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MSK 4 > Intro to Upper Quarter and Anatomy > Flashcards

Intro to Upper Quarter and Anatomy Flashcards

1
Q

What area of the Upper Quarter is most commonly injured?

A

The finger

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2
Q

What type of injury is most common in the upper quarter?

A

Fractures

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3
Q

What four basic functions of the shoulder anatomy are most commonly affected by shoulder pathologies?

A

Mobility
Stability
Smoothness
Strength

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4
Q

What is shoulder mobility dysfunction?

What may these restrictions be between?

A

loss of humerothoracic motion due to passive restrictions

scapula and thorax (scapulothoracic motion)
humerus and scapula (scapulohumeral motion)
combo of the two

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5
Q

What type of joint is the sternoclavicular joint?

What is the blood supply and nerve supply of this joint?

A

synovial saddle joint

Blood Supply-internal thoracic and suprascapular arteries
Nerve Supply- branches of suprascapular nerve and nerve to subclavius

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6
Q

what forms the anterior and posterior sternoclavicular ligaments?

A

thickenings of the fibrous capsule

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7
Q

what does the costoclavicular ligament attach to?

A

attaches the 1st rib and its costal cartilage to the anterior margin of the medial end of the clavicle

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8
Q

What type of joint is the acromioclavicular joint?

what ligaments support this joint?

What is the nerve and blood supply of the joint?

A

planar synovial joint

acromioclavicular lig. (strengthens capsule superiorly) and the coracoclavicular lig. (strengthens lateral end of the clavicle by attaching to clavicle)

Blood Supply-suprascapular and thoracoacromial arteries
Nerve Supply-Lateral pectoral and axillary nerves

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9
Q

What are the two parts of the coracoclavicular ligament?

A

Trapezoid and Conoid

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10
Q

What may cause mobility problems for scapulothoracic motion?

A
  • sternoclavicular/acromioclavicular arthritis
  • musculotendinous contracture
  • rib or scapular fracture
  • post traumatic scarring
  • tumor
  • dislocation
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11
Q

What are the three treatment options for painful scapulothoracic structures?

A
  1. modalities and mobilization for pain relief
  2. shield structures from abnormal.excessive forces during stretching of G/H joint
  3. Restore as much scapulohumeral ROM as possible
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12
Q

What type of joint is the glenohumeral joint?

What deepens the joint?

What covers the joint surface?

A

synovial ball and socket joint

glenoid labrum

hyaline cartilage

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13
Q

What are the intrinsic glenohumeral ligaments?

A

three fibrous bands found only on the internal aspect of the capsule that radiates laterally from the supraglenoid tubercle into three bands (superior, middle and inferior) and they function to strengthen the anterior capsule of the joint

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14
Q

What may cause scapulohumeral mobility deficits?

A

bony and or soft tissues that directly surround the glenohumeral joint or non-articular scapulohumeral motion interface

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15
Q

What two categories can generalized capsuloligamentous tightness be divided into?

A
  1. Idiopathic adhesive capsulitis-“primary frozen shoulder” (etiology unknown)
  2. Secondary frozen shoulder (etiology secondary to tendinopathy, fracture, post surgery)
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16
Q

If the posterior inferior shoulder capsule is tight what motion would be limited?

A

elevation in anterior planes
internal rotation of elevated arm
cross body adduction

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17
Q

If the posterior superior shoulder capsule is tight what motion would be limited?

A

reach up behind the back

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18
Q

If the anterior superior shoulder capsule is tight what motion would be limited?

A

external rotation with arm at the side

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19
Q

If the anterior inferior shoulder capsule is tight what motion would be limited?

A

external rotation with arm elevated

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20
Q

If the anterior shoulder capsule is tight what motion of the humeral head will happen with external rotation?

A

posterior translation of humeral head (posterior obligate translation)

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21
Q

What is capsulorrhaphy arthropathy?

A

wear of the posterior glenoid and subluxation of humeral head posteriorly

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22
Q

What is anterior superior obligate humeral translation?

What patient population is it typically observed in?

A

tight posterior capsule causes translation of the humeral head anteriorly and superiorly on the glenoid

impingement syndrome patients

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23
Q

What are the two parts of the non-articular scapulohumeral motion interface? What comprises of both part?

A

Deep interface (proximal humerus, rotator cuff, and biceps tendon sheath)

Superficial Interface (deltoid, acromion, coracoacromial ligament, coracoid process and attaching tendons)

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24
Q

What can cause stiffness of shoulder joint?

A

structural changes in periarticular tissues such as shortened capsule, ligaments and muscles that may be accompanied by adhesions and is generally result from combination of trauma and immobilization

non-structural changes in periarticular tissues such as pain, protective muscle spasm, or loose body within the joint

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25
Q

What are the two mobilization approaches for shoulder stiffness?

