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CATA 263 > lecture 11: conditions of the shoulder/upper arm > Flashcards

lecture 11: conditions of the shoulder/upper arm Flashcards

1
Q

what muscles stabilize the head of the humerus in the socket

A

teres minor
supraspinatus
infraspinatus
subscapulatris

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2
Q

what is the sternoclavicular joint

A

the attachment of the axial skeelteon to the appendicular skeletonn

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3
Q

what two bones are attached by the SC joint

A

clavicle and sternum

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4
Q

wht is the functions of the SC ligaments

A

stops anterior and posterior translation of the clavicles

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5
Q

what are the dynamic stabilizers of the SC joint

A

pectoralis major

SCM

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6
Q

what is the MOI of the SC joint

A

FOOSH
Direct trauma
Contact to lateral shoulder

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7
Q

what does FOOSh stand for

A

falling on an outstretched hand

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8
Q

what are some examples of direct trauma that cause injury to the SC joint

A

knee, head, equipment directly on chest near SC ligaments

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9
Q

what some examples of cotnact to lateral shoulder taht could cause injury to SC joint

A

body checked into the boards

rudgy player lands on shoulder

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10
Q

what forces cause injuries related to FOOSh

A

compresssion forces

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11
Q

what are the 2 major injuries associated with the SC joint

A

sprain

dislocation

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12
Q

whatt is more common an anterior or posterior discolation of the clavicle from the sternum

A

anterior

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13
Q

why is there more complications associated with posterior dislocation of the clavicle from the sternum

A

more structures are locatted posteriorly (ex:, lungs, trachea)

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14
Q

what will be a tell tale sign of SC joint injury

A

the clavicle will stick out anteriorly near the sternum

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15
Q

what are the common SS assocaited to SC joint sprain

A 
Pain with movement of the GH joint
Pain with breathing (especially deep breaths)
Pain with upright posture
Pain with sleeping on side
Clicking sensation at SC joint
Bruising or swelling maybe present
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16
Q

why is there pain assocaited with breathing for SC sprain injuryes

A

beacuse the lungs push o nthe clavicle and thoracic cage on inspiration

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17
Q

pain with upright posture is for anterior or posterior dislocations of the SC joint

A

anterior dislocationns

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18
Q

what is more commonn, AC or SC joint injury

A

AC is more common

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19
Q

the AC joint is located where

A

onn the lateral aspect of the shoulder

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20
Q

the ac joint involved what two structures/bones

A

clavicle and acromion process of the scapula

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21
Q

AC ligaments stop what motion

A

stops anterior and posterior translation of the clav

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22
Q

CC ligaments stop what movement of the clav

A

stops clav from moving upwards

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23
Q

which is more superior the acromioclavicular or coracoclavicular

A

AC

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24
Q

what muscles need to be strengthened to help prevent AC joint innuries

A

deltoid and pectoralis major

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25
Q

what muscles need to be stretched in order to proveent AC joint injuries

A

upper fiber traps

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26
Q

what is the most common injuries assocated with AC joint

A

sprain of AC lig or CC lig

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27
Q

what are the MOI for AC joint injuries

A

FOOSH
direct blow to the lateral shoulder
blow to the superior acromion

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28
Q

AC joint that cause dislcoation of the clav are caleld what

A

seperated shoulder

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29
Q

how many grades of AC joint sprain are there

A

6 types

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30
Q

what are the structures involved with a grade 1 AC joint sprain

A

Slight to partial damage of the AC ligament and capsule

no damage to CC

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31
Q

what are the signs and symptoms associated to type 1 ac joint sprain

A

Point tenderness, no laxity or deformity

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32
Q

what are the structures involved with a type 2 AC joint sprain

A

Rupture of the AC ligament and partial damage to the CC ligament
(slight step deformity)

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33
Q

what are the signs and symptoms associated with type 2 ac joint sprain

A

Slight laxity and deformity of AC joint, slight step deformity

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34
Q

what are the structures innvolved with type 3 AC joint sprain

A

Complete tearing of AC ligament and CC ligaments, possible involvement of deltoid and traps fascia
(OBVIOUS step deformity)

