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PM&R Board Review > MSK: Shoulder > Flashcards

MSK: Shoulder Flashcards

Based off Cuccurullo

1
Q

How many Degrees are there in shoulder flexion?

A

180

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2
Q

How many Degrees are there in shoulder extension?

A

60

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3
Q

How many Degrees are there in shoulder Abduction (thumb up)?

A

180

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4
Q

How many Degrees are there in shoulder abduction (thumb down)?

A

120

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5
Q

How many Degrees are there in shoulder adduction?

A

60

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6
Q

How many Degrees are there in shoulder internal rotation?

A

90

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7
Q

How many Degrees are there in shoulder external rotation?

A

90

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8
Q

What 4 muscles perform shoulder flexion?

A

Anterior deltoid
pecroralis major
biceps brachii
coracobrachialis

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9
Q

What 5 muscles perform shoulder extension?

A

Posterior deltoid
latissumus dorsi
teres major
tricepts (long head)
pectorasis major (sternocostal portion)

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10
Q

What 2 muscles perform shoulder ABduction?

A

middle deltoid
Supraspinatus

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11
Q

What 7 muscles perform Shoulder ADduction?

A

Pectoralis major
Latissimus dorsi
Teres Major
Coracobrachialis
Infraspinatus
Long head of the triceps
anterior & posterior deltoid

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12
Q

What 5 muscles perform shoulder Internal Rotation?

A

Supscapularis
Pectoralis major
Latissimus dorsi
Anterior deltoid
Teres major

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13
Q

What are the main components of the glenohumeral joint

A

Glenoid Fossa
humerus
labrum
Glenohumeral capsule and ligaments
Dynamic stabilizers

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14
Q

What attaches at the labrum?

A

glenohumeral ligaments, tendons,
shoulder capsule

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15
Q

What does the labrum prevent?

A

anterior and posterior humeral head dislocation

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16
Q

What is the purpose of the glenohumeral ligaments?

A

Provide stability and prevent translation of the head of the humerus from the glenoid fossa

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17
Q

What direction does the superior glenohumeral joint prevent translation of?

A

inferior

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18
Q

What direction does the middle glenohumeral joint prevent translation of?

A

Anterior

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19
Q

What direction does the inferior glenohumeral joint prevent translation of?

A

anterior when shoulder above 90 degrees

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20
Q

What are the dynamic stabilizers of the shoulder?

A

RTC muscles
long head of the biceps tendon
deltoid
teres major
latissimus dorsi
Supporting case: Scapular stabilizers

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21
Q

What are the static stabilizers of the shoulder?

A

glenoid, labrum, shoulder capsule, and glenohumeral ligament

22
Q

What is the purplose of the AC ligament

A

Provides horizontal stability of the AC Joint

23
Q

What is the purpose of the coracoclavicular ligament

A

prevents vertical translation of the clavicle by anchoring the calvical to the coracoid process

24
Q

What are the two mechanisms of injury for the shoulder

A

1) direct impact to the shoulder
2) FOOSH

25
Q

What is injured in a type 1 AC seperation regarding these structuress:
AC jt, Coracoclavicular jt, and Clavicular displacement?

A

AC: partial sprain
coracoclavicular: intact
Clavicular displacement: none

26
Q

What is injured in a type 2 AC seperation regarding these structuress:
AC jt, Coracoclavicular jt, and Clavicular displacement?

A

AC: complete tear
coracoclavicular: partial sprain
Clavicular displacement: none

27
Q

What is injured in a type 3 AC seperation regarding these structuress:
AC jt, Coracoclavicular jt, and Clavicular displacement?

A

AC: complete tear
coracoclavicular: complete tear
Clavicular displacement: superior

28
Q

What is injured in a type 4 AC seperation regarding these structuress:
AC jt, Coracoclavicular jt, and Clavicular displacement?

