\SetRowColor{white}
• {\bf{Pathophysiology:}} & {\bf{GH anatomy:}}\{\{nl\}\}- Complex, mobile, multiracial ball-and-socket articulation\{\{nl\}\}- Allows motion in frontal, transverse, \& sagittal planes\{\{nl\}\}- Glenoid fossa articulates w/ humeral head, allowing 360° circumduction\{\{nl\}\}- Movements at 4 distinct joints: SC, AC, GH, \& scapuloTx\{\{nl\}\}{\bf{Stabilisers:}}\{\{nl\}\}- {\bf{Static:}} GH articulation, labrum, ligaments, RC interval structures, intra-articular pressure\{\{nl\}\}- {\bf{Dynamic:}} RC muscles, deltoid, scapular \& periscapular stabilisers\{\{nl\}\}{\bf{Shoulder instability cascade:}}\{\{nl\}\}- Excessive translation of humeral head on glenoid leads to px, weakness, dysfunction\{\{nl\}\}- Anatomic risk factors identified\{\{nl\}\}- Differentiation between joint laxity \& instability crucial\{\{nl\}\}{\bf{Unidirectional instability:}}\{\{nl\}\}- May result from acute trauma or low-energy instability events\{\{nl\}\}- Soft tissue hyperlaxity may accompany\{\{nl\}\}- Hill-Sachs lesion on humeral side common\{\{nl\}\}- Glenoid bone loss prevalent, detected via CT scans\{\{nl\}\}- Blunted osseous defects due to acute or chronic/recurrent processes\{\{nl\}\}{\bf{Multidirectional instability:}}\{\{nl\}\}- Definition not precise; involves instability in multiple directions\{\{nl\}\}- Often accompanied by capsulolabral injuries\{\{nl\}\}- Soft tissue hyperlaxity associated w/ generalised hyperlaxity\{\{nl\}\}{\bf{Long-term implications:}}\{\{nl\}\}- Altered biomechanics due to glenoid bone loss\{\{nl\}\}- Scapular dyskinesia common, predisposing to instability\{\{nl\}\}- Recurrent instability possible post \seqsplit{non-operative/operative} management\{\{nl\}\}- Dislocation arthropathy: degenerative changes following instability events, possibly leading to GH arthritis \tn 
% Row Count 104 (+ 75)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{GH instability* (cont)}}  \tn
% Row 4
\SetRowColor{LightBackground}
• {\bf{Clinical presentation:}} & {\bf{1st time dislocations:}}\{\{nl\}\}- Recent high-energy trauma or collision is often reported as the cause\{\{nl\}\}- Ask about: degree of trauma, sports activities \& positions, discernment between true dislocation \& subluxation, \& the need for manual reduction\{\{nl\}\}{\bf{Chronic cases:}}\{\{nl\}\}- Pts often present after ROM limitations impact daily activities significantly\{\{nl\}\}- Detailed Hx of inciting instability events should be gathered\{\{nl\}\}- Initial injury may be overlooked, leading to chronic instability/recurrence\{\{nl\}\}- Heightened clinical suspicion is warranted in cases of seizures, polytrauma, or low-energy, recurrent subluxation \tn 
% Row Count 29 (+ 29)
% Row 5
\SetRowColor{white}
• {\bf{Physical examination:}} & {\bf{Cx exam:}}\{\{nl\}\}- Rule out Cx radiculopathy in neck or shoulder pathology\{\{nl\}\}- Evaluate neck posturing, muscular symmetry, palpable tenderness, \& ROM\{\{nl\}\}- Conduct {\emph{Spurling manoeuvre}}, myelopathies testing, reflex testing, \& neurovascular exam\{\{nl\}\}{\bf{Shoulder exam:}}\{\{nl\}\}- Compare B shoulder girdles for asymmetry, muscle bulk, or atrophic changes\{\{nl\}\}- Check for anterior fullness in chronic anterior instability\{\{nl\}\}- Assess scapulothoracic motion \& scapular winging\{\{nl\}\}- AROM \& PROM, noting limitation in complex instability cases\{\{nl\}\}- Assess axillary nerve function, supraspinatus muscle, \& sensory examination\{\{nl\}\}{\bf{Provocative tests:}}\{\{nl\}\}- Assess global tissue laxity, GH translation, \& hypermobility\{\{nl\}\}- Anterior apprehension test: reproduce Ssx of anterior instability\{\{nl\}\}- Jobe relocation test: alleviate Ssx\{\{nl\}\}- Load \& shift test: assess humeral head translation (Grade 1, 2, or 3)\{\{nl\}\}{\bf{Other exam considerations:}}\{\{nl\}\}- Check for posterior \& multidirectional instability\{\{nl\}\}- Expect associated shoulder pathologies based on age (e.g. RC injuries in older pts)\{\{nl\}\}- Note weakness or px of specific shoulder injuries (e.g. RC tears or Bankart lesions) \tn 
% Row Count 84 (+ 55)
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{GH instability* (cont)}}  \tn
% Row 6
\SetRowColor{LightBackground}
• {\bf{Diagnosis:}} & - X-rays for comprehensive evaluation\{\{nl\}\}- MRI \& CT for advanced imaging \tn 
% Row Count 4 (+ 4)
% Row 7
\SetRowColor{white}
• {\bf{Complications:}} & - Redislocation following surgical fixation\{\{nl\}\}- Nerve injuries (esp. axillary n.)\{\{nl\}\}- Infection (surgery)\{\{nl\}\}- Implant-related problems \tn 
% Row Count 11 (+ 7)
% Row 8
\SetRowColor{LightBackground}
• {\bf{Prognosis:}} & - Depends on various factors\{\{nl\}\}- \{\{popup="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6668005/\#:\textasciitilde{}:text=The\%20instability\%20severity\%20index\%20score\%20(ISIS)\%20was\%20designed\%20to\%20predict,open\%20or\%20bone\%20transfer\%20operation."\}\}Instability severity index score (ISIS)\{\{/popup\}\} to guide shoulder instability management\{\{nl\}\}- Risk factors for recurrence: age, gender, joint hyperlaxity, sport participation level/type, Hx of instability, \& osseous lesions (10-point scoring of ISIS)\{\{nl\}\}{\bf{5-year overall success rates:}}\{\{nl\}\}- 94\% w/ 1-2 risk factors (ISIS score ≤ 3)\{\{nl\}\}- 85\% w/ ISIS score of 4-6\{\{nl\}\}- 55\% w/ ISIS score \textgreater{}6 \tn 
% Row Count 41 (+ 30)
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{GH instability* (cont)}}  \tn
% Row 9
\SetRowColor{LightBackground}
• {\bf{Management:}} & - Rehab program aim: enhance scapular stability; correct postural or functional deficits; increase RC function; improve proprioception\{\{nl\}\}- \{\{popup="https://www.physio-pedia.com/Closed\_Chain\_Exercise\#:\textasciitilde{}:text=Share-,Closed\%20Chain\%20Lower\%20Body\%20Kinetic\%20Exercises,\%2C\%20soleus\%2C\%20and\%20gastrocnemius\%20muscles."\}\}Closed-chain exercises\{\{/popup\}\} help stability w/o increasing shear force\{\{nl\}\}- {\bf{Phase 1 (rehab):}} decrease px, regain ROM, improve functional coordination\{\{nl\}\}- {\bf{Phase 2 (exercises):}} improve strength, coordination, proprioception\{\{nl\}\}- \{\{popup="https://www.physio-pedia.com/Derby\_Shoulder\_Instability\_Programme"\}\}Derby shoulder instability programme\{\{/popup\}\} for recurrent {\emph{posterior}} instability: stepwise exercise progression\{\{nl\}\}- Scapular stability exercises focus on improving retraction \& EXT rotation\{\{nl\}\}- RC deficits, especially subscapularis, are crucial to address\{\{nl\}\}- {\emph{Forward shoulder posture}} may benefit from SMT in EXT rotation\{\{nl\}\}- {\emph{Controllable}} functional instability usually managed conservatively; {\emph{non-controllable}} cases may need surgical repair\{\{nl\}\}- Six-month conservative care trial appropriate before surgical intervention for non-traumatic posterior instability \tn 
% Row Count 56 (+ 56)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{GH instability* (cont)}}  \tn
% Row 10
\SetRowColor{LightBackground}
• {\bf{Ddx:}} & - Labral defect\{\{nl\}\}- SLAP lesion\{\{nl\}\}- Bankart lesion\{\{nl\}\}- Hill-Sachs lesion\{\{nl\}\}- Fracture\{\{nl\}\}- Inflammatory arthropathy\{\{nl\}\}- Shoulder impingement\{\{nl\}\}- RC tendinopathy\{\{nl\}\}- Biceps tendinopathy\{\{nl\}\}- Suprascapular n. entrapment\{\{nl\}\}- Quadrilateral space s.\{\{nl\}\}- Cx spine referral\{\{nl\}\}- Radiculopathy \tn 
