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Orthopedic Impairments & Therapeutic Exercise > Final Learning Objectives > Flashcards

Final Learning Objectives Flashcards

1
Q

Shoulder Girdle

A
  • AC joint → gliding joint
  • SC joint → saddle joint
  • Scapulothoracic interface → not classified as a joint, but the movement is vitally important for normal shoulder ROM
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2
Q

Shoulder Joint

A

Glenohumeral

  • Glenoid fossa and humeral head
  • Ball-in-socket
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3
Q

The Shoulder Capsule

A
  • Capsule is ~2x larger than the humeral head
  • Inferior portion is the weakest and is stretched out in order to stretch over the humeral head in full abduction or flexion
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4
Q

Glenohumeral Ligaments

A
  • Superior Glenohumeral Ligament
  • Middle Glenohumeral Ligament
  • Inferior Glenohumeral Ligament
  • Inferior band has to give out for a dislocation to occur
  • 3 of the 4 bands are anterior and help limit ER and create more anterior stability
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5
Q

Superior Glenohumeral Ligament

A

Resists inferior translation when the arm is hanging or adducted

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6
Q

Middle Glenohumeral Ligament

A
  • Some help with inferior translation when the arm is adducted
  • Helps resist anterior translation (max effect is at about 45 degrees of abduction)
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7
Q

Inferior Glenohumeral Ligament

A
  • Anterior Band
  • Posterior Band
  • Anterior stabilization in 90 degree abduction
  • Tightens when the arm is abducted and externally rotated and cradles inferior head
  • This is theorized to also add to the posterior/superior shift of the humeral head in throwing
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8
Q

When would the superior glenohumeral ligament tighten more than the others?

A

-

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9
Q

Movements of the scapula

A
  • Elevation/depression
  • Abduction/adduction (protraction/retraction)
  • Upward/Downward rotation
  • Tipping
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10
Q

Scapular Elevation/Depression

A

10-12 cm

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11
Q

Protraction/Retraction

A

15 cm

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12
Q

Rotation

A

60 degrees

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13
Q

Tipping

A
  • The scapula tilts forward around a frontal axis as it reaches the top of elevation
  • Occurs due to the natural curvature in the spine and rib cage
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14
Q

Resting Position of the Scapula

A
  • Between the 2nd through 7th ribs
  • 2 inches from the midline
  • Does not lie in the frontal plane (Wings 30-45 degrees towards sagittal)
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15
Q

Winging

A

When the scapula moves around the thorax

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16
Q

Abnormal Winging

A
  • When the vertebral border moves posteriorly away from the wall of the thorax
  • Usually caused by a problem with the long thoracic nerve
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17
Q

What ligaments restrict movement at the SC and make it so stable?

A
  • Interclavicular ligament restricts superior movement
  • Anterior/Posterior sternoclavicular ligament restrict anterior, posterior, and inferior movement
  • It’s capsular reinforced
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18
Q

Ligament components of the AC joint

A

-

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19
Q

Grades of Joint Separation

A
  • 1 → damage to AC joint capsule and ligament
  • 2 → joint capsule and trapezoid ligament
  • 3 → joint capsule, trapezoid, and conoid ligament damage
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20
Q

What makes up the coracoacromial arch?

A
  • Includes the anterior acromion, coracoacromial ligament and coracoid process
  • Prevents superior dislocation
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21
Q

What is the labrum?

A

A fibrocartilaginous rim that helps to deepen the glenoid

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22
Q

Glenohumeral Labrum

A
  • Almost triangular in shape and the bottom portion is firmly attached to the underlying bone
  • The top portion has variable attachments, but is loosely connected
  • The superior portion is attached to the biceps tendon (long head) as it connects at the supraglenoid tubercle
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23
Q

Changes in depth due to labrum

A
  • Increases depth to 5 mm Ant/Post
  • Increases depth to 9 mm Sup/Inf
  • Depth is only 2.5 mm without the labrum
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24
Q

Deltoid

A

shoulder flexion, abduction, extension

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25
Q

Trapezius

A

scapular elevation

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26
Q

Supraspinatus

A

shoulder abduction

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27
Q

Infraspinatus

A

external rotation

28
Q

Teres minor

A

external rotation

29
Q

Teres major

A

internal rotation

30
Q

Subscapularis

A

internal rotation

31
Q

Serratus Anterior

A

scapular protraction

32
Q

Latissimus Dorsi

A

adduction

33
Q

Rhomboids

A

scapular retraction

34
Q

Pectoralis minor

A

scapular depression

35
Q

Coracobrachialis

A

shoulder flexion

36
Q

Biceps (long head)

A

elbow flexion

37
Q

Biceps (short head)

A

elbow flexion

38
Q

Triceps (long head)

A

elbow extension

39
Q

Levator Scapulae

A

scapular elevation

40
Q

Omohyoid (inferior belly)

