Exam 2 Flashcards
What are the components of the shoulder joint complex? (Different joints within the shoulder)
-Glenohumeral Joint
-Acromioclavicular Joint
-Sternoclavicular Joint
-Scapulothoracic Joint (Not an actual bone on bone joint)
Which movements occur at the Sternoclavicular Joint?
-Elevation
-Depression
-Retraction
-Protraction
-Upward Rotation
-Downward Rotation
At which point of shoulder elevation does Sternoclavicular elevation occur
30-90 degrees of shoulder elevation
Where is most of the movement of the clavicle seen?
The Acromioclavicular Joint
Which 3 ligaments stabilizes the Acromioclavicular joint?
-Acromio-clavicular
-Coraco-acromio
-Coraco-clavicular
Where is the scapula positioned?
2 inches (5 cm) lateral of the spinous processes and between T2 and T7
Where is the Scaption Position?
30-45 degrees anterior to the frontal plane
What is the term used for the combination of scapular motions in conjunction with upper extremity movements, and is the key to stability of the GH joint?
Scapulohumeral Rhythm
What shape is the Glenoid?
Pear shaped
How many degrees of articular surface does the Glenoid have?
180 degrees
What is the fibrocartilaginous rim around the glenoid which enhances the concavity of the glenoid fossa?
The Glenoid Labrum
What is considered the “roof” over the humeral head?
The Coracoacromial Ligament
What is the term used for anything that stabilizes the shoulder joint that is not a muscle?
Static Stabilizers
What is the term used for the type of shoulder stabilizers which are muscle?
Dynamic Stabilizers
How much smaller is the glenoid than the humeral head?
3-4 times smaller
Which way does the Glenoid face?
-Superiorly
-Anteriorly
-Laterally
How much of the Humeral head is in contact with the glenoid?
25-30%
At what point does the Glenohumeral Joint have the most Articular Contact?
Between 60-120 degrees of elevation
What is the Glenoid Labrum made out of and what is it’s purpose?
-Fibrocartilage
-Doubles the depth of the glenoid fossa
-Serves as a buttress or chock-block controlling glenohumeral translation
-Increases surface area and load bearing for head of humerus
What is attached to the Glenoid Labrum, and what goes through it?
-The glenohumeral ligament is attached to it
-The biceps tendon goes through it
What does not return after surgery to a torn or punctured capsule and therefore results in shoulder instability?
Intraarticular pressure and joint cohesion
Which ligament gives anterior stability to the shoulder?
The Glenohumeral Ligament
What is the function of the Superior Glenohumeral Ligament?
Limits inferior motion of the humerus when carrying a load
What is the function of the Middle Glenohumeral Ligament?
Limits ER and Abd. at 45 degrees
What is the function of the Inferior Glenohumeral Ligament?
-This is the most important of the stabilizing ligaments in the shoulder
-The Anterior portion limits ER and Abd
-The Posterior portion limits IR and Abd
Which 3 things contribute to the depth of the glenoid fossa?
-Slight concavity of the glenoid
-Articular cartilage thicker in the periphery
-Glenoid labrum’s deepening effect
Definition: Muscles that produce movement about the glenohumeral joint also generate the primary forces responsible for stabilizing the joint
Dynamic Stabilizers
What are the Primary active stabilizers of the shoulder?
-Rotator Cuff Muscles
-Deltoid
-Long head of biceps brachii
What are the Secondary active stabilizers of the shoulder?
-Teres Major
-Latissimus Dorsi
-Pectoralis Major
Definition: 2 parallel forces of equal magnitude but opposite direction are applied to a structure at equal distances from the center mass; 2 groups of muscles contracting synchronously to enable a specific motion to occur
Force Couple
Which muscles work as a Force Couple to hold the head of the humerus inferiorly?
The IR and ER (Subscapularis and Infraspinatus/Teres Minor)
Which muscles work as a Force Couple to hold the head of the humerus superiorly?
The Deltoid and Inferior Rotator Cuff Muscles
What happens when the rotator cuff muscles become fatigued?
Superior migration of the humeral head
What do the Ruffinian/Pacinian Corpuscles and Golgi Mechanoreceptors present in the shoulder capsule do?
Give us feedback for proprioception
What are the Prime Movers (muscles) that span from the scapula to the humerus?
