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Extremity Biomechanics > final- Shoulder > Flashcards

final- Shoulder Flashcards

1
Q

What 4 joints contribute to the shoulder complex?

What are other contributors?

A

Glenohumoral
Acromioclavicular
Sternoclavicular
Scapulocostal

  • costosternal
  • costochonral
  • costotransverse
  • costovertebral
  • suprahumeral
  • Cox, Tex, Lx intervertebral
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2
Q

What is the most complex joint in the body?

A

Glenohumoral

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3
Q

Which joint has the greatest freedom range

A

Glenohumoral (ball and socket)

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4
Q

What are the 7 major movements of the glenohumoral joint?

A
  • Flexion
  • Extension
  • Adduction
  • Abduction
  • Internal Rotation
  • External Rotation
  • Circumduction
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5
Q

What makes the glenoid fossa less stable? 3

A
  • shallow
  • much smaller than the humeral head
  • anteverted (tilted slightly anterior)
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6
Q

What is the lip of the glenoid labrum composed of? What % of depth does it account for?

A

Fibrocartilage

50%

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7
Q

The tendon of the long head of the biceps attaches to which part of the glenoid labrum? What also attaches there?

A
  • Superior part

- rotator cuff

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8
Q

What is a SLAP lesion?

A
  • superior labrum anterior-posterior lesion

- often due to repetitive use

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9
Q

What is Bankart lesion?

A
  • anterior-inferior detachment

- Often due to dislocation

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10
Q

Which is more common, SLAP or Bankart?

A

SLAP

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11
Q

What are the 4 common causes of labral damage?

A
  • repetitive overuse (SLAP)
  • hypermobility
  • instability
  • dislocation (Bankart)
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12
Q

The humeral head faces _________ and _______. It is retroverted __degrees?

A

Medially and superiorly

30 degrees

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13
Q

Is the joint capsule (strong/weak) for the following:

  • anteriorly
  • inferiorly
  • posteriorly
A
  • strong
  • strong
  • weak
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14
Q

What are the 4 major ligaments of the anterior capsule? What is their function

A
  • coracohumeral
  • superior GH
  • middle GH
  • inferior GH
  • maintain a (-) intra-articular pressure and help resist external rotation and extension (throwing/reaching back) (i.e. anterior translation of the shoulder)
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15
Q

Which anterior capsule ligament is the most important with arm abducted >90 degrees?

A

Inferior GH

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16
Q

What does the coracoid-humeral ligament resist?

A

Distraction and inferior translation

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17
Q

What does the superior GH ligament resist?

A

Main restraint to discretion and external rotation

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18
Q

What does the middle GH ligament resist?

A

Distraction and external rotation

- especially with arm abducted 45-60 degrees

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19
Q

What does the inferior GH ligament resist?

A
  • resists Inferior glide and P-A translation

* Most important ligament with arm abducted >90 degrees

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20
Q

What do the axillary folds resist?

Increased laxity = (increased/decreased) dislocations

Decreased laxity = (increased/decreased) TOM

A

-extremes of internal and external rotation

  • increased dislocation
  • decreased ROM (adhesive capsulitis)
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21
Q

What are the primary stabilizers? 3

A
  • coracoid-humeral ligament
  • superior GH ligament
  • tendon of the supraspinatus

All three result in a compressive locking force into the glenoid fossa

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22
Q

What are the secondary stabilizers?

A

Rotator cuff

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23
Q

What are the most vulnerable positions to dislocation?

A
  • abduction and external rotation with a P-A force

OR

  • falling on outstretched hand (FOOSH) injury
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24
Q

Most dislocations are (anterior/posterior)

A

Anterior

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25
Q

What are the 4 rotator cuff muscles?

A
  • supraspinatus
  • infraspinatus
  • teres minor
  • subscapularis
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26
Q

What are the two regions of the capsule not covered by the cuff?

A
  • inferior portion

- rotator interval

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27
Q

Which tendons is the rotator interval between?

A

supraspinatus and subscapularis

*common site for anterior dislocation

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28
Q

Where is the site of impingement? It includes (superior/inferior) role and (superior/inferior) slide?

A

Subacromial space (Supra,biceps, bursa) at 80-120 degrees

  • superior roll
  • inferior slide
29
Q

What increases impingement?

A
  • IR and adduction (especially above 90)
  • superior translation
  • hypertonic deltoids, internal rotators and abductors
  • increased Thx kyphosis
  • anterior head carriage
  • shoulder hiking
30
Q

What factors decrease impingement?

A
  • ER
  • inferior translation
  • increased rotator cuff (especially external rotators)
31
Q

The AC joint starts as a _________, then becomes a meniscus by age 20 and appears degenerated by age 20-30

A

Fibrocartilagenous symphysis

32
Q

What is the most important AC joint ligament?

