GH Flashcards
shoulder girdle is made up of what 3 articulations
GH jt.
scapulothoracic articulation
Sternoclavicular jt
acromioclavicular jt.
AC joint classifications
amphiarthrodial and syndesmosis
arthrodial joint classification
plain jt
condyloid jt classification
ellipsoidal jt such as the knuckles
enarthrodial is also known as
ball and socket
ginglymus is also known as the
hinge joint, such as the elbow
sellar/saddle joint example
SC and thumb
Trochoid jt is also known as
pivot joint such as the radioulnar jt
GH joint classification
enarthrodial
what shoulder muscles insert onto the greater tubercle
supraspinatous
infraspinatous
teres minor
what muscle of the SITS insert on the lesser tubercle
subscapularis
head of the humerous faces ___ deg. superiorly
45
the head of the humerus faces ___ deg. posteriorly
30 to the coronal plane
when is the GH joint most stable
when the superior head contacts the fossa at a 90 deg abduction
most stable means the GH is what?
in closed packed position and ligaments are taught
the trade off for lack of greater deg. of motion is
lack of stability
what is the closed packed position of the GH?
full abduction and ER
what is the open packed position of the GH?
55 deg. of abd and 30 deg. horizontal adduction
AC and SC Jt. closed packed postion
90 deg. of arm abduction and elevation
AC and SC open packed position
at rest
Glenohumeral Fossa contains what to help with stability
the labrum
if glenoid labrum s injured what happens the the stability of the shoulder
it will decrease
what muscle tendon inserts onto the labrum
the long head of the biceps brachi
what is the # 1 joint of the body to dislocate
the GH
if supraspinatous mm. is injured what will happen to the subacromial outlet space
it will decrease in space
what are the boundaries of the Subacromial outlet space
head of the humerus , acromium, and the coracoacromial ligament
what is the movement of the GH joint in the z axis and coronal plane?
abduction and adduction
what is the movement of the GH joint in the sagittal plane in the X axis?
flexion and extension
what is the movement of the GH joint in the transvers plane and the Y axis
horizontal extension and flexion
shoulder ROM is dependent on the interaction between what structures?
thorax
scapula
humerus
clavical
AROM asses what
muscular, joint and ligament integrity
Passive ROM asses
ligament, joint, capsule integrity
RROM tests
muscular inegrity
isometric excercise means?
no change in angle
isotonic exercise means what?
change in angle
what is a grade 1 of a ligament tear?
slight tearing present
Grade 2 of ligament tear
partial tear with slight gapping
grade 3 of ligament tear
complete tearing of fibers with moderate gapping of the joint
sprain vs a strain
sprain is a ligament
while a strain is a muscle
what is a passive structure that is tested
cartilage
what is an active structure that is test for a Dx.
muscle
what is a bony structure that is tested for a Dx.?
joint
what are some causes of abnormal ROM?
alteration, adhesion, or damage to bone, ligaments or muscles.
pain
and
loss of nerve function
when is P. felt in AROM with arthritis?
at limit
when is P. felt in PROM with arthritis?
at the limit
when is P. felt in RROM with arthritis?
painless within limit
may be weak
when is P. felt in AROM with sprain?
decrease of movement due to P.
but if sprain is old there will be an increase in AROM
when is P. felt in PROM with sprain?
painful at stability change
when is P. felt in RROM with sprain?
Grade 1-2 has P
Grade 3 has no P but has weakness
when is P. felt in AROM with strain?
P at the midrange
when is P. felt in PROM with strain?
P only at the stretch/ end range
when is P. felt in RROM with strain?
painful and weak
if pt. comes in and they say that it hurt at first but not anymore what kind of injury does it indicate?
a sprain of a ligament
probably a grade 3
Degress of FLexion in the shoulder?
180
deg. of extension in the shoulder
50
reference position for flexion and extension of the shohlder
arm by side with thumb pointing forward
deg. of shoulder abduction
180
deg. of shoulder adduction
same as horizontal adduction
with AROM give the 3 phases of the shoulder abduction?
0-60 > GH
60-120 > GH +scapule motion
120-180 > GH + scap + spine
during flexion where does the humeral head go in regards to the ICR?
inferior
during axial rotation where is the ICR?
the middle
during abduction 0-50 deg. where is the ICR?
inferior medial aspect
during abduction 50-70/80 deg. where is the ICR?
superior portion of ICR
when should the humeral head drop superiorly to inferiorly during abduction?
between 80-90 deg. as it approaches horizontal
you do not want to loose more than how many mm in the subacromial outlet space?