A

Low-Load Prolonged Stress (LLPS)-via splinting which is more effective in managing structural causes of stiffness

High-Load Brief Stress (HLBS)-via mobilization or manipulation of joints and is more effective in managing non-structural causes of stiffness

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26
Q

Why might low-load prolonged stress be better than high-load brief stress for anterior superior obligate translation?

A

with any patient that has a tight capsule end range stretching can produce obligate translation and excessively high joint contact forces

27
Q

What is glenohumeral laxity?

What is glenohumeral stability?

What is glenohumeral instability?

A

translation observed on exam of G/H joint

ability to maintain humeral head centered in glenoid fossa

inability to maintain humeral head centered in glenoid fossa

28
Q

What is glenohumeral apprehension?

What is traumatic instability?

What is atraumatic instability?

A

sense of impending instability in certain G/H positions

arises from an injury sufficient to tear G/H capsule, labrum, ligaments, rotator cuff or produce fracture of humerus or glenoid

arises in absence of significant trauma

29
Q

How does balance in the shoulder joint affect stability?

A

Glenoid positioned so that the net humeral joint reaction force passes through the glenoid fossa

essentially identical humerothoracic positions (90*) achieved using different scapulohumeral positions, which in turn, have different implications for the balance mechanism

injury to the glenoid labrum will diminish the glenoid arc length and hence decrease the angular range of stability

musculature about the G/H joint plays a big role in maintaining balance stabilizing mechanisms which may fail in cases of muscular imbalance or abnormal glenoid version (glenoid center line deviates substantially from the plane of the scapula)

30
Q

What is concavity compression in the shoulder joint and how does it affect stability?

A

stability related to the magnitude of compressive force of the rotator cuff

Pull of the muscles helps keep the humerus stable (e.g the supraspinatus doesn’t pull the humerus downward due to the upward force of the compression from the deltoid) and the cuff muscles act as a “compressor” of head into glenoid concavity

31
Q

What is adhesion-cohesion and how does it increase shoulder stability?

A

joint surfaces wet with joint fluid are held together by molecular attraction of fluid to itself and to joint surfaces

stability is related to adhesive and cohesive properties (viscosity/stickiness) of joint fluid, wetability of joint surfaces, and area of contact b/w glenoid socket and humerus

32
Q

What is the syringe effect?

A

the GH joint is a closed space with minimal free fluid and is not easily distracted, movement is restricted by the negative fluid pressure which also adds resistance to distraction by drawing capsule inwards and tightening fibers

33
Q

How does capsuloligamentous constraint affect shoulder stability?

A
  • serve as “check reigns” at limits of G/H motion-translation and rotation
  • capsule and ligaments not “primary stabilizers”-cannot effectively hold humeral head centered in glenoid socket in most functional positions of joint
34
Q

What controls the maximal scapulohumeral angle that can be achieved in a given direction?

What limits cross body adduction?

A

Capsule and ligaments

posterior capsule

35
Q

Which ligament checks ROM of shoulder joint when the arm is elevated and forced into ER?

A

Inferior glenoid humeral ligament

36
Q

What tests can be done to test shoulder stability/instability?

A
  • sulcus sign
  • apprehension test
  • relocation test
  • O’brien’s active compression test
  • Anterior slide test
  • Load and shift test
  • Crank Test
37
Q

How do subluxation and dislocation occur and affect glenohumeral instability?

A

Subluxation results from an increased humeral head translation on the glenoid. The head moves partially off the glenoid rim and quickly repositions itself

Dislocation occurs when the humeral head moves off the glenoid rim and may require manipulation to be reduced

38
Q

What are the different types of instability?

A 
congenital
acute
chronic
recurrent
traumatic
atraumatic
voluntary
39
Q

What are the two groups of glenohumeral instability?

A

TUBS (torn loose)- traumatic, unidirectional, bankart, surgery

AMBRII (born loose)- Atraumatic (or microtraumatic), multidirectional, bilateral, rehab, inferior capsular shift, rotator interval

40
Q

Which group of glenohumeral instability usually needs medical assistance to reduce?

Which instability group will usually have negative X-rays?

A

TUBS (AMBRII reduces spontaneously)

AMBRII (Bankart and Hills-Sachs will show up on X-rays in TUBS group)

41
Q

What is the most common direction of instability in the shoulder?

What type of instability can be caused from seizures, shock, or falling on a flexed/adducted arm?

A

Anterior instability (for Abduction/ER mechanism) 97% of recurrent dislocations

Posterior instability (FOOSH)

42
Q

What is a bankart lesion?

A

detachment of the anterior glenoid labrum

43
Q

What is a Hills-Sachs Lesion?

A

When postero-superior aspect of the humeral head sustains a compression fracture or depression defect

44
Q

What is the typical pathology of an anterior dislocation/subluxation?

A

traction injury of the brachial plexus and axillary blood vessels can occur with a dislocation (nerve injury can happen to any brachial plexus nerve)

45
Q

What is the most common sequela of traumatic anterior shoulder instability?

What is a common complication of traumatic anterior shoulder instability in patients over 40?

