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MSK > 4b shoulder joint > Flashcards

4b shoulder joint Flashcards

1
Q

What type of joint is shoulder joint ?

A

ball & socket synovial joint

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2
Q

what gives the shoulder joint a wide range of movement at the cost of instability ?

A

head of humerus is much larger than the glenoid fossa (glenoid cavity )

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3
Q

shoulder joint has a ….. range of movements

A

wide

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4
Q

shoulder joint is most mobile and least stable meaning what ?

A

most mobile = has greatest range of all the joints

least stable = most commonly dislocated joint

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5
Q

acromion = palpable …

A

bony shelf above shoulder

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6
Q

caracoid process = palpable …

A

below the lateral clavicle

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7
Q

What are the close anatomical landmarks to where some of the rotator cuff muscles attach to ?

A

lesser and greater tubercles

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8
Q

Regional tenderness in the intertubercular (bicipital) groove indicates what ?

A

biceps tendon inflammation

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9
Q

Head of humerus attaches to what of the scapula ?

A

glenoid cavity

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10
Q

what is the shoulder joint also known as ?

A

glenohumeral joint

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11
Q

what is glenohumeral joint lined by ?

A

hyaline cartilage

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12
Q

what is glenoid cavity deepened by ? It is the fibrocartilaginous tissue within the glenoid cavity

A

glenoid labrum

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13
Q

Shoulder joint is inherently unstable what is this due to ?

A
  • shallow glenoid cavity
  • disproportion of articular surfaces
  • multiplanar movements
  • lax capsule (great mobility is permitted)
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14
Q

Stability of shoulder joint is achieved in 4 ways , which are what ?

A
  1. capsule
  2. ligaments (extracapsular + intracapsular)
  3. muscles of the rotator cuff
  4. other muscles
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15
Q

Shoulder capsule is attached to what ?

A
  • glenoid labrum & margins of glenoid cavity
  • anatomical neck of humerus
  • bridges intertubercular groove & dips down medially to surgical neck
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16
Q

In the shoulder joint what allows full abduction ?

A

bridges intertubercular groove & dips down medially to surgical neck

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17
Q

what does it mean by shoulder capsule bridges intertubercular groove ?

A

shoulder capsule attaches around area on humerus bone where tendon of long head of biceps muscle runs - help stabilise biceps tendon as it passes through the groove

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18
Q

[remove when content known] what does it mean by shoulder capsule dips down medially to the surgical neck ?

A

surgical neck is below the head of the humerus bone, arrangement of capsule dips allows for greater looseness in capsule particularly when fully abducted because abduction involves a significant amount of rotation and movement in the shoulder joint

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19
Q

Shoulder capsule is ..1.. but ..2… enough to allow movement

A
  1. tough
  2. lax (loose)
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20
Q

small opening anteriorly in shoulder capsule allows communication between where ?

A

synovial shoulder joint and subscapular bursa

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21
Q

1.

What is the purpose of the synovial membrane ?

A

line capsule and lines bone within capsule up to edge of articulating surfaces

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22
Q

Tendon of what muscles lies within the joint cavity ?

A

long head of biceps

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23
Q

What does the tendon acquire as it enters joint ?

A

tubular sleeve of synovium which surrounds the tendon up to its insertion on scapula

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24
Q

what does the gap in the capsule allow ?

A

synovium and joint cavity to be continuous with subscapular bursa

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25
Q

what are the 4 extracapsular ligaments ?

A
  • coracoacromial
  • coracohumeral
  • coracoclavicular
  • transverse humeral
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26
Q

location of coracoacromial ligament [most important ligament!]

A

between acromion and coracoid process

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27
Q

location of coracohumeral ligament

A

base of coracoid process to anterior part of greater tubercle

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28
Q

location of transverse humeral ligament

A

holds tendon of long head of biceps in place during shoulder movement

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29
Q

How can coracoclavicular ligament be torn ?

A

from AC joint dislocation

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30
Q

3 glenohumeral ligaments that are intracapsular ligaments

A
  • superior
  • middle
  • inferior
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31
Q

Where do intrascapular ligaments extend between ?

A

glenoid labrum and humerus

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32
Q

what reinforces the capsule anteriorly ?

A

parts of fibrous capsule - can only be seen from inside the capsule

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33
Q

coracoacromial arch is formed by ?

A

coracoacromial ligament + acromion + coracoid process

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34
Q

What kind of structure is coracoacromial arch ?

A

strong bony and ligamentous

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35
Q

coracoacromial arch :
1. overlies ….
2. prevents…
3. clinically important in …

A
  1. humeral head
  2. upper displacement
  3. in painful Arc syndrome
36
Q

What are the rotator cuff muscles ?

A

collective name given to 4 muscles closely associated with the shoulder joint

37
Q

Name the rotator cuff muscles

A

SITS
* Supraspinatus
* Infraspinatus
* teres minor
* subscapularis

38
Q

What are the most important structures that give stability to the joint ?

