Ch 22 The Shoulder Complex

Question 1

Muscles in the rotator cuff

Answer 1

supraspinatus, infraspinatus, teres minor, subscapularis

Question 2

Other muscles in the shoulder region

Answer 2

latissimus dorsi, pectoralis major, teres major, coracobrachialis, rhomboids, deltoids

Question 3

in what ways is the shoulder movable?

Answer 3

extension, flexion, rotation, circumduction

Question 4

What makes the shoulder so unstable?

Answer 4

flat glenoid fossa, round humerus head. 50% of dislocations in body, esp vulnerable in overhead position

Question 5

What helps provide additional stability?

Answer 5

glenoid labrum (similar to knee meniscus), and glenohumeral joint capsule

Question 6

brachial plexus nerves

Answer 6

(C5,6,7,8,T1)

Question 7

prevention of shoulder injuries

Answer 7

maintenance strengthening, tackling/falling correctly, correct biomechanics

Question 8

Clavicle fracture

Answer 8

Mech: Foosh, direct hit. S&S: deformity, inability to raise arm, support of arm. MGMT: sling, refer to MD, Figure 8 brace, surgery

Question 9

Scapular fracture

Answer 9

Mech: direct blow. S&S: inability to move shoulder, pain. MGMT: refer for x-rays, sling

Question 10

humerus fracture

Answer 10

Mech: FOOSH, direct blow, dislocation. S&S: difficult to determine if there is no deformity, pain, swelling. MGMT: refer for x-rays, sling, surgery

Question 11

Sternoclavicular joint sprain

Answer 11

Mech: FOOSH. S&S: pain with shoulder mvmt, point tender. MGMT: RICE, rehab

Question 12

Acromioclavicular joint sprain

Answer 12

Mech: FOOSH, direct blow to shoulder. S&S: pain with overhead movement, step off deformity??, swelling. MGMT: RICE, rehab

Question 13

Dislocation/Subluxation

Answer 13

Mech: abduction, external rotation, extension. It usually dislocates anteriorly. S&S: flattened deltoid, inability to move arm. MGMT: refer for reduction

Question 14

Bankart lesion

Answer 14

Glenohumeral lig defect anteriorly

Question 15

Hill-Sachs lesion

Answer 15

cartilage defect

Question 16

SLAP lesion

Answer 16

labrum defect

Question 17

anterior instability

Answer 17

seen in overhead athletes after dislocation/subluxation. mech: stretched capsule, torn/stretched ligaments, poor rotator cuff stretch. -> excessive mvmt of head of humerus, generalized shoulder pain, and loss of forceful mvmt. MGMT: strengthen rotator cuff, eccentric mvmts, scapular stabilizers, CORE, surgery.

Question 18

shoulder impingement

Answer 18

Mech: compression of subacromial bursa, supraspinatus tendon, and the long head of the biceps tendon caused by overhead activity, recurrent instability. S&S: generalized shoulder pain in overhead activity. MGMT: Ice, avoid aggravating activities, strengthen rotator cuff and scapular stabilizers

Question 19

adhesive capsulitis

Answer 19

Frozen shoulder. capsule around glenohumeral joint becomes stiff and fibrotic. Caused by: surgery with inadequate rehab, age, or a systemic disease such as diabetes or cardiopulmonary problems. MGMT: aggressive stretching

Question 20

biceps brachii rupture

Answer 20

Mech: forceful contraction. S&S: snap, deformity in the muscle belly, weakness with elbow flexion. MGMT: ice, refer to MD, surgery.

Question 21

throwing

Answer 21

wind up: prep for movement. cocking: shoulder reaches full extension. acceleration: concentric forward movement. deceleration: eccentric slowing of arm. follow through: regain balance

Question 22

rehab

Answer 22

Some injuries/surgeries require immobilization. may begin easy conditioning, ROM, isometric strengthening. Early easy movement to avoid frozen shoulder, kept below 90/90 plane. strengthen: rotator cuff, scapular stabilizers, core. functional progressions for tennis, golf, and throwing

Question 23

scapular stabilizer muscles

Answer 23

levator scapulae, trapezius, rhomboids, and the serratus anterior/posterior

Question 24

with a sternoclavicular sprain the clavicle is generally displaced in what direction?

Answer 24

upward and anteriorly

Question 25

winging of only one scapula indicates injury to which structure?

Answer 25

long thoracic nerve

Question 26

the drop arm test is used to determine injury to which muscle?

Answer 26

supraspinatus

Question 27

the most important and most commonly injured bursa in the shoulder is the__?

Answer 27

the subacromial bursa