Shoulder Flashcards
Describe resting position for the GH joint
55* abduction, 30* horizontal adduction
In what direction do roll and glide go for the GH joint?
roll in the same direction, glides in the opposite
What is the CPR for the shoulder?
ER > abd > IR
What is closed pack position for the SC joint?
full elevation and protraction
What is resting position for the AC and SC joints?
arm resting at side
What is the CPR for the AC and SC joints?
pain at extreme ROM - especially horizontal adduction & full elevation
What are the expected ROM for the shoulder joint?
180 flex/abd 100 horizontal abd 90 ER 70 IR 60 EXT 45 add/horizontal add
SC joint is a ___ joint, AC joint is a ___ joint.
saddle, planar
The SC joint is convex ____ and concave ____.
convex superior-to-inferiorly
concave anteriorly-to-posteriorly
In order for maximal abduction of the arm to occur, __* of ___ is required.
90* of lateral rotation
In order for the shoulder to abduct 180, the arm has to abduct ___ and the scapula must upwardly rotate __*
arm: 120*
scapula: 60*
The rotator cuff helps stabilize/maintain the position of the humeral head in the glenoid fossa. Which depress and which elevate it?
depress: infraspinatus, subscap, teres minor, supraspinatus (late stages of abduction)
elevate: deltoid, supraspinatus (early stages of abduction)
What is the most common cause of shoulder pain in adults?
impingement syndromes
Impingement syndrome pain has a significant ___ pain component.
nocturnal
Extrinsic impingement is a result of ____
mechanical wear of rotator cuff against anteroinferior 1/3 of acromion in the suprahumeral space during humeral elevation
Primary extrinsic vs. secondary extrinsic impingement are usually due to:
primary: anatomical or biomechanical factors
secondary: hypermobility or instability
The subacromial space is narrowed by excessive ___ and ___ of the scapula
anterior tilt & protraction
internal rotation of humerus
What is the most important function of the inferior GH ligament?
supports humeral head above 90* abduction by limiting inferior translation
The posterior band of the GH inferior ligament is most effective during __ of the humerus, while the anterior band of this ligament tightens to function most during ___.
posterior: medial rotation
anterior: lateral rotation
How would you perform the Active Compression of O’Brien test?
Step 1: Patient’s arm is forward flexed to 90, elbow extended, arm adducted to 10-15 and full pronation.
Step 2: Repeat with forearm fully supinated.
Downward force is applied for each of these.
What would be a (+) result for the active compression of O’Brien test?
pain on joint line or painful clicking that is apparent in part 1 but eliminated or decreased in part 2
What special test is this?
Patient supine, hold the humerus proximal to the elbow and fully abduct the arm over the patient’s head. Place one hand on posterior aspect of humeral head and push anteriorly while holding the arm in lateral rotation.
Clunk test
What special test is this?
Patient’s shoulder is flexed to 90* and medially rotated with elbow flexed to 90*
What can it be adapted to? How?
Hawkins-Kennedy
Coracoid impingement test, but you bring the arm 10-20* horizontally adducted before applying medially rotation.
A (+) result for the Hawkins-Kennedy test would be either…
pain –> supraspinatus tendonosis or secondary impingement
CPR for the acromioclavicular joint is…
??
CPR for the sternoclavicular joint is…
pain at extreme end ROM - especially horizontal adduction and elevation
During abduction at the GHJ, the first _ ribs ____, while all others elevate
2 ribs descend
When the arm abducts at the GHJ, the clavicle will __ and ___ rotate
elevate & posteriorly rotate
If total arm elevation is 180*, how much is scapulothoracic?
60*
GH head depressors include:
SITS mm - supraspinatus only in mid to late stages of abduction
GH head elevators include:
supraspinatus (early stages)
deltoid
What is the most common cause of shoulder pain in adults?
impingement syndromes
Impingement syndromes see pinching of the rotator cuff and subacromial tissues between the ___ and ____
coracoacromial arch and proximal humerus
This shoulder condition has a “toothache like discomfort with a significant nocturnal component”
impingement syndromes
Extrinsic impingement is believed to occur as a result of the RC mm against the _____ of the ____
anteroinferior 1/3 of the acromion in the suprahumeral space during elevation of the humerus
Differentiate external (primary & secondary) vs. internal impingement
external occurs anteriorly
internal occurs posteriorly
Who does internal impingement most commonly occur in, and what happens?
overhead athletes get the undersurface of the RC mm caught with the posterior-superior glenoid labrum when arm is pretty close to being in closed pack position
What three tests would you use to confirm a shoulder impingement dx?