A

rotator cuff muscles

39
Q

In rotator cuff muscles:
* tendons …1… to form a cuff
* cuff fuses with ..2… and …3.. it
* ..4… in muscles holds humeral head close to ….5… cavity
* supraspinatus tendon is separated from CAA (coracoacromial) by …..6…

A
  1. blend
  2. capsule
  3. strengthens
  4. tone
  5. glenoid
  6. subacromial bursa
40
Q

Action of rotator cuff muscle: supraspinatus

A

initiation and first 15 degrees of abduction

41
Q

Action of rotator cuff muscle: infraspinatus

A

lateral rotation of arm

42
Q

Action of rotator cuff muscle: teres minor

A

lateral rotation of arm/ weak adductor

43
Q

Action of rotator cuff muscle: subscapularis

A

medial rotation of arm

44
Q

Nerve involved with supraspinatus

A

suprascapular nerve (C5,6)

45
Q

Nerve involved with infraspinatus

A

suprascapular nerve (C5,6)

46
Q

Nerve involved with teres minor

A

axillary nerve (C5,6)

47
Q

Nerve involved with subscapularis

A

upper and lower subscapular nerve

48
Q

What are the other muscles that act on the shoulder joint to stabilise it ?

A
  1. deltoid
  2. long head of biceps
  3. long head of triceps
49
Q

where does long head of biceps attach to ?

A

supraglenoid tubercle

50
Q

where does long head of triceps attach to ?

A

infraglenoid tubercle

51
Q

Which muscle can bring about all shoulder movements except adduction ?

A

deltoid

52
Q

What does deltoid attach to ?

A
  • lateral clavicle
  • acromion
  • scapula spine
  • humerus
53
Q

What are the 6 pectoral girdle muscles ?

A
  • trapezius
  • latissimus dorsi
  • levator scapulae
  • rhomboid minor & major
  • teres major
54
Q

Function of trapezius muscle ?

A

elevates, retracts and depresses the scapula

55
Q

Function of latissimus dorsi ?

A

extends, adducts and medially rotates humerus
can raise the trunk to the arm e.g. dips. climbing

56
Q

function of levator scapulae ?

A

elevates & rotates scapula

57
Q

function of rhomboid minor & major

A

retract & fix position of scapula

58
Q

function of teres major

A

adduction & medial rotation of humerus

59
Q

What does subacromial bursa facilitate movement of ?

A
  • supraspinatus tendon under CAA (coracoarcomial arch)
  • deltoid muscle over the shoulder joint capsule and greater tubercle of humerus
60
Q

What is subacromial bursitis ?

A

inflammation of the subacromial bursa

61
Q

What does subacromial bursitis cause ?

A

pain on adbuction of arm between 50 - 130 degrees
‘painful arc’ syndrome

62
Q

what does subscapular bursa facilitate movement of ?

A

subscapularis tendon over scapula

63
Q

subscapular bursa communicates with what ?

A

joint cavity

64
Q

…?.. anterior protract scapula (reaching out) & holds it close to the thoracic wall

A

? = serratus anterior

65
Q

Where does the serratus anterior attach to ?

A

ribs 1-8 and medial scapula border

66
Q

Dislocation of glenohumeral joint is typically what ?

A

inferior & anterior

67
Q

Dislocation of glenohumeral joint is clinically defined how ? why ?

A

as anterior dislocation -> humeral head locating anteriorly (pull of powerful adductors)

68
Q

dislocation of glenohumeral joint is usually caused by ?

A

trauma on a fully abducted arm

69
Q

humeral head comes to lie below what ?

A

coracoid process

70
Q

capsule and rotator cuff may tear = poor healing leading to what ?

A

recurrent dislocation

71
Q

anterior dislocation :
* loss of ..1.. contour of shoulder -> appears ..2…
* head of humerus lies ….3.. below ….4… process
* arm supported by other hand (very …5…)

A
  1. round
  2. square
  3. anteriorly
  4. coracoid
  5. painful
72
Q

when is axiallary nerve injured ?

A
  • in dislocation
  • or fracture of surgical neck of humerus
73
Q

2 main results of axillary nerve damage

A
  • loss of sensation in ‘regimental badge area’
  • motor function loss
74
Q

The regimental badge area is an area over ….1…. & supplied by ..2… nerve (C ….3…)

A
  1. central part of deltoid
  2. axillary
  3. C5, 6
75
Q

Why is important to not test motor function loss as a result of axillary nerve damage ?

A

could cause incredible pain, more damage

76
Q

what does it mean by motor loss as a result of axillary nerve damage ?

A

loss of deltoid muscle (no abduction of arm)

77
Q

Problem of ‘painful arc’ syndrome

A

supraspinatus tendon rubbing under CAA (Coracoacromial Arch)

78
Q

‘Painful arc’ syndrome leads to 3 things which are what ?

A
  • Subacromial Bursitis (+/- calcification)
  • Supraspinatus Tendonitis (+/- calcification)
  • Degeneration and rupture of tendons
79
Q

4 risk factors for painful arc syndrome

A
  • reptitive overuse
  • ageing
  • avascularity of supraspinatus tendon
  • slight differences in anatomy = may increase chances of impingement (compression of soft tissue)
80
Q

Example of repetitive overuse as a risk factor for painful arc syndrome

A
  • Sports (racquet sports, climbing, swimming)
  • Work involving overhead use of arms
81
Q

Why is agening a risk factor for painful arc syndrome ?

A

degenerative changes in tendons

82
Q

causes of painful arc syndrome

A

irritation and inflammation of the supraspinatus tendon/subacromial bursa

83
Q

Pain during when in painful arc syndrome ?

A

60-120 degrees of abduction arc

84
Q

Why do symptoms of painful arc syndrome (pain during 60-120 degrees of abduction arc) happen ?

A

impingement (compression of soft tissue) of inflamed rotator cuff tendons, or inflamed subacromial bursa (between acromion and head of humerus)

85
Q

Whcih ligaments can be ruptured by AC (acromioclavicular) joint dislocation ?

A

coracoclavicular ligaments

MSK (25 decks)

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