% Row Count 15 (+ 15)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{\{\{popup="https://www.ncbi.nlm.nih.gov/books/NBK538234/\#\_article-22269\_s12\_"\}\}link text\{\{/popup\}\}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{GH internal rotation deficit (GIRD)}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{• {\bf{GREEN}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
• {\bf{Intro:}} & - Commonly results from repetitive over-head throwing\{\{nl\}\}- Results in loss of IR\{\{nl\}\}- Functional deficit, not a specific injury \tn 
% Row Count 7 (+ 6)
% Row 2
\SetRowColor{LightBackground}
• {\bf{Aetiology (risk factors):}} & - Throwing motion ABD + ER + EXT w/ high velocities\{\{nl\}\}- High amount of stress on static \& dynamic stabilisers of shoulder\{\{nl\}\}- Throwers often have a component of pathologic laxity or micro-instability (deposition for injuries) \tn 
% Row Count 18 (+ 11)
% Row 3
\SetRowColor{white}
• {\bf{Pathophysiology:}} & - Chronic tensile loading of posterior capsule leads to micro-tears \& scarring\{\{nl\}\}- Resultant tissue changes contribute to loss of INT GH rotation\{\{nl\}\}- Limitation contributes to various shoulder, elbow, \& wrist conditions\{\{nl\}\}- Sequellae inc: scapular dyskinesia, anterior shoulder impingement, RC s., \& labral lesions\{\{nl\}\}- Limited shoulder ROM can also result from these conditions \tn 
% Row Count 36 (+ 18)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{GH internal rotation deficit (GIRD) (cont)}}  \tn
% Row 4
\SetRowColor{LightBackground}
• {\bf{Clinical presentation:}} & - Vague posterior shoulder px\{\{nl\}\}- Need for prolonged warm-up due to shoulder stiffness\{\{nl\}\}- Loss of throwing velocity, described as dead arm\{\{nl\}\}- Ssx exacerbated in the late cocking phase of throwing, typically localised to the posterior shoulder\{\{nl\}\}- Rare radiation of discomfort extending into the arm \tn 
% Row Count 15 (+ 15)
% Row 5
\SetRowColor{white}
• {\bf{Physical examination:}} & - Increased EXT rotation \& decreased INT rotation - NOT related to MSK injuries or px in overhead throwing athletes\{\{nl\}\}- TrPs: infraspinatus \& teres minor\{\{nl\}\}{\bf{GIRD Dx criteria:}}\{\{nl\}\}- At least 20* deficit of IR in dominant arm (compared B)\{\{nl\}\}- TTP in posterior shoulder musculature \tn 
% Row Count 29 (+ 14)
% Row 6
\SetRowColor{LightBackground}
• {\bf{Management:}} & - Target improving shoulder ROM (early focus), reduce muscle stiffness, \& increase flexibility\{\{nl\}\}- Stretching targets tightness in posterior capsule \& INT rotators - pecs, biceps, subscapularis, infraspinatus, teres minor, \& levator\{\{nl\}\}- Crossbody stretching may be beneficial\{\{nl\}\}- After pain-free ROM, follow w/ incremental strengthening of GH \& scapular stabilisers\{\{nl\}\}- TrPs like infraspinatus \& teres minor (EXT rotators)\{\{nl\}\}- SMT - IR \& inferior glide\{\{nl\}\}- Rest from throwing \& physical therapy for 6 months \tn 
% Row Count 53 (+ 24)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{GH internal rotation deficit (GIRD) (cont)}}  \tn
% Row 7
\SetRowColor{LightBackground}
• {\bf{Ddx:}} & - Shoulder Impingement s.\{\{nl\}\}- RC s.\{\{nl\}\}- Biceps tendinopathy\{\{nl\}\}- Labral lesion \tn 
% Row Count 4 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{\{\{popup="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5865552/\#:\textasciitilde{}:text=Glenohumeral\%20internal\%20rotation\%20deficit\%20(GIRD,compared\%20to\%20the\%20contralateral\%20shoulder."\}\}link text\{\{/popup\}\}; \{\{popup="https://www.orthobullets.com/shoulder-and-elbow/3055/glenohumeral-internal-rotation-deficit-gird"\}\}link text\{\{/popup\}\}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Glenolabral articular disruption (GLAD)*}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{• {\bf{YELLOW or RED}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
• {\bf{Intro:}} & - Soft tissue shoulder injury subtype\{\{nl\}\}- Involves a tear to anterior-inferior labrum \& adjacent glenoid articular cartilage damage\{\{nl\}\}- Uncommon but established post-trauma cause of shoulder px\{\{nl\}\}- Associated w/ stable GH joint; full ROM w/o apprehension or subluxation\{\{nl\}\}- GLAD lesions seen in isolated or recurrent dislocations, challenging clinical Dx\{\{nl\}\}- Imaging required for confirmation \tn 
% Row Count 20 (+ 19)
% Row 2
\SetRowColor{LightBackground}
• {\bf{Aetiology (risk factors):}} & - Rare condition\{\{nl\}\}- Est. 1.5-2.9\% of cases of traumatic labral tears\{\{nl\}\}- Younger M, consistent w/ general traumatic labral pathology\{\{nl\}\}- Result from shoulder joint trauma, often involving forced ADD from a position of ABD + EXT rot, e.g. {\emph{FOOSH}}\{\{nl\}\}- Injury mechanism also inv. forceful ADD from throwing\{\{nl\}\}- Anterior GH instability is a common injury mechanism associated w/ GLAD \tn 
% Row Count 38 (+ 18)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Glenolabral articular disruption (GLAD)* (cont)}}  \tn
% Row 3
\SetRowColor{LightBackground}
• {\bf{Pathophysiology:}} & - Affects the labrum \& underlying glenoid cartilage in the GH joint\{\{nl\}\}- GH: synovial ball \& socket joint formed by the humeral head \& glenoid fossa of the scapula\{\{nl\}\}- Labrum function: adds depth to fossa \& attachment point for long head of biceps tendon \& GH ligaments\{\{nl\}\}- Anterior labroligamentous complex: anterior-inferior GH ligament \& labrum\{\{nl\}\}- Function: prevents anterior dislocation \& maintaining shoulder stability\{\{nl\}\}- Injury mechanism: forceful ADD of the humeral head against the glenoid fossa, potentially accompanied by shear force, resulting in tears to the labrum \& varying degrees of cartilage damage\{\{nl\}\}- Despite the damage, the anterior labroligamentous complex often remains intact → shoulder joint remains stable in GLAD lesions\{\{nl\}\}- Association between GLAD lesions \& anterior shoulder instability \tn 
% Row Count 39 (+ 39)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Glenolabral articular disruption (GLAD)* (cont)}}  \tn
% Row 4
\SetRowColor{LightBackground}
• {\bf{Clinical presentation:}} & - Younger male, w/ clear onset of px after the event\{\{nl\}\}- Potentially anteriorly, possibly diffusely\{\{nl\}\}- Pt may localise px to deep-seated anterior joint\{\{nl\}\}- Clear Hx of FOOSH, mechanism ADD force onto an ABD + EXT rot shoulder \tn 
% Row Count 11 (+ 11)
% Row 5
\SetRowColor{white}
• {\bf{Physical examination:}} & - Px may be elicited on ABD \& EXT rot\{\{nl\}\}- Force ADD may produce {\emph{'popping'}} sensation\{\{nl\}\}- {\bf{Special tests:}} \{\{popup="https://www.physio-pedia.com/Crank\_Test"\}\}Crank test\{\{/popup\}\}; \{\{popup="https://www.physio-pedia.com/O'Briens\_Test?utm\_source=physiopedia\&utm\_medium=related\_articles\&utm\_campaign=ongoing\_internal"\}\}O'Briens test\{\{/popup\}\}; \{\{popup="https://www.physio-pedia.com/Apprehension\_Test"\}\}Anterior Apprehension test\{\{/popup\}\}; \{\{popup="https://www.physio-pedia.com/Passive\_compression\_test"\}\}Passive Compression test\{\{/popup\}\}\{\{nl\}\}- High association between GLAD \& anterior shoulder instability \tn 
% Row Count 39 (+ 28)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Glenolabral articular disruption (GLAD)* (cont)}}  \tn
% Row 6
\SetRowColor{LightBackground}
• {\bf{Diagnosis:}} & - Imaging, especially MRA, crucial for Dx\{\{nl\}\}- Challenging to detect on non-contrast MRI or CTA\{\{nl\}\}- Findings: superficial tear to the anterior-inferior labrum w/ an underlying glenoid cartilage defect (from superficial to trans-chondral)\{\{nl\}\}- MRA demonstrates contrast tracking the labral tear \& filling into the chondral defect or under a damaged articular flap \tn 