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35
Q

what are the signs and symtpoms associated with grade 3 AC joint sprain

A

Obvious dislocation of the distal end of clavicle from acromion process

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36
Q

what are the structures involved with a grade 4 AC joint sprain

A

Complete tearing of AC and CC ligaments and tearing of the deltoid and trapezius fascia

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37
Q

what are the structures involved with a type 5 AC joint sprain

A

Complete tearing of AC and CC ligaments and tearing of the deltoid and trapezius fascia

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38
Q

what are tthe strcutres invovled in a type 6 AC joint sprain

A

Complete tearing of AC and CC ligaments and tearing of the deltoid and trapezius fascia

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39
Q

whatt are the SS associated with grade 4 AC joint sprain

A

Posterior clavicular displacement into the insertion of the UFT

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40
Q

what are the SS associated with grade 5 AC joint sprain

A

displacement of clavicle 3x height compared to other side

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41
Q

what are the SS associated with a grade 6 AC joint sprain

A

Displacement of clavicle inferiorly under coracoid

clavicle disapears

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42
Q

can you differentiate between all 6 og the AC joint sprains

A

no , only differentiate between grade 1-3

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43
Q

step deformity is very common in what injury

A

AC joint injuries

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44
Q

what are the common SS of AC joint sprain

A

Pain with movement of the GH joint
(Especially limited ROM in Flexion, abduction, cross flexion)

Step deformity

Some bruising may be present

Pin point pain on AC joint

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45
Q

what is the commonly fractured bone of the upper sholder

A

clavicle

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46
Q

where do fractures mostly occur in the clavicle

A

mostly at the 2 of the s shape

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47
Q

what is the MOI of clavicular fractures

A

direct impact, impact to lateral shoulder, FOOSH

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48
Q

what is the difference between AC joint sprain and clav fracture

A

positive tap test

sound of crepitus

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49
Q

what is the athelette has a clav fracture but has equipmennt on

A

equipment stays onn and you can use arm movement or palpationn to assess

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50
Q

80% of clavicular fractures happen at the lateral or medial side or middle

A

middle

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51
Q

which side of the clavicle is the least commonly fractured

A

medial (only 5%)

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52
Q

true or false: clav fracture and AC joint sprain look similar

A

true

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53
Q

what is the function of the should labrum

A

deepens cavity

decreases friction

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54
Q

what makes up the glenohumeral joint

A

the head of the humerus and the glenoid cavity of the scapula

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55
Q

true or false: GH joint is a dynamic joinnt

A

yes

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56
Q

explain how GH joint is a dynamic joint

A

WOrks with scapula and clavicle to ensure full ROM

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57
Q

what are the GH ligaments

A

superior
inferio
posterior
middle/anterior

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58
Q

whta are the muscles associated near the GH joint

A

biceps (long head), rotator cuff muscles, pectoralis major, deltoid, triceps

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59
Q

glenohumeral instability is in whatt directions

A

anterior postrior inferior or multiple directions

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60
Q

what is instability of GH joint graded on

A

Joint play- movement of head of humerus in glenoid fossa

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61
Q

what contributes to passive stability of GH

A

capsular ligaments and GH ligaments

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62
Q

what contrtibutes to dynamic stability of the GH

A

rotator cuff muscles, and other GH muscles

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63
Q

what is a tetst to diadnose GH instability

A

apprensionn test

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64
Q

what are the 2 tyoes of GH instability

A

TUBS

AMBRI

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65
Q

what is TUBS

A

traumatic unidirection instability

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66
Q

is TUBS usually treated with surgery or conservation

A

surgery

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67
Q

TUBS is usually associated with what other injury

A

bankart lesion

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68
Q

what is AMBRI

A

atraumatic multidirectional frequently bilateral

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69
Q

what is AMBRi treated with

A

rehab or inferior capsular shift

70
Q

which of these is usually treated with surger: TUBS OR AMBRI

A

TUBS

71
Q

which of these is usually treated with rehab: TUBS OR AMBRI

A

ambri

72
Q

true or false: in AMRBI the person usually has hyperlaxity

A

true

73
Q

GH isntability can only be traumatic?

