Stooped posture changes the angle of the scapula Increased rotator cuff tears/irritation Degenerative Joint changes Loss of ROM Subluxation (secondary to CVA)

Injury varies Nerve roots Brachial plexus Sensory and motor loss Long thoracic nerve most common

Exam 2 Flashcards by Mykia Woolridge

Ligaments near AC joint:

Acromioclavicular
Coracoacromia
Coracoclavicular

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Muscles connecting shoulder girdle to trunk:

Serratus Anterior
Trapezius (3 parts)
Rhomboids (Major &Minor)
Levator Scapulae
Pectoralis Minor

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Shoulder girdle linear movements:

Elevation
Depression
Retraction (ADD)
Protraction (ABD)

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Shoulder girdle rotational movements:

Upward rotation
Downward rotation
Tilt (sort of)

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Important to remember about the scapula:

Paralysis of one scapular muscle will cause functional limitations

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Which muscle is paralyzed/weakened when the scapula “wings”?

Serratus Anterior

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What shoulder girdle motion will a person with “wings” be unable to perform?

Upward rotation, protraction (Abduction)

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Name the “Companion” Motionsshoulder joint (GH)/shoulder joint (GH)/shoulder girdle:

Abduction (Upward Rotation)
Horizontal Abduction (Retraction)
Horizontal ADD (Protraction)
Flexion (Upward Rot.,Pro)
*ADDuction (Downward rotation)
*Extension- starting insh. flexion (Downward rotation/retraction)
*Hyperextension (Scapular tilt)

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Muscles connecting the shoulder girdle to the humerus provide mobility and stability:

– Deltoid
– Subscapularis
– Supraspinatus
– Teres Major
– Infraspinatus
– Coraco Brachialis
– Teres Minor
– (Biceps & Triceps

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Muscles from the trunk to the humerus provide mobility (with strength):

– Latissimus Dorsi
– Pectoralis Major

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Joint Capsule’s role in joint integrity:

– Ligaments and tendons provide capsular reinforcement
– Joint capsule encases GH joint creating a vacuum

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What happens when the medial deltoid contracts?

the subscapularis, infraspinatus, teres minor pulldown on the humerus just enough to prevent the humerus from hitting the roof of the acromion (socket)

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The “SITS” muscles work as stabilizers for all . . .

major upper body motions

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What are the SITS muscles?

Supraspinatus, Infraspinatus,Teres minor, and Subscapularis

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muscles are involved in decelerating the arm during throwing motions

SITS

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What are the primary external rotators of the arm?

infraspinatus and teres minor and the supraspinatus

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What happens if the rotator cuff is compromised, through weakness or injury?

the prime and secondary movers cannot act effectively at the joint, regardless of how strong the prime and secondary movers are

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Shoulder disorders (adulthood):

*Age-related changes
* Peripheral nerve injury
* Fractures
* Tendonitis
* Capsulitis

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Subluxation

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Peripheral Nerve Injuries:

Brachial plexus
Avulsion (traction injuries)
Compression(Injuries)

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Age-related changes:

Stooped posture changes the angle of the scapula
Increased rotator cuff tears/irritation
Degenerative Joint changes
Loss of ROM* Subluxation (secondary to CVA)

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Avulsion (traction):

Injury varies
Nerve roots
Brachial plexus
Sensory and motor loss
Long thoracic nerve most common

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injuries most commonly occur during motor vehicle or motorcycle accidents when the arm and shoulder are severely stretched during the collision

Avulsion

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Treatment of Avulsion Injuries:

Most difficult to treat.
Surgeons can perform nerve transfers.
These may or may not take.
The expected result is a partial elevation of the arm.

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OT’s Role in Avulsion Injuries:

* Positioning * ADL * Hand dominance retraining * Monthly Assessment * HEP as appropriate * Therapeutic Exercise as appropriate

Compression Injury:

* Crutches * Poor transfers * “Saturday Night” Palsy

OT’s Role in Compression Injuries:

* Positioning * ADL * Hand dominance retraining as needed * Monthly Assessment * Retraining of tendon transfers as appropriate * HEP as appropriate Therapeutic Exercise as appropriate

Fracture Classification:

* Location * Angle of fracture * Simple vs. Comminuted * Open vs. Closed * Displaced vs. Non-Displaced

Common fracture types:

* Diaphyseal: mid-shaft * Metaphseal: near the articulating surface of the bone * Articular: fracture into the joint

Angles of fractures:

transverse oblique spiral stellate longitudinal

an angle that is straight across the bone

transverse

an angle that is at an angle through the bone

oblique

an angle that is around the bone

spiral

an angle that is star-like fragments transverse and longitudinal

stellate

an angle that is along the length of the bone

longitudinal

Simple vs. Comminuted

* Simple: two fracture fragments * Comminuted: multiple fragments

When dealing with fractures you must get orders from who?