% Row Count 17 (+ 17)
% Row 7
\SetRowColor{white}
• {\bf{Complications:}} & - Linked to episodes of anterior shoulder instability\{\{nl\}\}- Higher failure rates in arthroscopic Bankart repair w/ GLAD lesions\{\{nl\}\}- Correlation between GLAD lesions \& reduced GH stability\{\{nl\}\}- GLAD lesions as biomechanical risk factor in shoulder instability by reducing joint concavity depth\{\{nl\}\}- Risk of OA following GLAD injury (hypothesis) \tn 
% Row Count 33 (+ 16)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Glenolabral articular disruption (GLAD)* (cont)}}  \tn
% Row 8
\SetRowColor{LightBackground}
• {\bf{Management:}} & - Conservative: time, NSAIDs, \& PT (especially for older pts)\{\{nl\}\}- Incidental findings on imaging may complicate Dx in older pts due to common age-related cartilage \& labral degeneration\{\{nl\}\}- Treatment approach depends on the size \& nature of the chondral defect \& labral injury \tn 
% Row Count 13 (+ 13)
% Row 9
\SetRowColor{white}
• {\bf{Ddx:}} & - Common traumatic labral tears, tearing of the labrum \& associated ligaments partially or completely off the glenoid, most commonly the anterior-inferior labrum {\emph{(Bankart lesions)}}\{\{nl\}\}- Anterior-inferior instability lesions that include a glenoid rim \# - {\emph{bony Bankart lesions}}\{\{nl\}\}- {\emph{Perthes lesion}}: labral complex injury, but the labrum is still attached to the glenoid via a periosteal sleeve\{\{nl\}\}- {\emph{Anterior ligamentous periosteal sleeve avulsion}}: another labral injury, but it displaces medially on the glenoid neck\{\{nl\}\}- {\emph{(HAGL)}} or {\emph{Bony HAGL}}: this time, the anterior-inferior GH ligament is avulsed from the humeral rather than labral attachment \tn 
% Row Count 44 (+ 31)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{\{\{popup="https://www.ncbi.nlm.nih.gov/books/NBK589638/\#\_article-149868\_s9\_"\}\}link text\{\{/popup\}\}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Polymyalgia rheumatica (PMR)*}}  \tn
% Row 0
\SetRowColor{LightBackground}
• {\bf{YELLOW or RED}} & - Red if signs of vascular arteritis \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
• {\bf{Intro:}} & - Rheumatic disorder 1° affecting white adults \textgreater{}50\{\{nl\}\}- Characterised by px in neck, shoulder, \& hip areas\{\{nl\}\}- Inflammatory condition w/ elevated erythrocyte sedimentation rate (ESR) \& C-reactive protein (CRP)\{\{nl\}\}- Coexistence w/ or development of \{\{popup="https://www.ncbi.nlm.nih.gov/books/NBK459376/"\}\}Giant cell arteritis\{\{/popup\}\} (GCA) possible\{\{nl\}\}- Dx challenges inc. distinguishing PMR from other conditions\{\{nl\}\}- Does not lead to RA development \tn 
% Row Count 24 (+ 22)
% Row 2
\SetRowColor{LightBackground}
• {\bf{Aetiology (risk factors):}} & - 100,000 / year\{\{nl\}\}- White \textgreater{}50\{\{nl\}\}- Second most common inflammatory autoimmune rheumatic disease (after RA)\{\{nl\}\}- Etiology not well understood\{\{nl\}\}- Some genetic predisposition\{\{nl\}\}- Infection contribute: mycoplasma pneumonia, parvovirus B19, \& Epstein-Barr virus (EBV)\{\{nl\}\}- Some connection between PMR \& diverticulitis, suggesting a role for changes in microbiota \& chronic bowel inflammation \tn 
% Row Count 43 (+ 19)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Polymyalgia rheumatica (PMR)* (cont)}}  \tn
% Row 3
\SetRowColor{LightBackground}
• {\bf{Pathophysiology:}} & - Immune-mediated disorder\{\{nl\}\}- Elevated inflammatory markers are common\{\{nl\}\}- PMR pts have decreased number of circulating B cells (correlates w/ ESR \& CRP) compared to healthy pts \tn 
% Row Count 9 (+ 9)
% Row 4
\SetRowColor{white}
• {\bf{Clinical presentation:}} & - Symmetrical px \& stiffness: affects shoulders, neck, \& hip girdle\{\{nl\}\}- Morning stiffness: worst in the morning, worsens after rest or inactivity\{\{nl\}\}- Restricted shoulder ROM: common\{\{nl\}\}- Upper body complaints: px \& stiffness in upper arms, hips, thighs, upper \& lower back\{\{nl\}\}- Rapid onset: Ssx develop within day - 2 weeks\{\{nl\}\}- Impact on quality of life: px impairs sleep \& ADLs, e.g. getting out of bed, showering, driving, etc\{\{nl\}\}- Inflammation sites: GH \& hip joint, subacromial, subdeltoid, \& trochanteric bursa\{\{nl\}\}- Systemic Ssx: fatigue, malaise, anorexia, weight loss, low-grade fever (in some cases)\{\{nl\}\}- Peripheral involvement: arthritis in 1/4 of pts, carpal tunnel s., distal extremity swelling w/ pitting edema, distal tenosynovitis \tn 
% Row Count 44 (+ 35)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Polymyalgia rheumatica (PMR)* (cont)}}  \tn
% Row 5
\SetRowColor{LightBackground}
• {\bf{Physical examination:}} & - Diffuse tenderness over shoulder\{\{nl\}\}- Restricted AROM\{\{nl\}\}- Normal PROM\{\{nl\}\}- Restricted Cx \& hip movements\{\{nl\}\}- Muscle tenderness: neck, arms, \& thigh\{\{nl\}\}- Intact muscle strength despite complaints of weakness\{\{nl\}\}- Normal sensory \& reflexes (helps rule out mimicking conditions, e.g. peripheral neuropathy)\{\{nl\}\}- Gait changes due to px \& stiffness, e.g. shortened stride length, slow gait speed, stiffness, difficulty initiating movement, antalgic gait, decreased arm swing, \& trunk lean \tn 
% Row Count 23 (+ 23)
% Row 6
\SetRowColor{white}
• {\bf{Diagnosis:}} & {\bf{Labs:}}\{\{nl\}\}- Elevated ESR (\textgreater{}40mm)\{\{nl\}\}- Elevated CRP\{\{nl\}\}- Liver enzymes, especially alkaline phosphate, occasional elevated\{\{nl\}\}- Serologic test (ANA, RF, Anti-CCP AB) negative\{\{nl\}\}- CPK value within normal range\{\{nl\}\}{\bf{Imaging:}}\{\{nl\}\}- US: assess \seqsplit{subacromial/subdeltoid} bursitis, biceps tenosynovitis, \& GH synovitis\{\{nl\}\}- MRI: depicts bursitis, synovitis, \& tenosynovitis, more sensitive for hip \& pelvic girdle findings; pelvic MRI often shows B peri-tendinous enhancement of pelvic girdle tendons \& occasional low-grade hip synovitis\{\{nl\}\}- PET: shows FDG uptake in shoulders, ischial tuberosities, greater trochanters, GH, \& SC joints\{\{nl\}\}{\bf{Provisional classification criteria for PMR:}}\{\{nl\}\}Age 50 or older w/ B shoulder aching \& abnormal CRP/ESR, + specific points from:\{\{nl\}\}- Morning stiffness \textgreater{}45 min duration\{\{nl\}\}- Hip px or restricted ROM\{\{nl\}\}- Absence of rheumatoid factor or anti-citrullinated protein antibodies\{\{nl\}\}- Absence of other joint involvement\{\{nl\}\}- US findings (if available) \tn 
% Row Count 70 (+ 47)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Polymyalgia rheumatica (PMR)* (cont)}}  \tn
% Row 7
\SetRowColor{LightBackground}
• {\bf{Complications:}} & - PMR pts have an increased risk of CV diseases\{\{nl\}\}- Premature arteriosclerosis due to chronic inflammation is the probable cause of premature coronary artery disease (CAD)\{\{nl\}\}- Some increased risk of lymphoplasmacytic lymphoma\{\{nl\}\}- Higher likelihood of developing inflammatory arthritis (factors: small joint synovitis, younger age, \& +ve anti-CCP) \tn 
% Row Count 17 (+ 17)
% Row 8
\SetRowColor{white}
• {\bf{Management:}} & - Excellent prognosis w/ prompt Dx \& appropriate treatment\{\{nl\}\}- Medication\{\{nl\}\}- Vitamin D \& calcium supplementation for long-term steroids\{\{nl\}\}- Pt should be educated on temporal/optic arteritis \& how to act \tn 
