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Upper Extremity > Glenohumeral joint > Flashcards

Glenohumeral joint Flashcards

1
Q

what is the glenohumeral complex a balance of

A

osseous and myo-kinetic chain

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2
Q

How many cc’s of fluid can the GH capsule hold

A

30

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3
Q

How many cc’s of fluid is normally in the GH capsule

A

.5-1.5

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4
Q

What type of disc is the sternoclavicular joint

A

bilaminar joint

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5
Q

True/False: The sternoclavicular joint is NOT well anchored.

A

False: it IS well anchored

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6
Q

ROM degrees for sternoclavicular joint elevation

A

4-60 degrees

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7
Q

ROM degrees for sternoclavicular joint depression

A

5-15 degrees

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8
Q

ROM degrees for sternoclavicular protraction and retraction

A

15 degrees

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9
Q

ROM degrees for sternoclavicular rotation

A

30-50 degrees

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10
Q

what are the three directions of separation for the s/c joint

A

superior
inferior
anterior

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11
Q

why doesn’t the s/c joint separate posterior

A

because 1st and 2nd ribs are behind it

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12
Q

if the s/c joint moves posterior what do you do

A

call 911 could potentially occlude carotid or jugular arteries/veins

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13
Q

what is the most common direction of s/c joint separation

A

anterior and superior

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14
Q

how do you check the s/c PMC muscle test

A

stress the joint by having the patient do a pushup or a throwing maneuver to see if the joint is stable

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15
Q

if the s/c joint is stable what are the recommendations

A

tape 6 weeks to 3 months

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16
Q

if the s/c joint is x-rayed, what should the post look like

A

should be less than 5 mm height difference

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17
Q

if the s/c joint is not better within 6 weeks what should you do

A

refer out

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18
Q

how was the acromioclavicular joint designed

A

designed to move in concert with the S/C joint

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19
Q

what holds the a/c joint

A

conoid/trapezoid ligaments

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20
Q

within the a/c joint, which ligament is often “released” in “decompression”

A

coracoacromial

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21
Q

on x-ray, what should the coracoid to clavicle distance be

A

1.1-1.3 cm

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22
Q

on x-ray, if a/c space is greater than 1.3 cm this indicates

A

coracoclavicular ligamentous disurption

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23
Q

when the A/c joint separates and the clavicle lifts up from the acromial process is known as what sign

A

horizon sign

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24
Q

what is occurring within the biomechanics when a horizon sign is present

A

the scapula drops inferior to give the appearance of a raised clavicle

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25
Q

what is the MOI for an a/c separation

A

FOOSH injury and direct and indirect trauma to the joint

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26
Q

how would you take an x-ray of the a/c joint

A

a-p view
10 lb bag hanging in the hand of the involved arm
central ray through the coracoid process

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27
Q

what indicates an a/c separation being a grad 2 or 3

A

seeing superior displacement of the clavicle at the acromion process on an x-ray

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28
Q

when the pt reaches over to the opposite shoulder with the involved are and experiences pain or discomfort in the shoulder

A

indicates a/c joint pathology

  • this compresses the a/c joint
  • known as cross over maneuver
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29
Q

what are the rehabilitation recommendations for an a/c joint separation

A

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
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30
Q

what is the efficiency of the g/h joint dependent on

A

scapular position

31
Q

what does PICR stand for

A

path of instant center of rotation

32
Q

when is the rotator cuff overloaded

A

when the scapula is inefficient

33
Q

what is the scapulothoracic ratio in translation

A

2:1
3 phases with different ratios
80-140 degrees

34
Q

what motion does the scapula contribute most to

A

more to arm elevation than the glenohumeral joint

35
Q

what is the goal with an inferior scapula

A

break adhesions between the subscapularis, bursa and serrates anterior

36
Q

how can you visualize both scapula

A

ap thoracic x-ray

measure inferior tip of scapula for height difference

37
Q

what is the scapula measurement of the inferior tip that indicates an UNSTABLE shoulder

A

greater than 15 mm

38
Q

what is it called if the scapula is superior or inferior

A

diagnostic puzzle

39
Q

is it common for other factors to be the cause of shoulder instability?

