Final - Shoulder Flashcards
3 bones of the shoulder
clavicle, scapula, humerus
4 joints of the shoulder
sternoclavicular
acromioclavicular
glenohumeral
scapulothoracic
clavicle - 3
slender s that limits shock to upper limb - distal part is the weakest (where it changes shape - #)
from sternum to acromion process
support ant aspect of shoulder
shoulder separation or SC SS - 3
MOI
ladder, cant abduct arm or move shoulder around
shoved into boards or fall
tests for shoulder seperation - 3
percussion, TOP, indirect pressure
scapula - 2
prominent projects - 3
fossas - 2
function
flat triangle - articular surface of humerus in glenoid fossa)
acromion, spine, coracoid process
infraspinatus and supraspinatus
site of attachment for muslces that move the shoulder - little midgits pulling on a floating iceberg
scapular resting position - 6
arms at side, overlies ribs 2-7, vertebral border 2" lat to thoracic spinous processes, sup angle approx even with T1-T2 spine - T3 inf angle - T7/8
humeral head
spherical in glenoid fossa
humeral tuberosities
greater - lateal
lesser - medial
form bicipital groove for biceps tendon
sternoclavicular joint
plane joint formed by the larger medial end of clavicle that articulates with the manubrium of the sternum - compressed in dogpiles and strength depends on the lig
articular disc - 3
improves contact area on bony ends, enhances joint stability, prevent dislocation of clavicle
sternoclavicular lig - 3
ant SC lig
pos SC lig - reinforce ant and pos aspect of capsule
costoclavicular ligs - 2
inf surface of clavicle to sup surface of first rib - limit for elevation of pectoral girdle
interclavicular lig
attaches both clavicles across manubrium - strengthen sup capsule
AC joint
plane/gliding jt
clavicle and acromion that is covered by fibrocarilage
ac lig - 3
ac lig - reinforce sup aspect
cc lig - trapezoid and conoid
scapulothoracic jt - 3
not a true jt - shoulder blade on your rib cage
enables shoulder to function correctly
scapula and thoracic wall
larger shoulder blade
more force
3 types of movement of scapulothoracic jt
elevation/depression
protraction/retraction
lat/med rotation
glenohumeral jt - 6
synovial - ball and socket - multi axial
most movable jt in the body
active restraints of rotator cuff and deltoid, passive restraint of ligs and labrum
humeral head and glenoid fossa of scapula full with hyaline cartilage
incongruent becuase the head is too large
glenoid labrum
continuous with jt capsule
fibrocartilage ring
deepens the fossa and increases contact surface area and stability by 50%
purpose of lats and pec
movers of your arm - not biomechanically made to stablize your shoulder
ligs strengthening the ant capsule - 3
sup, mid and inf glenohumeral lig
ligs strengthening the sup capsule
coracohumeral lig
coracoacromial arch
prominent diseases - 5
coracoid process, acromion and coracoacromial lig
- impingement and tendinitis - cant lift it above your head
overlies the humeral head and limit the sup displacement of humerus, supraspinatus tendon passes through arch
External rotator cuff muscles
supraspinatus - from supraspinous fossa to greater tuberosity of humerus - abduction
infraspinatus - infraspinous process to greater tuberosity
teres minor - lateral border of scap to greater tuberosity
to avoid shoulder problems if you work out
stabilize your scapula before you start
subscapularis
subscapular fossa to lesser tuberosity - internal rotation
serratus ant
inside of ribcase ribs 2-9 and goes to medial border of scap - push up with a plus , scapula protraction, rotation and stabilize scap against thorax when pushing
weakness - scapular winging
rhomboids (maj and min)
spinous process of c7-t5 to medial border of scap from inf angle - scapular retraction and stabilize scap on thoracic wall, downward rotation
weakness - scap winging
thumbs down reverse fly would test
rhomboids
thumbs up reverse fly would test
middle trap
who does the rhomboids work against
serratus ant
levator scapulae
transverse process of V1-4 to sup angle and med border of scap - elevates scap and extend head
cervical genic headache
when you are typing all the time - tight levator scapulae, stretch - flex head and side flex
trapezius
from occipital bone and lig nuchae and spinous processes of c7-12 to lat clavicle and spine of scap
upper fibers - scap elevation, lower fibres - scap depression and external lat rotation, all retract scap
pec minor
ant rib 3-5 to coracoid
protraction, depression, and downward rotation
under the pec, ant and pos tilt
release by foam rolls
how many muscles in the ST jt
5
history of pain
activity level, contractile tissue? referred pain? chronic vs acute
observation
resting posistion protracted? tilted? angulation in unilateral athlete
all the movements of the shoulder
flex/ext, int/ex rotate, ad/adduction, elevation/depression, retraction/protraction
functional movement of the shoulder
buckling - horizontal adduction
3 ways to test strength
bilateral, isometrically and functionally
apprehension test
dislocation/subluxation
abduct 90 degree flexed arm 90 degrees then gentaly externall rotate
- pos - spasm and tense up, apprehensive and watch for facial expressions - joint structure test for labral tear
relocation
apprehensive in apprehensive test - push humeral back
pos - apprehension improved
sulcus sign
GH instability
seated and grab the elbow and pull down
pos - depression under acromion for inf stability of labrum
load and shift
ant shoulder instability
grab head ant and pos - push into glenoid fossa and push ant or pos - >25% movement is bad
neers
shoulder impingement
passively internally rotate and flex
pos - pain at end ROM
ramming it into acromion
hawkins kennedy
shoulder impingement
passively flexed to 90 and internally rotated
pos - pain at end range/with rotation
painful arc
shoulder impingement
supraspinatus, subacromial bursa
raise arm into full abduction
pos - pain between 45-120 and 170-180
empty can
supraspinatus
90 degree forward flexion and 30 degree adduction then internally rotated with slight downward pressure
pos - weakness and pain
supraspinatus vs delt
externally rotate and primary abduction until delt kicks in
scaption
30 degrees, where scap is sitting on your rib cage
drop arm test
RC (supraspinatus) tendon tear (punching and catching)
abduct arm to 90 degrees - slowly lower
pos - drop and sharp pain
why do we want to drop the arm?