% Row Count 27 (+ 10)
% Row 9
\SetRowColor{LightBackground}
• {\bf{Ddx:}} & - RA\{\{nl\}\}- GCA\{\{nl\}\}- ANCA related vasculitis\{\{nl\}\}- Inflammatory myositis \& statin-induced myopathy\{\{nl\}\}- Gout \& CPPD\{\{nl\}\}- Fibromyalgia\{\{nl\}\}- Overuse or degenerative shoulder pathology (e.g. OA, RC tendinitis \& tendon tear, adhesive capsulitis)\{\{nl\}\}- Cx spin disorders (e.g. OA, radiculopathy)\{\{nl\}\}- Crown dens s.\{\{nl\}\}- Hypothyroidism\{\{nl\}\}- Obstructive sleep apnea\{\{nl\}\}- Depression\{\{nl\}\}- Viral infections (e.g. EBV, hepatitis, HIV, parvovirus B19)\{\{nl\}\}- Systemic bacterial infections, septic arthritis\{\{nl\}\}- Cancer\{\{nl\}\}- Diabetes \tn 
% Row Count 52 (+ 25)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Polymyalgia rheumatica (PMR)* (cont)}}  \tn
% Row 10
\SetRowColor{LightBackground}
• {\bf{Temporal arteritis (TA):}} & - 1 in 5 pts develop TA\{\{nl\}\}- Systemic inflammatory vasculitis of arteries\{\{nl\}\}- Scalp is painful to touch (hair brushing)\{\{nl\}\}- Prominent, hardened \& tender superficial temporal artery\{\{nl\}\}- HA\{\{nl\}\}- Claudication masticatoria\{\{nl\}\}- Preliminary stage to optic arteritis (threat to visual ability) \tn 
% Row Count 14 (+ 14)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{\{\{popup="https://www.ncbi.nlm.nih.gov/books/NBK537274/"\}\}link text\{\{/popup\}\}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.9442 cm} x{9.3258 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Rotator cuff injury*}}  \tn
% Row 0
\SetRowColor{LightBackground}
• {\bf{GREEN to RED}} & - Grade 1, 2, 3 \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
• {\bf{Classification of strains:}} & - {\bf{Grade 1 (green):}} few torn/stretch muscle fibres w/ normal strength\{\{nl\}\}- {\bf{Grade 2 (yellow):}} several injured muscle fibres w/ muscle px, tenderness, mild swelling, bruising \& loss of strength\{\{nl\}\}- {\bf{Grade 3 (red):}} complete tear of muscle w/ a possible audible sensation \& a total loss of muscle function, severe px, bruising \& swelling\{\{nl\}\}- Referral depending on grade \tn 
% Row Count 21 (+ 19)
% Row 2
\SetRowColor{LightBackground}
• {\bf{Intro:}} & - RC injuries range from {\emph{tendinopathy}} to {\emph{complete tears}}\{\{nl\}\}- Rotator cuff: subscapularis (INT rotator), supraspinatus (ABductor), infraspinatus (EXT rotator), \& teres minor (EXT rotator) \tn 
% Row Count 31 (+ 10)
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{7.9442 cm} x{9.3258 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Rotator cuff injury* (cont)}}  \tn
% Row 3
\SetRowColor{LightBackground}
• {\bf{Aetiology (risk factors):}} & - Most common tendon injury in adults\{\{nl\}\}- Approx 30\% of adults \textgreater{}60 have a tear, 62\% in those \textgreater{}80\{\{nl\}\}- Age is 1° factor for RC disease, being degenerative \& progressive\{\{nl\}\}- Risk factors: smoking (increases severity), family Hx, poor posture (kyphotic-lordotic, flat-back, swayback), trauma, hypercholesterolemia, \& overhead activities\{\{nl\}\}- Partial tears are prone to further propagation, factors inc. tear size, Ssx, location, \& age\{\{nl\}\}- Larger tears more likely to deteriorate structurally, w/ actively enlarging tears having higher likelihood of developing Ssx\{\{nl\}\}- Anterior tears are more likely to progress to cuff degeneration \tn 
% Row Count 31 (+ 31)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.9442 cm} x{9.3258 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Rotator cuff injury* (cont)}}  \tn
% Row 4
\SetRowColor{LightBackground}
• {\bf{Pathophysiology:}} & - {\bf{Macro}}-trauma leads to acute tears, commonly in younger pts, resulting in complete tears\{\{nl\}\}- {\bf{Micro}}-trauma causes tendon degeneration, leading to degenerative tears\{\{nl\}\}- Acute tears are typical in younger pts, while degenerative tears occur in older pts\{\{nl\}\}- Sufficient tendon degeneration can make a complete tear possible w/ less force\{\{nl\}\}- Multiple possible mechanisms: chronic degenerative tear, chronic impingement, acute avulsion injuries, iatrogenic injuries \tn 
% Row Count 23 (+ 23)
% Row 5
\SetRowColor{white}
• {\bf{Clinical presentation:}} & - Typically begins w/ px, which can be acute or gradual\{\{nl\}\}- Athletes often adapt biomechanics until they can no longer do their sport w/o px\{\{nl\}\}- Pts may experience increasing px \& difficulty w/ overhead activities \& lifting heavy objects\{\{nl\}\}- Px can radiate into the deltoid muscle area \& may be felt when lying on the affected side\{\{nl\}\}- Younger pts often have overuse tendinopathy\{\{nl\}\}- Older pts may have OA contributing to the condition \tn 
% Row Count 45 (+ 22)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.9442 cm} x{9.3258 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Rotator cuff injury* (cont)}}  \tn
% Row 6
\SetRowColor{LightBackground}
• {\bf{Physical examination:}} & - Tenderness at muscle insertion\{\{nl\}\}- Muscle atrophy\{\{nl\}\}- Abnormal scapular motion\{\{nl\}\}- {\bf{Special tests:}} Jobe (empty can) test, resisted EXT rotation, belly press test, drop arm test, \& EXT \& INT rotation lag sign \tn 
% Row Count 11 (+ 11)
% Row 7
\SetRowColor{white}
• {\bf{Diagnosis:}} & - Plain radiography\{\{nl\}\}- US - good for evaluating RC\{\{nl\}\}- MRI - gold standard \tn 
% Row Count 15 (+ 4)
% Row 8
\SetRowColor{LightBackground}
• {\bf{Complications:}} & - Retearing the cuff repair\{\{nl\}\}- Adhesive capsulitis\{\{nl\}\}- Inability to regain motion\{\{nl\}\}- Cuff strength \tn 
% Row Count 21 (+ 6)
% Row 9
\SetRowColor{white}
• {\bf{Management:}} & - Surgical \& conservative treatment largest improvement at 12 months\{\{nl\}\}- Surgery generally recommended for complete tears in pts \textless{}40, followed by rehab\{\{nl\}\}- Conservative: PT, NSAIDs, subacromial corticosteroid injections\{\{nl\}\}- STW\{\{nl\}\}- SMT Cx \& Tx\{\{nl\}\}- GH mobs\{\{nl\}\}- Nerve floss - brachial plexus\{\{nl\}\}- Exercise phase 1: Codman pendulum, YTWL scapular depression, GH INT rotation, corner pectoral stretch\{\{nl\}\}- Exercises phase 2: low row, eccentric supraspinatus, eccentric scapular stabilisers, eccentric shoulder ER's \tn 
% Row Count 47 (+ 26)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.9442 cm} x{9.3258 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Rotator cuff injury* (cont)}}  \tn
% Row 10
\SetRowColor{LightBackground}
• {\bf{Ddx:}} & - SLAP or other labral tears\{\{nl\}\}- Subacromial impingement from bursitis, os acromiale, bone spurs\{\{nl\}\}- AC OA\{\{nl\}\}- Biceps tendinitis\{\{nl\}\}- Cx radiculopathy \tn 
% Row Count 8 (+ 8)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{\{\{popup="https://www.ncbi.nlm.nih.gov/books/NBK547664/"\}\}link text\{\{/popup\}\}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Rotator cuff tendinopathy*}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{• {\bf{YELLOW}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
• {\bf{Intro:}} & - RC injuries vary from minor contusions \& tendonitis to chronic tendinopathy, partial tears (PTTs), \& full-thickness tears (FTTs)\{\{nl\}\}- They can impact diverse pt groups, from recreational athletes (weekend warriors) to elite athletes\{\{nl\}\}- RC pathology is observed across all age demographics \tn 
% Row Count 15 (+ 14)
% Row 2
\SetRowColor{LightBackground}