-Deltoid
-Latissimus Dorsi
-Pectoralis Major
Which muscles must work together to keep the head of the humerus in alignment?
The deltoid and rotator cuff muscles
What is it called when traction on the Coracoacromial ligament causes abnormal bone growth?
Traction Spur
When the anterior shoulder capsule is tight, ER against the tight capsule can produce a force in which direction?
Posteriorly
Tightness of the posterior shoulder capsule can create a force in which direction with humerus elevation?
Anterior-superior
Which scapular muscles do you need to strengthen in scapular dumping?
Upward Rotators
How is Shoulder Internal Rotation Tested?
The highest segment of posterior anatomy reached with the thumb
What does the Drop Arm test for?
Full thickness RC tear
What does the Empty Can/Full Can test for?
Supraspinatus weakness or lesion (RC disfunction)
What does the Apprehension Test test for?
Shoulder instability and proneness to subluxation
What does the Speeds Test test for?
Biceps Tendon/SLAP/Labrum
What does the Neer’s Sign Test for?
Shoulder Impingement
What does the Hawkin’s Kennedy test for?
Shoulder Impingement
What is the most common reason for instability of the shoulder?
Impairment to the Static or Dynamic Stabilizers
What are the RC muscles and what do they do?
-Supraspinatus: Shoulder Abduction to 90 degrees
-Infraspinatus: Shoulder ER
-Teres Minor: Shoulder ER
-Subscapularis: Shoulder IR
They all depress and stabilize the head of the humerus in the glenoid
Which RC muscle(s) insert into the Greater Tubercle?
-Supraspinatus
-Infraspinatus
-Teres Minor
Which RC muscle(s) insert into the Lesser Tubercle?
-Subscapularis
Which nerve innervates the Supraspinatus and Infraspinatus?
Suprascapular nerve
Which nerve innervates the Teres Minor?
Axillary nerve
Which nerve innervates the Subscapularis?
Subscapular nerve
What is Impingement Syndrome?
When the Supraspinatus becomes compressed between the head of the humerus and the acromion process
Which stage of shoulder impingement is this?
-Edema and hemorrhage
-Pain with shoulder abduction >90
-Reversible lesion
Stage I
Which stage of shoulder impingement is this?
-Fibrosis and tendonitis
-Pain, especially at night and with ADL
-Less chance of reversing condition due to fibrosis
Stage II
Which stage of shoulder impingement is this?
-Tendon degeneration
-Hx of shoulder P! and dysfunction
-Muscle atrophy and weakness
-Usually a candidate for surgery
Stage III
At what point does the GH joint have the greatest amount of articular contact?
60-120 degrees of elevation
What is the difference in GH Dislocation and Subluxation?
-Dislocation: Full dislocation
-Subluxation: Partial dislocation
In which direction is the GH joint most commonly dislocated?
Anterior and Inferior
Will Extrinsic or Intrinsic Forces most likely cause a full dislocation?
Intrinsic
What is the term for when the shoulder labrum tears away from the anterior/inferior glenoid?
Bankart Lesion
What occurs in 85% of traumatic shoulder dislocations?
A Bankart Lesion
What happens in a Bankart repair?
The Labrum is sutured directly to the bone
What usually accompanies a Bankart Lesion?
A Hill-Sachs Lesion
What is a Hill-Sachs Lesion
An osteochondral depression (compression fx) in the posterior humeral head due to impact on glenoid rim during anterior dislocation
What is a Reverse Hill-Sachs Lesion?
An osteochondral depression in the Anterior humeral head due to impaction on glenoid rim during posterior location
Where do SLAP tears occur?
Where the biceps tendon anchors to the labrum
What position of the shoulder is most comfortable for post-surgery patients?
Scaption
What is Scapulohumeral Rhythm?
2 degrees of GH motion to 1 degree of scapular motion
When does Scapulohumeral Rhythm begin?
After the first 30 degrees of shoulder motion
At what phase of rehabilitation does Restoration of Functional Motion typically occur?
Phase III
Which muscle is usually involved with a Bankart Repair?
Subscapularis
What is the technical term for Frozen Shoulder?
Adhesive Capsulitis
What are the types of RC repairs?
