Exam 3 Flashcards
What percentage of people have shoulder pain?
70%
Who has more shoulder issues?
Males and Females
Males are from traumatic collisions
Females are more from laxity and less muscular strength
Shoulder girdle is made up of what?
Clavicle and Scapula
What is the clavicle?
The collar bone
Only bony attachment from upper appendicular skeleton to the axial skeleton
S shaped bone: Allows room for 1st rib and several arteries and veins
Several muscles attach
What is the scapula?
Site of the “true” shoulder joint
In the back but all joint movement in the front
Lots of muscle attachments
Attachment to rear thorax
Bone embedded in muscles
Where does the clavicle attach to?
Upper sternum to form the sternoclavicular joint at medial
Attaches to scapula at lateral to form the acromioclavicular (AC) joint
How common are clavicle fractures?
5% in adults
15% in children
Most common age 10-19
3 to 6 weeks for children to heal
6-12 weeks for adults to heal
What are the landmarks of the scapula?
Acromion process
Glenoid fossa
Spine
Supraspinous fossa
Infraspinous fossa
Subscapular fossa
The sternoclavicular joint is made up of what?
Clavicle and scapula
What are the movements of the sternoclavicular joint?
Anterior/posterior rotation (Mediolateral axis)
Elevation/depression & Upward/downward rotation (Anteroposterior axis)
Protraction/retraction (Superoinferior axis)
The acromioclavicular joint is made up of what?
Acromion process and clavicle
What is the acronmioclavicular joint movement and for?
Gliding movement
Allows for more ROM for shoulder abduction
What is the coracoclavicular joint made of?
Coracoid process and clavicle
What is the coracoclavicular joint movement and for?
Little to no movement
Allows for more stability
What is the scapulothoracic?
Is a articulation but not a true joint
Scapula lays on thoracic cavity but connected by muscles and ligaments
What movements does the scapulothoracic do?
Elevation/depression (mediolateral axis)
Protraction/retraction (superoinferior axis)
Medial/lateral rotation (Anteroposterior axis)
What is the true shoulder joint?
Glenohumeral joint
What is the glenohumeral joint?
Most mobile and least stable of the body
50% of all dislocations occur at shoulder w/ anterior dislocation being most common
After first dislocation, over 90% chance of another
What is the glenohumeral joint made of?
Scapula (Glenoid fossa)
Humerus
Like a golf ball on a tee
How is the glenohumeral joint held together?
Ligaments and tendons (and a labrum for more surface area)
What is a subluxation of the long head of the biceps tendon?
Long head of the biceps attach at the labrum of the shoulder
Injury: Weak scapularis and/or non-activation of rotator cuff
What is the humerus for the glenohumeral joint?
Long bone in the proximal arm
What are the landmarks of the humerus?
Head: Attachment of the glenohumeral joint
Anatomical neck: Attachment site for joint capsule
Surgical Neck: Site commonly susceptible to fractures
Tubercle and grooves: Locations for muscle attachments and nerves/blood vessels
Glenohumeral joint movements are?
All 4 planes: Sagittal, Frontal, Transverse, and Oblique
Ball and socket joint
True shoulder joint
The glenohumeral joint can abduct and adduct on what planes?
Frontal Plane: Anteroposterior axis
Transverse plane: superoinferior axis
Oblique plane
On the mediolateral axis, the glenohumeral joint can do what movements?
Flexion
Extension
Hyperextension
Internal and external rotation and scaption can be done on what planes?
Transverse
Sagittal
What are the rotator cuff muscles?
Supraspinatus
Infraspinatus
Teres minor
Subscapularis
What is the main action of the supraspinatus muscle pertaining to the rotator cuff?
Stability and about the first 10% of abduction
What is the main action of the infraspinatus pertaining to the rotator cuff?
External rotation
What is the main action of the teres minor pertaining to the rotator cuff?
External rotation
What is the main action of the subscapularis pertaining to the rotator cuff?
Internal rotation
Sternoclavicular protraction (abduction) muscles are?
Pectoralis minor
Serratus anterior
Subclavius
Sternoclavicular retraction (adduction) muscles are?
