03-05: The Shoulder Joint Flashcards

1
Q

Description of Shoulder Joint (3)

A
  1. Ball-and-socket joint
  2. One of the most movable joints
  3. One of the least stable joints
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2
Q

Labrum

A

Cartilagenous disk between head of humerus and glenoid fossa; helps with joint congruency

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3
Q

Plane of Scapula

A

Lateral, Anterior, Superior (somewhat upward elevation); ROM at 45˚

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4
Q

Joint Motion - Flexion/Abduction

A

0-180˚

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5
Q

Joint Motion - Medial Rotation (Internal)

A

0-70˚ (Any further is scapular tilt)

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6
Q

Joint Motion - Lateral Rotation (External)

A

0-90˚

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7
Q

Joint Motion - Horizontal Adduction

A

0-30˚

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8
Q

Joint Motion - Horizontal Abduction

A

0-120˚

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9
Q

Glenohumeral Ligament - Superior

A

Resists external rotation in neutral ABD

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10
Q

Glenohumeral Ligament - Middle

A

Resists external rotation in 45˚ ABD

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11
Q

Glenohumeral Ligament - Inferior

A

Resists external rotation in 90˚ ABD

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12
Q

Elements of Glenohumeral Joint

A
  • Glenohumeral Ligaments (3)
  • Coracohumeral Ligament
  • Axillary Recess
  • Tranverse Ligament
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13
Q

Coracohumeral Ligament

A

Resists excessive external rotation, excessive extension, excessive depression of head of humerus; Limits flexion

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14
Q

Axillary Recess

A

An excess tissue of joint capsule (inferior to glenohumeral capsule)

  • “Pleats” allow humeral head to descend; slides into pleats and allow for motion
  • Must free up before muscle control
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15
Q

Transverse Ligament

A

Synovial sheath that prevents friction of bicipital tendon - crosses over bicipital groove and holds tendon in groove

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16
Q

GH Kinematics

A

Flexion/Extension (120˚/45˚) - Sagittal Plane/Frontal Axis
Abduction/Adduction (120˚) - Frontal Plane/Sagittal Axis
Internal/External Rotation (80˚/70˚) - Tranverse Plane/Vertical Axis

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17
Q

Glenohumeral Scapulothoracic Rhythm (GHST)

A

2:1 Ratio - For every 2 degrees of shoulder abduction at GH joint, 1 degree occurs at ST joint (SC, AC)

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18
Q

Scapulothoracic Rhythm (ST)

A

First 30˚ of shoulder joint = pure shoulder motion

After first 30˚, 2:1 ratio = 2˚ of shoulder flexion/abduction accompanied by 1˚ of upward rotation of scapula

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19
Q

Muscles of the Shoulder Joint (12)

A

Deltoid (3), Supraspinatus, Pectoralis Major (2), Latissimus Dorsi, Teres Major, Infraspinatus, Teres Minor, Subscapularis, Coracobrachialis

20
Q

Rotator Cuff Muscles (SITS)

A

Supraspinatus, Infraspinatus, Teres Minor = Posterior

Subscapularis = Anterior

21
Q

Supraspinatus

A

O: Supraspinous fossa
I: Superior facet of greater tubercle of humerus
A: Initiates “roll”
N: Suprascapular Nerve (Superior Trunk)

  • Travels under acromion
  • No roll = arm doesn’t move overhead
22
Q

Infraspinatus

A

O: Infraspinous fossa
I: Middle facet of greater tubercle of humerus
A: Lateral/External Rotation, Horizontal Abduction
N: Suprascapular Nerve (Superior Trunk)

23
Q

Teres Minor

A

O: Axillary border of scapula
I: Inferior facet of greater tubercle of humerus
A: Lateral/External Rotation, Horizontal Abduction
N: Axillary Nerve (Posterior Cord)

24
Q

Subscapularis

A

O: Subscapular fossa
I: Lesser tubercle of humerus
A: Medial/Internal Rotation
N: Subscapular Nerve (Posterior Cord)

25
Q

Quadrangular Space

A

Common site of impingement - hypertrophy, trauma to shoulder
- Border of teres minor (superior), teres major (inferior), long head of triceps (medial), and lateral lip of humerus (lateral)

26
Q

Anterior Deltoid

A

O: Inferior aspect of lateral 1/3 of clavicle
I: Deltoid tuberosity
A: Shoulder abduction, flexion, medial rotation, horizontal abduction
N: Axillary Nerve (Posterior Cord)

