MSK: Shoulder Flashcards
Based off Cuccurullo
How many Degrees are there in shoulder flexion?
180
How many Degrees are there in shoulder extension?
60
How many Degrees are there in shoulder Abduction (thumb up)?
180
How many Degrees are there in shoulder abduction (thumb down)?
120
How many Degrees are there in shoulder adduction?
60
How many Degrees are there in shoulder internal rotation?
90
How many Degrees are there in shoulder external rotation?
90
What 4 muscles perform shoulder flexion?
Anterior deltoid
pecroralis major
biceps brachii
coracobrachialis
What 5 muscles perform shoulder extension?
Posterior deltoid
latissumus dorsi
teres major
tricepts (long head)
pectorasis major (sternocostal portion)
What 2 muscles perform shoulder ABduction?
middle deltoid
Supraspinatus
What 7 muscles perform Shoulder ADduction?
Pectoralis major
Latissimus dorsi
Teres Major
Coracobrachialis
Infraspinatus
Long head of the triceps
anterior & posterior deltoid
What 5 muscles perform shoulder Internal Rotation?
Supscapularis
Pectoralis major
Latissimus dorsi
Anterior deltoid
Teres major
What are the main components of the glenohumeral joint
Glenoid Fossa
humerus
labrum
Glenohumeral capsule and ligaments
Dynamic stabilizers
What attaches at the labrum?
glenohumeral ligaments, tendons,
shoulder capsule
What does the labrum prevent?
anterior and posterior humeral head dislocation
What is the purpose of the glenohumeral ligaments?
Provide stability and prevent translation of the head of the humerus from the glenoid fossa
What direction does the superior glenohumeral joint prevent translation of?
inferior
What direction does the middle glenohumeral joint prevent translation of?
Anterior
What direction does the inferior glenohumeral joint prevent translation of?
anterior when shoulder above 90 degrees
What are the dynamic stabilizers of the shoulder?
RTC muscles
long head of the biceps tendon
deltoid
teres major
latissimus dorsi
Supporting case: Scapular stabilizers
What are the static stabilizers of the shoulder?
glenoid, labrum, shoulder capsule, and glenohumeral ligament
What is the purplose of the AC ligament
Provides horizontal stability of the AC Joint
What is the purpose of the coracoclavicular ligament
prevents vertical translation of the clavicle by anchoring the calvical to the coracoid process
What are the two mechanisms of injury for the shoulder
1) direct impact to the shoulder
2) FOOSH
What is injured in a type 1 AC seperation regarding these structuress:
AC jt, Coracoclavicular jt, and Clavicular displacement?
AC: partial sprain
coracoclavicular: intact
Clavicular displacement: none
What is injured in a type 2 AC seperation regarding these structuress:
AC jt, Coracoclavicular jt, and Clavicular displacement?
AC: complete tear
coracoclavicular: partial sprain
Clavicular displacement: none
What is injured in a type 3 AC seperation regarding these structuress:
AC jt, Coracoclavicular jt, and Clavicular displacement?
AC: complete tear
coracoclavicular: complete tear
Clavicular displacement: superior
What is injured in a type 4 AC seperation regarding these structuress:
AC jt, Coracoclavicular jt, and Clavicular displacement?
AC: complete tear
coracoclavicular: complete tear
Clavicular displacement: superior and posterior (into trap)
What is injured in a type 5 AC seperation regarding these structuress:
AC jt, Coracoclavicular jt, and Clavicular displacement?
AC: complete tear
coracoclavicular: complete tear + disruption of the deltoid and trap fiber
Clavicular displacement: superior and posterior (into trap)
What is injured in a type 6 AC seperation regarding these structuress:
AC jt, Coracoclavicular jt, and Clavicular displacement?
AC: complete tear
coracoclavicular: complete tear
Clavicular displacement: inferior
What AC joint separation type(s) will you see actual displacement and gross deformity
Grade 3 and higher
How do you treat type 1/2 AC joint separtions
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)
How do you treat type 3 AC joint separtions
Controversial if conservative like Type 1/2 or Surgery.
Surgery recommended if athlete/heavy laborer.
How do you treat type 4-6 AC joint separtions
Surgery: ORIF vs distal clavicular resection with reconstruction of the CC ligament
How would you treat chronic AC pain?
rehab
CSI
Surgery as last resort
What are 3 complications of AC joint injuries?
Associated Calvicular fx and dislocations
Distal clavicle osteolysis
AC jt Arthrits
In an anterior shoulder dislocation, what are two lesions that associated with it? These can be seen on Xray
Bankart and hill sachs lesion
What is a bankart lesion?
Labral tear off the anterior glenoid allowing the huneral head to slip anteriorly
Identify the finding pointed by the black arrow on this Xray
Identify the finding pointed by the White arrow on this Xray
Define instability
regarding GHJ
translation of the humeral head on the glenoid fossa
Define Subluxation
regarding GHJ
incomplete separation of the humeral head from the glenoid fossa with immediate reduction
Define Dislocation
regarding GHJ
complete separation of the humeral head from the glenoid fossa with immediate reduction
Fill in the blank
There is a : glenohumeral:scapulothoracic motion accounting for the abilty to abduct the arm
2:1
120 degrees of motion comes from GH and 60 degrees of scapulothoracic
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?
Anterior
Arm abducted and externally rotated
How does Posterior glenohumeral instabilty occur?
Give 1 medical condition and the mechanism during a fall
Seizure
landing on a forward flexed adducted arm
What nerve could be injured during a shoulder anterior dislocation?
Axillary
What is a hill-sachs lesion?
Compression fx of the posterolateral humeral head caused by abutment against the anterior rim of the glenoid fossa
How do you treat anterior glenohumeral instabilty?
conservative vs surgical
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)
How do you treat Posterior glenohumeral instabilty?
conservative vs surgical
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
How do you treat multidirectional glenohumeral instability?
REHAB!!! Surgery is only last resport
