3.1 Shoulder Complex Part 2 Flashcards
1
Q
Scapular Dyskinesis +
A
SICK Scap: (alteration in the normal scapulohumeral coupled motion) Scapular malposition Inferior medial border prominence Coracoid pain dysKinesis
2
Q
Scapular Dyskinesis is due to …
A
abnormal funcitoning of scapular stabilizing mm. (loss of coordination)
- rhomboids muscles - serratus anterior mm. - trapezius mm.
3
Q
Sx of scapular dyskinesis
A
- shoulder drop of affected side
- scapular pain
- jerky movements of scapular during normal range
- P at:
- anterior shoulder
- lateral shoulder
- posterior shoulder
- acromial region
4
Q
Risk factors of scapular dyskinesis
A
- Repetitive overhead activities
- fatigue
- nerve damage to mm.
- direct muscular damage/strain
- unbalanced weight training
- tight pectoral mm.
5
Q
Tx. (conservative for scapular dyskinesis
A
- PT
- focus on ROM/strength (for balance on agonists and antagon.)
- proprioceptive exercises
6
Q
Types of scapular Dyskinesis+
A
Type 1,2,3
7
Q
Type I scap dyskinesis +
A
Inferior Dysfunction -inferior angle prominence -some medial border winging -rotator cuff dysfunction? (from weak traps, tight pec minor, latissimus dorsi, serratus)
8
Q
Type II scapular dyskinesis +
A
Medial Dysfunction
-medial border winging only
-GH Joint instability
(weak rotator cuffs, rhomboidius)
9
Q
Type III scapular dyskinesis +
A
Superior Dysfunction
- superiomedial border prominence - rotator cuff dysfunction and DELTOID-ROTATOR CUFF DYSKINESIS - too high or prominent scapula
10
Q
Acromioclavicular joint
A
Joint structure:
- acromial end (clavicle) and acromion process (scapula) - partial articular disc at superior capsule (small jts.)
11
Q
acromioclavicular joint reinforcement by:
A
- superior acromioclavicular lig.
- Trapezius tendinous fibers
12
Q
acromioclavicular lig. blood supply
A
- suprascapular a/v
- thoraco-acromial a/v
13
Q
acromioclavic. lig. n. supply
A
-lateral pectoral & axillary n.
14
Q
Coracoclavicular ligament- beween ____ and _____
A
point of balance (COM) between UPPER LIMB MASS and SCAPULAR MASS
-scapula/upper limb suspended from clavicular “strut”
15
Q
Coracoacromial ligament gives support for…
A
superior support forming a “shelf” (prevents superior dislocation)
16
Q
Coracoclavicular ligaments
1.
2.
A
- Conoid ligament
- trapezoid ligament
***point of balance!
17
Q
Acromioclavicular Dislocation +
aka…
A
shoulder separation
-usually a downward force over the acromion
or an upward force from elbow
18
Q
Type 1 Acromioclavicular dislocation-
A
Acromioclavicular ligament sprain
19
Q
Type 2 Acromioclavicular dislocation-
A
ACL (acromioclavicular) rupture & coracoclavicular sprain
20
Q
Type 3 Acromioclavicular dislocation-
A
Rupture of acromioclavicular ligament AND
rupture of coracoclavicular ligament
21
Q
Acromioclavicular dislocations (aka shoulder separation) draws what down??
what up?
A
scapula down and upper limb down
- gravity - mm. tension (serratus, pec minor, biceps (LH)
pulls clavicle up
- mm. tension (trapezius, levator, sternocleidomastoid_ - "spring up" appearance or piano key sign!
22
Q
Glenohumeral Joint
-Blood supply
A
- ant/posterior circumflex a.
- branches of suprascapular a.
23
Q
GHJ n. supply
A
- axillary n.
- suprascapular n.
- lateral pectoral n.
24
Q
GHJ reinforcing ligaments
-Glenohumeral ligament (intrinsic)
(fibers blend with capsule)
A
- Superior (SGHL)
- Middle (MGHL)
- Inferior (IGHL)
25
GHJ reinforcing ligaments... (red one)
- coracohumeral ligament
- overlays SGHL
- inner surface (coracoid process)> greater tubercle
26
Glenohumeral joint has a shallow
glenoid cavity
27
Glenoid labrum made of
- fibrocartilage meniscus
| - deepens socket by ~50%
28
Articular capsule of GHJ
- taut...