27
Q

Middle Deltoid

A

O: Acromion
I: Deltoid tuberosity
A: Shoulder abduction
N: Axillary Nerve (Posterior Cord)

28
Q

Posterior Deltoid

A

O: Inferior aspect of spine of scapula
I: Deltoid tuberosity
A: Shoulder abduction, extension, lateral rotation, horizontal abduction
N; Axillary Nerve (Posterior Cord)

  • Actions are opposite of anterior deltoid
29
Q

Pectoralis Major (Clavicular portion)

A

O: Inferior aspect of medial 2/3 of clavicle
I: Lateral lip of bicipital groove of humerus
A: Shoulder flexion (0-60˚)

30
Q

Pectoralis Major (Sternal portion)

A

O: Sternum, Costal cartilage of ribs 1-6
I: Lateral lip of bicipital groove of humerus
A: Shoulder extension from full flexion (180˚-120˚)

31
Q

Pectoralis Major (Sternal AND Clavicular)

A

A: Shoulder adduction, medial rotation, horizontal adduction
N: Lateral pectoral (Lateral Cord), Medial Pectoral (Medial Cord)

  • Primary medial rotator
  • Restricted shoulder adduction to muscle test
  • Also abdominal head of pec major
32
Q

Latissimus Dorsi

A

O: Spinous process of T7-L5, posterior surface of sacrum, iliac crest, lower 3 ribs, thoracolumbar fascia
I: Floor of the bicipital groove of humerus, inferior angle of scapula
A: Prime shoulder extension, medial rotation of humerus, also contributes to scapular depression
N: Thoracodorsal (Posterior Cord)

  • Largest muscle in body (surface area)
33
Q

Teres Major

A

O: Inferior angle of scapula
I: Medial lip of bicipital groove of humerus
A: Medial/Internal rotation, Shoulder adduction, Extension
N: Subscapular Nerve (Posterior Cord)

34
Q

“Lady that sits between the two majors”

A

Teres Major - Medial lip of bicipital groove
Latissimus Dorsi - Middle floor of bicipital groove
Pectoralis Major - Lateral lip of bicipital groove

35
Q

Coracobrachialis

A

O: Coracoid process of the scapula
I: Medial aspect of the mid-shaft of the humerus
A: Assists with shoulder flexion, shoulder adduction
N: Musculocutaneous Nerve (Lateral Cord)

  • Adjacent to insertion of deltoid (lateral aspect)
36
Q

Glenohumeral Movement (Arthorkinematic motions)

A

Shoulder ABD

  1. Supraspinatus initiates roll, gives deltoid mechanical advantage for ABD
  2. “ITS” pulls down humeral head posterior and inferior
  3. Deltoid ABD shoulder
  4. Scapula must rotate (upper/lower trap, serratus anterior) to complete ABD

Rotation of Humerus
Must be performed to move bony landmarks (greater tubercle, acromion) out of the way during movement

37
Q

Traction ischemia of rotator cuff musculature, especially supraspinatus

A
  • Blood cut off when arm is by side

- Need to angle arm at 55˚ to loosen up blood flow

38
Q

Coracoacromical Arch & Bursa

A

1 cm of space between acromion process and humeral head
Arch contains supraspinatus, subacromial bursa, long head of the biceps, superior joint capsule
Site of shoulder impingement

39
Q

Muscle Action - Flexion

A
Anterior deltoid
Pectoralis major (clavicular)
40
Q

Muscle Action - Extension

A
Posterior deltoid
Latissimus dorsi
Teres major
Pectoralis major (sternal)
41
Q

Muscle Action - Hyperextension

A

Latissimus dorsi

Posterior deltoid

42
Q

Muscle Action - Abduction

A

Deltoid

Supraspinatus

43
Q

Muscle Action - Adduction

A

Pectoralis major
Teres major
Latissimus dorsi

44
Q

Muscle Action - Horizontal Abduction

A

Posterior deltoid
Infraspinatus
Teres minor

45
Q

Muscle Action - Horizontal Adduction

A

Pectoralis major

Anterior deltoid

46
Q

Muscle Action - External Rotation

A

Infraspinatus
Teres minor
Posterior deltoid

47
Q

Muscle Action - Internal Rotation

A
Latissimus dorsi
Teres major
Subscapularis
Pectoralis major
Anterior deltoid