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shoulder > biomechanics > Flashcards

biomechanics Flashcards

1
Q

What is the foramen of weitbrecht?

A
  1. area of weakness in the anterior GH capsule between the midde and superior bands
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2
Q

Dislocation of the shoulder typically occur where?

A

through the foramen of weitbracht

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3
Q

What is the foreamen of Rouviere?

A
  1. area of weakness between the middle and inferior band of GH ligament
  2. synovial commuication can occur with the subcoracoid bursa at this point
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4
Q

What are the attachments of the coracohumeral ligament?

A
  1. orginates from the coracoid process
  2. two bands
    - greater tubercle at the supraspinatus attachment
    - lessor tubercle at the subs cap attachment
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5
Q

How is the coracohumeral ligament loaded?

A
  1. anterior band taught in extension
  2. posterior taut with flexion
  3. both taut with ER
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6
Q

why is the coraochumeral ligament important for stability

A
  1. it blends with the RTC adn fills the interval between the supra and subscap
  2. reenforces the biceps tendon sheath
  3. helps prevent anterior dislocation during ER
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7
Q

what is the musculotendonis glenoid?

A

structures that provide posterior stability of the GH including the supraspinatus, infraspinatus and teres minor

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8
Q

why are inferior dislocations of the GH uncommon fro mthe resting position?

A

the self locking mechanism

  • orientation of the glenoid places it under the humeral head
  • passive tension on GH joint prevents it from sliding off
  • supraspinatus and posterior deltoid reenforce horizontal tension
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9
Q

what direction does the clavical rotate with shoulder elevation?

A

inferior and anterior

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10
Q

How is the AC joint oriented?

A

the acromial surface in concave and faces medially and forward
2.the clavicualr part faces inferior, posterior and lateral

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11
Q

what type of joint is the AC joint?

A

plane synovial

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12
Q

what is the basic function of the AC joint

A

allow the scapula to move to maintain the glenoid in proper orientation to the humeral head

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13
Q

what anatomical sturcutre is somtimes present in the shoulder?

A

a disc, rarely divides the joint

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14
Q

what are the ligaments of the AC joint?

A

superior, strongest to do to reenforcments with trap and deltoid
inferior- indirect contact with subacromial bursa and RTC

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15
Q

How is the scapula supplied with blood?

A
  1. muscular vasculature
  2. nutrient arteries in the suprascapular fossa
  3. additional blood from suscapular, suprascapular, circumflex scapular, and acrominal artery
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16
Q

what major ligaments attach to the scapula?

A
  1. coracoclavicular
  2. coracoacromial
  3. glenohumeral
  4. coracohumeral
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17
Q

what attaches to the coracoid process?

A
  1. shor head of biceps
  2. coracobrachialis
  3. pectoralis minor
  4. coracacromial ligament
  5. coarcoaclavicular ligament (conoid and trapezoid)
  6. coracoglenoid ligament
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18
Q

what are the attachments of the coracoglenoid ligament?

A
  1. coracoid process between coracoacromial and coracohumeral ligaments
  2. near the orgin of the biceps long head
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19
Q

Where can the AC joint refer pain?

A
  1. trap
  2. neck
  3. tip of acromium
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20
Q

how do you mechanically compress the AC joint?

A

Hawkins Kennedy

1.closed pack positions

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21
Q

AC is innervated by what nerve?

A

suprascapular

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22
Q

When are the coracoclavicular ligaments tensioned in shoulder ROM

A

Conoid- begining and end

trapezoid- mid range

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23
Q

what nerve entrapment can occur around the scapula?

A

suprascapular as it passes through the suprascapular notch

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24
Q

what movement can lead to suprascapular nerve irritation?

A
  1. sling effect- depression and reiteration
  2. hyper abdution with ER
  3. forceful horz adduction
  4. typically in overhead athletes
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25
Q

what are the coracoclavicular ligaments and their orientation

A

trapezoid- horizaontal

conoid- vertical

26
Q

what are the attachments of the conoid ligaments?

A

base of the coracoid process on the scapula, medial to the trapezoid ligament; above, by its expanded base, to the conoid tubercle on the under surface of the clavicle, and to a line proceeding medialward from it for 1.25 cm.

27
Q

What are the attachments of the trapezoid ligament

A

acromium to the oblique ridge on the under surface of the clavicle.
Its anterior border is free; its posterior border is joined with the conoid ligament

28
Q

At what point in the ROM does movement of the AC joint occur?

A
  1. first 30-60 degrees with 10 degress of upward rotation

2. after 135 degree finishes rotating

29
Q

what parts of clavicular motion promote greater arm elevation?

A

the rotaiton of about 45 degress raises the clavical and the scapular about 30 more degrees

30
Q

what are the axis of motion of the AC joint?

A
  1. longitudnal through the clavicle
  2. CSH angle is motion through the horizontal plane about the vertical axis of the conoid directed by the trapezoid
  3. CSV angle is motion through the transverse plane about eh horizontal axis of the trapezoid directed by the conoid
31
Q

What are the mechanics of the AC CSH angle of motions?

A

the movement of the coracoid forward and back ward tensions the trapezoid cause the spine about the conoid ligament
-During abduction the angle decreases

32
Q

what are the mechanics of the AC CSV angle of motion?

A

scapular upward rotation tenstions the condoid causeing the rotation of the AC about the axis of the trapezoid

33
Q

what is the longitudinal axis of AC motion?

A
  1. includes AC and SC motion of about 30 degrees of clavicular rotation
  2. paces through the long axis of the clavicale
34
Q

How much motion does the clavicle demonstrate?