A

false also chronic

74
Q

explain the MOI for traumatic GH instability

A

Apprehension position
FOOSH- anterior/posterior
Direct trauma

75
Q

expklain the MOI for chronic GH instability

A

Large strains or weakness of RC
Dysfunction of long head of biceps tendon
Apprehension position- repetitive
Genetics

76
Q

which is more common anterior or posterior dislocation of the shoulder

A

anterior dislocation

77
Q

anterior instability of the GH joint causes laxity where

A

Middle GH ligament

Anterior aspect of the inferior ligament

78
Q

what are commonn inn=juries asosciated with anterior GH instability

A

sprain

dislocations

79
Q

what are the ways to tell if the shoulder is dislocated

A

1 arm is longer

lacking roundness of shoulder

80
Q

posterior instability of the GH joint is rare or common and explain

A

rare only 3% of all shoulder instabilities

81
Q

what is the position of the humerous in posterior istability

A

humerus is flexed and internally roated

82
Q

true or false: posterior instability of GH joint is more common nas a microtrauma than acute

A

true

83
Q

what aare some examples of of microtrauma that cause posterior instability of GH joint

A

Repeated blows in a flexed arm (blocking football)

Follow through phases of overhead throwing

84
Q

what is multidirectionnal instability of the GH joint

A

combination of 2 of more unidirectional instabilityies

85
Q

whattt does congenital MDI of the shoulder present with

A

presents with generalized hyper laxity of the shoulders and other joints

86
Q

what does acquired MDI of shoulder usually arrise from

A

participate in overhead activities, that impose repetitive microtrauma

87
Q

whatt are the common SS of GH instability

A

Complains of the feeling of instability

MOI of dislocation or subluxation

Pain with movement of the GH joint
Pain/Apprehension in abduction, external rotation (anterior instability)
Pain/apprehension with closed kinetic loading (posterior)

Muscle imbalances

Poor posture

Weakness in RC muscles and GH stabilizers

Clicking or popping sensation (associated with labrum tear)

88
Q

whatt are common injured with GH instability and why

A

labrum tears because the inferior GH ligament has attachement to the labrum

89
Q

true or false: biceps tendonn has attachment to the labrum

A

true

90
Q

what is the problem with the biceps tendon being attached to the labrum

A

During eccentric contraction of the biceps to slow elbow down from extension, the tension pulls on the labrum

91
Q

what is a bankart lesion

A

Injury to the anterior labrum associated with anterior shoulder instability

92
Q

what is the time region assocaited to bankart lesion

A

3 oclock to 6 oclock

93
Q

what is the time region for a reverse bankart lesion

A

6-9 oclock

94
Q

where is a reverse bankart lesion found

A

on the posterior aspect of the labrum

95
Q

where is slap lesion common

A

common in reporitive overhead motions (when biceps contract it can pull in the labrum)

96
Q

what is a slap lesion

A

teaar of the superior labrum anterior to psoterior

97
Q

what is the time region of a slap lesion

A

11 oclock to 1 oclok

98
Q

true or false: Bankart lesion has biceps tendon involvment

A

false, slap lesion may have biceps tendon atttachement

99
Q

slap lesionn has invovlements with what muscles

A

tthey may have biceps tendon involvement

100
Q

why may there be biceps tendon involvement in skao lesions

A

beause of the biceps tendonn attaching superiorly on labrum

101
Q

explain type 1 slap lesion classifcation

A

Degenerative fraying of the labrum near the insertion of the LHBT
=does no t affect biceps tendon

102
Q

explain type 2 classication of slap lesions

A

Avulsion of the glenoid labrum with an associated tear of the LHBT

103
Q

what is type 3 classification of slap lesion

A

Bucket handle tear with displacement of the fragment. No LHBT involvement

104
Q

what is type 4 of slap lesion classfication

A

Bucket handle tear with associated LHBT tear

105
Q

what clasffications of slap lesions have biceps involvement

A

2 and 4

106
Q

wht classifcations of slap lesionns have no biceps invovlement

A

1 and 3

107
Q

what are the common SS with labral tear

A

Pain with GH movement

Feeling of locking, clicking, clunking

Pain in biceps tendon (attachment to superior labrum)