A

yes

40
Q

if the scapula is high on the side of involvement

A

cervicobrachial compression syndrome

41
Q

if the scapula is low on the side of involvement

A

cervicobrachial traction syndrome

42
Q

what do pre and post checks show

A

significant differences and may be close to normal after all subluxations are corrected

43
Q

what are the ROM degrees for scapular rotation

A

50-60 degrees

44
Q

what is the g/h ROM degrees for rotation

A

105-120 degrees

45
Q

what are the combined ROM degrees for g/h and scapula

A

165-180 degrees

46
Q

what are the force coupling ratios of g/h and scapula for internal rotation: external rotation

A

3:2

47
Q

what are the force coupling ratios of g/h and scapula for extension: flexion

A

5:4

48
Q

what are the force coupling ratios of g/h and scapula for adduction: abduction

A

2:1

49
Q

what are the sources of pain for g/h

A 
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
50
Q

what is the sign when the g/h joint dislocates

A

sulcus sign

51
Q

what is the most common disloction

A

atnerior inferior

90%

52
Q

what is the likelihood of recurrent dislocations after the initial dislocation

A

95% in patients aged 25 years or younger

53
Q

what occurs when there is damage to the labrum

A

SLAP lesion
bankhart lesion
impingement
decompression

54
Q

what is the most common reason for re-injury of the g/h joint

A

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

55
Q 
Tendinitis
overuse
recovery
chronic
prognosis
surgery
A 
overuse-rare
recovery-days- 2 weeks
chronic- 4-6 weeks
anti inflammation
prognosis-99% full recovery
surgery-not likely, recovery 3-4 weeks
56
Q 
Tendinosis
overuse
recovery
chornic
prognosis
surgeyr
A 
overuse-common
recovery-6-10 weeks
chronic-3-6 months
collagen synthesis
prognosis-80%
surgery- option, exception, recovery 4-6 months
57
Q

how old are pt’s when TE occurs

A

usually over 35 with history of playing tennis

-incidences peak at 40-50

58
Q

what is the management for TE

A

relative rest
rest
injections/PT
surgical intervention

59
Q

what is the MOI for TE

A

mechanics
torque
vibration
deceleration

60
Q

how many stages did Nirschl develop for tendinosis

A

4

61
Q

how long is TE healing time

A

LONG
1-72 weeks
mean=36 weeks
90% resolve w/o surgery

62
Q

what type of process is tendinosis

A

non inflammatory process

63
Q

what is type of degeneration is tendinosis described as

A

mucoid

64
Q

what occurs with tendinosis collagen degeneration

A

variable fibrosis
neovascularization
hyper sensitivity to nociceptive firing

65
Q

describe the kinetic link system uncoiling process

A
  • feet, knees, hips, limbo-pelvic complex

- shoulder, elbow, wrist, phalanges

66
Q

describe the kinetic link system coiling process

A
  • shoulders, LPHC (lumbo, pelvic, hip, complex)
  • feet, knees
  • wind up of upper extremity complex
67
Q

within tensile tendinitis what occurs after a tendon becomes fatigued and weakened

A

tendon- fatigue and weakness- inflammation, vascular compromise, permanent tendon change (angiofibroblastic degernation)

68
Q

within tensile tendinitis what occurs after a tendon ruptures

A

rupture-loss of humeral head control-superior migration-secondary impingement-sub deltoid bursitis, fibrosis, exostosis, osteoarthritis

69
Q

what is primary impingement syndrome

A

subacromial impingement syndrome

aka= swimemrs shoulder

70
Q

what ages does primary impingement syndrome occur in

A

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)

71
Q

where does a primary tear occur

A

intracapsular
biceps-long head
labrum- SLAP, bankhart

72
Q

what causes a primary tear

A

tensile filure
poor biomechanics
aggravated by heavy loads

73
Q

what causes a secondary tear

A 
poor biomechanics
rate of irritation
greater than rater of recovery
tensile failure
extra-capsular
aggravated by motion above 90 degrees

Upper Extremity (4 decks)

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