MSK: Shoulder

Question 1

How many Degrees are there in shoulder flexion?

Answer 1

180

Question 2

How many Degrees are there in shoulder extension?

Answer 2

60

Question 3

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

Answer 3

180

Question 4

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

Answer 4

120

Question 5

How many Degrees are there in shoulder adduction?

Answer 5

60

Question 6

How many Degrees are there in shoulder internal rotation?

Answer 6

90

Question 7

How many Degrees are there in shoulder external rotation?

Answer 7

90

Question 8

What 4 muscles perform shoulder flexion?

Answer 8

Anterior deltoid
pecroralis major
biceps brachii
coracobrachialis

Question 9

What 5 muscles perform shoulder extension?

Answer 9

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

Question 10

What 2 muscles perform shoulder ABduction?

Answer 10

middle deltoid
Supraspinatus

Question 11

What 7 muscles perform Shoulder ADduction?

Answer 11

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

Question 12

What 5 muscles perform shoulder Internal Rotation?

Answer 12

Supscapularis
Pectoralis major
Latissimus dorsi
Anterior deltoid
Teres major

Question 13

What are the main components of the glenohumeral joint

Answer 13

Glenoid Fossa
humerus
labrum
Glenohumeral capsule and ligaments
Dynamic stabilizers

Question 14

What attaches at the labrum?

Answer 14

glenohumeral ligaments, tendons,
shoulder capsule

Question 15

What does the labrum prevent?

Answer 15

anterior and posterior humeral head dislocation

Question 16

What is the purpose of the glenohumeral ligaments?

Answer 16

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

Question 17

What direction does the superior glenohumeral joint prevent translation of?

Answer 17

inferior

Question 18

What direction does the middle glenohumeral joint prevent translation of?

Answer 18

Anterior

Question 19

What direction does the inferior glenohumeral joint prevent translation of?

Answer 19

anterior when shoulder above 90 degrees

Question 20

What are the dynamic stabilizers of the shoulder?

Answer 20

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

Question 21

What are the static stabilizers of the shoulder?

Answer 21

glenoid, labrum, shoulder capsule, and glenohumeral ligament

Question 22

What is the purplose of the AC ligament

Answer 22

Provides horizontal stability of the AC Joint

Question 23

What is the purpose of the coracoclavicular ligament

Answer 23

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

Question 24

What are the two mechanisms of injury for the shoulder

Answer 24

1) direct impact to the shoulder
2) FOOSH

Question 25

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

Answer 25

AC: partial sprain coracoclavicular: intact Clavicular displacement: none

Question 26

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

Answer 26

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

Question 27

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

Answer 27

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

Question 28

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

Answer 28

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

Question 29

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

Answer 29

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

Question 30

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

Answer 30

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

Question 31

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

Answer 31

Grade 3 and higher

Question 32

How do you treat type 1/2 AC joint separtions

Answer 32

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)

Question 33

How do you treat type 3 AC joint separtions

Answer 33

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

Question 34

How do you treat type 4-6 AC joint separtions

Answer 34

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

Question 35

How would you treat chronic AC pain?

Answer 35

rehab CSI Surgery as last resort

Question 36

What are 3 complications of AC joint injuries?

Answer 36

Associated Calvicular fx and dislocations Distal clavicle osteolysis AC jt Arthrits

Question 37

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

Answer 37

Bankart and hill sachs lesion

Question 38

What is a bankart lesion?

Answer 38

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

Question 39

Identify the finding pointed by the black arrow on this Xray

Answer 39

Question 40

Identify the finding pointed by the White arrow on this Xray

Answer 40

Question 41

Define instability | regarding GHJ

Answer 41

translation of the humeral head on the glenoid fossa

Question 42

Define Subluxation | regarding GHJ

Answer 42

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

Question 43

Define Dislocation | regarding GHJ

Answer 43

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

Question 44

# Fill in the blank There is a _:_ glenohumeral:scapulothoracic motion accounting for the abilty to abduct the arm

Answer 44

2:1 | 120 degrees of motion comes from GH and 60 degrees of scapulothoracic

Question 45

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?

Answer 45

Anterior Arm abducted and externally rotated

Question 46

How does Posterior glenohumeral instabilty occur? | Give 1 medical condition and the mechanism during a fall

Answer 46

Seizure landing on a forward flexed adducted arm

Question 47

What nerve could be injured during a shoulder anterior dislocation?

Answer 47

Axillary

Question 48

What is a hill-sachs lesion?

Answer 48

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

Question 49

How do you treat anterior glenohumeral instabilty? | conservative vs surgical

Answer 49

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)

Question 50

How do you treat Posterior glenohumeral instabilty? | conservative vs surgical

Answer 50

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

Question 51

How do you treat multidirectional glenohumeral instability?

Answer 51

REHAB!!! Surgery is only last resport