3.2 Shoulder Complex Flashcards
1
Q
Resting Scapula Position
A
- Medially rotated (30 to 45 from Coronal Plane)
- Anteriorly tilted (10 to 20 from vertical plane)
- Superiorly rotated (5 to 10 from longitudinal axis)
2
Q
Normal resting position of GH Joint
A
Slight retroverted humerus (head points slightly posterior and medially and superiorly) centers humeral head against glenoid cavity, aligned with scapula axis
3
Q
Retroverted humerus
A
head faces more posterior, two dots closer
4
Q
Anteverted humerus
A
head faces more anterior, greatest gapping of dots
5
Q
GH Reinforcement
A
Capsule, and Reinforcing ligaments
6
Q
GH capsule
A
- strength of capsule changes with age
- older pt., thinner joint capsule
7
Q
GH capsule limits…
A
anterior/inferior and some posterior translation
8
Q
Reinforcing ligaments
A
- Glenohumeral ligament
- Coracohumeral ligament
- Biceps Brachii Long Head
9
Q
GH Ligament
A
decreases lateral rotation
10
Q
Coracohumeral ligament reinforces…
A
reinforces superior pt of capsule
11
Q
Biceps Brachii Long Head Origin-
A
O- supraglenoid tubercle (scapula)
- fibers blend with SUPERIOR GLENOID LABRUM
- functions to stabilitze GHJ (prevents superior glide of humeral head)
12
Q
+Adhesive Capsulitis
A
Frozen shoulder syndrome
-Stiff, painful GHJ- results in loss of mobility
13
Q
Adhesive capsulitis sx:
A
- may last months to 2 years
- 3/4 stages
1) Painful (freezing) Stage
2) Frozen stage
3) Thawing Stage
14
Q
Adhesive capsulitis stage 1
A
Painful (Freezing) Stage ( couple weeks to 9 months)
-Pain both passive & active
>Palpation, ext. rotation & Abd (&flexion?)
-synovitis; SITS Tendinitis?
15
Q
Ad. capsulitis st. 2
A
Frozen stage (4-6 months) -pain resolving -stiffness; poor Scapulohumeral rhythm -Dec. ROM (P at night , ROM much worse than st. 1 and not as painful)
16
Q
Ad. capsulitis st. 3
A
Thawing Stage (6month-2 years)
- improvement
- end capsular feel for them, NO ROM
17
Q
Causes of Ad. Cap.
A
- etiology unknown
- capsule thickens & tightens, adhesions formed
- prolonged immob. (more likely to get Ad. Cap.)
18
Q
Risk Factors of Ad. Cap.
A
- Women (~70%)- 20-30% will repeat in other shoulder
- 40+ years
- stroke, mastectomy
- diabetes; hypo/hyperthyroidism
- TB; CVD; Parkinson’s
19
Q
TX of Ad. Cap.
A
- NSAIDS; Narcotics (Dec. P to mobilize Jt.)
- PT
- Inc. ROM
- Tensile Stresses (Inc. fiber length to provide more mob.)
- Injections
- Steroids (chemical ablation): early intervention!
- Joint Distension (Sterile H20)
- Surgery RARE
- closed manipulation
- arthroscopic (remove adhesions and scar tissue)
20
Q
SLAP Labral Tear
A
Superior Labrum Anterior and Posterior Tear
- Superior labrum attached to Biceps Brachii Long Head Muscle
- Named for regions of Labral tears
- Superior labrum (tears on either side of attachment, both anterior and posterior to attachment)
21
Q
Causes of SLAP labral tear
A
- car accident/acute trauma
- fall on outstretched arm
- overuse & repetitive overhead activities
- dislocation
- over 40 y.o. (normal aging wear and tear)
22
Q
SLAP sx
A
- locking, popping, grinding
- pain w movement
- pain w elevation overhead
- reduced strength in shoulder and ROM
- guarding
23
Q
SLAP tx
A
- NSAIDS
- PT
- restrengthen stabilizing muscles, stretching, ROM
- Surgery
24
Q
Muscles of Shoulder Complex
A
Scapulohumeral Muscles (intrinsic)
Anterior Axio-appendicular Muscles
Posterior Axio-appendicular Muscles (extrinsic)
25
Scapulohumeral Muscles (intrinsic)
Scapulohumeral Muscles (intrinsic)
- O: clavicle &/or scapula
- I: humerus
26
Anterior Axio-appen. Muscles
Anterior Axio-appendicular Muscles
- O: clavicle, sternum &/or anterior ribs
- I: girdle or humerus
27
Posterior Axio-appendicular Muscles (extrinsic)
Posterior Axio-appendicular Muscles (extrinsic)
O: vertebrae &/or Cranium
I: girdle or humerus
28
Glenohumeral Reinf.
