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shoulder > anatomy > Flashcards

anatomy Flashcards

1
Q

How does humeral elevation take place over two area and what is the advantage of this?

A

one third of the motion comes from scapula while the other two thirds comes from the GH joint
two advatagnes to the divistion
-opitmized length tension of the muscle involved
-brings the glenoid under the humeral head to decrease demand on musculature

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2
Q

What are the coupled motions of the shoulder?

A
  1. cervical spine with single arm elevation must sidebend towards and rotate away
  2. lumbar spine with double arm elevation must extend
  3. One third of shoulder motion from ST joint
  4. 2/3 of shoulder motion from GH
  5. upper thoracic side bend and rotate towards Theodoridis, “The effect of shoulder movements on thoracic spine 3D motion.” Clinical Biomechanics (2002)
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3
Q

What is the resting position of the shoulder and how is this significant for therapy?

A

1.position where intracapuslar space is greatest and tension on soft tissues is least
2.ABD 70, FLEX 30, ER 30, elbow flex 60
ITs important because
-it the begin position for articulations
-also best position to start exercises because of optimal muscle recruitment and mechno stimulation

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4
Q

What is the closed pack position of the AC, SC and GH joints?

A
  1. GH max ABD, ER, EXT or IR, EXT, ADD
  2. AC ABD 90
  3. SC: full ELEVATION or max HORZ ADD
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5
Q

What is the capsular pattern of the shoulder?

A
  1. shoulder cap pat: reduced ER, ABD, IR

2. Capsular pattern is an effective way for identifying arthritic condition due to the irritation of the synovial lining

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6
Q

What impact does the incongruence of the GH joint configuration have on the mobility of the shoulder girdle?

A
  1. The shoulder trades mobility for stability by having decreased congruence of joint surfaces. the head of the humerus is is much larger that the glenoid
  2. the rotation of the scapula on the clavicale at the AC joint allows for increased congruency of the glenoid and humeral head
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7
Q

what are the attachments of the labrum?

A

1basal surface attaches to the rim of the glenoid cavity

  1. outer surfaces attachs to the capsule, ligaments
  2. innersurface linded with cartilage
  3. the upper edge is not completely fixed to the bone
  4. the inner edge lies free like a meniscus
  5. inferior GH ligament
  6. long head biceps tendon
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8
Q

What is the function of the glenoid labrum?

A
  1. protect joint edges from loading
  2. aid in lubrication of the joint by increase surface area to distribute synovial fluid
  3. deepen the glenoid cavity
  4. increase GH stability
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9
Q

What is the humeral neck?

A

It is defined as the area between the articular surface and the attachments of the capsule and muscles.

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10
Q

What is the size and orientation of the humeral head>

A
  1. the head faces medially superiorly, and posteriorly 30 deg
  2. the humeral head is angulated at 135 decrease 3.relative to the shaft
  3. Radius of curvature is 2.25 cm
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11
Q

what are the basic causes of the capsular pattern?

A
  1. Capsular pattern can be due to
    - a capsular adhesion
    - neuromuscular guarding
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12
Q

What attaches to the glenoid labrum?

A
  1. rim of the glenoid cavity
  2. capsule
  3. long head of the biceps tendon
  4. inferior GH ligament
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13
Q

how does the labrum contribute to GH stability?

A
  1. doubles the anteroposterior depth of the glenoid socket from 2.5 to 5 mm and deepens the concavity to 9 mm in the superior–inferior plane
  2. the labrum enhances stability of the joint by
    increasing the surface area of contact for the humeral head
  3. the labrum serves as a fibrocartilaginous ring to
    which the glenohumeral ligaments attach.
    Itoigawa, “Anatomy of the capsulolabral complex and rotator interval related to glenohumeral instability.” (2016)
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14
Q

what is the humeral neck?

A

It is defined as the area between the articular surface and the attachments of the capsule and muscles.

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15
Q

How big is the the humeral neck

A
  1. it varies in size from one cm to undetectable

2. Most narrow at the RTC insertions

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16
Q

What is the function of the greater tubercle?

A
  1. increases the lever arm of both the suprapinatus (30 degree or greater) and the deltoid (greater than 60 degree)
  2. works like the patella in the quad
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17
Q

What covers the intertubercular groove?