• {\bf{Aetiology (risk factors):}} & - Subacromial impingement s. (SIS) is the most common cause of shoulder px, RC tendonitis is often seen associated\{\{nl\}\}- Occur acutely due to trauma or chronically from repetitive overuse activities\{\{nl\}\}- 5-10\% in pts \textless{}20, \& over 60\% in pts \textgreater{}80\{\{nl\}\}- {\bf{Acute RC tendonitis}} often affects athletes due to direct trauma, poor throwing mechanics, or FOOSH\{\{nl\}\}- {\bf{Chronic RC tendinopathy}} can result from {\emph{extrinsic}} compression (mechanical impingement) or {\emph{intrinsic}} mechanisms (cuff degeneration)\{\{nl\}\}- Extrinsic compression can be caused by degenerative bursa, acromial spurring, or presupposing acromial morphologies\{\{nl\}\}- Intrinsic degenerative theories suggests cuff degeneration compromises joint stability, making the cuff susceptible to extrinsic compressive forces\{\{nl\}\}- Risk factors: vascular changes, age, sex, \& genetics \tn 
% Row Count 54 (+ 39)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Rotator cuff tendinopathy* (cont)}}  \tn
% Row 3
\SetRowColor{LightBackground}
• {\bf{Pathophysiology:}} & {\bf{Acute RC tendonitis can be caused by:}}\{\{nl\}\}- Direct blows to the shoulder\{\{nl\}\}- Poor throwing mechanics in overhead sports\{\{nl\}\}- FOOSH\{\{nl\}\}{\bf{Tendinopathy develops from repetitive RC injury, leading to:}}\{\{nl\}\}- Recurrent pathological cycle\{\{nl\}\}- Acute or chronic tendonitis\{\{nl\}\}- Increasing levels of tendinopathy \& tendinosis\{\{nl\}\}- Potential progression to PTTs \&/or FTTs\{\{nl\}\}{\bf{Exact pathogenesis of RC tears is controversial, but likely involves:}}\{\{nl\}\}- Extrinsic impingement from surrounding structures\{\{nl\}\}- Intrinsic degeneration within the tendon itself \tn 
% Row Count 27 (+ 27)
% Row 4
\SetRowColor{white}
• {\bf{Clinical presentation:}} & - Acute RC tendonitis: Hx of trauma or acute exacerbation on a chronic condition\{\{nl\}\}- Chronic RC tendinopathy: either acute on chronic Hx/mechanism or a gradual, atraumatic onset\{\{nl\}\}- Ssx may worsen w/ overhead activities\{\{nl\}\}- Px, especially at night, is common\{\{nl\}\}{\bf{Thorough exam includes:}}\{\{nl\}\}- Sports participation (including specific position played)\{\{nl\}\}- Occupational Hx \& current status\{\{nl\}\}- Hand dominance\{\{nl\}\}- Hx of shoulder \&/or neck injury/trauma\{\{nl\}\}- Relevant surgical Hx \tn 
% Row Count 50 (+ 23)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Rotator cuff tendinopathy* (cont)}}  \tn
% Row 5
\SetRowColor{LightBackground}
• {\bf{Physical examination:}} & {\bf{Cx exam:}}\{\{nl\}\}- Rule out Cx radiculopathy (Spurling's test)\{\{nl\}\}- Evaluate neck posturing, muscular symmetry, tenderness, \& ROM\{\{nl\}\}- {\bf{Special tests:}} Spurling's, sensation testing, reflex testing, \& neurovascular exam (7 P's)\{\{nl\}\}{\bf{Shoulder exam:}}\{\{nl\}\}- Shoulder girdle symmetry, posturing, \& muscle bulk\{\{nl\}\}- Check for scapular winging \& skin abnormalities\{\{nl\}\}- Palpate for tenderness\{\{nl\}\}- AROM \& PROM\{\{nl\}\}- Consider {\emph{RC tendonitis}} w/ anterolateral tenderness\{\{nl\}\}- Test motor strength C5-T1\{\{nl\}\}{\bf{Special tests:}}\{\{nl\}\}- {\bf{Supraspinatus (SS):}} Jobe's \& drop arm test\{\{nl\}\}- {\bf{Infraspinatus (IS):}} Strength test \& EXT rotation lag sign\{\{nl\}\}- {\bf{Teres minor (TM):}} strength test \& Hornblower's sign\{\{nl\}\}- {\bf{Subscapularis (SubSc):}} IR lag sign, passive ER ROM, lift-off test, \& belly press\{\{nl\}\}- {\bf{EXT / subacromial impingement:}} Neer impingement sign, Near impingement test, \& Hawkin-Kennedy test\{\{nl\}\}- {\bf{Internal impingement:}} pt supine, shoulder brought into terminal ABD \& EXT rotation; +ve if px reproduced \tn 
% Row Count 48 (+ 48)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Rotator cuff tendinopathy* (cont)}}  \tn
% Row 6
\SetRowColor{LightBackground}
• {\bf{Diagnosis:}} & - Imaging should be obtained in all pts w/ acute or chronic shoulder px\{\{nl\}\}- Plain radiographs\{\{nl\}\}- US (should be used more due to their specificity)\{\{nl\}\}- MRI (provides more accurate tear details) \tn 
% Row Count 10 (+ 10)
% Row 7
\SetRowColor{white}
• {\bf{Complications:}} & {\bf{Non-operative:}}\{\{nl\}\}- Persistent px / recurrent Ssx\{\{nl\}\}- Setting of PTTs: risk of tear propagation, lack of healing, fatty infiltration, atrophy, \& retraction\{\{nl\}\}- Risks for tear progression: initial presence of FTT, medium-sized cuff tears (1-3cm), smoking\{\{nl\}\}- Setting of chronic/atrophic tears: DJD \& RC atrophy\{\{nl\}\}{\bf{Surgical:}}\{\{nl\}\}- Most effective for pts who failed 4-6 months of conservative care\{\{nl\}\}- Risks of surgery: recurrent px/Ssx, infection, stiffness, neurovascular injury, \& risks associated w/ anaesthetic use\{\{nl\}\}- Subacromial \seqsplit{decompression/acromioplasty:} deltoid dysfunction or anterosuperior escape \tn 
% Row Count 39 (+ 29)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Rotator cuff tendinopathy* (cont)}}  \tn
% Row 8
\SetRowColor{LightBackground}
• {\bf{Management:}} & - Majority of pts w/o FTTs improve w/ non-operative management\{\{nl\}\}- NSAIDs, rest/activity modification, cortisone injections\{\{nl\}\}- STW RC muscles\{\{nl\}\}- Cx \& Tx SMT\{\{nl\}\}- GH mobs\{\{nl\}\}- Nerve floss - brachial plexus\{\{nl\}\}- Exercises Phase 1: Codman pendulum, YTWL scapular depression, GH IR, \& Corner pec stretch\{\{nl\}\}- Exercises Phase 2: low row, eccentric supraspinatus, eccentric scapular stabilisers, eccentric shoulder ER's\{\{nl\}\}- Surgery \tn 
% Row Count 21 (+ 21)
% Row 9
\SetRowColor{white}
• {\bf{Ddx:}} & {\bf{Impingement:}}\{\{nl\}\}- External / subacromial\{\{nl\}\}- Subcoracoid\{\{nl\}\}- Calcific tendonitis\{\{nl\}\}- Internal (inc. SLAP, GIRD, little League shoulder, posterior labral tears)\{\{nl\}\}{\bf{RC pathology:}}\{\{nl\}\}- Tendonitis (acute), Tendinopathy (chronic or acute on chronic)\{\{nl\}\}- PTTs vs FTTs\{\{nl\}\}- RC arthropathy\{\{nl\}\}{\bf{Degenerative:}}\{\{nl\}\}- Advanced DJD (often associated w/ RC arthropathy)\{\{nl\}\}- GH arthritis\{\{nl\}\}- Adhesive capsulitis\{\{nl\}\}- AVN\{\{nl\}\}- Scapulothoracic crepitus\{\{nl\}\}{\bf{Proximal biceps:}}\{\{nl\}\}- Subluxation (associated w/ subscapularis injuries)\{\{nl\}\}- Tendonitis \& tendinopathy\{\{nl\}\}{\bf{AC joint conditions:}}\{\{nl\}\}- AC separation\{\{nl\}\}- Distal clavicle osteolysis\{\{nl\}\}- AC arthritis\{\{nl\}\}{\bf{Instability:}}\{\{nl\}\}- Unidirectional instability - seen in association w/ an inciting event/dislocation (anterior, posterior, inferior)\{\{nl\}\}- Multidirectional instability (MDI)\{\{nl\}\}- Associated labral injuries/pathology\{\{nl\}\}{\bf{Neurovascular conditions:}}\{\{nl\}\}- Suprascapular neuropathy (can be associated w/ paralabral cyst at the spinoglenoid notch)\{\{nl\}\}- Scapular wining (medial or lateral)\{\{nl\}\}- TOS\{\{nl\}\}- Quadrilateral space s.\{\{nl\}\}{\bf{Other conditions:}}\{\{nl\}\}- Scapulothoracic dyskinesia\{\{nl\}\}- Os acromiale\{\{nl\}\}- Muscle ruptures (pec major, deltoid, lat dorsi)\{\{nl\}\}- Fracture (acute injury or px resulting from long-standing deformity, malunion, or nonunion) \tn 
% Row Count 84 (+ 63)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{\{\{popup="https://www.ncbi.nlm.nih.gov/books/NBK532270/\#\_article-28654\_s12\_"\}\}link text\{\{/popup\}\}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Scapulothoracic dyskinesis*}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{• {\bf{GREEN}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