A

AC: complete tear
coracoclavicular: complete tear
Clavicular displacement: superior and posterior (into trap)

29
Q

What is injured in a type 5 AC seperation regarding these structuress:
AC jt, Coracoclavicular jt, and Clavicular displacement?

A

AC: complete tear
coracoclavicular: complete tear + disruption of the deltoid and trap fiber
Clavicular displacement: superior and posterior (into trap)

30
Q

What is injured in a type 6 AC seperation regarding these structuress:
AC jt, Coracoclavicular jt, and Clavicular displacement?

A

AC: complete tear
coracoclavicular: complete tear
Clavicular displacement: inferior

31
Q

What AC joint separation type(s) will you see actual displacement and gross deformity

A

Grade 3 and higher

32
Q

How do you treat type 1/2 AC joint separtions

A

RICE
Sling for comfort (1-2wks)
Avoid heavy lifting and contact sports
Rehab: work on strengthening and stabilizing the shoulder girld
RTP: Full ROM and NO sxs (usually 2wks for type 1 and 6 for type 2)

33
Q

How do you treat type 3 AC joint separtions

A

Controversial if conservative like Type 1/2 or Surgery.
Surgery recommended if athlete/heavy laborer.

34
Q

How do you treat type 4-6 AC joint separtions

A

Surgery: ORIF vs distal clavicular resection with reconstruction of the CC ligament

35
Q

How would you treat chronic AC pain?

A

rehab
CSI
Surgery as last resort

36
Q

What are 3 complications of AC joint injuries?

A

Associated Calvicular fx and dislocations
Distal clavicle osteolysis
AC jt Arthrits

37
Q

In an anterior shoulder dislocation, what are two lesions that associated with it? These can be seen on Xray

A

Bankart and hill sachs lesion

38
Q

What is a bankart lesion?

A

Labral tear off the anterior glenoid allowing the huneral head to slip anteriorly

39
Q

Identify the finding pointed by the black arrow on this Xray

A
40
Q

Identify the finding pointed by the White arrow on this Xray

A
41
Q

Define instability

regarding GHJ

A

translation of the humeral head on the glenoid fossa

42
Q

Define Subluxation

regarding GHJ

A

incomplete separation of the humeral head from the glenoid fossa with immediate reduction

43
Q

Define Dislocation

regarding GHJ

A

complete separation of the humeral head from the glenoid fossa with immediate reduction

44
Q

Fill in the blank

There is a : glenohumeral:scapulothoracic motion accounting for the abilty to abduct the arm

A

2:1

120 degrees of motion comes from GH and 60 degrees of scapulothoracic

45
Q

What is the most common direction of GH instability? What is the common mechanism for this, as in what is the orientation of the arm?

A

Anterior
Arm abducted and externally rotated

46
Q

How does Posterior glenohumeral instabilty occur?

Give 1 medical condition and the mechanism during a fall

A

Seizure
landing on a forward flexed adducted arm

47
Q

What nerve could be injured during a shoulder anterior dislocation?

A

Axillary

48
Q

What is a hill-sachs lesion?

A

Compression fx of the posterolateral humeral head caused by abutment against the anterior rim of the glenoid fossa

49
Q

How do you treat anterior glenohumeral instabilty?

conservative vs surgical

A

Conservative
* Sling immobilization
* Rehab: ROM after immobilization. Start with pROM and then proceed to isometric exercises etc
Surgical
* Failure of conservative tx
* 3 dislocations as risk for another is almost 100% (can do earlier if there is a labral tear too)

50
Q

How do you treat Posterior glenohumeral instabilty?

conservative vs surgical

A

Conservative
* immobilization in neutral position for 3 weeks
* Rehab: Most importantly need to strengthen the posterior shoulder-scapula musculature
Surgical
* Failure of conservative tx.
* Posteiror capsulorrhapy is the procedure of choice

51
Q

How do you treat multidirectional glenohumeral instability?

A

REHAB!!! Surgery is only last resport

PM&R Board Review (2 decks)

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