A

-

41
Q

Clavicle Movement

A 
Elevation/Depression
- Elevation → 45 degrees
- Depression → 5-15 degrees
Pro/Retraction
- 15 degrees
Rotation
- 30-45 (posterior only)
- The only time it moves anteriorly is to return to its resting position
42
Q

Muscles of the Rotator Cuff

A
  • Supraspinatus
  • Ingraspinatus
  • Teres minor
  • Subscapularis
43
Q

Insertions of the Rotator Cuff Muscles

A

Greater Tubercle
- SIT
Lesser Tubercle
- Subscapularis

44
Q

Primary Forces of the Rotator Cuff and Shoulder Stability

A
  • Rotator cuff helps offset the superior (or positive) pull of the deltoid
  • Helps strengthen joint capsule and thus, indirectly help strengthen anterior and posterior capsular stability
  • All the rotator cuff muscles help compress the humeral head into the glenoid
45
Q

Rotator Cuff Test- Supraspinatus

A

Full can (80 degrees of flexion w/ horizontal abduction 30 degrees) with resistance against flexion

46
Q

Rotator Cuff Test- Infraspinatus and Teres Minor

A

0 degrees abduction with arm in 45 degrees of internal rotation with resistance against external rotation

47
Q

Rotator Cuff Test- Subscapularis Lower Fibers

A
  • Lift off test

- Resistance to internal rotation with GH joint in extension and adduction with the hand behind the back.

48
Q

Rotator Cuff Test- Subscapularis Upper Fibers

A
  • Abdominal push test

- Patient pushes hand into abdomen. Look for humeral internal rotation. Substitution is humeral extension

49
Q

Rotator Cuff Test- Sulcus Test

A
  • Tests for inferior stability of the GH joint
  • Positive test indicates laxity of the superior and middle glenohumeral and coracohumeral ligaments
  • Positive when the sulcus below the acromion process is >1 fingers width
  • Often present in patients with multidirectional instability
50
Q

Hawkins and Kennedy Impingement Test

A
  • Arm and elbow is flexed to 90 degrees, then forcibly internally rotated
  • A positive test is pain and apprehension secondary to the rotator cuff tissues being impinged between the greater tubercle and coracoacromial arch
51
Q

Clancy Impingement Test

A
  • Arm abducted and elbow flexed 90 degrees
  • Arm is adducted horizontally while internally rotating the arm and maintaining 90 degrees flexion
  • A positive test is pain and apprehension as rotator cuff is impinged against the mid to anterior third of the acromion and the coracoacromial ligament
52
Q

Neer and Walsh Impingement Test

A
  • Arm is forcefully flexed causing a jamming of the greater tubercle against the anterior inferior acromial surface
  • A positive test is pain, discomfort and/or apprehension secondary to a supraspinatus and/or biceps tendon pathology
53
Q

External Impingement

A
  • Common in general population
  • Soft tissue is being pinched b/t the humerus and the acromion
  • Includes tissue that is “external” to the capsule
54
Q

Internal Impingement

A
  • Pinching the rotator cuff tendons on the posterior glenoid within the capsule
  • More common in throwers
55
Q

SLAP Lesion

A
  • SLAP Lesion = Superior Labral Anterior-Posterior Lesion

- It is a tear in the superior aspect of the labrum and is commonly associated with undersurface rotator cuff tears

56
Q

Type I SLAP Lesion

A
  • Fraying and degeneration of the superior labrum, normal biceps
  • Most common type of SLAP tear
  • Often associated with rotator cuff tears
  • These are treated w/ debridement
57
Q

Type II SLAP Lesion

A
  • Detachment of the superior labrum and biceps insertion from the supraglenoid tubercle
  • When traction is applied to the biceps, the labrum arches away from the glenoid
  • Typically the superior and middle glenohumeral ligaments are unstable
  • May resemble a normal variant
58
Q

Subtypes of Type II SLAP Lesions

A
  • Anterior
  • Posterior
  • Combined anteroposterior
59
Q

Type III SLAP Lesion

A
  • Bucket handle type tear

- Biceps anchor is intact

60
Q

Type IV SLAP Lesion

A
  • Vertical tear (bucket-handle tear) of the superior labrum, which extends into biceps
  • May be treated w/ biceps tenodesis if more than 50% of the biceps tendon is involved
61
Q

Biceps Tenodesis

A

Involves detaching the LHB from its superior labrum in the shoulder and reattached to the humerus bone just below the shoulder

62
Q

What kind of lesion is more common in the general population?

A

-

63
Q

What kind of lesion is more common in the throwers?

A

Type II

64
Q

What happens to the angle of torsion for people who throw a lot or have grown up and continue to pitch?

A

-

65
Q

Baseball stuff…

A

-

Orthopedic Impairments & Therapeutic Exercise (17 decks)

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