• {\bf{Intro:}} & - Altered position \& motion of the scapula\{\{nl\}\}- Also known as {\emph{dysrhythmia}}, {\emph{dyskinesia}},or {\emph{SICK scapula syndrome}}\{\{nl\}\}- Scapular wining, exists but denoted a distinct condition typically following Tx or spinal accessory n. injury\{\{nl\}\}- Observed in overhead athletes \& pts w/ shoulder issues like RC disease, GH instability, impingement s., \& labral tears, as well as in healthy pts\{\{nl\}\}- No clear relationship between SD \& shoulder px, even though some pts present w/ shoulder px\{\{nl\}\}- Theory: SD might predict future shoulders even in the absence of current Ssx \tn 
% Row Count 27 (+ 26)
% Row 2
\SetRowColor{LightBackground}
• {\bf{Aetiology (risk factors):}} & {\bf{Shoulder-related:}}\{\{nl\}\}- Shoulder pathologies associated w/ SD {\emph{(AC instability, shoulder impingement, RC injuries, glenoid labrum injuries, clavicle \#)}}\{\{nl\}\}- Inflexibility of the pec minor \& short head of biceps\{\{nl\}\}- Stiffness of posterior GH capsule\{\{nl\}\}{\bf{Neck-related:}}\{\{nl\}\}- Mechanical neck px s.\{\{nl\}\}- Cx n. root-related s.\{\{nl\}\}{\bf{Posture-related:}}\{\{nl\}\}- Excessive Tx kyphosis \& Cx lordosis\{\{nl\}\}- Athletes show these are more related causes SD \tn 
% Row Count 49 (+ 22)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Scapulothoracic dyskinesis* (cont)}}  \tn
% Row 3
\SetRowColor{LightBackground}
• {\bf{Pathophysiology:}} & {\bf{Scapular motions:}}\{\{nl\}\}- Upward/downward rotation\{\{nl\}\}- Internal/external rotation\{\{nl\}\}- Anterior/posterior tilt\{\{nl\}\}{\bf{Scapular translation:}}\{\{nl\}\}- Upward/downward sliding on the Tx\{\{nl\}\}- Medial/lateral sliding around the curvature of Tx\{\{nl\}\}{\bf{Common scapular patterns:}}\{\{nl\}\}- Scapular retraction: EXT rot + posterior tilt + upward rot + medial translation\{\{nl\}\}- Protraction: INT rot + anterior tilt + downward rot + lateral translation\{\{nl\}\}- Shrug: upward translation + anterior tilt + INT rot\{\{nl\}\}{\bf{Normal overhead elevation:}}\{\{nl\}\}- Minimal INT/EXT rot until 100°\{\{nl\}\}- 1° scapular motion: upward rot\{\{nl\}\}- 2° scapular motion: posterior tilt\{\{nl\}\}{\bf{Scapulohumeral rhythm:}}\{\{nl\}\}- Coordinated movement between scapula \& humerus for efficient arm movement\{\{nl\}\}- 2:1 ratio between GH elevation \& scapular upward rot\{\{nl\}\}- Consistent pattern during scapular plane elevation: upward rot + posterior tilt + EXT rot + clavicular elevation + retraction\{\{nl\}\}{\bf{Altered mechanics in SD:}}\{\{nl\}\}- Increased scapular anterior tilt\{\{nl\}\}- Increased scapular INT rot\{\{nl\}\}- Altered scapular upward rot \tn 
% Row Count 51 (+ 51)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Scapulothoracic dyskinesis* (cont)}}  \tn
% Row 4
\SetRowColor{LightBackground}
• {\bf{Clinical presentation:}} & - Pts w/ SD can be symptomatic or asymptomatic\{\{nl\}\}{\emph{Ssx can be one or combination of the following:}}\{\{nl\}\}- Anterior shoulder px\{\{nl\}\}- Posterosuperior scapular px (may radiate into ipsilateral para spinous Cx region or radicular/thoracic outlet-type Ssx in the affected UL)\{\{nl\}\}- Superior shoulder px\{\{nl\}\}- Proximal lateral arm px \tn 
% Row Count 16 (+ 16)
% Row 5
\SetRowColor{white}
• {\bf{Physical examination:}} & - Assess AC \& SC for instability\{\{nl\}\}- Infraspinatus strength test\{\{nl\}\}- Manual resistance of the arm at 130° of FX (for serratus anterior)\{\{nl\}\}- Manual resistance of the arm at 130-150° of ABD (for lower \& middle traps)\{\{nl\}\}- Extension of the arm at the side (for rhomboids)\{\{nl\}\}- Low row test\{\{nl\}\}- Scapulohumeral rhythm test\{\{nl\}\}- Quadruped rock\{\{nl\}\}- Lateral scapular slide test\{\{nl\}\}- Scapular dyskinesia test\{\{nl\}\}- SICK scapula sign \tn 
% Row Count 37 (+ 21)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Scapulothoracic dyskinesis* (cont)}}  \tn
% Row 6
\SetRowColor{LightBackground}
• {\bf{Diagnosis:}} & {\bf{Classification of dyskinesia types:}}\{\{nl\}\}- {\bf{Type 1:}} inferior angle prominence (i.e. anterior tilt of scapula)\{\{nl\}\}- {\bf{Type 2:}} medial border prominence (i.e. winging of the scapula)\{\{nl\}\}- {\bf{Type 3:}} early scapular elevation or \seqsplit{excessive/insufficient} upward rot during arm elevation \tn 
% Row Count 14 (+ 14)
% Row 7
\SetRowColor{white}
• {\bf{Complications:}} & - SD diminishes subacromial space \& leads to decreased RC strength, impingement Ssx, \& eventual RC damage\{\{nl\}\}- 100\% of pts w/ shoulder impingement demonstrate dyskinesia\{\{nl\}\}- 5\% of pts w/ dyskinesia have neurologic injury/damage (spinal accessory, long Tx, suprascapular)\{\{nl\}\}- SD can occur from core \& hip ABD weakness\{\{nl\}\}- SD becomes more apparent w/ dynamic testing, particularly during the lowering phase of arm movement\{\{nl\}\}- Recognition \& rehab should begin independent of (generally absent) Ssx \tn 
% Row Count 38 (+ 24)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Scapulothoracic dyskinesis* (cont)}}  \tn
% Row 8
\SetRowColor{LightBackground}
• {\bf{Management:}} & - STW: upper traps, pec minor, biceps\{\{nl\}\}- SMT: Cx \& Tx\{\{nl\}\}- Scapular mobs\{\{nl\}\}- Treatment aims at restoration of scapular retraction, posterior tilt \& EXT rot\{\{nl\}\}- Exercises Phase 1: trap stretch - sitting, YTWL scapular depression\{\{nl\}\}- Exercises Phase 2: low row, burger w/ band \tn 
% Row Count 14 (+ 14)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{\{\{popup="https://www.physio-pedia.com/Scapular\_Dyskinesia"\}\}link text\{\{/popup\}\}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Subacromial bursitis}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{• {\bf{YELLOW}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
• {\bf{Intro:}} & - Bursa is a fluid-filled sac\{\{nl\}\}- Lubricatesjoints \& body surfaces prone to wear \& friction\{\{nl\}\}- Subacromial bursa is surrounded by the acromion, coracoid, coracoacromial ligament, \& deltoid muscle fibres\{\{nl\}\}- Inflammation of this bursa can lead to subacromial bursitis \tn 
% Row Count 14 (+ 13)
% Row 2
\SetRowColor{LightBackground}
• {\bf{Aetiology (risk factors):}} & - Around 0.4\% of primary care visits\{\{nl\}\}- F=M\{\{nl\}\}{\bf{Common aetiologies:}}\{\{nl\}\}- Subacromial impingement (especially in older pts)\{\{nl\}\}- Repetitive overhead activities / overuse (athletes, factory workers, manual labourers)\{\{nl\}\}- Direct trauma\{\{nl\}\}- Crystal deposition\{\{nl\}\}- Subacromial hemmorhage\{\{nl\}\}- Infection\{\{nl\}\}- Autoimmune disease (e.g. RA) \tn 
% Row Count 31 (+ 17)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Subacromial bursitis (cont)}}  \tn
% Row 3
\SetRowColor{LightBackground}
• {\bf{Pathophysiology:}} & - Aetiologies can cause inflammation of the subacromial bursa, leading to increased fluid \& collagen formation\{\{nl\}\}- Fluid is often rich in fibrin \& can become hemorrhagic\{\{nl\}\}{\bf{Bursitis has 3 phases:}}\{\{nl\}\}- {\bf{Acute:}} marked by local inflammation w/ thickened synovial fluid, resulting in painful movement, especially w/ overhead activities\{\{nl\}\}- {\bf{Chronic:}} constant px due to a chronic inflammatory process, which can weaken \& eventually rupture surrounding ligaments \& tendons. Require attention to tendinitis as they may coexist\{\{nl\}\}- {\bf{Recurring:}} can result from repetitive trauma or routine overhead activities, \& it may also be seen in pts w/ inflammatory conditions (e.g. RA) \tn 