Levator scapulae (weak)
Rhomboid major and minor
Trapezius (middle and inferior fibers)
Sternoclavicular elevation muscles are?
Levator scapulae
Rhomboid major and minor
Trapezius (Superior and middle fibers)
Sternoclavicular depression muscles are?
Pectoralis minor
Serratus anterior (weak)
Subclavius
Trapezius (inferior fibers)
Sternoclavicular upward rotation muscles are?
Serratus anterior
Trapezius (all fibers)
Sternoclavicular downward rotation muscles are?
Levator scapulae (weak)
Pectoralis minor
Rhomboid major and minor
Glenohumeral flexion muscles are?
Coracobrachialis
Deltoid (anterior)
Pectoralis major (clavicular head)
Glenohumeral extension (hyperextension) muscles are?
Deltoid (posterior)
Infraspinatus
Latissimus dorsi
Pectoralis major (sternal head, from flexion)
SUbscapularis
Teres major
Teres minor
Glenohumeral abduction muscles are?
Deltoid (all fibers)
Pectoralis major (Clavicular head)
Supraspinatus
Glenohumeral adduction muscles are?
Coracobrachialis
Latissimus dorsi
Pectoralis major (sternal head)
Subscapularis
Teres major
Glenohumeral external rotation muscles are?
Deltoid (posterior)
Infraspinatus
Teres minor
Glenohumeral internal rotation muscles are?
Deltoid (anterior)
Latissimus dorsi
Pectoralis major (both heads)
Subscapularis
Teres major
Glenohumeral horizontal abduction muscles are?
Deltoid (middle and posterior)
Infraspinatus
Latissimus dorsi
Pectoralis major (clavicular head)
Teres minor
Glenohumeral horizontal adduction muscles are?
Coracobrachialis
Deltoid (anterior)
Pectoralis major (both heads)
Glenohumeral diagonal abduction muscles are?
Deltoid (posterior)
Infraspinatus
Teres minor
Glenohumeral diagonal adduction muscles are?
Coracobrachialis
Deltoid (anterior)
Pectoralis major (both heads)
Elbow contact injuries are what percentage common?
67
When is a Tommy John Surgery needed?
Loosing of ligament
Partial tear
Bone breaks and ligament goes
Full rupture
Who has more elbow issues?
Males
What is tennis elbow?
Affects men and women equally
Known as lateral epicondylitis
Caused by repetitive motion to forearm muscles which attach to lateral elbow
From repetitive backhand swinging
Gets better on own with rest and ice
What are the bones of the humeroulnar joint?
Humerus
Radius
Ulna
What is the humerus of the humeroulnar joint?
Largest bone in upper arm
Features and interest:
Medial and lateral epicondyle
Radial fossa
Trochlea
Capitulum
Olecranon fossa
Coronoid fossa
What is the radius of the humeroulnar joint?
Lateral side of forearm
Head glides with capitulum of humerus
What is the ulna of the humeroulnar joint?
Medial side of forearm
Coronoid process
Olecranon process
Trochlear notch
Radial notch
The annular ligament is a common what in children with low muscle mass?
Dislocation
What are the elbow complex ligaments and tendons?
Articular capsule
Radial collateral ligament
Annular ligament
Biceps brachii tendons
Triceps brachii tendon
What is a Bursa sac?
Cushion like a pillow
Olecranon Bursitis: Swelling, redness, and pain at tip of elbow
What is the funny bone?
Ulnar nerve runs down the medial portion of the humerus and runs along the outside of the ulna
Most exposed nerve of the elbow joint
Hitting “funny bone” is squashing ulnar nerve against the medial condyle of the humerus
What is the humeroulnar joint?
True elbow joint
Humerus, radius, and ulna
Hinge joint
Can flex and extend
Can be all 3 planes depending on arm location
Proximal Radioulnar joint is made up of what bones?
Radius and ulna
What is the proximal radioulnar joint?
Primarily responsible for supination/pronation
Can happen in all 3 planes
Humeroulnar joint flexion muscles are?
Bicep brachii
Brachialis
Brachioradialis
Flexor carpi radialis
Palmaris longus
Flexor carpi ulnaris
Flexor digitorum superficialis
Extensor carpi radialis brevis
Extensor carpi radialis longus
Humeroulnar joint extension muscles are?