-Arthroscopy
-Mini Open
-Open
Is Primary or Secondary Adhesive Capsulitis…
-Idiopathic
-Spontaneous
-Post Menopausal
-Diabetes related
Primary
Is Primary or Secondary Adhesive Capsulitis…
-Following a trauma
Secondary
What is the Capsular Pattern?
Loss of shoulder ER, then Abduction, then IR
What is loss of or a decrease in the capsular pattern indicative of?
Adhesive Capsulitis
How many phases of Adhesive Capsulitis is there?
4
Which phase of Adhesive Capsulitis is…
-Adhesions are significant
-Loss of axillary fold
-Maturation phase
-Inferior capsule is extremely tight
Phase III
Which phase of adhesive Capsulitis is…
-Mild signs and symptoms
-Minimal restriction in ROM
-Preadhesive phase
Phase I
Which phase of adhesive Capsulitis is…
-Motion is restricted and painful
-Synovitis is present
-Adhesive phase
Phase II
Which phase of adhesive capsulitis is…
-Range of motion severely restricted
-Axillary fold severely contracted
-Synovitis no longer present
Phase IV
Which phase of adhesive capsulitis is the most painful?
Phase II
Which area of the shoulder girdle is most commonly fractured in those under the age of 16?
The Clavicle
What is a positive Sulcus Sign indicative of?
An AC tear
Which shoulder ligaments are sprained the most?
-Acromioclavicular
-Coracoclavicular
Which AC sprain classification is…
-Complete tear AC ligaments
-Complete tear of coracoclavicular ligament
-Marked P!
-Severe limitation of shoulder motion
3rd Degree
Which AC sprain classification is…
-Complete tear AC ligament
-Partial tear coracoclavicular ligament
-Gap between acromion and clavicle
-P! with elevation and horizontal adduction
2nd Degree
Which AC sprain classification is…
-Partial tear AC ligament
-No instability
-Minimal functional loss
-Point tenderness over AC joint
1st Degree
Which stage of injury to the AC ligaments are these rehab goals…
-Gradual restoration of ROM
-Strengthening in pain-free ROM
-Joint accessory motion for restrictions
Subacute
Which stage of injury to the AC ligaments are these rehab goals…
-Taping to promote correct joint mechanics
-Joint accessory motion
-Progressive restoration of function
-Orthotics during “at-risk” activity
Chronic
Which stage of injury to the AC ligaments are these rehab goals…
-Manage P! and edema
-P! free ROM
-Avoid elevation >90 degrees and horizontal adduction
-Brace as needed
Acute
What are the surgical options for AC tear?
-Resection of distal clavicle
-ORIF to AC joint
Why are Intra vs. Extra-articular joint fractures a cause for rehab concern?
Intra-articular fractures do not heal as well as extra-articular fractures
Which part of the scapula is most commonly fractured?
The body
How is the glenoid neck usually fractured?
FOOSH
How are scapular fractures most commonly treated?
A sling and early mobilization (after 1-2 weeks)
What is the most common site for clavicular fracture>
Mid-clavicle
Who Fx’s their clavicles the most?
Men <25
What type of orthotic is worn for clavicle Fx’s and for how long?
Figure 8 harness for 4-6 wks
What should shoulder elevation be limited to for 4-6 wks after a clavicle Fx?
50/70 degrees
What are the four parts of a four part humeral Fx?
-Humeral head
-Humeral shaft
-Greater Tuberosity
-Lesser Tuberosity
What type of humeral Fx is most common?
One-part type
Which nerve is most commonly injured in proximal humerus Fx’s and what may this cause?
-Axillary
-Lateral deltoid parasthesia
What is the most common reason for a Shoulder Arthroplasty?
Uncontrolled P! secondary to arthritis in the shoulder
What is a Non/Un-constrained TSA?
The most common type of shoulder arthroplasty which resembles an actual shoulder joint and provides the greatest ROM
What is a Reverse TSA?
A type of TSA which reverses the arthrokinematics are the shoulder.
-Used when there is an inability to repair the rotator cuff
Which stage of rotator cuff impingement occurs in patients younger than 25 years of age?
Type 1
Stage III rotator cuff impingement normally affects patients more than ______ years of age.
