Chapter 16 - Shoulder Flashcards by Katie Binfet

What are the primary and secondary functions of the shoulder complex?

PRIMARY = position the hand in space and allowing interaction with the environment
SECONDARY = suspending the upper limb, providing fixation so motion of upper extremity/trunk can occur, serves as fulcrum for arm elevation

How well did you know this?

Not at all

Perfectly

Degree of mobility is contingent upon…

healthy articular surface
intact muscle-tendon units
supple capsuloligamentous restraints

How well did you know this?

Not at all

Perfectly

Degree of stability is dependent on…

intact capsuloligamentous structures
proper function of muscles
integrity of osseous articular strucutres

How well did you know this?

Not at all

Perfectly

Which way does the head of the humerus face?

medially
posteriorly
superiorly

How well did you know this?

Not at all

Perfectly

Which way does the glenoid fossa face?

laterally
superiorly
anteriorly

How well did you know this?

Not at all

Perfectly

How much deeper is the glenoid fossa made by the labrum?

50%

How well did you know this?

Not at all

Perfectly

Where does the labrum attach?

glenoid cavity
joint capsule
lateral portion of biceps

How well did you know this?

Not at all

Perfectly

What percent of fibers of LH biceps originate from the superior labrum?

50%

How well did you know this?

Not at all

Perfectly

How much (%) of the humeral head is in contact with the glenoid during elevation?

25-30%

How well did you know this?

Not at all

Perfectly

In what positions is the glenohumeral joint most significantly reduced?

1) ADD, flex, IR
2) ABD, elevation
3) ADD at side with downwardly rotated scapula

How well did you know this?

Not at all

Perfectly

What are the dynamic mechanisms of the GH joint?

Muscles of RTC

Other force couples

How well did you know this?

Not at all

Perfectly

What are the static stabilizers of the GH joint?

Joint capsule
Joint cohesion
Ligamentous support

How well did you know this?

Not at all

Perfectly

What is the location of scaption?

Arm elevation with arm held 30-45 anterior to frontal plane

How well did you know this?

Not at all

Perfectly

How many muscles attach to the scapula? What do they do?

16 (6 support and move the scapula, 10 concerned with GH motion)

How well did you know this?

Not at all

Perfectly

When is the anterior GH ligament under tension?

When the shoulder is in EXT, ABD and/or ER

How well did you know this?

Not at all

Perfectly

When is the posterior GH ligament under tension?

When the shoulder is in FLEX and ER

How well did you know this?

Not at all

Perfectly

When is the inferior GH ligament under tension?

When the shoulder is in ABD, EXT and/or ER

How well did you know this?

Not at all

Perfectly

When is the middle GH ligament under tension?

When the shoulder is flexed and in ER

How well did you know this?

Not at all

Perfectly

Which ligament is the primary restraint against anterior and posterior humeral head dislocation?

Inferior GH ligament

How well did you know this?

Not at all

Perfectly

What structures are in the coracoacromial arch?

head of humerus
LH biceps tendon
superior aspect joint capsule
supraspinatus, upper margins of subscap and infraspinatus
subdeltoid bursa
subacromial bursa
inferior surface of coracoacromial arch

How well did you know this?

Not at all

Perfectly

What is the normal size of the GH joint?

10-11 mm (height)

How well did you know this?

Not at all

Perfectly

What can cause narrowing of the subacromial space?

Muscle imbalances or capsular contractures (cause an superior translation of humeral head)

How well did you know this?

Not at all

Perfectly

What ares some strong predictors of RC impingement?

Acromial morphology and biomechanics

How well did you know this?

Not at all

Perfectly

What nerves innervate the anterior shoulder joint?

Axillary, subscapular and lateral pectoral

How well did you know this?

Not at all

Perfectly

What nerves innervates the posterior should joint?

Suprascapular nerve, small branches of axillary

What is the arterial supply of the shoulder complex?

Axillary artery

What is the arterial supply of the GH joint?

Anterior and posterior circumflex humeral, suprascapular and circumflex scapular vessels

What is the arterial supply of the biceps brachii?

Brachial artery

What is the arterial supply of the rotator cuff?

Thoracoacromial, suprahumeral, subscapular arteries

What are the closed and open packed positions of the GH joint?

``` closed = abduction and full ER open = 55 ABD, 30 horizontal adduction ```

What is the capsular pattern of the GH joint?

ER > ABD > IR

What are the closed and open packed positions of the AC joint?

``` closed = 90 ABD open = arm at side ```

What is the capsular pattern of the AC joint?

Pain at extremes of ROM, especially horizontal adduction and full arm elevation

What does the AC joint do?

serves as main articulation that suspends the UE from the trunk

What is the primary support for the AC joint?

Coracoclavicular ligament

What ligaments provide vertical stability?