Triceps brachii
Anconeus
Extensor carpi ulnaris
Extensor digitorum
Extensor digitiminimi
Proximal Radioulnar joint supination muscles are?
Biceps brachii
Supinator
Brachiorradialis (from a pronated position)
Proximal radioulnar joint pronation muscles are?
Pronator teres
Pronator quadratus
Brachioradialis (from a supinated position)
How common is a wrist sprain?
Most common soft tissue injury
Can take 1 week up to several months to heal
About 25% of all sports injuries are hand and wrist
Who has more wrist problems?
Men
What is carpel tunnel syndrome?
Irritated or swollen ligaments across the carpel tunnel
Caused by repetitive movements putting pressure on the carpel tunnel
Lots of wrist flexion
From overuse
Rest and brace
Surgery if inflammation does not go away
Half of pregnant women get it
Transverse carpel ligament is the ligament responsible and operated on for carpel tunnel syndrome
What makes up the wrist and hand?
Distal radius
Distal Ulna (kinda)
8 carpel bones
5 “hand bones”
14 finger and thumb bones
What is the distal radius for the wrist and hand?
Styloid process
Lister’s tubercle
Ulnar notch
What is the distal ulnar for the wrist and hand?
Head
Styloid Process
Why are most measurements done on the right side of the body?
Most people are right handed
Consistency
Why is the scapholunate ligament most common ligament injury?
All weight is put onto it
What makes up the distal radial ulnar joint?
Ulnar
Radius
What makes up the radial carpal joint
Radius
Scaphoid
Lunate
What makes up the thumb joint?
Trapezium
First Metacarpal bone
What bone in the wrist (carpal bones) is the most fractured?
Scaphoid
Links the two rows of carpel bones
Prevents wrist from extending too far
What bone in the wrist (carpel bones) is the most dislocated?
Lunate
Has the least amount of ligament and muscle attachments
What is De Quervain’s Tenosynovitis?
Effects around 1% of individuals in the US
Can be from acute or chronic overuse stress
Direct impact to thumb/wrist
Sports that require a tight grip on an object
Individuals who lift young children (Mommy’s thumb)
Abductor pollicus longus and extensor pollicus brevis
What is the radiocarpal joint?
The wrist joint
Radius, scaphoid, lunate, and kinda ulna and triquetrum
Ulna and triquetrum (stability)
What is the distal radioulnar made of?
Radius and ulna
Very little movement
Mainly stability for wrist joint
Movements of the radiocarpal joint are?
Flexion and Extension (Sagittal plane & mediolateral axis)
Radial deviation (abduction) (Frontal plane & anteroposterior axis)
Ulnar deviation (adduction (Frontal plane & anteroposterior axis)
What is diabetic hand syndrome?
Diabetes can exacerbate or lead to
higher risk of limited joint mobility: hands don’t move properly
Dupuytren’s Disease: 3rd and 4th finger tendons thicken & genetic seizures
Trigger Finger: 1st and middle finger & inflammation tendon sheath
Carpel tunnel syndrome: inflammation
How do we assess function?
Kapandji Thumb opposition scale
What are the wrist and hand flexion muscles?
Flexor carpi radialis
Palmaris Longus
Flexor carpi ulnaris
Flexor digitorum superficialis
Flexor digitorum profundus
Flexor pollicis longus
What are the wrist and hand extension muscles?
Extensor carpi ulnaris
Extensor carpi radialis longus
Extensor carpi radialis brevis
Extensor digitorum
Extensor pollicis longus
Extensor pollicis brevis
Abductor pollicis longus
Extensor indicis
Extensor digiti minimi
What are the wrist and hand radial deviation (abduction) muscles?
Flexor carpi radialis
Flexor pollicis longus
Extensor carpi radialis longus
Extensor carpi radialis brevis
Extensor pollicis longus
Extensor pollicis brevis
Abductor pollicis longus
What are the wrist and hand ulnar deviation (adduction) muscles?
Flexor carpi ulnaris
Extensor carpi ulnaris
