Lecture 7 - Shoulder ax Flashcards
Type of joint at shoulder
Multiaxial ball and socket synovial joint
At the shoulder, you sacrifice __ to gain __ compared to the hip which is a deeper joint
Stability for mobility
GH joint - resting position + close packed position + capsular pattern
rest. pos = 40-55d ABD, 30d horiz ADD (scapular plane)
close packed = full ABD + lat rot
capsular pattern = ext rot, ABD, int rot
Shoulder is a shallow socket, what increases it?
Labrum by 50%
Type of joint for AC joint
Plane synovial joint
Purpose of AC joint
Augments the ROM of the humerus in the glenoid
AC joint - resting position, close packed position, capsular pattern
rest pos = arm resting by side
close packed = 90 ABD
capsular patt = pain at extremes of ROM (hor add + full elevation)
Role of SC joint
along with AC joint, enables the humerus in the glenoid to move through a full 180d of ABD
Mvt of SC - horizontal ABD
Moves forward
Mvt of SC - shoulder depression
Moves superior
Mvt of SC - Horizontal ADD
Moves posterior
SC joint - resting position, close packed position, capsular pattern
rest pos = arm resting by side
close packed = full elevation + protraction
capsular pattern = pain at extremes of ROM (horiz ADD + full elevation)
No capsular pattern
Is a stable base for the RC
20-30d forward of sagittal plane
Scapulothoracic
Scapulothoracic rhythm
at 0-30d
at 30-90d
at more than 90d
should have no scapular mvt
2:1
1:1
Special thing to check in posture anterior view at shoulder
Head and neck are in the midline of the body and observe their relation to the shoulders
In most people, dominant shoulder is __ than the nondominant side
lower
Injured shoulder, when protecting/guarding, will be __ than the other side
Higher
What to note in posterior view of shoulder (4)
- Scapular dyskinesia
- Primary scapular winging
- Secondary scapular winging
- Dynamic scapular winging
Scapular dysfunction - type 1
- Inferior medial border being prominent at rest
- Inferior angle tilts dorsally with movement (scapular tilt)
- Acromion tilts anteriorly over the top of the thorax
Type 1 scap dysk. indicates what
Presence of weak muscles or tight pecs pulling or tilting the scapula forward
Scapular dysfunction - Type 2
- Classic winging, whole medial border
- Prominent, lifting from the posterior chest wall
- Statically and dynamically
Type 2 scap dysk. indicates what
Presence of SLAP lesion
Weakness of SA, Rhomb, UFT/MFT/LFT, long thoracic n. problem, or tight RC
Scapular dysfunction - Type 3
- Superior border elevated at rest and during movement
- Minimal winging
Type 3 scap dysk. indicates what?
Over activity of letavor scapulae and UFT
Imbalances in UFT/LFT force couple
Impingement and RC lesions
Scapular dysfunction - Type 4
- Symmetrical scapulae
- Rotatory winging (inferior angles rotating laterally)
Type 4 scap dysk. indicates what?
during movement and may indicate the scapular control muscles are not stabilizing the scapula (WHAT YOU WANT- but could be both not normal even though they both move symmetrically)
Primary scapular winging
Due to muscle weakness of one of the scapular muscle stabilizers
Secondary scapular winging
Normal movement of scapula is altered because of pathology in glenohumeral joint
Dynamic scapular winging
may be due to lesion of the long thoracic nerve affecting serratus anterior, trapezius palsy (spinal accessory nerve), rhomboid weakness, multidirectional instability, voluntary action, or a painful shoulder resulting in splinting of the glenohumeral joint, which in turn causes reverse scapulohumeral rhythm
4 causes of scapular dyskinesia
- Bony
- Joint
- Soft tissue
- Neurological
Scapular dyskinesia - bony
thoracic kyphosis
clavicular fracture or malunion
Scapular dyskinesia - Joint
AC instability/arthrosis
GH internal derangement
Scapular dyskinesia - Neurological
Cervical radiculopathy
Long thoracic n. palsy
Spinal accessory n. palsy
Scapular dyskinesia - soft tissue
- intrinsic m. pathology
- hypomobility
- GH int. rot deficit
- altered m. activation patterns
What is the popeye sign
Bicep long head tendon rupture
What is the lennie test
Measure the distance between scapula and compare dominant vs nondominant side
See slide 47 for abnormal active ROM
4 causes
What is GERG and GIRD
Glenohumeral external rotation gain
Glenohumeral internal rotation deficit
If GIRD/GERG ratio is >1
Patient will probably develop shoulder problems
What is snapping scapula
Comes from the scapular retraction/protraction cycle
Caused by the scapular rubbing over the underlying ribs
Explain apley’s scratch test
Med rot + adduction
Lat rot + abduction
Functional ADLs at shoulder
Brush teeth
Brush hair
Tuck in shirt
Reach to shelf
Sport-specific movts
Define characteristics of laxity
Nonpathological “looseness”
Greater ROM in one or more directions
SHD complex functions normally
Found bilaterally
Define characteristics of instability
Inability to control or stabilize a joint
Dynamic or static
Static restraints have been injured
Weak muscles or unbalanced force couples
Anatomical instability
Static restraints have been injured
Translational instability
Weak muscles or unbalanced force couples
2 types of sh instabilities
TUBS or AMBRI
TUBS
Traumatic, unidirectional, Bankart, SLAP
Surgery required
AMBRI
Autraumatic, multidirectional, bilateral, rehabilitation/inferior capsular shift
Jobe classification - Grade 1
Pure impingement with no instability (often seen in older patients)
Jobe classification - Grade 2
Secondary impingement and instability caused by chronic capsular and labral microtrauma
Jobe classification - Grade 3
Secondary impingement and instability caused by generalized hypermobility or laxity
Jobe classification - Grade 4
Primary instability with no impingement
Types of SLAP tears - Type I
Degenerative fraying with no detachment of biceps insertion
Types of SLAP tears - Type II
Most common type and represents a detachment of the superior labrum and biceps from the glenoid rim
Types of SLAP tears - Type III
Bucket-handle tear of the labrum with an intect biceps tendon insertion to the bone
Types of SLAP tears - Type IV
Least common type represents intra-substance tear of the biceps tendon with a bucket-handle tear of the superior aspect of the labrum
See chart document for special tests
+ practice charting slide 130