Physician

fracture does not puncture the skin

Closed fracture

fracture that punctures the skin

Open fracture

What are the 3 types of open fractures?

type 1 type 2 type 3

small puncture wound without gross contamination –the fracture is noncomminuted

type 1 open fracture

aceration>1cm with Min – Modsoft tissue crush –fracture still simple

type 2 open fracture

* Type IIIA –extensive soft tissue injury but still adequate to obtain coverage * Type IIIB –extensive soft tissue injury will likely require delayed coverage via skin graft or flap * Type IIIC –same as typeIIIB with arterial injury requiring repair orreconstruction*Most type III are comminuted fractures**

type 3 open fracture

Displaced vs. Non-displaced fractures:

* Displaced: Any amount of non-anatomic alignment * Non-displaced:

Fixation Options:

1. closed reduction 2. external fixation 3. open reduction internal fixation (ORIF)

a type of fixation that use of distraction for fracture alignment

closed reduction

a type of fixation that external traction application to fracture alignment – Allows for early mobilization of uninvolved joints

external fixation

use of internally placed hardware for fracture alignment – Provides maximum fracture stability, allows early mobilization

open reduction internal fixation (ORIF)

Why do we care about fractures:

* Fracture characteristics are essential in identifying the appropriate therapeutic interventions. * Allow for more concise communication with the physician with regard to treatment.

Shoulder fractures include:

* Humerus, proximal * Humerus, shaft (humeral fractures associated with FOOSH, osteoporosis) * Scapula * Clavicle

Mid Shaft Humeral Fractures:

* Concerns are for radial nerve palsy * May be treated operatively or nonoperatively

– Allows for secondary healing of bone through micro motion at the fracture site. – Provides a stabilizing force through

Fracture Brace Fabrication

OT’s Role in Fracture Management:

* Must follow MD orders for all weight-bearing, ROM, and ther-ex – Weight bearing * NWB – Non Weight Bearing * Platform Weight Bearing (On forearm) * WBAT – Weight Bearing as Tolerated * Splinting / Bracing as indicated * ROM as prescribed * ADL management

tendonitis

a popping, clicking, or crackling sound in a joint

crepitus

"Frozen shoulder" *Inflammation of joint capsule *Loss of normal tissue redundancy *Reduction of “joint space” *Leads to severe loss of ROM, pain

Adhesive Capsulitis

Elbow joint:

* Three bones * Two joints * Three ligaments * One joint capsule * One plane of motion

What are the three bones in the elbow joint?

Humerus Ulna Radius

What are the two joints at the elbow?

Ulnotrochlear and Radiocapitular

What are the three ligaments?

Medial (ulnar), lateral collateral ligaments & annular ligament

Which holds the head of the radius in place?

Annular

The radius _____ around the ulna both proximally and distally. The ulna remains _____.

rotates, stable

ELBOW AND FOREARM MUSCLES:

Biceps Brachialis Brachioradialis Triceps Supinator Pronator Teres Pronator quadratus Anconeus

Which elbow muscles cross both the GH and elbow joint?

Biceps, both heads Triceps, long head

Which muscles cross only the elbow?

Flexors: Brachialis (no supination) Brachioradialis (in mid position) Extensors: Medial & lateral(short) head of triceps

What are the supinators?

Biceps Supinator

What are the pronators?

Pronator Teres Pronator quadratus

What do the supinator and pronator muscles have in common?

insert into the radius

What bones articulate at the distal radioulnar joint?

Radius rotates around the ulna

What are the two prominent bony landmarks of the distal radioulnar joint?

Ulnar Styloid, Radial Styloid

What is the true wrist joint called?

Radiocarpal (radius, scaphoid, lunate)

Carpal bones and joints:

Eight bones Two rows Three “joints” A whole mess of ligaments

Carpal bones and joints:

Scaphoid Lunate Triquetrium Pisiform Trapezium Trapezoid Capitate Hamate

Wrist Ligaments:

Radial Collateral Ulnar Collateral Palmar radiocarpal Dorsal radiocarpal

Mnemonic for the carpal bones and joint:

Some Lovers Try Positions That They Can't Handle

Exam 2 Flashcards

Shoulder Complex