- loose...
- taut superiorly
- loose anteriorly & inferiorly
- AXILLARY RECESS- capsule 2x size of head
29
Bursae around the shoulder joint
- Subacromial bursa (one of largest!)
- subdeltoid bursa (not continous w/ synovial cavity)
- Subtendinous bursa of subscapularis (protects from coracoid process)
30
Subacromial Bursitis- Impingement Syndrome
| -lies b/w?
- impingement of subacromial bursa
| - SA Bursa lays between SUPRASPINATUS M. & ACROMION
31
Sx. of subacromial bursa
- pain in shoulder and down arm
- limited ROM
- in flexion, hyperextension, or ABD of arm
- inflammation causes:
- injury to rotator cuff
- infection
- arthritis
- impingement (most common)
32
Causes of subacromial bursitis (impingement syndrome)
-overhead work
-increase muscle mass
-arthritis (reduced space)
May result in:
-bone spurs (osteophytes)
-damage to rotator cuff mm.
33
Tx. of subacromial bursitis
- NSAIDS
- Steroid injections
- PT
- Surgery
- subacromial decompression
- removal of bursa
- release coracoacromial lig.
- shaving inferior surface of acromion
34
Elbow complex Bones and Joints
- Distal humerus
- Distal epiphysis- flange
- condyle:
- most prominent anterior
- thin w/in fossae
- supra-epicondylar Ridge (M/L)
- attachment for mm.
- epicondyle (M/L)
- medial epicondyle most easily palpated
- origin for superficial wrist flexors
- ulnar n. posterior (funny bone)
35
Articular surfaces
| -capitulum
- sits at a slight angle
- Capitulotrochlear Groove
- Rim of radial head glides within
- Trochlear Groove
- sits obliquely
- divides trochlea
- trochlear ridge of ulna glides within
- medial part of trochlea is larger
36
Joints within elbow complex
1) humeroulnar joint (Medial)
2) humeroradial joint (latera)
3) radioulnar joint
1) humeroulnar joint (medial) *one of most congruent joints*
- uniaxial- hinge
- trochlea
- articulates w/ trochlear notch of ulna
2) humeroradial joint (lat)
- uniaxial- hinge
- capitulum
- articulates w/ fovea of head of radius
3) Radioulnar joint:
- uniaxial- pivot
- head of radius articulates with radial notch of ulna
37
Radius has a _____ ___ on head
concave FOVEA on head
- defined rim
- sits w/in a radial notch of ulna
38
Ulna has a _____ _____
C-shaped trochlear notch
- divided by trochlear ridge
- anterior coronoid process (means crown!)
- posterior olecranon process
- elbow
39
```
Radioulnar joints (3)
1. Proximal radioulnar joint
```
1- proximal radioulnar joint
- synovial- pivot
- diarthrosis- uniaxial
- y-axis
40
2. middle radioulnar joint
2- syndesmosis structural joint
| -amphiarthrosis functional joint
41
3. distal radioulnar joint
3- synovial- pivot
- diarthrosis- uniaxial
- y axis
42
Middle radioulnar joint
helps..
site for...
fiber arrangement
- keep bones aligned
- site for mm. attachment
- fiber arrangement of interosseous membrane
- transports forces up from hand to radius
- directs across to ulna
- ulna transmits up to elbow and humerus
43
elbow complex
| -medial 1/2 of trochlea projects more
DISTALLY
- the shorter the person (humerus) the longer the projection)
- causes axis of rotation to be at angle
- "carrying angle" aka cubitus valgus (pushes hand away from body
44
Carrying Angle
- forearm is angled away long axis of humerus
- in the anatomical position
- fully extended
- angle goes away when forearm is pronated or flexed
- based on trochlear groove angle
- 10-15 deg. for males
- greater than 15 deg for females
45
Humeroulnar contact
- central trochlear notch does NOT touch trochlea between 30-120 degrees flexion
- one of most congruent
- increases articular contact with load applied
46
humeroradial contact
- less congruent
- in extension, no contact b/w articulating surface
- slight contact in flexion
- more likely to sublux
47
Normal alignment of elbow
| -elbow extended (posterior)
- Elbow extended (posterior)
| - epicondyles and superior olecranon should lie in a straight horizontal line
48
elbow flexed (medial view)
-olecranon and epicondyles lie in a straight vertical line
49
elbow flexed (posterior)
-olecranon and epicondyles form and equilateral triangle
50
Olecranon fx +
- generally isolated fx.
