Glenohumeral joint Flashcards
what is the glenohumeral complex a balance of
osseous and myo-kinetic chain
How many cc’s of fluid can the GH capsule hold
30
How many cc’s of fluid is normally in the GH capsule
.5-1.5
What type of disc is the sternoclavicular joint
bilaminar joint
True/False: The sternoclavicular joint is NOT well anchored.
False: it IS well anchored
ROM degrees for sternoclavicular joint elevation
4-60 degrees
ROM degrees for sternoclavicular joint depression
5-15 degrees
ROM degrees for sternoclavicular protraction and retraction
15 degrees
ROM degrees for sternoclavicular rotation
30-50 degrees
what are the three directions of separation for the s/c joint
superior
inferior
anterior
why doesn’t the s/c joint separate posterior
because 1st and 2nd ribs are behind it
if the s/c joint moves posterior what do you do
call 911 could potentially occlude carotid or jugular arteries/veins
what is the most common direction of s/c joint separation
anterior and superior
how do you check the s/c PMC muscle test
stress the joint by having the patient do a pushup or a throwing maneuver to see if the joint is stable
if the s/c joint is stable what are the recommendations
tape 6 weeks to 3 months
if the s/c joint is x-rayed, what should the post look like
should be less than 5 mm height difference
if the s/c joint is not better within 6 weeks what should you do
refer out
how was the acromioclavicular joint designed
designed to move in concert with the S/C joint
what holds the a/c joint
conoid/trapezoid ligaments
within the a/c joint, which ligament is often “released” in “decompression”
coracoacromial
on x-ray, what should the coracoid to clavicle distance be
1.1-1.3 cm
on x-ray, if a/c space is greater than 1.3 cm this indicates
coracoclavicular ligamentous disurption
when the A/c joint separates and the clavicle lifts up from the acromial process is known as what sign
horizon sign
what is occurring within the biomechanics when a horizon sign is present
the scapula drops inferior to give the appearance of a raised clavicle
what is the MOI for an a/c separation
FOOSH injury and direct and indirect trauma to the joint
how would you take an x-ray of the a/c joint
a-p view
10 lb bag hanging in the hand of the involved arm
central ray through the coracoid process
what indicates an a/c separation being a grad 2 or 3
seeing superior displacement of the clavicle at the acromion process on an x-ray
when the pt reaches over to the opposite shoulder with the involved are and experiences pain or discomfort in the shoulder
indicates a/c joint pathology
- this compresses the a/c joint
- known as cross over maneuver
what are the rehabilitation recommendations for an a/c joint separation
functional taping of an a/c separation of grade 2 or 3
- elastic tape for 6 weeks
- avoid lifting elbow above the shoulder level as this creates too much motion within the a/c joint
what is the efficiency of the g/h joint dependent on
scapular position
what does PICR stand for
path of instant center of rotation
when is the rotator cuff overloaded
when the scapula is inefficient
what is the scapulothoracic ratio in translation
2:1
3 phases with different ratios
80-140 degrees
what motion does the scapula contribute most to
more to arm elevation than the glenohumeral joint
what is the goal with an inferior scapula
break adhesions between the subscapularis, bursa and serrates anterior
how can you visualize both scapula
ap thoracic x-ray
measure inferior tip of scapula for height difference
what is the scapula measurement of the inferior tip that indicates an UNSTABLE shoulder
greater than 15 mm
what is it called if the scapula is superior or inferior
diagnostic puzzle
is it common for other factors to be the cause of shoulder instability?
yes
if the scapula is high on the side of involvement
cervicobrachial compression syndrome
if the scapula is low on the side of involvement
cervicobrachial traction syndrome
what do pre and post checks show
significant differences and may be close to normal after all subluxations are corrected
what are the ROM degrees for scapular rotation
50-60 degrees
what is the g/h ROM degrees for rotation
105-120 degrees
what are the combined ROM degrees for g/h and scapula
165-180 degrees
what are the force coupling ratios of g/h and scapula for internal rotation: external rotation
3:2
what are the force coupling ratios of g/h and scapula for extension: flexion
5:4
what are the force coupling ratios of g/h and scapula for adduction: abduction
2:1
what are the sources of pain for g/h
joint misalignment (direct irritation) pathology (tendinitis) acute tissue damage (tendinitis) chronic inflammatory processes chronic trigger points -referral pattern -stimulated by stress, ischemic compression, muscle function under load, weight bearing
what is the sign when the g/h joint dislocates
sulcus sign
what is the most common disloction
atnerior inferior
90%
what is the likelihood of recurrent dislocations after the initial dislocation
95% in patients aged 25 years or younger
what occurs when there is damage to the labrum
SLAP lesion
bankhart lesion
impingement
decompression
what is the most common reason for re-injury of the g/h joint
failure to properly condition the healed tissues
-bringing the tissues back to a level of tolerating the forces desired to be directed though the tissue
Tendinitis overuse recovery chronic prognosis surgery
overuse-rare recovery-days- 2 weeks chronic- 4-6 weeks anti inflammation prognosis-99% full recovery surgery-not likely, recovery 3-4 weeks
Tendinosis overuse recovery chornic prognosis surgeyr
overuse-common recovery-6-10 weeks chronic-3-6 months collagen synthesis prognosis-80% surgery- option, exception, recovery 4-6 months
how old are pt’s when TE occurs
usually over 35 with history of playing tennis
-incidences peak at 40-50
what is the management for TE
relative rest
rest
injections/PT
surgical intervention
what is the MOI for TE
mechanics
torque
vibration
deceleration
how many stages did Nirschl develop for tendinosis
4
how long is TE healing time
LONG
1-72 weeks
mean=36 weeks
90% resolve w/o surgery
what type of process is tendinosis
non inflammatory process
what is type of degeneration is tendinosis described as
mucoid
what occurs with tendinosis collagen degeneration
variable fibrosis
neovascularization
hyper sensitivity to nociceptive firing
describe the kinetic link system uncoiling process
- feet, knees, hips, limbo-pelvic complex
- shoulder, elbow, wrist, phalanges
describe the kinetic link system coiling process
- shoulders, LPHC (lumbo, pelvic, hip, complex)
- feet, knees
- wind up of upper extremity complex
within tensile tendinitis what occurs after a tendon becomes fatigued and weakened
tendon- fatigue and weakness- inflammation, vascular compromise, permanent tendon change (angiofibroblastic degernation)
within tensile tendinitis what occurs after a tendon ruptures
rupture-loss of humeral head control-superior migration-secondary impingement-sub deltoid bursitis, fibrosis, exostosis, osteoarthritis
what is primary impingement syndrome
subacromial impingement syndrome
aka= swimemrs shoulder
what ages does primary impingement syndrome occur in
all ages
12-25 y/o- subacromial bursitis> thickening and fibrosis (pain and activity and sometimes at night, 25 y/o and older)
> partial or full thickness tear with spurring (40 y/o and up)
where does a primary tear occur
intracapsular
biceps-long head
labrum- SLAP, bankhart
what causes a primary tear
tensile filure
poor biomechanics
aggravated by heavy loads
what causes a secondary tear
poor biomechanics rate of irritation greater than rater of recovery tensile failure extra-capsular aggravated by motion above 90 degrees
