lecture 11: conditions of the shoulder/upper arm Flashcards
what muscles stabilize the head of the humerus in the socket
teres minor
supraspinatus
infraspinatus
subscapulatris
what is the sternoclavicular joint
the attachment of the axial skeelteon to the appendicular skeletonn
what two bones are attached by the SC joint
clavicle and sternum
wht is the functions of the SC ligaments
stops anterior and posterior translation of the clavicles
what are the dynamic stabilizers of the SC joint
pectoralis major
SCM
what is the MOI of the SC joint
FOOSH
Direct trauma
Contact to lateral shoulder
what does FOOSh stand for
falling on an outstretched hand
what are some examples of direct trauma that cause injury to the SC joint
knee, head, equipment directly on chest near SC ligaments
what some examples of cotnact to lateral shoulder taht could cause injury to SC joint
body checked into the boards
rudgy player lands on shoulder
what forces cause injuries related to FOOSh
compresssion forces
what are the 2 major injuries associated with the SC joint
sprain
dislocation
whatt is more common an anterior or posterior discolation of the clavicle from the sternum
anterior
why is there more complications associated with posterior dislocation of the clavicle from the sternum
more structures are locatted posteriorly (ex:, lungs, trachea)
what will be a tell tale sign of SC joint injury
the clavicle will stick out anteriorly near the sternum
what are the common SS assocaited to SC joint sprain
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
why is there pain assocaited with breathing for SC sprain injuryes
beacuse the lungs push o nthe clavicle and thoracic cage on inspiration
pain with upright posture is for anterior or posterior dislocations of the SC joint
anterior dislocationns
what is more commonn, AC or SC joint injury
AC is more common
the AC joint is located where
onn the lateral aspect of the shoulder
the ac joint involved what two structures/bones
clavicle and acromion process of the scapula
AC ligaments stop what motion
stops anterior and posterior translation of the clav
CC ligaments stop what movement of the clav
stops clav from moving upwards
which is more superior the acromioclavicular or coracoclavicular
AC
what muscles need to be strengthened to help prevent AC joint innuries
deltoid and pectoralis major
what muscles need to be stretched in order to proveent AC joint injuries
upper fiber traps
what is the most common injuries assocated with AC joint
sprain of AC lig or CC lig
what are the MOI for AC joint injuries
FOOSH
direct blow to the lateral shoulder
blow to the superior acromion
AC joint that cause dislcoation of the clav are caleld what
seperated shoulder
how many grades of AC joint sprain are there
6 types
what are the structures involved with a grade 1 AC joint sprain
Slight to partial damage of the AC ligament and capsule
no damage to CC
what are the signs and symptoms associated to type 1 ac joint sprain
Point tenderness, no laxity or deformity
what are the structures involved with a type 2 AC joint sprain
Rupture of the AC ligament and partial damage to the CC ligament
(slight step deformity)
what are the signs and symptoms associated with type 2 ac joint sprain
Slight laxity and deformity of AC joint, slight step deformity
what are the structures innvolved with type 3 AC joint sprain
Complete tearing of AC ligament and CC ligaments, possible involvement of deltoid and traps fascia
(OBVIOUS step deformity)
what are the signs and symtpoms associated with grade 3 AC joint sprain
Obvious dislocation of the distal end of clavicle from acromion process
what are the structures involved with a grade 4 AC joint sprain
Complete tearing of AC and CC ligaments and tearing of the deltoid and trapezius fascia
what are the structures involved with a type 5 AC joint sprain
Complete tearing of AC and CC ligaments and tearing of the deltoid and trapezius fascia
what are tthe strcutres invovled in a type 6 AC joint sprain
Complete tearing of AC and CC ligaments and tearing of the deltoid and trapezius fascia
whatt are the SS associated with grade 4 AC joint sprain
Posterior clavicular displacement into the insertion of the UFT
what are the SS associated with grade 5 AC joint sprain
displacement of clavicle 3x height compared to other side
what are the SS associated with a grade 6 AC joint sprain
Displacement of clavicle inferiorly under coracoid
clavicle disapears
can you differentiate between all 6 og the AC joint sprains
no , only differentiate between grade 1-3
step deformity is very common in what injury
AC joint injuries
what are the common SS of AC joint sprain
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
what is the commonly fractured bone of the upper sholder
clavicle
where do fractures mostly occur in the clavicle
mostly at the 2 of the s shape
what is the MOI of clavicular fractures
direct impact, impact to lateral shoulder, FOOSH
what is the difference between AC joint sprain and clav fracture
positive tap test
sound of crepitus
what is the athelette has a clav fracture but has equipmennt on
equipment stays onn and you can use arm movement or palpationn to assess
80% of clavicular fractures happen at the lateral or medial side or middle
middle
which side of the clavicle is the least commonly fractured
medial (only 5%)
true or false: clav fracture and AC joint sprain look similar
true
what is the function of the should labrum
deepens cavity
decreases friction
what makes up the glenohumeral joint
the head of the humerus and the glenoid cavity of the scapula
true or false: GH joint is a dynamic joinnt
yes
explain how GH joint is a dynamic joint
WOrks with scapula and clavicle to ensure full ROM
what are the GH ligaments
superior
inferio
posterior
middle/anterior
whta are the muscles associated near the GH joint
biceps (long head), rotator cuff muscles, pectoralis major, deltoid, triceps
glenohumeral instability is in whatt directions
anterior postrior inferior or multiple directions
what is instability of GH joint graded on
Joint play- movement of head of humerus in glenoid fossa
what contributes to passive stability of GH
capsular ligaments and GH ligaments
what contrtibutes to dynamic stability of the GH
rotator cuff muscles, and other GH muscles
what is a tetst to diadnose GH instability
apprensionn test
what are the 2 tyoes of GH instability
TUBS
AMBRI
what is TUBS
traumatic unidirection instability
is TUBS usually treated with surgery or conservation
surgery
TUBS is usually associated with what other injury
bankart lesion
what is AMBRI
atraumatic multidirectional frequently bilateral
what is AMBRi treated with
rehab or inferior capsular shift
which of these is usually treated with surger: TUBS OR AMBRI
TUBS
which of these is usually treated with rehab: TUBS OR AMBRI
ambri
true or false: in AMRBI the person usually has hyperlaxity
true
GH isntability can only be traumatic?