A
  1. transverse humeral ligament and coracohumeral ligament
  2. pec major
  3. deltoid
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18
Q

What muscle attach along the tubercular groove?

A
  1. lateral to the groove is supraspinatus and pec major

2. medial to the groove are supscap, lat, teres major and coracobrachilais

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19
Q

How big the GH joint capsule?

A

It is a large loose sleeve around the GH joint with twice the surface area of the humeral head and can be distracted so that the head of the humerus can be displaced more than a cm

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20
Q

What are the different fibers of the GH joint capsule?

A
  1. longitudinal- connecting bone to bone and tensioning with IR and ER
  2. circular- do not go bone to bone, but increase stability of capsule
  3. spiral- connect the two systems
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21
Q

What muscles tie into the GH capsule?

A
  1. RTC
  2. teres major
  3. pec major
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22
Q

What ligaments tie into the GH capsule?

A

GH and coracohumeral

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23
Q

How are the synovial folds and adhesive capsulitis related?

A
  1. Synovial folds can become inflamed and adhere together resulting in non contractile loss of ROM in a capsular pattern (ER, ABD, IR)
  2. Research show that the primary cause of adhesive capsulitis is a contracted GH capsule and vascular synovitis combined with an neuromuscular pattern of guarding
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24
Q

What are the attachments and orientation of the GH ligaments?

A
  1. They are “Z” shaped in their attachment pattern

2. They are attached to the anterior and medial glenoid rim and run to the lessor tubercle and anatomical neck

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25
Q

How do you tension the GH ligaments?

A
  1. adbuction- lower two taut and superior slack
  2. IR- all slack
  3. 45 degree ABD with ER- middle and superior taut
  4. 90 degree ABD with ER- inferior taut
  5. End range flexion there is some IT that decreases the tension on the GH and coracohumeral ligament that allows for some additional ROM
26
Q

What is the function of the coracohumeral ligament?

A
  1. It is the thickest and strongest supporting ligament of the GH joint
  2. fills in the space between the supraspinatus and subscapularis
  3. reinforces the biceps tendon and sheath
  4. strengthens the superior capsule to prevent anterior dislocation during external rotation
27
Q

What are the attachments of the coracohumeral ligament?

A
  1. Coracoid process
  2. made of two bands that fuse to the anterior superior capsule
    - greater tuberlce with supraspinatus
    - lessor tubercle with subscapularis
28
Q

How do you tension the coracohumeral ligament?

A
  1. External rotation it becomes taut
  2. flexion posterior become taut until until end range motion when there is some IR that allow for greater motion as tension on the GH and coracohumeral ligaments is reduced
  3. Extension the anterior band becomes taut
29
Q

What is the self locking mechanism of the shoulder?

A
  1. The glenoid is oriented is a superior direction creating a wedge-like formation so that as the humeral head slides down you get a natural traction on the joint to increase tension on the soft tissues
    - tightening of the superior capsule
    - tightening of supraspinatus
    - tightening of posterior deltoid
    - coracohumeral and superior GH ligaments
  2. This does not apply during abduction
30
Q

What muscles attach to the clavicle?

A
  1. anterior deltoid
  2. pectoralis major
  3. upper trap
  4. subclavius
  5. SCM
  6. Sternothyroid
31
Q

How does the shape of the clavicle play into its function?

A

Double curve gives it a crank like function so that you can get rotation and elevation simultaneously

32
Q

How is the coracoid process oriented relative to the scapula?

A

found at the base of the glenoid neck, runs anterior and lateral initially, before turnign more laterally.

33
Q

What is the supraspinatus outlet?

A
  1. suprascapular fossa
  2. acromium
  3. coracoacromial ligament
  4. about 10 mm separate the head of the humerus and acromium
34
Q

what are the different acromium types?

A

type I: almost flat surface with the greatest supraspinatus outlet
Type II: curved surface
Type III: sudden discontinuity or hook

35
Q

What muscles attach to the coracoid process?

A
  1. short head biceps
  2. coracobrachiallis
  3. pec minor
36
Q

What are the three axis of scapular motion and how to they influence shoulder motion ?

A

CSH, CSV, longitudinal

37
Q

What are the functions of the AC joint?