Limited ROM

Pain feels deep in the shoulder
Usually complains of pain anteriorly

108
Q

where will pain be for labral tear

A

feels pain deep in the shoulder located anterior

109
Q

why would you get a locking feelinng in a labrial tear

A

if there is a large tear that flaps and acts like a door stop

110
Q

why would you hear clicking i na labral tear

A

head of the humerous is movign over the labral tear

111
Q

what is impingment at the shoulder

A

A decreased space where the Rotator cuffs tendons pass through the coracoacromial arch

112
Q

what arae the most common impingements of the shoulder

A

subacromial bursa
rotator cuff
lonng head of the biceps

113
Q

what are the causes of shoulder impingement

A 
Irregular shaped acromion
Enlarged bursa
Enlarged tendons
Loss of humeral head depression/stabilization
Poor posture (stretching rhom ifnra and tightening pecs and lats)
Repetitive overhead movements
Scapular dyskinesis
RC weakness
GH instability
114
Q

what are the common SS of impingement

A

Pinching sensation with ROM, especially overhead

Weakness in RC muscles and/or biceps brachii

Pain at common origin of RC or below AC joint

115
Q

where will there usually be pain on palpation for shoulder immpingment

A

Pain at common origin of RC or below AC joint

116
Q

why is there excess pain in overhead movements in impingments

A

because you are changing the subacromial space

117
Q

rotator cuff is subjected to more microtrtauma or macrottrama

A

microtrauma

118
Q

tears of rotator cuff can be partial or complete

A

both

119
Q

who is most liekly to get partial tears of RC

A

young individuals

120
Q

who is most likely to get complete tears of RC

A

30 +

121
Q

what are chronic tears of the RC

A

degeneration of tendond

122
Q

does RC tendinopathy occur more beacuse of concentric or eccenric conractionn

A

eccentic

123
Q

what does eccentric cotnraction of rc muscles cause

A

microtearing

124
Q

what are larger tears of the RC tendons caused by

A

acute of microtearing overtime

125
Q

what is an example of eccenntric contraction of the RC muscles

A

follow through in throwing

126
Q

what are the intrinsic factors contributing to RC tendinopathy

A 
Muscle imbalances
Muscle weaknesses
Poor posture
Capsular laxity
Poor scapular control
Impingement syndromes
127
Q

whatt are extrinnsic factors thatt contribute to RC tendinopathy

A

Training errors
Faulty techniques
Incorrect surfaces an equipment
Poor environmental conditions

128
Q

what causes full thickness tears

A

may develop from untreated partial thickness tears or sceondary to a single force trauma

129
Q

whar are the common SS of RC tendinopathy

A

Weakness in RC muscles
Poor posture
MOI or repetitive movements
Referred pain to deltoid tuberosity and/or lateral elbow
Pain with palpation of the common insertion of RC muscles
Trigger points in the RC muscles
Pain with GH movements
Especially flexion, abduction, external rotation

130
Q

where is reffered pain for RC tendinopathies

A

to deltoid tuberisity and/or lateral elbow

131
Q

where will there be pain on palpation for RC tendinipathies

A

of the common insertion of RC muuscles

132
Q

subacromial bursitis is the result of what other conditions

A

impringments

degenerative changes in RC muscles

133
Q

true or false: subacromial bursistis is common in OH atheltes

A

true

134
Q

its difficult to differentiate between RC pathlogy and what

A

subacromial bursistis

135
Q

what are the SS of subacromial bursitis

A

Point tenderness on anterior and lateral edges of acromion process

Painful arc between 70-120° of passive abduction

Inability to sleep (affected side)

Pain referred to distal deltoid attachment

Pain on initiation and acceleration of throw

136
Q

where will there pointt tenderness for subacromial bursitis

A

Point tenderness on anterior and lateral edges of acromion process

137
Q

where is the painful arc for subacromial bursitis

A

Painful arc between 70-120° of passive abduction

138
Q

what condition is associated with the inability to sleep

A

subacromial bursitis

139
Q

where is the reffered pain for subacromial bursitis

A

distal deltoid attCHEMENT

140
Q

WHAT ALLOWS you to differentiate between RC and bicep tendinopathy

A

palpation

141
Q

what is the common MOI for biceps tendinopathy

A

Repetitive overuse during rapid OH movements (Involving elbow flexion and supination activities)

Direct blow
(Transverse humeral ligament damage)