false also chronic
explain the MOI for traumatic GH instability
Apprehension position
FOOSH- anterior/posterior
Direct trauma
expklain the MOI for chronic GH instability
Large strains or weakness of RC
Dysfunction of long head of biceps tendon
Apprehension position- repetitive
Genetics
which is more common anterior or posterior dislocation of the shoulder
anterior dislocation
anterior instability of the GH joint causes laxity where
Middle GH ligament
Anterior aspect of the inferior ligament
what are commonn inn=juries asosciated with anterior GH instability
sprain
dislocations
what are the ways to tell if the shoulder is dislocated
1 arm is longer
lacking roundness of shoulder
posterior instability of the GH joint is rare or common and explain
rare only 3% of all shoulder instabilities
what is the position of the humerous in posterior istability
humerus is flexed and internally roated
true or false: posterior instability of GH joint is more common nas a microtrauma than acute
true
what aare some examples of of microtrauma that cause posterior instability of GH joint
Repeated blows in a flexed arm (blocking football)
Follow through phases of overhead throwing
what is multidirectionnal instability of the GH joint
combination of 2 of more unidirectional instabilityies
whattt does congenital MDI of the shoulder present with
presents with generalized hyper laxity of the shoulders and other joints
what does acquired MDI of shoulder usually arrise from
participate in overhead activities, that impose repetitive microtrauma
whatt are the common SS of GH instability
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)
whatt are common injured with GH instability and why
labrum tears because the inferior GH ligament has attachement to the labrum
true or false: biceps tendonn has attachment to the labrum
true
what is the problem with the biceps tendon being attached to the labrum
During eccentric contraction of the biceps to slow elbow down from extension, the tension pulls on the labrum
what is a bankart lesion
Injury to the anterior labrum associated with anterior shoulder instability
what is the time region assocaited to bankart lesion
3 oclock to 6 oclock
what is the time region for a reverse bankart lesion
6-9 oclock
where is a reverse bankart lesion found
on the posterior aspect of the labrum
where is slap lesion common
common in reporitive overhead motions (when biceps contract it can pull in the labrum)
what is a slap lesion
teaar of the superior labrum anterior to psoterior
what is the time region of a slap lesion
11 oclock to 1 oclok
true or false: Bankart lesion has biceps tendon involvment
false, slap lesion may have biceps tendon atttachement
slap lesionn has invovlements with what muscles
tthey may have biceps tendon involvement
why may there be biceps tendon involvement in skao lesions
beause of the biceps tendonn attaching superiorly on labrum
explain type 1 slap lesion classifcation
Degenerative fraying of the labrum near the insertion of the LHBT
=does no t affect biceps tendon
explain type 2 classication of slap lesions
Avulsion of the glenoid labrum with an associated tear of the LHBT
what is type 3 classification of slap lesion
Bucket handle tear with displacement of the fragment. No LHBT involvement
what is type 4 of slap lesion classfication
Bucket handle tear with associated LHBT tear
what clasffications of slap lesions have biceps involvement
2 and 4
wht classifcations of slap lesionns have no biceps invovlement
1 and 3
what are the common SS with labral tear
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
where will pain be for labral tear
feels pain deep in the shoulder located anterior
why would you get a locking feelinng in a labrial tear
if there is a large tear that flaps and acts like a door stop
why would you hear clicking i na labral tear
head of the humerous is movign over the labral tear
what is impingment at the shoulder
A decreased space where the Rotator cuffs tendons pass through the coracoacromial arch
what arae the most common impingements of the shoulder
subacromial bursa
rotator cuff
lonng head of the biceps
what are the causes of shoulder impingement
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
what are the common SS of impingement
Pinching sensation with ROM, especially overhead
Weakness in RC muscles and/or biceps brachii
Pain at common origin of RC or below AC joint
where will there usually be pain on palpation for shoulder immpingment
Pain at common origin of RC or below AC joint
why is there excess pain in overhead movements in impingments
because you are changing the subacromial space
rotator cuff is subjected to more microtrtauma or macrottrama
microtrauma
tears of rotator cuff can be partial or complete
both
who is most liekly to get partial tears of RC
young individuals
who is most likely to get complete tears of RC
30 +
what are chronic tears of the RC
degeneration of tendond
does RC tendinopathy occur more beacuse of concentric or eccenric conractionn
eccentic
what does eccentric cotnraction of rc muscles cause
microtearing
what are larger tears of the RC tendons caused by
acute of microtearing overtime