A
  1. protraction and retraction of the scapulothoracic joint

2. anterior and posterior rotation on the clavicle to orient glenoid under the humeral head

38
Q

What are the shapes and orientation of the articular surfaces of the AC?

A
  1. acromial surface faces anterior medial and is slightly concave
  2. clavicular surface faces inferior, posterior and latera and is slightly convex
39
Q

What nerves innervate that AC joint?

A
  1. pectoral
  2. axially
  3. suprascapular nerves
40
Q

Describe the AC joint capsule

A

AC ligaments are relatively weak and provide support around the circumfrence of the joint

41
Q

What are the different AC joint injuries?

A

Type I: downward forces straining AC joint ligaments
Type II: rupture of AC joint
TypeIII: rupture of AC and Coracoclavicular lig
Type IV: add posture displacement of calvical
Type V: clavicle fractures as it is fulcrums across the first rib

42
Q

What elements produce stability of the shoulder?

A
  1. stability and congruency of the associated bones
  2. stability and attachemnts of the ligaments
  3. dynamica stability of the muscles
43
Q

What joints must you take into consideration when evaluating the shoulder?

A

1.ac
2.sc
3.gh
4.scapulothoracic
5.subacromial
6.costovertebral
7.cervicothoracic
8/lumbar spine

44
Q

What advantages do gain with humeral elevation occuring at the GH adn ST joints?

A
  1. muscles crossing these articulations can contract with optimal length tension relationships
  2. GH rhythm brings the glenoid below the humorous so it bears some of the weight of the UE
45
Q

what type of joint is the GH?

A

diathordial synovial ball and socket

46
Q

how is the humeral head and glenoid oreinted in the rest position?

A
  1. humeral head: medial, superior, posterior

2. glenoid:superior, anterior, lateral

47
Q

how is the humeral head oriented relative to the shaft of the humerus?

A

135degree to the long axis (neck shaft angle)
45 degree from the horizontal planet (relative to plane of surgical neck)
20-30 degrees from the transverse plane

48
Q

How much of the humeral head is in contact the glenoid at any one time?

A

1/3 to 1/2

49
Q

How big is the articular surface of the glenoid?

A

39 mm superior to inferior
29 mm anterior to posterior in the lower half, lower half to upper half ratio A/P width is 1/0.8

Iannotti “the normal glenohumeral relationships. an anatomical study of one hundred and forty shoulders” (1992)

50
Q

How is the glenoid surface shaped and why is this important

A
  1. pear shaped
  2. greater ROM occurs when the huad of the humerus is in the wider region
  3. in prone you have the least ER and standing you have the most
51
Q

where is the surgical neck of the humerus

A

region below the tubercles and is the primary site for fractures

52
Q

What is the primary restraint for the biceps tendon in the intratrabecular groove

A

coracohumeral ligament

53
Q

What structures provide the primary passive restraints of the GH joint?

A
  1. coracohumeral ligament
  2. posterior capsule
  3. GH ligaments
54
Q

What blood vessels closely relates to the bicepital groove.

A
  1. anterior circumflex artery passes under the long head of the biceps
  2. the ascending branch enters to supply the humeral head at the lateral lip
55
Q

Is the biceps tendon intra or extra capsular?

A

intracapsular, but extrasynovial

56
Q

What part of the shoulder joint capsule has redundant folds?

A
  1. inferior

2. anterior

57
Q

What causes adhesions within the synovial capsule

A

1.decreased motion -> decreased viscosity -> decreased synovial pH -> increased adhesions
2 Research show that the primary cause of adhesive capsulitis is a contracted GH capsule and vascular synovitis combined with an neuromuscular pattern of guarding

58
Q

How much can the GH joint be distracted?

A

greater than 1 CM

59
Q

At what point in the ROM can the GH ligament effect inferior glide of the humeral head?

A

45-90 degrees

60
Q

What is unique about the inferior band of the GH ligaments?

A
  1. it is the thickest of the three
  2. it attaches to the labrum
  3. it has an anterior and posterior part
61
Q

What is the Buford Complex?

A
  • the anterior–superior labrum is absent and replaced by a cord-like middle glenohumeral ligament (MGHL), can be encountered and may be misdiagnosed as a separation of the anterior labrum
  • 1-6% of normal shoulders

shoulder (6 decks)

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