40
A reduction in available space in the shoulder is known as…
Anatomic Crowding
T or F: Active muscle contractions of the deltoid are contraindicated during the prefunctional phase after rotator cuff repair.
True
What is the name of the medial end of the humerus that articulates with the ulna?
Trochlea
What is the name of the lateral end of the humerus that articulates with the radius?
Capitulum
What is the medical term for someone who claims to have golfer’s elbow?
Medial Epicondylitis
What is it called when the angle of the elbow is increased to wear the forearm points medially?
Cubitus varus
What kind of joint is the elbow?
Hinge
What are the 3 main ligaments of the elbow?
-LCL (Radial Collateral)
-MCL (Ulnar Collateral)
-Annular Ligament
Which muscles flex the elbow?
-Biceps
-Brachialis
-Brachioradialis
Which nerve innervates the Biceps and Brachialis?
Musculotaneous
Which nerve innervates the Brachioradialis?
Radial
Which muscles extend the elbow?
-Triceps
-Anconeus
Which nerve innervates the Triceps and Anconeus?
Radial
What are the main differences between Tendinitis and Tendinosis?
-Tendinitis only lasts for <2 wks and heals in 4-6 weeks
-Tendinosis lasts for 6-10 weeks and heals in 3-6 mnths
What is the prognosis for full recovery of Tendinitis?
90%
What is the prognosis for full recovery of Tendinosis?
80%
These are the mechanisms of which injury?
-Repetitive stress/microtrauma
-Extensor carpi radialis brevis
-Hyperpronation
-Excessive wrist extension
Tennis Elbow
Is Transverse Friction a better Tx for Tendinitis or Tendinosis?
Tendinosis: to realign fibers
Which type of contraction is best for treating epicondylitis?
Eccentric
Does Medial or Lateral Epicondylitis occur more frequently?
Lateral
Which injury is described by…
-Transverse fracture
-Caused usually by trauma
-Most common in children
-Risk of Volkmann’s ischemic contracture
Supracondylar Fx
What is a Volkmann’s ischemic contracture?
A contracture causing vascular compromise/obstruction to the supracondylar region of the elbow
Describe a Type I Supracondylar Fx and what causes it.
-Distal humerus displaced posteriorly
-FOOSH
Describe a Type II Supracondylar Fx and what causes it.
-Distal humerus displaced anteriorly
-Direct trauma to posterior elbow
Is Type I or Type II Supracondylar Fx most common?
Type I
Which kind of elbow fracture is the most common in adults and accounts for 1/3 of all elbow fractures?
Radial Head Fx
What causes a Radial Head Fx?
FOOSH
What accounts for 20% of all elbow trauma?
Radial Head Fx
Which type of Radial Head Fx is non-displaced?
Type I
Which type of Radial Head Fx is a marginal Fx with displacement?
Type II
Which type of Radial Head Fx is a comminuted Fx of head?
Type III
Which type of Radial Head Fx is any Fx with elbow dislocation?
Type IV
Which type of Radial Head Fx is immobilized short term and doesn’t require surgery?
Type I
Which type of Radial Head Fx requires surgery?
Types II, III, IV
During the US Open, which most likely diagnosis would you expect those particular athletes to be treated for when off the courts?
Lateral epicondylitis
You are treating a patient with a diagnosis of epicondylitis and the PT POC indicates a prognosis for full recovery is expected in 3-6 months. This information helps you to realize you are dealing with…
Tendinosis
What is the most common Tx for supracondylar Fx’s?
Closed reduction and immobilization for 4-6 wks
What is normal elbow ROM?
0-145 degrees
T or F: In severe cases of tennis elbow, the use of a wrist cock-up splint is advocated for the management of inflamed wrist extensor tendons.
T
T of F: During the subacute recovery phase of rehabilitation for lateral epicondylitis, initial instruction for patients to perform forearm pronation and supination must include the use of a hammer while holding the end of the shaft away from the head of the hammer.
F
T or F: Passive stretching is advocated during the early recovery phase of healing after supracondylar fractures.
F
T or F: A type IV intercondylar fracture, which is severely comminuted with significant separation, always is treated with an ORIF procedure
F
T or F: Displaced or comminuted fractures of the olecranon can be treated with an ORIF procedure or, in cases of severely comminuted fractures, excision of up to 80% of the olecranon
T