Conoid and trapezoid ligaments (also control superior and anterior translation, anterior axial rotation)

What is the capsular pattern of the SC joint?

Pain at extremes of ROM, especially horizontal adduction and full arm elevation

What are the closed and open packed positions of the SC joint?

``` closed = max arm elevation and protraction open = arm at side ```

If held vertically, the proximal end of the clavicle is _______.

convex

If held in A/P, the proximal end of the clavicle is ________.

concave

What is the available motion at the scapulothoracic joint?

Upward roation = 60 IR/ER = 40-60 A/P Tipping = 30-40

What is the capsular pattern of the scapulothoracic joint?

none

What are the open and closed packed positions of the scapulothoracic joint?

``` closed = none open = 30-40 IR, slight upward rotation and 5-20 of anterior tipping ```

What are the scapular pivoters?

- trapezius - serratus anterior - levator scpaulae - rhomboids

What is the main function of serratus anterior?

To protract and upwardly rotate the scapula | To provide strong, mobile, BOS to position the glenoid for maximum efficacy

What muscle provides eccentric control of the scapula during flexion and abduction?

levator scapulae

What muscles help control scapular position (esp horizontal flexion and extension)?

Rhomboids

What are the humeral propellers?

- latissimus dorsi - teres major - pectoralis major and minor

What does the latissimus dorsi do?

extends, adducts and IR of the shoulder | assists in scapular depression, retraction, downward rotation

What does the pectoralis major do?

IR, horizontal ADD, flexion, ABD (humerus 90+) and ADD (humerus below 90)

What doest the pectoralis minor do?

draws the scapula inferiorly and medially towards the thorax

What are the humeral postioners?

Deltoid

What are the shoulder protectors?

Rotator cuff, LG biceps brachii

What do the muscles of RTC do?

- actively move the humerus and fine tune humeral head position - assist in rotation of shoulder and arm - reinforce GH capsule - control active arthokinematics of the GH joint

What are the functions of the LH biceps brachii?

- forearm supinator and secondary elbow flexor - humeral head depressor - ant/post stabilizer - limiter of ER - lifter of glenoid labrum - humeral head compressor - decelerates rapidly moving arm during OH activities

What contributes to shoulder abduction up to 90 degrees?

60 GH abduction | 30 ST upward rotation

What contributes to first 30 degrees of ST upward rotation?

20-25 clavicular elevation | 5-10 upward rotation of AC

What contributes to shoulder abduction from 90 to 180 degrees?

60 GH abduction | 30 ST upward rotation

What contributes to final 30 degrees of ST upward rotation?

5 elevation of SC | 20-25 AC scapula upwardly rotates

What are the primary muscles that abduct the GH joint?

middle deltoid and supraspinatus

What are the primary muscles that elevate the GH joint?

anterior deltoid, coracobrachials, LHB brachii

What are the prime upward rotators of the scapula (in first 30)?

traps and SA

Where should the medial scapula spine be equal to? Inferior angle? Medial border?

T3 T7 T2 - T7

What does pain during 70-110 of abduction indicate?

may indicate RC impingement/tearing or subacromial bursitis

What does pain during 120-180 of abduction indicate?

AC joint involvement

What happens when there is a muscle imbalance and the deltoid is dominant?

the humeral head glides superiorly during elevation, called "humeral superior glide syndrome"

Where should the thumb reach during Apley's scratch test?

T5 - T10

When does the scapula stop rotating during elevation?

140 degrees (at completion, inferior angle should be in close proximity to midline of thorax)

Pain with isometric muscle testing is indicative of what?

Generally a sign of 1st or 2nd degree M/T lesion

Pain that occurs during a muscle contraction is indicative of what?

Most likely a lesion within the muscle belly

Pain that occurs on release of a contraction is indicative of what?

Most likely a lesion within the tendon

ROM needed for eating

70-100 horizontal ADDuction | 45-60 abduction

ROM needed for combing hair

30-70 horizontal ADDuction 105-120 abduction 90 ER

ROM needed for reaching perineum

75-90 horizontal ABDuction 30-45 abduction 90+ IR

ROM needed for tucking in shirt

50-60 horizontal ABDuction 55-65 abduction 90 IR

ROM needed for positioning hand behind head

10-15 horizontal ADDuction 110-125 flexion 90 ER

ROM needed for putting an item on a shelf

70-80 horizontal ADDuction 70-80 flexion 45 ER

ROM needed to wash opposite shoulder

60-120 horizontal ADDuction | 60-90 flexion

List the shoulder outcome scales

- UCLA Shoulder Rating Scale - Simple Shoulder Test - Should Pain and Disability Index - Disabilities of the Arm, Shoulder and Hand (DASH) - Penn Shoulder Score

Grade I and II oscillations are used for...

Pain, graded depending on the stage of healing

Grade III - V techniques are used to...

Increased ROM