Anterior impingement may damage tendon

142
Q

antterior impingement can injury what structure

A

biceps tendon

143
Q

what sports are commonly associated with biceps tendinopathy

A

Racquet sports, shot putters/javelin, baseball/softball, QB, swimmers

144
Q

biceps tendinipathy is irritation of what

A

irritation of tendon as it slides within the bicipital groove

145
Q

what are the common SS of biceps tendinpotahy

A

Pain with flexion of the shoulder and elbow

Pain with OH movements

Pain in the anterior aspect of the shoulder in the groove for biceps tendon (With internal and external rotation )

Pain with palpation of the biceps tendon, coracoid process

146
Q

where will there be pain on palpation for biceps tendinopathy

A

on biceps tendon and coracoid process

147
Q

true or false: biceps stain/rupture can only be caued by macrotrauma

A

macro and microtrauma

148
Q

what are the MOI for biceps strain

A

FOOSH

Excessive resistance
(Gymnasts, swimmers, weight lifter)

Prolonged tendinopathy

149
Q

what are some common sports associated with biceps strain

A

Gymnasts, swimmers, weight lifting

150
Q

what are the SS of biceps tendon rupture

A 
Snapping sensation
Intense pain
Ecchymosis
Palpable defect
Weakness in flexion of elbow and shoulder and supination of forearm
151
Q

in what movements will there be weakness

A

weakness in flexion of elbow and shoulder and supinatoion of forearm

152
Q

what is the MOI of pectoralis major strain

A

forceful eccentric contraction (tackle, weightlifting)

153
Q

what is the MOI of muscle contusions

A

direct trauma to the muscle belly

154
Q

where are msucle contusions in upper exrtremity common in

A

common in biceps, deltoid and triceps

155
Q

what are the SS of muscle contusions

A

ecchymosis =, swelling, limited ROM and weakness in MMT

156
Q

what is thoracic outlet compression syndrome

A

Nerves and/or vessels become compressed in proximal neck or axilla

157
Q

what is the cause for 90% of thoracic outlet compression syndrome cases

A

neurological

158
Q

what are the two effects of thoracic outlet compression syndrome

A

neurological compressions (lower truck of brachial plexus)

vascular (subclavian artery and vein)

159
Q

true or false: if thoracic outlet compresion syndrome is compression subclavian arterires and veins you need surgery

A

true

160
Q

what are the SS of thoracic outlet syndrome if nerves are compressed

A

Aching
Pins/needles sensation
Numbness
Weakness in gripping and atrophy of hand muscles

161
Q

what are the SS of Thoracic outlet syndrome fi subclavian vein is compressed

A

edema s
stiffness (in hand)
cyanosis

162
Q

what is the SS of thoracic outlet syndrome is the subclavian artery is compressed

A

Rapid onset of coolness
Numbness in entire arm
Fatigue after exertional OH activity
Radial pulse maybe weak/absent with arm hyper extension

163
Q

long thjoracci nerve palsy goes through what spinal cord sections

A

c5-7

164
Q

can long thoracic nerve palsy only be traumatic

A

no also sponteanous

165
Q

who is at higher risk of long thoracic nerve palsy

A

OH atheltes

166
Q

what innervates SA

A

long thoracic nerve

167
Q

what is the problem is the kong thoracic nerve palsy affected the SA

A

it will affect the position of the scapula on the rib cage

168
Q

what is scapular dyskinesis

A

abnormal scapular positioning and kinematics

169
Q

what is the acronym assocaited with scapular dyskiinesis

A

SICk

170
Q

what does the acronym SICK stnad for

A

Scapular malposition
Inferiomedial border prominence
Coracoid pain and malposition
dysKinesis of scapular motion

171
Q

what is normal stattic allignement (4 things)

A

1) Vertebral border of scapular is parallel to the spine and positioned 3 inches from midline
2) Situated between 2nd and 7th rib
3) Scapula is flat against thorax
4) Rotated 30 degrees anterior to the frontal plane

172
Q

what are the SS associated to scapular dyskinesis

A

Pain in anterior or posterior superior aspect of the shoulder
Pain in upper part of lateral arm below acromion
Pain in UFT
“SICK” acronym
Improper posture
Fatigue with activity

CATA 263 (17 decks)

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