A

Coracoclavicular (conoid, trapezoid)

33
Q

T/F the AC joint resists distraction?

A

T

34
Q

What causes distraction at the AC joint?

A
  • abduction
  • flexion
  • ER
  • lifting (i.e. suitcase)
  • pull-up or chin-up
35
Q

What causes Compression at the AC joint?

A
  • horizontal adduction
  • pushing
  • pulling (@ 90 degrees)
36
Q

Which joint is smaller and more prone to dislocation, the AC or SC?

A

AC

37
Q

What type cartilage is the SC?

A

Fibrocartilagenous

38
Q

Which joint links the appendicular skeleton to the axial skeleton?

A

SC

*firmly attached but considerable ROM

39
Q

The anterior fibers of the costoclavicular ligament of SC joint resists? 4

A
  • *distraction
  • elevation
  • *external rotation
  • depression
40
Q

The posterior fibers of the costoclavicular ligament of SC joint resists? 4

A
  • *compression
  • elevation
  • *internal rotation
  • depression
41
Q

At what degrees do the three phases of scapulohumeral rhythm occur?

A

Phase 1 = 0-30
Phase 2 = 30-90
Phase 3 = 90-180

42
Q

The humerus at the GH it accounts for ___ degrees

A

120

43
Q

The scapula accounts for __ degrees

A

60

44
Q

The clavicle at the SC joint accounts for __ degrees

A

25 elevation and 25 posterior rotation

45
Q

The acromian at the AC joint accounts for ___ degrees of upward rotation of the distal clavicle

A

35

46
Q

The total motion of the shoulder is ____ degrees. The GH joint accounts for / and / involves the shoulder girdle

A

180
2/3
1/3

47
Q

In phase 1 of scapulohumeral rhythm, the GH:Scapula ratio is : and has ____ roll and ____ slide

A

7:1

Superior roll, inferior slide

48
Q

What muscles initiate abduction in phase 1

A

Glenohumoral (supraspinatus and deltoid) & Girdle (serratus anterior and traps)

49
Q

T/F you want a lot of help from upper traps in phase 1

A

F - don’t want too much upper trap activity. Premature, excessive or uneven hiking can lead to impingement

50
Q

In phase 1, the SC oint in responsible for (3 things) and the AC joint is responsible for (1 thing)

A
  • begins distal elevation, superior roll, inferior slide

- begins initial rotation

51
Q

T/F the price movers of the GH joint are the same for phase 1 and phase 2

A

T

Biceps also helps to abduct and depress humerus and the rotator cuff depresses/counteracts deltoid muscles

52
Q

Maximum impingement in phase 2 occurs at ____ degrees

A

80-120

53
Q

The scapula moves and additional ___ degrees in phase 2

A

20-25

54
Q

T/F the upper traps are more involved in phase 2 than phase 1

A

T - still, too much elevation is bad causing impingement

55
Q

In phase 2, the SC joint accounts for (2 things) and the AC joint (1 things)

A
  • additional elevation, same superior roll and inferior slide
  • additional external rotation
56
Q

Lack of SC motion may lead to what?

A

Increased motion and wear and tear on the AC joint

57
Q

In phase 3, the GH joint has an additional ___ degrees of motion. ___ total

A

60

120

58
Q

T/F the GH joint has the same kinematic and prime movers in phase 3 as the other phases

A

T

59
Q

In phase 3, impingement is still a problem at _____ degrees and again at 180

A

80-120

60
Q

In phase 3, the posterior capsule is reinforced by what muscle?

A

Triceps long head

*if the triceps is to tight it causes abnormal movement

61
Q

In phase 3, the scapula experiences and additional ____ degrees of movement. ___ total

A

30

60

62
Q

T/F the scapula has different kinematic and muscles acting on it in phase 3 as compared to previous phases?

A

F - same

63
Q

T/F upper traps is more active in phase 3

A

T

64
Q

What is the different kinematic of the SC joint in phase 3?

A

More external rotation instead of roll/slide at GH abduction end range

65
Q

In phase 3, what is the most important stabilizer of the scapula?

A

Serratus anterior

66
Q

How does the pec minor stabilize the scap/

A

Draws it inferior and anteriorly

67
Q

What are tight adductors that can limit abduction of the shoulder?

A

GH (last, teres Major, pec major, subscapularis)

Girdle (rhomboids, traps, pec minor)

68
Q

What are the tight internal rotators the limit abduction of the shoulder?

A

GH (lasts, pec major, teres major, subscapularis)

Girdle (last, pec minor, rhomboids)

Extremity Biomechanics (9 decks)

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