Hawkins-Kennedy, infraspinatus test, and painful arc
What distinguishes stage 2 from stage 1 impingement?
pain at night, not alleviated by rest
What distinguishes stage 3 from stage 2 impingement?
diffuse pain may refer to wrist
usually after 40yoa - M/C with women
degeneration & bony changes
Describe stage 4 impingement
complete RC mm tear & atrophy
surgical candidates
usually necessary to limit GH movements
Where is the subacromial bursa found?
between the acormiom/deltoid muscle and the supraspinatus muscle
Which shoulder bursa typically DOES communicate with the joint capsule?
subscapular bursa
Describe the pain character/onset of bursitis
acute pain arising suddenly over 12-72 hours building to severe, disabling pain
intense, dull, throbbing, often with referral - all movements limited & painful. disturbs sleep
EMPTY end feel (cannot complete ROM d/t extreme pain)
Anterior shoulder dislocation occurs when…
an anterior force is applied to the arm in abd & ER
Repetitive forces against a forward flexed humerus OR a FOOSH can result in…
posterior dislocation
Which type of shoulder dislocation is commonly seen in people with hemiplegia?
inferior
4 possible directions for shoulder dislocation are:
subacromial, subglenoid, subclavicular, and subspinous
Which location of humeral dislocation is most common?
subcoracoid (anterior & inferior)
Sulcus sign is associated with ___, step deformity is associated with ___
sulcus: dislocations
step deformity: A/C separation
The foramen of Weitbreicht is found where?
between the superior and middle GH ligaments
Which 3 ligaments can be affected with AC sprains/separations? Where do they attach?
CORACOCLAVICULAR LIGAMENTS: trapezoid: coracoid process & clavicle
conoid: coracoid process & clavicle (more medial)
ACROMIOCLAVICULAR LIGAMENTS
Which 3 ligaments can be affected with AC sprains/separations? Where do they attach?
CORACOCLAVICULAR LIGAMENTS: trapezoid: coracoid process & clavicle
conoid: coracoid process & clavicle (more medial)
ACROMIOCLAVICULAR LIGAMENTS
Differentiate grade 1 vs. grade 2 AC separation/sprain
grade 2 sees sublux of AC joint and disruption of AC ligaments, step deformity
grade 1 sees damage to AC without displacement of clavicle
Pain from labral tears will be described as at what location, typically?
posterior or posterior-superior joint line, especially in abd, exacerbated by overhead and behind the back arm movements
What is a BANKART LESION?
tear of the anteroinferior labrum, M/C d/t traumatic anterior dislocation leading to anterior instability
What is a SLAP LESION
superior labrum injured possibly involving the biceps
Bankart lesion is found at what clock position of the labrum?
3pm-7pm
SLAP lesion is found at what clock position of the labrum?
10am-2pm
True or false: labrum tx goals include posterior capsule stretching
True
Are intraarticular adhesions of adhesive capsulitis a cause or result?
may be more of a result… unsure
Adhesive capsulitis humeroscapular movement ratio is usually…
1:1
What are the 3 stages of frozen shoulder?
1 - freezing (gradual onset, pain at night)
2 - frozen (pain diminishing, possible disuse atrophy)
3 - thawing (pain local to lateral arm & diminishing, motion/function gradually return)
Which 3 RC mm are most frequently torn?
supraspinatus, infraspinatus, and subscapularis
What is Kehr’s sign?
Kehr’s sign is the occurrence of acute pain in the tip of the shoulder due to the presence of blood or other irritants in the peritoneal cavity when a person is lying down and the legs are elevated
The liver/gallbladder refer pain to the… the left shoulder will feel pain referred from the…
right shoulder… spleen
Which type of SLAP lesion is: bucket-handle tear of labrum that may displace into joint, labral biceps attachment still intact
type III
Which type of SLAP lesion is: bucket handle tear of labrum extending into biceps tendon, allowing the tendon to sublux into joint
Type 4
What is the most common type of slap lesion? Describe it
Type II: superior labrum has small tear, instability of labral-biceps complex
Differentiate grade 1 and 2 shoulder impingements
grade 1: pure impingement with no instability
grade 2: secondary impingement and instability d/t chronic capsular or labral microtrauma
Differentiate grades 3 and 4 of shoulder impingement
Grade III: secondary impingement and instability d/t generalized hypermobility/laxity
Grade IV: primary instability, no impingement
Differentiate grade 1 vs. grade 4 shoulder impingement
1: pure impingement with no instability
4: primary instability with no impingement
What is the typical MOI for a Galeazzi fracture? What IS a Galeazzi fracture?
spiral fracture of radial shaft at RUJ , may include ulnar nerve lesion
FOOSH with rotational component
What is the typical MOI for a Monteggia fracture, and what is it?
direct blow to anterior forearm
dorsally angulated fracture and dislocation of radial head