1.5
which muscle of the shoulder is mostly responsible for the first motion of abduction and then which muscle takes over?
first he supraspinatus is responsible for abduction than it is the deltoid.
specifically the posterior deltoid
reference position for abduction and adduction?
thumb should be pointing to the side away from you with arm to the side of your body
the deg. of IR for the GH?
45
the deg. of ER for GH?
100-110 with regular reference point
start position for IR
elbow flexed at 90 and arm abducted at 90 with palm down
start positions for ER
same as IR
OR
start with thumb up and elbow flexed at 90 deg. and reference point
with the law if inverse muscular action what is being said
with elbow at the side of the body the ligament become taught leading to a decrease in ER
reference point for horizontal movement?
arm abducted and palm up
deg of horizontal flex/add
140
deg of horizontal ext/abd
30
what motion of the GH uses maximal range within 3 axes?
circumduction
if painful arc is in sagittal place what muscle is responsible
biceps brachi
if painful arc is in the coronal plane what muscle is injurred?
suraspinatus
if pt. has P. at end range of in coronal plane what should you inspect further??
the AC joint
where should N soft tissue aprox. occur?
horizontal flexion
when should you feel capsuler end feel of the shoulder?
ER
when should you feel a boney end feel in the shoulder?
at abduction
where do the GH ligaments attach to?
lesser tubercle
when do the GH ligaments become taught?
with ER
superior GHL is tight when and resrains what kind of dislocation?
adduction is when the superior is tight and it prevents inferior dislocation
the middle GHL is tight when? and resrains what kind of dislocation
abduction
anterior dislocation
inferior GHL is taught when?
the inferior prevents what kind of dislocation?
taught in abduction and prevents anterior inferior dislocation
anterior inferior dislocation is also known as
subcoracoid dislocation
is the inferior GHL more loose in reference position of scapular?
scapular
which ligament sits on top of the bicep tendon?
the coracohumeral lig.
the anterior band of the coracohumeral L. attaches where?
lesser tubercle
when is the anterior band of the coracohumeral L taught
extension at 30
where does the posterio band of the coracohumeral band insert?
the greater tubercle
when does the posterior band of the coracohumeral band become taught?
in 60-70 deg. of flexion
which of the coracohumeral bands prevents the long head of the biceps subluxation medially?
the posterior
the coracoacromial lig. forms what?
acromial arch
common injuries to subacromial outlet
shoulder impingment
RTC syndrome
and jumping shoulder
Jumping should indicates what has happened?
tear of the labrum
definition of instability
functional complaint that occurs in an individual with or without laxity of lig.
definition of laxity
looseness secondary to repetitive, overstretching, traumatic over-stretching or genetics
what does the concavity of the GH have to do with shoulder motion?
degree of translation in the GH, and ligamentous integrity
what is the foramen of weitbretch
between the superior and medial ligaments
what is the rouviere
between the medial and inferior lig.
what is beightons?
tests for hypermobility: thumb --> forearm pinky --> extend beyond 90 elbow hyperextended genu recovatum palms touch floor with forward flexion
if a Pt. has 4+ in Beightons tests what does that indicate?
hypermobility
AMBRI stands for
atraumatic multidirectional bilateral rehab helps inferior capsule stabilized
TUBS stands for
traumatice
unilateral
bankart lesion - ant –> inferior
surgical
does the long head of biceps tendon lie under of above the labrum?
above
what pushes the humeral head against the cavity during abduction
the tendon of the long head of biceps
if the long head of biceps ruptures what will occur?
20% drop in abduction strength
when if the GH most efficient?
when GH is in slight abduction and external rotation / scaption
when the bicipital groove slip what direction does it go?
toward the angle of the lesser tubercle wall
when transverse ligament is torn what happens?
the bicep tendon will slip
to help slipped tendon which direction should you pull it?
the opposite way of slippage
what are some labral tears?
SLAP
BANKHART
bennet
SLAP tear stand for what
superior labral tear going A–>P
when does a SLAP occur?
with violent concentric contraction of eccentric contraction.
Bankhart lesion is what kind of tear>
anterior to inferior
Bennet is what kind of tear
2ry to a deceleration arm
subacromial bursa sits between what 2 muscles?
deltoid and the supraspinatus
what is the most common shoulder injury with throwing sport?
GIRD
what does GIRD stand for>
GH internal rotation def.
to DX. GIRD what do you do?
compare the IR and ER on each side and if there is a 10% difference than there is GIRD present
freezing stage of froozen shoulder is also known as
adhesive capsulitis
the frozen stage of frozen shoulder can last how long?
6 mos
thawing stage of frozen shoulder can last how long?
1 y
Pt. with frozen shoulder will present how?
with a decrease in external rotation and secondary abduction by 25%