delt will hold the arm in place
lift off
subscapularis muslce
internal rotation - hand behind back and lift off against resistance
pos - weakness and unble
door open test
SIT
external rotation
pos - cant
speeds
long head of bicep/suspect rotator tendon
palpate bicipital groove - internal and external rotation
resisted supinated straight arm flexion
pos - pain over biceps tendon and weakness
if your humerus constantly subluxes
long head of biceps starts to act as a lig and works too hard - wear out as a pulley
sheer/AC compression test
fallen or jammed - AC stability/sprain should separation - cant sleep on your side or back
put palm at distal end clavicle with finders interlocked on top
pos - pain and laxity
AC cross over test
AC stability/sprain shoulder separation
lift arm and horizontally adduct
pos - pain with movement and unable to perform
hit the boards with their left shoulder, roll inward forcing his arm into cross flexion - pain on sup aspect of shoulder
AC jt sprain
AC joint sprain MOI S&S G1 G2 G3 management rehab
acromion goes down, back or inward and clavicle pushed against rib cage - foosh, landing on lat aspect of shoulder
step deformity
point tenderness and discomfort with movement of tip of clavicle/acromion, no deformity
tearing of AC and CC lig, slight prominence of clavicle, lose abduction, and pt tender
complete rupture of AC and CC, prominence of distal clavicle, more pain and loss of function
PIER, sling, MD for #, tape it down for healing by primary intention - scar in 3-5 days
jt ROM, stability, strength,
trips and grabs onto rail, forcing his arm into hyperextension and rotation, - come to you supporting it and cant move
glenohumeral dislocation
glenohumeral dislocation MOI S&S Management rehab
impact with shoulder abducted, externally rotate and extend, most often ant and downward - high chance of reoccurance - hitting someone about to throw a football
flatten delt contour
palpate axilla for prominence of humeral head
loss of function, ROM and pain
towel under arm and longitudinal traction
conservative
MD for reduction
PIER and sling
restore ROM, stability and strength
tape/brace for RTP
ROM - isometric scapular stability
instability of GH jt MOI SS management rehab
chronic instability of shoulder after recurrent subluxation/dislocation traumatic/congenital/repetitive overuse ant/pos instability or multidirectional pain, clicking, weakness, increased motion of humeral head, avoidance of positions due to pain/apprehension, impingement of rotator cuff because of poor stability conservative then surgical strengthen RC - sup, ant and pos strengthen scapular stabilization muslces and proprioception of the should - open and closed kinetic chain exercises - one hand on the mirror or hands and knees on a table cloth and slide - no pattern play with speeds
Sports for ppl with GH instability
no throwing sports, not biomechanically great
rotator cuff tear
MOI - 4
management
rehab
overuse or acute
poor blood supply - not adequate healing
begin with microtearing and impingement
older pop
pain, weakness, loss of ROM, partial can move with pain, full tear not normal ROM
vague pain in area and catching when arm is moved, cant sleep on the affected side
PIER, correct mechanics (muscle imbalance), prop up to 30 degress to give it room to heal
conservative
stretching to maintain and improve ROM, scap stabilization, strengthen, may be surgery.
chronic shoulder pain - progressively worse with overhead strokes
shoulder impingement syndrome
shoulder impingement syndrome MOI S&S Management Rehab
repetitive overhead - swimming, tennis, postural abnormalities, loss of scap control, mechanical compression of bursa, supraspinatus of biceps tendon under coracoacromial arch - irritation and inflammation
generalized aching with abduction and flexion, pos painful arc and impingement
tender over RC tendons, decreased strength with resisted muscle testing
flexibility and rest
strengthen RC - below 90 degrees then progress to overhead, PIER
increase weight for bicep curls, snap in front of shoulder, unable to lift, flatten bicpes muslce
biceps brachii rupture
Biceps rupture
MOI
S&S
management
powerful concentric/eccentric contraction, often near the origin in the groove but can happen at distal end
audible snap and intense pain, weakness with elbow flexion and resisted biceps
PIER, sling, MD? surgery?
fit 40 yr judo with worsening shoulder pain - known history of RC tear, no new trauma, constant pain, full strength but poor ROM
adhesive capsulitis - frozen shoulder
painful restriction of GH due to thickening and contracture of capsule
adhesive capsulitis
MOI
S&S
management
no exact, may be synovial inflammation causing pain and disuse, >40yr, shoulder immob increase risk, diabetes, hyperthyroidism, hypertriglyceridemia increases risk
progressive onset, worse with movement and at night, decrease ROM
aggresive stretching and manipulation - cortisone may feel good but not in the long run
jump to side with arms outstretched, lands hard on arm, immediate pain and hold on to support
clavicle fracture
clavicle fracture MOI S&S management rehab
FOOSH, fall on tip of shoulder or direct impact
support arm at the elbow, deformity, pain, swelling
sling up to 8 weeks, xrays
ROM, strength, surgery?