A 
30 degree rotaiton
60 elevation
20 depression
30 anterior
20 posterior
35
Q

What mechanical dysfunction will occur if the CSH angle does not derease with arm elevation?

A

you don’t get the tension on the trapezoid to pull the clavical into rotation to allow for completion of arm elevation

36
Q

How is the SC joint shaped?

A

Saddle

1.sturnum is convex A/P and concave med/lateral

37
Q

what unique articular structure is found in the SC joint?

A

disc

  1. flat and circular
  2. blends with the capsule
  3. attaches to the first costal cartilage and sternum up to the clavical
38
Q

what muscle help strengthen the SC joint?

A
  1. SCM anteriorly spans the joint
  2. sternohyoid and sterhothyroid posteriorly
  3. subclavius prevents excessive protraction and elevation
39
Q

what ligaments support the SC joint?

A
  1. costoclavicular

2. intraclavicular

40
Q

what are the attachments of the costoclavicular ligament

A
  1. runs superiorly and laterally from the superior medial first rib
  2. attaches to the inferior aspect of the clavicle
41
Q

Where is the relative axis of motion of the the SC joint?

A

just above the costoclavicular ligament about 2-3 c lateral to the the SC joint

42
Q

How much motion occurs at the SC joint with arm elevation?

A

10 degrees of arm = 4 degrees of SC

43
Q

What role does the clavicle play in arm elevation?

A

total of 60 degrees of elevation of the clavicle

  • 15 degrees in first 30 degrees
  • completes motion at 90 degrees
  • 1/2 is true elevation the other is from the crank shaft effect of the rotation
44
Q

what structures check scapular depression at the SC joint?

A
  1. first rib

2. superior capsule

45
Q

What SC structures check protraction and retractio?

A 
retraction
1.SC ligament
2.posterior capsuel
protraction
1.SC ligament
2.anteior capsule
46
Q

what shoulder movements effect function of the subclavian vein?

A
  1. compressed with retraction

2. expanded with protraction

47
Q

How does clavicular motion relate to scapular rotation?

A

The clavicle dictates the scapular rotation

  1. 30 degrees of up rotation is from 30 degree of clavicular elevation
  2. the second 30 degrees is from the crankshaft posterior rotation and influence of the acromioclavicular ligaments
48
Q

At what point in the movement of the arm does the clavicle reach its terminal position?

A

During the first 30 degrees it elevates 15 degrees and reaches its final position at about 90 degrees of arm elevation

49
Q

How will the supine versus the seated position effect your differentials and what are some examples?

A
  1. the humeral head will ride higher supine

2. tendonosis and bursitis will have a greater likelyhood of producing pain in supine and your testing is less sensitive

50
Q

How would you differentiate subclavius strain?

A
  1. pain in same area as suboracoid bursa

2. pain with scapular depression

51
Q

What must you rule out with subacromial bursitis?

A
  1. AC joint strain- tender, painful horz add
  2. tendonitis of RTC- painx3 MMT, decrease pain with distraction, less pain supine
  3. subcoracoid bursa-coracoid pain and pain with ER
  4. subclavius strain
  5. coracoclaivicalar lig- mid clavical pain, pain greater abdcuted and ER to 90
  6. aseptic necrosis- non capsular pattern with pain in all directions
52
Q

DD actue bursitis?

A
  1. rapid onset, slight movement causes pain, empty end feel, flex and abduction most painful
  2. rule out fracture, gout (capsular pattern of loss), septic arthritis (similar to acute with fever and warmth)
53
Q

What are the TUBS adn AMBRI classification of instability?

A

calssifications based on tryp of injury, direction/location, type of lesion and treatment

  1. Traumatic unilateral.directional Bankart Surgery
  2. atrumatic multidirection bilateral rehab inf cap shift
54
Q

What are the grades of instability in the GH joint>

A

grade I- rides up but not over the glenoid rim
grade II- rides up and over and reduces
grade III- rides up and over the glenoid rim and does not reduce

55
Q

How does anterior instbility lead to superior glenoid impingement?

A
  1. To prevent the greater tuberosity from hitting the superior glenoid rim during elevation of the arm you must ER the arm
  2. When you develop anterior laxity the humeral head will translate anterior and as a result the greater tuberosity will glide forward into the posterior glenoid rim
  3. When ER the shoulder as you elevate the greater tuberosity clears the superior glenoid rim and moves behind the rim, but with anterior instability it glides forward and hits the glenoid
  4. Some degree of contact is normal between the greater tuberosity and the posterior super glenoid rim
  5. When there is contact with the glenoid rim you are pinching the supraspinatus
56
Q

What are the risk factors associated with cummulative trauma?

A
  1. angle and position of work- outside optimal length tension
  2. force requirements and its relative %MVC as it effect how hard the work is and blood flow
  3. static contractions
  4. grip and pinch
  5. repeatition
  6. acceleration of deceleration
  7. vibration
  8. impact
  9. cold
  10. individual
  11. envrinment
57
Q

what is myofacial pain?

A

taut bands of skeletal muscle or fascia painful with compression and may refer pain or autonomic response

58
Q

what are the categories of myofacial pain?

A
  1. active
  2. latent
  3. primary
  4. associated
  5. satellite
  6. secondary
59
Q

what are the causes of myofascial pain?

A
  1. hyper irritability from serotonin, histamine, bradykinin, protaglandin E
  2. local increase in metabolic demand
  3. actue connective tissue or muscle stain
  4. tearing of sarcoplasmic reticulum and release of Ca++ stores
60
Q

what are some potential visceral sources of pain to the shoulder?

A
  1. diaphragm
  2. pulmonary infarct
  3. myocardial ischemia
  4. perforated abdominal viscera
  5. gall bladder

shoulder (6 decks)

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