- high energy fx: direct hit or fall
- low energy fx:
- most common in elderly
- fall on an outstretched arm
- sudden pull from triceps mm. & brachialis mm.
51
SX. of olecranon fx.
-sudden, intense pain
-swelling over the bone site
-numbness in one or more fingers
-inability to extend elbow
-indicates disconnect of triceps extension!!
(comminuted olecranon fx.- tears to pieces)
52
Possible complications
1) damage to peri-articular arterial anastamosis
- intra-articular hemorrhagic effusion (lifting up of synovial membrane)
2) ulnar n. parasthesia (direct or bleeding)
3) non-union
- unstable fx. or refracture
- pull of triceps mm. pulls apart 2 sides
4) loss of extension
53
Olecranon fx. + tx:
- immobilization in splint or cast, then sling
- often many weeks
- back to normal (non-sport) activity is ~4 mos.
- surgery
- when bones are displaces
- when "open fx:"
- surgery type:
- tension band wiring
- plate and screw fixation
- screws only
54
Synovial capsule
- large, loose, weak anterior & posterior
- folds can expand
- envelops all three joints
- blends with the annular & collateral ligaments
- fat-pads
- between synovial membrane and fibrous capsule
- within fossae of humerus
- intracapsular fat pad
55
Elbow fat pad
- between synovial membrane & fibrous capsule
- location:
- anterior:
- coronoid fossa
- radial fossa
- posterior
- olecranon fossa
56
intra-articular trauma +
- visible as a "sail-sign"- posterior fat-pad
| - elevated and displaced posterior or anteriorly
57
Radial Head Fx +
General:
- ~20% of elbow injuries
- fx in 10% of elbow dislocations
- more in females
- usually b/w 30-40
- frequently displays "sail-sign)
58
causes of radial head fx
- fall on outstretched arm
- valgus stress on elbow (angled laterally)
- chronic articular degeneration can lead to fx
59
sx of radial head fx
- pain in lateral elbow
- swelling
- decreased ROM in flexion/ extension/ pronation/ supination
- any fx will result in some loss of extension
60
fracture types
| -Type 1 elbow fx
Type I elbow fx
- small fx; no displacement
- shows in xray after 3 weeks!
- immobilization for few days (sling)
- want to prevent bone displacement
61
Type 2 elbow fx
- medium fx; little displacement
- splint for 1-2 weeks
- small bone fragments removed; large ones pinned
62
Type 3 (IV) elbow fx
- comminuted fx; much displacement
- great joint & soft tissue damage (maybe bleeding)
- surgery required
- radial head removed
- replacement prosthesis used if needed
- if you cant get blood there
63
ligaments of the elbow
strong where?
weak where?
- strong triangular lateral/medial ligaments
- seen as thickening to capsule
- weak anterior and posteriorly
64
```
humeroulnar ligaments
-medial (ulnar) collateral lig.
-
-
-
```
humeroulnar lig.
- medial (ulnar) collateral lig.
- Anterior "cord-like" band
- strongest band
- Posterior "fan-like" band
- weakest band
- Oblique "slender" band
- deepens trochlear "socket"
65
Humeroradial ligaments
| -Lateral (radial) collateral lig.
- Lateral (radial) collateral lig.
- "fan-like" band
- from lateral epicondyle to annular ligament
66
Radioulnar ligaments
- oblique cord ligament
- anterolateral proximal band
- posteromedial distal to radial tuberosity
- purpose??
67
Radioulnar ligaments
- Annular (Anular) Ligament
- holds radial head against radial notch (ulna)
- like button hole
68
Annular Ligament
| -allows for
- allows for pivot point
- head glides against radial notch and within annular ligament
- distal radius crosses over ulna!! (huge role in the radius cross over)
69
-Sacciform Recess
- extension of capsule (synovial membrane) on neck of radius
- "baggy" to allow for radial pivot
70
Radial head dislocation +
| -aka
nursemaid's elbow
-see mainly in children (lax annular ligament)
-more likely in girls
-radial head slips out of annular ligament
-radial head slides away from radial notch (ulna)
-radial head pulls away from capitulum (humerus)
(to rebutton, supinate flex and extend