% Row Count 32 (+ 32)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Subacromial bursitis (cont)}}  \tn
% Row 4
\SetRowColor{LightBackground}
• {\bf{Clinical presentation:}} & - Px in the anterolateral aspect of the shoulder\{\{nl\}\}- Possible causes: trauma (fall w/ direct impact), repetitive overhead activities (sports, lifting)\{\{nl\}\}- Impingement s. as a common cause\{\{nl\}\}- Mechanism: decreased subacromial space due to overhead activities\{\{nl\}\}- Effect of arm ABD: brings humerus closer to acromion, reducing subacromial space\{\{nl\}\}- Function of subacromial bursa: protects supraspinatus muscle from wear between humeral head \& acromion\{\{nl\}\}- Result of repetitive activity: irritation \& inflammation of the bursa\{\{nl\}\}- Consideration of tendon pathology: supraspinatus tendinitis or tear may coexist w/ impingement s. \tn 
% Row Count 30 (+ 30)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Subacromial bursitis (cont)}}  \tn
% Row 5
\SetRowColor{LightBackground}
• {\bf{Physical examination:}} & - TTP at anterolateral aspect of shoulder below acromion\{\{nl\}\}- Localised px, doesn't usually radiate (if it does, consider Cx pathology)\{\{nl\}\}- Warm or boggy skin at site, but no erythema typically\{\{nl\}\}- Px on resisted ABD of arm beyond 75-80°\{\{nl\}\}- Compression of subacromial bursa at undersurface of acromion during motion \tn 
% Row Count 15 (+ 15)
% Row 6
\SetRowColor{white}
• {\bf{Diagnosis:}} & - X-rays may be used to rule out other pathologies (e.g. fractures, dislocations, OA, etc)\{\{nl\}\}- MRI: burial fluid accumulation visible\{\{nl\}\}- US: evaluates the thickness of the bursa \tn 
% Row Count 24 (+ 9)
% Row 7
\SetRowColor{LightBackground}
• {\bf{Complications:}} & - Not associated w/ many complications\{\{nl\}\}- Repeated steroid injections: theoretical risk of introducing an infection into skin/joint\{\{nl\}\}- Risk of damaging RC muscles w/ recurrent injections \tn 
% Row Count 33 (+ 9)
\end{tabularx}
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
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\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Subacromial bursitis (cont)}}  \tn
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• {\bf{Management:}} & - Good prognosis for pts w/ conservative care, even w/ surgery\{\{nl\}\}- Rest, NSAIDs, PT, \& corticosteroid injections\{\{nl\}\}- Surgery for pts non responsive to conservative care \tn 
% Row Count 8 (+ 8)
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• {\bf{Ddx:}} & - Impingement syndrome\{\{nl\}\}- RC tendinitis/tear\{\{nl\}\}- Biceps tendinitis\{\{nl\}\}- Adhesive capsulitis\{\{nl\}\}- AC joint OA \tn 
% Row Count 14 (+ 6)
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
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\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Subacromial impingement syndrome (SIS)*}}  \tn
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\mymulticolumn{2}{x{17.67cm}}{• {\bf{GREEN}}} \tn 
% Row Count 1 (+ 1)
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• {\bf{Intro:}} & - SIS is the inflammation, irritation, degradation in subacromial space structures\{\{nl\}\}- Shoulder impingement s. is considered most common cause of shoulder px\{\{nl\}\}- Shoulder px often persists or recurs\{\{nl\}\}- 54\% of pts experience persistent Ssx after 3 years \tn 
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• {\bf{Aetiology (risk factors):}} & - Common in overhead sports (handball, volleyball), \& manual labourers\{\{nl\}\}- Incidence rises w/ age (especially 60s)\{\{nl\}\}- Shoulder {\emph{external}} impingement distinguished from {\emph{internal}} impingement by RC anatomy\{\{nl\}\}{\bf{Extrinsic risk factors:}}\{\{nl\}\}- Heavy loads\{\{nl\}\}- Infection\{\{nl\}\}- Smoking \tn 
% Row Count 27 (+ 14)
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• {\bf{Pathophysiology:}} & - Normal shoulder movement narrows subacromial space, causing px\{\{nl\}\}- Unclear whether tendon damage or narrowed space causes impingement\{\{nl\}\}- Described by location (external/internal) \& cause (1°/2°)\{\{nl\}\}{\bf{Anatomic borders:}}\{\{nl\}\}- Acromion\{\{nl\}\}- Coracoacromial ligament\{\{nl\}\}- AC joint\{\{nl\}\}- Humeral head\{\{nl\}\}{\bf{External (subacromial) impingement:}}\{\{nl\}\}- Mechanical encroachment of soft tissue in subacromial space\{\{nl\}\}- {\bf{1° impingement:}} structural narrowing (e.g. abnormal acromion)\{\{nl\}\}- {\bf{2° impingement:}} onset during motion due to RC weakness \tn 
% Row Count 53 (+ 26)
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
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\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Subacromial impingement syndrome (SIS)* (cont)}}  \tn
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• {\bf{Staging:}} & {\bf{Neer's classification:}}\{\{nl\}\}- {\bf{Stage 1:}} edema, haemorrhage from overuse\{\{nl\}\}- {\bf{Stage 2:}} fibrosis, irreversible tendon changes\{\{nl\}\}- {\bf{Stage 3:}} tendon rupture/tear due to chronic fibrosis \tn 
% Row Count 10 (+ 10)
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• {\bf{Clinical presentation:}} & - Px upon lifting the arm or lying on the affected side\{\{nl\}\}- Pts may report loss of motion, nighttime px, weakness, \& stiffness\{\{nl\}\}- Onset is gradual over weeks to months, w/o a specific traumatic event\{\{nl\}\}- Px is typically felt over the lateral acromion w/ radiation to the lateral mid-humerus\{\{nl\}\}- Inquire: onset, quality, exacerbating factors, interventions tried, \& prior injuries\{\{nl\}\}- {\bf{Important:}} overhead \& repetitive activities\{\{nl\}\}- Relief: rest, NSAIDs, ice\{\{nl\}\}- Ssx often return w/ activity \tn 
% Row Count 34 (+ 24)
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
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\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Subacromial impingement syndrome (SIS)* (cont)}}  \tn
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• {\bf{Physical examination:}} & - Inspection, palpation, A \& PROM, \& strength testing of neck \& shoulder\{\{nl\}\}- B comparison\{\{nl\}\}- Common weakness: ABD \&/or EXT rotation\{\{nl\}\}- {\emph{Scapular dyskinesis}} during arm forward elevation\{\{nl\}\}- Tenderness over the coracoid process of affected arm\{\{nl\}\}{\bf{Special tests for shoulder impingement:}}\{\{nl\}\}- Hawkins test - subacromial (external)\{\{nl\}\}- Neer sign - anterior px = subacromial; posterior px = internal\{\{nl\}\}- Jobe (empty can test)\{\{nl\}\}- Painful arc of motion\{\{nl\}\}{\bf{Special tests for shoulder instability:}}\{\{nl\}\}- Sulcus sign\{\{nl\}\}- Anterior apprehension\{\{nl\}\}- Relocation test - internal \tn 
% Row Count 28 (+ 28)
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• {\bf{Diagnosis:}} & - Dx made from physical exam\{\{nl\}\}- Imaging used to confirm \& rule out other issues \tn 
% Row Count 32 (+ 4)
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
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\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Subacromial impingement syndrome (SIS)* (cont)}}  \tn
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• {\bf{Complications:}} & - Due to structural damage within subacromial space\{\{nl\}\}- Altered biomechanics\{\{nl\}\}- Avoidance of use w/ subsequent atrophy\{\{nl\}\}- Potential pathologies that may result: RC tendonitis/tear, bicipital tendonitis/tear, or adhesive capsulitis \tn 