what is an example of eccenntric contraction of the RC muscles
follow through in throwing
what are the intrinsic factors contributing to RC tendinopathy
Muscle imbalances Muscle weaknesses Poor posture Capsular laxity Poor scapular control Impingement syndromes
whatt are extrinnsic factors thatt contribute to RC tendinopathy
Training errors
Faulty techniques
Incorrect surfaces an equipment
Poor environmental conditions
what causes full thickness tears
may develop from untreated partial thickness tears or sceondary to a single force trauma
whar are the common SS of RC tendinopathy
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
where is reffered pain for RC tendinopathies
to deltoid tuberisity and/or lateral elbow
where will there be pain on palpation for RC tendinipathies
of the common insertion of RC muuscles
subacromial bursitis is the result of what other conditions
impringments
degenerative changes in RC muscles
true or false: subacromial bursistis is common in OH atheltes
true
its difficult to differentiate between RC pathlogy and what
subacromial bursistis
what are the SS of subacromial bursitis
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
where will there pointt tenderness for subacromial bursitis
Point tenderness on anterior and lateral edges of acromion process
where is the painful arc for subacromial bursitis
Painful arc between 70-120° of passive abduction
what condition is associated with the inability to sleep
subacromial bursitis
where is the reffered pain for subacromial bursitis
distal deltoid attCHEMENT
WHAT ALLOWS you to differentiate between RC and bicep tendinopathy
palpation
what is the common MOI for biceps tendinopathy
Repetitive overuse during rapid OH movements (Involving elbow flexion and supination activities)
Direct blow
(Transverse humeral ligament damage)
Anterior impingement may damage tendon
antterior impingement can injury what structure
biceps tendon
what sports are commonly associated with biceps tendinopathy
Racquet sports, shot putters/javelin, baseball/softball, QB, swimmers
biceps tendinipathy is irritation of what
irritation of tendon as it slides within the bicipital groove
what are the common SS of biceps tendinpotahy
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
where will there be pain on palpation for biceps tendinopathy
on biceps tendon and coracoid process
true or false: biceps stain/rupture can only be caued by macrotrauma
macro and microtrauma
what are the MOI for biceps strain
FOOSH
Excessive resistance
(Gymnasts, swimmers, weight lifter)
Prolonged tendinopathy
what are some common sports associated with biceps strain
Gymnasts, swimmers, weight lifting
what are the SS of biceps tendon rupture
Snapping sensation Intense pain Ecchymosis Palpable defect Weakness in flexion of elbow and shoulder and supination of forearm
in what movements will there be weakness
weakness in flexion of elbow and shoulder and supinatoion of forearm
what is the MOI of pectoralis major strain
forceful eccentric contraction (tackle, weightlifting)
what is the MOI of muscle contusions
direct trauma to the muscle belly
where are msucle contusions in upper exrtremity common in
common in biceps, deltoid and triceps
what are the SS of muscle contusions
ecchymosis =, swelling, limited ROM and weakness in MMT
what is thoracic outlet compression syndrome
Nerves and/or vessels become compressed in proximal neck or axilla
what is the cause for 90% of thoracic outlet compression syndrome cases
neurological
what are the two effects of thoracic outlet compression syndrome
neurological compressions (lower truck of brachial plexus)
vascular (subclavian artery and vein)
true or false: if thoracic outlet compresion syndrome is compression subclavian arterires and veins you need surgery
true
what are the SS of thoracic outlet syndrome if nerves are compressed
Aching
Pins/needles sensation
Numbness
Weakness in gripping and atrophy of hand muscles
what are the SS of Thoracic outlet syndrome fi subclavian vein is compressed
edema s
stiffness (in hand)
cyanosis
what is the SS of thoracic outlet syndrome is the subclavian artery is compressed
Rapid onset of coolness
Numbness in entire arm
Fatigue after exertional OH activity
Radial pulse maybe weak/absent with arm hyper extension
long thjoracci nerve palsy goes through what spinal cord sections
c5-7
can long thoracic nerve palsy only be traumatic
no also sponteanous
who is at higher risk of long thoracic nerve palsy
OH atheltes
what innervates SA
long thoracic nerve
what is the problem is the kong thoracic nerve palsy affected the SA
it will affect the position of the scapula on the rib cage
what is scapular dyskinesis
abnormal scapular positioning and kinematics
what is the acronym assocaited with scapular dyskiinesis
SICk
what does the acronym SICK stnad for
Scapular malposition
Inferiomedial border prominence
Coracoid pain and malposition
dysKinesis of scapular motion
what is normal stattic allignement (4 things)
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
what are the SS associated to scapular dyskinesis
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
