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Clinical Anatomy > 3.1 Shoulder Complex Part 2 > Flashcards

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
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2
Q

Scapular Dyskinesis is due to …

A

abnormal funcitoning of scapular stabilizing mm. (loss of coordination)

- rhomboids muscles
- serratus anterior mm.
- trapezius mm.
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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
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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.
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5
Q

Tx. (conservative for scapular dyskinesis

A
  • PT
    • focus on ROM/strength (for balance on agonists and antagon.)
    • proprioceptive exercises
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6
Q

Types of scapular Dyskinesis+

A

Type 1,2,3

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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)
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8
Q

Type II scapular dyskinesis +

A

Medial Dysfunction
-medial border winging only
-GH Joint instability
(weak rotator cuffs, rhomboidius)

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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
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10
Q

Acromioclavicular joint

A

Joint structure:

- acromial end (clavicle) and acromion process (scapula)
- partial articular disc at superior capsule (small jts.)
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11
Q

acromioclavicular joint reinforcement by:

A
  • superior acromioclavicular lig.

- Trapezius tendinous fibers

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12
Q

acromioclavicular lig. blood supply

A
  • suprascapular a/v

- thoraco-acromial a/v

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13
Q

acromioclavic. lig. n. supply

A

-lateral pectoral & axillary n.

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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”

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15
Q

Coracoacromial ligament gives support for…

A

superior support forming a “shelf” (prevents superior dislocation)

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16
Q

Coracoclavicular ligaments
1.
2.

A
  1. Conoid ligament
  2. trapezoid ligament

***point of balance!

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17
Q

Acromioclavicular Dislocation +

aka…

A

shoulder separation
-usually a downward force over the acromion
or an upward force from elbow

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18
Q

Type 1 Acromioclavicular dislocation-

A

Acromioclavicular ligament sprain

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19
Q

Type 2 Acromioclavicular dislocation-

A

ACL (acromioclavicular) rupture & coracoclavicular sprain

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20
Q

Type 3 Acromioclavicular dislocation-

A

Rupture of acromioclavicular ligament AND

rupture of coracoclavicular ligament

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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!
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22
Q

Glenohumeral Joint

-Blood supply

A
  • ant/posterior circumflex a.

- branches of suprascapular a.

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23
Q

GHJ n. supply

A
  • axillary n.
  • suprascapular n.
  • lateral pectoral n.
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24
Q

GHJ reinforcing ligaments
-Glenohumeral ligament (intrinsic)
(fibers blend with capsule)

A
  • Superior (SGHL)
  • Middle (MGHL)
  • Inferior (IGHL)
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25
Q

GHJ reinforcing ligaments… (red one)

A
  • coracohumeral ligament
    • overlays SGHL
    • inner surface (coracoid process)> greater tubercle
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26
Q

Glenohumeral joint has a shallow

A

glenoid cavity

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27
Q

Glenoid labrum made of

A
  • fibrocartilage meniscus

- deepens socket by ~50%

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28
Q

Articular capsule of GHJ

  • taut…
  • loose…
A
  • taut superiorly
  • loose anteriorly & inferiorly
    - AXILLARY RECESS- capsule 2x size of head
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29
Q

Bursae around the shoulder joint

A
  • Subacromial bursa (one of largest!)
  • subdeltoid bursa (not continous w/ synovial cavity)
  • Subtendinous bursa of subscapularis (protects from coracoid process)
30
Q

Subacromial Bursitis- Impingement Syndrome

-lies b/w?

A
  • impingement of subacromial bursa

- SA Bursa lays between SUPRASPINATUS M. & ACROMION

31
Q

Sx. of subacromial bursa

A
  • 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
Q

Causes of subacromial bursitis (impingement syndrome)

A

-overhead work
-increase muscle mass
-arthritis (reduced space)
May result in:
-bone spurs (osteophytes)
-damage to rotator cuff mm.