Scapulohumeral (Intrinsic) Muscles
- Deltoid Muscle
- Teres Major Muscle
- Rotator Cuff muscles (SITS)
29
Scapulohumeral (intrinsic) muscles:
| 1. Deltoid Muscle (_, _)
Deltoid (C5,6)
- Acts as "shunt" muscle to stabilitze GHJ
- prevents downward pull
- Deltoid pull= long axis of humerus
- can't abduct when fully adducted (for first 15 degrees)
- Needs supraspinatus muscle to abduct first 15 deg, then deltoid can abduct
- ant/post fibers= fixators
- performs all movements possible (everything)
30
Scapulohumeral (intrinsic) muscles:
| 2. Teres Major Muscle (_, _)
Teres Major (c5,c6)
- thick muscle
- combines w latissimus dorsi m. at insertion
- forms part of posterior axillary fold
- O: at thick scapular inferior angle (post. surface)
- I: Medial border of intertubercular groove
31
N. to deltoid mm.
axillary n.
32
N. to teres major mm.
lower subscapular n.
33
SITS muscles
- tendons form fibrous "cuff" over humeral head
- ROTATORS of the humerus (fibers of GHJ capsule blends with fibers of rotator cuff tendons
- main stabilizers for GHJ (both at rest and during movement
34
Supraspinatus mm. (_,_,_)
C4, C5, C6
O: supraspinous fossa
I: greater tubercle of humerus
A: -abduct humerus first 15 deg. for deltoid
-stabilize humeral head and prevents inferior glide of humerus (opposite of all other SITS muscles) because all others prevent superior glide
35
N. to supraspinatus muscle (_,_,)
c4, C5, c6 suprascapular n.
36
Infraspinatus mm. (_,_,_)
```
c4, C5, c6
O: infraspinous fossa
I: Greater tubercle of humerus
A: -externally rotate humerus
-stabilitze humeral head
-prevents superior glide, when flexed
```
37
Teres minor muscle (_,_)
```
C5, c6
O: middle lateral border of scapula
I: greater tubercle of humerus
A: externally rotates humerus, and weak adductor
-stabilize humeral head
```
38
Subscapularis mm. (_,_,_)
c5, C6, c7
O: subscapular fossa
I: LESSER tubercle of humerus
A: adducts & internally rotates humerus (only one)
-stabilize humeral head
-prevents superior glide of humerus when flexed or abducted
39
N. to subscapularis mm.
c5, C6, c7
| Upper and lower subscapular n.
40
Rotator Cuff Tear+
Tearing one of the SITS muscles
- insertion on tubercles- supraspinatus mm is MOST common!
- Tears- Forms Hole:
- partial tear
- full thickeness tear (complete tear off insertion)
41
Sx of rotator cuff tear:
- P at rest and motion
- weakness & P raising arm overhead, AB- or ADduction, or rotating
- crepitus or crackling when moving
- arm drop test!
42
Causes of rotator cuff tear:
- Acute Tear
- trauma
- Degenerative Tear
- repetitive use injury
- aging
- avascular necrosis
- osteophyte fraying (bone spurs)
43
Tx of Rotator Cuff Tears
- Non-surgical (~50%)
- NSAIDS
- PT (maintain ROM, and strengthen)
- steroid injections dec. inflamm.
- Surgery
- only way to return strength or prevent increase in tear size
44
Humeral Head Dislocation +
Dislocation due to:
- sports injuries
- car/motorcycle accident trauma
- falls
- FORCED:
- abduction
- extension
- external rotation
45
Population affected by humeral head dislocations
- high energy dislocations:
- males, late teens early 20s
- low energy dislocations:
- elderly
46
Humeral head dislocations may occur w/
- avulsion of G. tubercle
| - no superior and medial pull from missing mm.
47
Humeral head dislocations may spontaneously relocate with ...
too much laxity
48
What prevents superior dislocation of humeral head?
coracoacromial arch
49
Anterior dislocation (95-98%)
- subcoracoid- most common (front bulge)
- subglenoid
- subclavicular
- intrathroacic- very rare
50
Posterior dislocation occurs in...
-4% very rare!
51
Direct Inferior occurs in...
-1%!
52
most dislocations will be...
anterior and inferior!!
53
humeral head dislocation tx:
- closed reduction----turn it medially and slowly!
