Lecture 11 Flashcards
4 joints of the shoulder (pectoral) girdle
-glenohumeral joint
-acromioclavicular joint
-sternoclavicular joint
-scapulothoracic joint
Glenoid labrum
-helps to deepen socket
-decrease incongruency in the joint
-allow for more stability
What are the ligaments of the shoulder joint
-acromioclavicular ligament
-coracoacromial ligament
-coracohumeral ligament
-transverse humeral ligament
-coracoclavicular ligament
Divisions of the coracoclavicular ligament
-conoid ligament
-trapezoid ligament
Is there is a bursa in the shoulder joint
-yes
What are the pectoral muscles
-pectoralis major
-pectoralis minor
What else lies deep to the pectoral muscles
-brachial plexus
-subclavian artery and vein
What pectoral muscle may cause neural or circulatory issues if tight
-pectoralis minor
Muscles acting on the scapula
-levator scapulae muscle
-rhomboid minor muscle
-rhomboid major muscle
-trapezius muscle
-latissimus dorsi muscle
How many insertion points does the latissimus dorsi have
-11
What are the muscles of the rotator cuff
-supraspinatus
-infraspinatus
-teres minor
-subscapularis
What is the rotator cuff
-major dynamic stabilizer of the shoulder
Physiological ROM of GH joint
-abduction
-adduction
-flexion
-extension
-internal rotation
-external rotation
-horizontal adduction
-horizontal abduction
-accessory movements (roll, spin, glide)
What is a dislocation
-head of humerus translates completely out of the glenoid
What is a subluxation
-a partial or incomplete dislocation of the GH
What type of shoulder dislocations are there
-anterior
-posterior
-inferior
What type of shoulder dislocation is most common
-anterior
What type of shoulder dislocation is rare
-inferior
What does SLAP lesion/tear stand for
-superior labrum anterior and posterior
What is a SLAP lesion/tear
-injury to superior aspect of labrum from anterior to posterior
What can also be injured in a SLAP lesion/tear
-biceps tendon
How many types of SLAP lesions/tears are there
-4
MOI SLAP lesions
-repetitive overhead movements (throwing)
-FOOSH (fall on out stretched hand)
-sudden traction to the arm
-dislocation of GH
Signs and symptoms of SLAP lesions
-clicking/catching/popping
-pain moving arm overhead
-pain lifting heavy objects
-pain deep in joint or in back of joint
-anterior shoulder pain if biceps involved
What is a bankart lesion
-injury to the anterior-inferior glenoid labrum
What is a bankart lesion usually second to
-anterior dislocation
Signs and symptoms of a bankart lesion
-pain and limited ROM with most shoulder movements
-clicking
-catching
-grinding
-popping
-subluxation
What is a hills-sachs lesion
-a divot-type fracture of the head of the humerus following a dislocation
-head of humerus gets compressed against the rim of the glenoid
MOI anterior dislocation
-hit from the back
-anything that drives head of humerus forward
Signs and symptoms of dislocations
-pain
-pop
-reduced ROM
-reduced strength
-swelling
-numbness
MOI posterior dislocation
-hit from the front
-anything that drives head of humerus backwards
MOI inferior dislocation
-anything that drives head of humerus downward
-tumbling movements etc.
Acute management of dislocations
-PIER
-treat for shock
-refer
What are different types of rotator cuff injuries
-impingement
-tendonitis/osis
-rotator cuff tears
MOI rotator cuff impingement
-overuse
-poor mechanics
MOI rotator cuff tendonitis
-overuse
-poor mechanics
MOI rotator cuff tears
-acute
-overuse
MOI AC separation/sprain
-FOOSH
-fall/tackle, landing on side of shoulder
-checked into boards
Signs and symptoms of AC separations/sprains
-pain
-step deformity at AC
-weakness in shoulder/arm
Acute management of AC separations/sprains
-PIER
-sling
-swatch
-severe deformities need to be referred
What tape job can be used for AC separation to support healing
-AC tape
What are the different stages in the rockwood classification of AC injuries
-type I
-type II
-type III
-type IV
-type V
-type VI
Treatment of acute shoulder injuries
-PIER
-sling
-Ac tape job to approximate joint
-rehab to promote tissue healing and regain mobility and stability
When is surgery considered for shoulder injuries
-middle third clavicle fractures
-type III Ac sprains in active people
-type IV, V, and VI AC sprains
-first time GH dislocation in young athletes
-full thickness rotator cuff tears
-displaced or unstable proximal humerus fractures
When should urgent surgical referral happen in shoulder injuries
-for posterior sternoclavicular dislocations
Why should surgical referral be urgent in posterior sternoclavicular dislocations
-because of important structures that sit behind (vasculature)
MOI subacromial (shoulder) impingement syndrome
-overuse
-biomechanical imbalances
-pinching and subsequent inflammation of structures under coracoacromial ligament
What may subacromial (shoulder impingement syndrome include
-supraspinatus tendon
-long head of biceps tendon
-subacromial bursa
Signs and symptoms of subacromial (shoulder) impingement syndrome
-pain and weakness in painful arc of abduction, and reaching
-catching/clicking
-pain with sleeping on affected side
-pain putting jacket on
Special test for subacromial (shoulder) impingement syndrome
-painful arc
What is a positive test in the painful arc test
-pain furing GH abduction between 60 and 120 degrees
When would pain clear in a positive arc test
-beyond 120 degrees
Where is referred pain in subacromial (shoulder) impingement syndrome felt
-often reported in supraspinatus pattern down middle deltoid
What sport is subacromial (shoulder) impingement syndrome common in
-swimmers
-overhead athletes
MOI humerus fractures
-high-energy direct blow
Signs and symptoms of humerus fractures
-pain
-swelling
-bruising
-unable to move arm or grinding when they do
What is the most common fracture site on humerus
-surgical neck
What percent of humeral fractures are non-displaced (non-surgical)
-80%
Acute management of humerus fracture
-PIER
-sling
-treat for shock
-send to emerge if stable or call EMS
Management of humerus fracture
-sling
-pain management
-start treatment early to avoid frozen shoulder
MOI scapula fractures
-high-energy blunt trauma
-fall from height
Signs and symptoms of scapula fractures
-extreme pain with arm movements
-localized swelling
-bruising/trauma to area
Management of scapula fractures
-sling
When is surgery indicated for scapula fractures
-displaced fractures of glenoid
-displaced fracture at neck of scapula
-acromion fractures causing impingement
MOI clavicle fractures
-force to lateral shoulder
-FOOSH
-direct trauma
Signs and symptoms of clavicle fractures
-severe pain and swelling over site
-deformity
-unwillingness to move
Acute management of clavicle fractures
-tube sling
-PIER
Treatment of clavicle fractures
-sling or figure 8 brace
-PIER
-pain management
-alleviate spasm
Important considerations in treating the shoulder girdle
-thoracic spine mobility
-scapular mobility
-scapular stability
-upper limb proprioception
What is a special test for GH dislocation
-apprehension test
How to perform the apprehension test
-put arm into cactus position
-push arm backwards
What would a positive apprehension test look like
-they do not want to move into that position
-grimace, pain etc.