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• {\bf{Management:}} & - Most pts resolve within 2 yrs w/ conservative care (initial approach before considering surgery)\{\{nl\}\}- Restoring ROM is crucial, avoid aggravating movements e.g. elevation \& INT rotation\{\{nl\}\}- Tape used enhance recovery \& decrease px\{\{nl\}\}- Steroid injections\{\{nl\}\}- Surgery\{\{nl\}\}- STW (RC), SMT (Cx/Tx), GH mobs, nerve floss (brachial plexus)\{\{nl\}\}- Exercises Phase 1: Codman pendulum, YTWL scapular depression, GH INT rotation, Corner pec stretch\{\{nl\}\}- Exercises Phase 2: low row, Brugger w/ band \tn 
% Row Count 34 (+ 23)
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• {\bf{Ddx:}} & - Adhesive capsulitis\{\{nl\}\}- RC tear\{\{nl\}\}- AC OA\{\{nl\}\}- AC sprain\{\{nl\}\}- Trapezius muscle spasm\{\{nl\}\}- Biceps tendonitis\{\{nl\}\}- Biceps tendon rupture\{\{nl\}\}- Calcific tendonitis\{\{nl\}\}- GH arthritis\{\{nl\}\}- Distal clavicle osteolysis\{\{nl\}\}- Cx radiculopathy\{\{nl\}\}- TOS \tn 
% Row Count 13 (+ 13)
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\mymulticolumn{2}{x{17.67cm}}{\{\{popup="https://www.ncbi.nlm.nih.gov/books/NBK554518/\#article-28996.s8"\}\}link text\{\{/popup\}\}}  \tn 
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
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\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Hypermobility syndromes (HMS)}}  \tn
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\mymulticolumn{2}{x{17.67cm}}{• {\bf{GREEN}}} \tn 
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• {\bf{Intro:}} & - Generalised articular hypermobility, w/ or w/o subluxation or dislocation\{\{nl\}\}- Also known as {\emph{joint hypermobility s.}} \& {\emph{benign hypermobility joint s.}}\{\{nl\}\}- Primary Ssx: excessive laxity of multiple joints\{\{nl\}\}- Differs from localised joint hypermobility \& other disorders e.g. Ehlers-Danlos s, RA, lupus, \& Marfan s.\{\{nl\}\}- May occur in chromosomal \& genetic disorders like Down syndrome, \& metabolic disorders e.g. homocystinuria \& hyperlysinemia\{\{nl\}\}- Lab tests used to exclude other systemic disorders when HMS is suspected \tn 
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• {\bf{Aetiology (risk factors):}} & - Most prevalent in children \& tends to decrease w/ age\{\{nl\}\}- Joint mobility is at its highest at birth, decreasing in children around 9-12 yrs\{\{nl\}\}- Adolescent girls hypermobility peak at 15, decrease after, influenced by hormonal changes\{\{nl\}\}- F\textgreater{}M\{\{nl\}\}- More prevalent in ASIA, Africa, \& Middle East \tn 
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
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\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Hypermobility syndromes (HMS) (cont)}}  \tn
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• {\bf{Pathophysiology:}} & - Involves systemic collagen abnormality\{\{nl\}\}- Joint hypermobility \& tissue laxity are linked to abnormal collagen ratios\{\{nl\}\}- Collagen types I, II, \& III are decreased in the skin\{\{nl\}\}- Dx criteria include joint abnormality\{\{nl\}\}- Affects cardiac tissue, smooth muscle in female genital system, \& GI system\{\{nl\}\}- Impairs joint position sense \tn 
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• {\bf{Clinical presentation:}} & {\bf{Joint instability \& trauma:}}\{\{nl\}\}- Recurrent ankle sprains\{\{nl\}\}- Meniscus tears\{\{nl\}\}- Acute or recurrent dislocations or subluxations of various joints (shoulder, patella, MCP joints, TMJ)\{\{nl\}\}- Traumatic arthritis\{\{nl\}\}- Bruising\{\{nl\}\}- Fractures (chronic or non-traumatic)\{\{nl\}\}- Chondromalacia\{\{nl\}\}{\bf{Soft tissue disorders:}}\{\{nl\}\}- Tendinitis\{\{nl\}\}- Epicondylitis\{\{nl\}\}- RC syndrome\{\{nl\}\}- Synovitis\{\{nl\}\}- Juvenile episodic synovitis\{\{nl\}\}- Bursitis\{\{nl\}\}{\bf{MSK conditions:}}\{\{nl\}\}- Scoiliosis\{\{nl\}\}- OA\{\{nl\}\}- Congenital hip dislocation\{\{nl\}\}- Delayed motor development\{\{nl\}\}- Flat feet \& sequelae\{\{nl\}\}{\bf{Neurological Ssx:}}\{\{nl\}\}- Nerve compression disorders - carpal tunnel, tarsal tunnel, TOS\{\{nl\}\}- Raynaud s.\{\{nl\}\}- Clumsiness\{\{nl\}\}- Chronic HA\{\{nl\}\}{\bf{Px \& sleep issues:}}\{\{nl\}\}- Exercise-related / post-exercise-related px\{\{nl\}\}- Nocturnal leg px\{\{nl\}\}- Low nocturnal sleep quality\{\{nl\}\}- Joint swelling\{\{nl\}\}- Back px\{\{nl\}\}- Unspecified arthralgia or effusion of affected joint\{\{nl\}\}{\bf{Other systemic effects:}}\{\{nl\}\}- Fibromyalgia\{\{nl\}\}- Chronic fatigue s.\{\{nl\}\}- Functional GI disorders\{\{nl\}\}- Immune system dysregulation\{\{nl\}\}- Pelvic dysfunction\{\{nl\}\}- CV dysautonomia\{\{nl\}\}- Exocrine glands dysfunction\{\{nl\}\}- Little changes of the skin\{\{nl\}\}- Greater risk of failures in tendon, ligament, bone, skin, \& cartilage\{\{nl\}\}- Enhanced flexibility\{\{nl\}\}- Ankylosing spondylitis (axial spondyloarthritis) \tn 
% Row Count 81 (+ 65)
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\begin{tabularx}{17.67cm}{x{7.7715 cm} x{9.4985 cm} }
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\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Hypermobility syndromes (HMS) (cont)}}  \tn
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• {\bf{Physical examination:}} & - ROM\{\{nl\}\}- End feel\{\{nl\}\}- Beighton score\{\{nl\}\}- Paradoxical breathing evaluation \tn 
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• {\bf{Diagnosis:}} & {\bf{Major criteria:}}\{\{nl\}\}- Beighton score of ≧4/9\{\{nl\}\}- Arthralgia for \textgreater{}3 months in \textgreater{}4 joints\{\{nl\}\}{\bf{Minor criteria:}}\{\{nl\}\}- Beighton score of 1-3\{\{nl\}\}- Arthralgia in 1-3 joints\{\{nl\}\}- Hx of joint dislocation\{\{nl\}\}- Soft tissue lesions \textgreater{}3\{\{nl\}\}- Marfan-like habitus\{\{nl\}\}- Skin striae, hyperextensibilty or scarring\{\{nl\}\}- Eye signs, lid laxity\{\{nl\}\}- Hx of varicose veins, hernia, visceral prolapse\{\{nl\}\}{\bf{Requirement for Dx of HMS:}}\{\{nl\}\}- 2 major criteria\{\{nl\}\}- 1 major criteria + 2 minor criteria\{\{nl\}\}- 4 minor criteria\{\{nl\}\}- 2 minor criteria \& unequivocally affected 1st-degree relative in FHx \tn 
% Row Count 32 (+ 28)
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• {\bf{Complications:}} & - Px \& stiffness\{\{nl\}\}- Clicking\{\{nl\}\}- Dislocations\{\{nl\}\}- Recurrent injuries\{\{nl\}\}- Digestive problems\{\{nl\}\}- Dizziness \& fainting\{\{nl\}\}- Fatigue \tn 
% Row Count 7 (+ 7)
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• {\bf{Management:}} & - Education\{\{nl\}\}- Abdominal brace exercise\{\{nl\}\}- Active mobs exercises\{\{nl\}\}- Strengthening exercises - muscle surrounding the joint\{\{nl\}\}- Proprioceptive exercises\{\{nl\}\}- Control neutral joint position\{\{nl\}\}- Re-train dynamic control\{\{nl\}\}- Motion control\{\{nl\}\}- NSAIDs for px management \tn 
% Row Count 21 (+ 14)
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• {\bf{Ddx:}} & - Ehlers-Danlos syndrome\{\{nl\}\}- Fibromyalgia\{\{nl\}\}- Chronic fatigue syndrome\{\{nl\}\}- Depression \tn 
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\mymulticolumn{2}{x{17.67cm}}{\{\{popup="https://www.physio-pedia.com/Hypermobility\_Syndrome\#cite\_note-p4-4"\}\}link text\{\{/popup\}\}}  \tn 
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\end{document}