33
Q

Tx. of subacromial bursitis

A
  • NSAIDS
  • Steroid injections
  • PT
  • Surgery
    • subacromial decompression
      - removal of bursa
      - release coracoacromial lig.
      - shaving inferior surface of acromion
34
Q

Elbow complex Bones and Joints

 - Distal humerus
    - Distal epiphysis- flange
A
  • 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
Q

Articular surfaces

-capitulum

A
  • 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
Q

Joints within elbow complex

1) humeroulnar joint (Medial)
2) humeroradial joint (latera)
3) radioulnar joint

A

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
Q

Radius has a _____ ___ on head

A

concave FOVEA on head

- defined rim - sits w/in a radial notch of ulna
38
Q

Ulna has a _____ _____

A

C-shaped trochlear notch

  - divided by trochlear ridge  - anterior coronoid process  (means crown!) - posterior olecranon process 
- elbow
39
Q 
Radioulnar joints (3)
1. Proximal radioulnar joint
A

1- proximal radioulnar joint

- synovial- pivot 
- diarthrosis- uniaxial 
    - y-axis
40
Q
  1. middle radioulnar joint
A

2- syndesmosis structural joint

-amphiarthrosis functional joint

41
Q
  1. distal radioulnar joint
A

3- synovial- pivot

  • diarthrosis- uniaxial
  • y axis
42
Q

Middle radioulnar joint
helps..
site for…
fiber arrangement

A
  • 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
Q

elbow complex

-medial 1/2 of trochlea projects more

A

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
Q

Carrying Angle

A
  • 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
Q

Humeroulnar contact

A
  • central trochlear notch does NOT touch trochlea between 30-120 degrees flexion
  • one of most congruent
    - increases articular contact with load applied
46
Q

humeroradial contact

A
  • less congruent
  • in extension, no contact b/w articulating surface
  • slight contact in flexion
  • more likely to sublux
47
Q

Normal alignment of elbow

-elbow extended (posterior)

A
  • Elbow extended (posterior)

- epicondyles and superior olecranon should lie in a straight horizontal line

48
Q

elbow flexed (medial view)

A

-olecranon and epicondyles lie in a straight vertical line

49
Q

elbow flexed (posterior)

A

-olecranon and epicondyles form and equilateral triangle

50
Q

Olecranon fx +

A
  • 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
Q

SX. of olecranon fx.

A

-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
Q

Possible complications

A

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
Q

Olecranon fx. + tx:

A
  • 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
Q

Synovial capsule

A
  • 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
Q

Elbow fat pad

A
  • between synovial membrane & fibrous capsule
  • location:
    - anterior:
    - coronoid fossa
    - radial fossa
    • posterior
      - olecranon fossa
56
Q

intra-articular trauma +

A
  • visible as a “sail-sign”- posterior fat-pad

- elevated and displaced posterior or anteriorly

57
Q

Radial Head Fx +

A

General:

 - ~20% of elbow injuries 
       - fx in 10% of elbow dislocations
 - more in females
- usually b/w 30-40
 - frequently displays "sail-sign)
58
Q

causes of radial head fx

A
  • fall on outstretched arm
  • valgus stress on elbow (angled laterally)
  • chronic articular degeneration can lead to fx
59
Q

sx of radial head fx

A
  • pain in lateral elbow
  • swelling
  • decreased ROM in flexion/ extension/ pronation/ supination
  • any fx will result in some loss of extension
60
Q

fracture types

-Type 1 elbow fx

A

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
Q

Type 2 elbow fx

A
  • medium fx; little displacement
  • splint for 1-2 weeks
  • small bone fragments removed; large ones pinned
62
Q

Type 3 (IV) elbow fx

A
  • 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
Q

ligaments of the elbow
strong where?
weak where?

A
  • strong triangular lateral/medial ligaments
    - seen as thickening to capsule
  • weak anterior and posteriorly
64
Q 
humeroulnar ligaments
   -medial (ulnar) collateral lig.
         -
         -
        -
A

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
Q

Humeroradial ligaments

-Lateral (radial) collateral lig.

A
  • Lateral (radial) collateral lig.
    - “fan-like” band
    - from lateral epicondyle to annular ligament
66
Q

Radioulnar ligaments

A
  • oblique cord ligament
  • anterolateral proximal band
  • posteromedial distal to radial tuberosity
  • purpose??
67
Q

Radioulnar ligaments

A
  • Annular (Anular) Ligament
    • holds radial head against radial notch (ulna)
    • like button hole
68
Q

Annular Ligament

-allows for

A
  • 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
Q

-Sacciform Recess

A
  • extension of capsule (synovial membrane) on neck of radius
  • “baggy” to allow for radial pivot
70
Q

Radial head dislocation +

-aka

A

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

Clinical Anatomy (8 decks)

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