A

recurrence, which will happen with 90% of those between the ages of 11 and 20

neurologic injury and rotator cuff tears

46
Q

True or false: length of immobilization, avoidance of overhead activity, and supervised PT has no effect on the outcome of reccurence of anterior shoulder instability

A

True

47
Q

What are the 5 areas of smoothness in the shoulder complex?

A 
G/H Joint
S/C Joint
A/C Joint
Scapulothoracic motion interface
Scapulohumeral motion interface
48
Q

What causes loss of smoothness in the shoulder joint?

A

infammatory joint disease, avascular necrosis, tumor, or osteomyelitis, as well as labral tears or loose bodies

49
Q

What is the most common injury to the shoulder? What does it usually involve?

A

Supraspinatus Tendinitus

usually involves avascular zone of the tendon and may include synovial irritation (bursa and capsule), micro or macro tears

50
Q

What motion may be most painful in a patient suffering from infraspinatus tendinitis?

A

Ext. Rotation

51
Q

What signs during the subjective history exam would be common in patients with shoulder tendinits?

A
  • anterolateral shoulder pain, especially with reaching or lifting overhead
  • onset may involve trauma, overuse, or gradual overload of the cuff
  • pain may be greater at night when arm is by the side or overhead (wringing out phenomena-avascular zone)
52
Q

What are the physical signs and symptoms of shoulder tendinitis?

A
  • AROM may display decreased motion or a painful arc
  • PROM may be painfree (contractile lesion)
  • Resistive may be painful in the primary motion of the involved structure
  • Mobility testing normal unless there are long term capsular changes
53
Q

What common muscle imbalances may be present in a patient with shoulder tendinitis?

What faulty movement patterns would be observed?

A

Tight: levator, upper trap, pec major/minor, lats, SCM, and scalenes
Weak: Middle/lower trap, serratus, rhomboids, deltoid, deep neck flexors

Abnormal scapulo-humeral rhythm in a 1:1 ratio, winging, increased scapular protraction and elevation with initial downward rotation

54
Q

What is bicipital tendinitis/tenosynovitis?

How common is it?

A

inflammation of the biceps tendon in the bicipital groove or inside the capsule

present in 1/7 RC lesions

55
Q

What is impingement Syndrome?

What does it lead to?

A

repetitive compressive loads on structures in the suprahumeral space which lead to inadequate inferior glide with elevation leads to “impingement”

leads to tendinitis and/or bursitis. Most patients will have inflammation of both structures as both are impinged-may culminate in a rotator cuff tear

56
Q

What are the intrinsic causes of impingement syndrome?

A
  • degenerative tendinopathy
  • muscle weakness may cause superior humeral glide wi/ movement
  • overuse
  • laxity anteriorly w/ a tight posterior capsule can lead to secondary or internal impingement
  • hypovascular area: Codman’s “critical zone” of the supraspinatus tendon where most degenerative changes occur
57
Q

What can cause weakness in the shoulder joint?

A 
full/partial thickness tears
C-spine radiculopathy
Long thoracic nerve palsy
Suprascapular neuropathy
Axillary nerve trauma
Scapulohumeral muscular dystrophy
58
Q

What is the most common cause of rotator cuff tears?

A

impingement wear and attrition

59
Q

What are the 3 progressive stages of impingement?

A

Stage 1: less than 25 y.o w/ acute inflammation, edema and homorrhage in rotator cuff, reversible and non-operative

Stage 2: 25-40 years w/ progression from acute edema and hemorrhage to fibrosis and tendinitis of rotator cuff, usually responds to conservative management

Stage 3: 40+ years w/ mechanical disruption of tendons (tears) and osteophytes under acromion, thickening of coracoacromial arch, more likely to require surgery

60
Q

What are the 3 common sites of tears in rotator cuff and which is most common?

A

Bursal Side
Articular Side (most common)
Midsubstance

61
Q

What is the notch phenomenon?

A

the stress on the tendon is channeled toward the edges of the defect, leading to further fiber failure

62
Q

What is the natrual progression of rotator cuff tears?

A
  • starts as a partial thickness tear secondary to tendon overload
  • poor healing potential and progression of tear due to hostile environment
  • rotator cuff insufficiency due to pain and inhibition
  • superior migration of humeral head and increased contact forces in subacromial space
  • degenerative chanes in under surface of subacromial space
  • impingement syndrome and progression to full thickness tear
  • degenerative joint disease “cuff tear arthropathy”
63
Q

What is “cuff tear arthropathy”?

A

When X-rays show an ‘acetabularization’ of upper glenoid and coracoacromia arch, and ‘femorilzation’ of proximal humerus

64
Q

What are the indications for total shoulder replacement?

A
  • Shoulder joint pain from destructive arthritis secondary to OA, RA, or traumatic arthritis
  • Avascular Necrosis
  • Severe loss of upper extremity strength
  • Limitations of ADL function secondary to pain

MSK 4 (14 decks)

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