- immobilization for ~6 weeks
- PT- to strengthen stabilizing SITS
- Surgery:
- open- "capsular shift"
- arthroscopic *heat
- high risk of repeated dislocations or subluxations!
- MDI (sulcus sign)
54
MDI=
multidirectional instability
55
Anterior Axioappendicular Muscles (thoracoappendicular/pectoral muscles)
1. pectoralis major
2. pec minor
3. subclavius mm.
4. serratus anterior mm.
56
Pectoralis Major
c5, C6, C7, C8, t1
- 3 heads
- clavicular head (girdle to forearm)
- sternocostal head (Rafi)
- abdominal head (not in everyone)
- forms anterior axillary fold!!
57
with deltoid mm. pectoralis major forms...
- Deltopectoral groove
- cephalic vein
- Clavipectoral triangle
- palpate coracoid process here!!
58
Deltopectoral groove holds...
cephalic vein!
59
Pectoralis minor mm. (c8, t1)
- mostly covered by pec major mm.
| - anterior border of cervicoaxillary canal (brachial plexuas and BV lie posterior)
60
subclavius mm. (_,_)
C5, c6
- runs horizontally
- ACTS TO depress and stabilize clavicle
- protects-
- subclavian a/v & brachial plexus
- ensheathed in clavipectoral fascia
61
n. to sublavius mm.
subclavius n.
62
Serratus anterior mm. forms...
medial wall of axilla (thoracic cage)
| -extremely!! strong protractor
63
Serratus anterior also known as
boxer's muscle- used when punching fwd
64
serratus anterior acts as a
- inferior fibers important in upward rotation of scapula (?)
- anchor for scapula
- holds flat against thorax
- important for pushing against resistance!
65
paralysis of serratus anterior mm. +
| Testing-
```
Testing- serratus anterior mm.
long thoracic nerves
-flex arm
-press against wall or resistance
-should be able to palpate digitation at lateral thoracic wall
```
66
if weak serratus anterior mm.
pronounced winging! - medial border!
67
paralysis of serratus anterior mm. damage to the ....
LONG THORACIC N.
- Causes:
- usually due to trauma or injury to lateral thoracic wall
- stabbling, car accident, thorocotomy, etc.
- post-infectious neuritis (n. could be damaged)
- abnormal pressure on n.
- sports, anatomical structures, etc.
- mastectomy
- idiopathic
68
sx of paralysis of serratus anterior mm.
- scapula
- medial border "winging"
- anterior tilting (inferior angle protrudes)
- shoulder drop
- stretched middle and lower trapezius fibers
- weak and reduced abduction and flexion
69
posterior axioappendicular mm.
- superficial posterior extrinsic mm.
- deep posterior extrinsic mm.
- trapezius m. (superficial)
- latissimus dorsi m. (superficial)
- levator scapulae m. (deep)
- rhomboid major m. (deep)
- rhomboid minor m. (deep)
70
Superficial posterior extrinsic mm.
| Trapezius mm. (_,_)
c3,c4
- directly attaches the girdle to the trunk
- act "scapulothoracic joint"
- has 3 parts
71
3 parts of trapezius mm.
1. descending fibers
- mainly attached to ligamentum nuchae
2. middle fibers
- upper thoracic spinous process
3. ascending fibers
- lower thoracic spinous process
72
n. to trapezius mm.
c3, c4
Accessory nerve (CN XI)- motor
C3 and C4- somatic sensory
73
Latissimus Dorsi mm (c6,c7)
- "widest of the back"
- trunk to humerus
- acts on GHJ
- Action:
- extends, adducts, & medially rotates humerus
- retracts shoulders
- some downward rotation of the scapula, thru adduction of humerus
74
N. to latissimus dorsi m.
thoracodorsal n.
75
Posterior axioappen. mm. (deep posterior extrinsic mm.)
| -Deep are innervated by...
- DEEP posterior extrinsic mm. are innervated by
- dorsal scapular n.
- Directly attach scapula to axial skeleton**
76
Levator scapulae mm. (c4, c5)
| -Action
Primary:
-Elevates scapula
-rotates w/ other mm.
-Extend and laterally flex cervical vertebrae
Secondary:
-Fix scapula (resists depression when carrying load)
77
Rhomboid mm. (c4,c5)
| are important in...
rhomboids are important in preventing winging
| -fix scapula in forced extension (hammering, pull ups, etc.)
78
Rhomboid minor location:
superior
79
Rhomboid major location:
inferior; 2x larger
