Shoulder Flashcards
The upper extremity’s only attachment to the axial skeleton occurs at which of the following?
Sternoclavicular joint (SC) joint
What is known as the indented superior region of the manubrium?
Sternal notch or jugular notch
The angle of inclination-the relationship between the humerous and the humeral head in the frontal plane-should normally have a range of which of the following?
130-150 degrees
Which ligament is responsible for restricting superior movement of the clavicle at the AC joint?
Conoid Ligament
What is a weak site in the GH capsule that is often torn during an anterior GH dislocation?
Weitbrecht’s Foramen
Which position would place the GH joint in its closed-pack position?
90 degrees abduction with external rotation
Injury to what nerve would be indicated by scapular winging?
Long Thoracic Nerve
A weakness of which muscle in the shoulder complex can result in scapular winging?
Serratus Anterior
Which fibers of the trapezius muscle are responsible for scapular retraction?
middle trapezius
What is the only member of the rotator cuff group that internally rotates the humerus?
Subscapularis
Which of the following describes the ratio that exists between GH elevation and upward scapular rotation?
2 to 1
What is the pain during the follow-through phase of the pitching motion commonly associated with?
Rotator Cuff pathology
What is the pain in the cocked position during the pithing motion commonly associated with?
Instability or impingement
What is the pain during the deceleration phase of the pitching motion commonly associated with?
SLAP lesion or biceps tendon pathology
Bilateral or unilateral depression of the shoulder complexes as a result of decreased upper trapezius muscle tone predisposes an athlete to which of the following?
Thoracic outlet syndrome
Injury or trauma to what nerve roots may be indicated by atrophy of the deltoid muscle group?
C5 and C6
Injury or trauma to what nerve may be indicated by atrophy of the deltoid muscle group?
Axillary nerve
The superior angle should sit at what spinous process level during observation of the vertebral borders of the scapula?
T2
The inferior angel should sit at what spinous process level during observation of the vertebral borders of the scapula?
T7
What traumatic injury to the shoulder complex would constitute a medical emergency?
Posterior SC joint dislocation
What special test evaluates for the shoulder impingement?
Neer’s Sign
Hawkin’s Kennedy
For which muscle does the coracoid precess serve as the point of insertion?
Pectoralis minor
What is the strength ration of internal to external rotators for concentric contractions for profession baseball pitchers?
3 to 2
What is the most common sit for fractures of the clavicle?
Junction of the convex and concave curvature of the clavicle, middle 2/3
What is the last growth plate in the body to close?
Medial clavicular epiphysis
What makes the SC joint different from other joints in the body?
It has the poorest boney stability of any joint in the body
What muscle internally rotates the humerus
Subscapularis
A patient that exhibits a painful arc during abduction will usually experience pain in what range
between 60 and 120 degrees
Rotator cuff muscles
Formed by four muscles arising off the scapula: (SITS) Supraspinatus -assists in abd & ER humerus
Infraspinatus - ER humerus & assists horizontal abd
Teres minor - same as infraspinatus but assists ext GH joint
Subscapularis - IR humerus
What does a positive Gerber’s lift-off test indicate
Tear of the subscapularis
If the scapula cannot achieve a posterior tilt, it is due to tightness of what muscle
Pectoralis minor
A “separated” shoulder is a common name for which injury
AC sprain
A Bankart lesion can be formed by which ligament pulling off with a portion of the labrum
Inferior GH ligament
Which two tests can be used to evaluate posterior GH instability
Jerk Test and posterior apprehension test
Tears most commonly occur in which rotator cuff muscle
Supraspinatus
What best describes the plane of the scapula
30 degrees into the frontal plane
When palpating the bicipital groove, the __________ is lateral to the groove, while the __________ is on the medial aspect of the groove.
Greater tubercle, lesser tubercle
What ligament creates the coracoacromial arch
Coracoaromial ligament
Helps prevent superior dislocation of GH joint
What is the function of the Transverse Humeral Ligament
To stabilize the long head of the biceps within the bicipital groove
What rotator cuff muscle is not a GH-joint internal rotator
Supraspinatus
What special test evaluates ROM of the upper extremity
Apley’s
Name the two bursa at the GH-joint
Subacromial & subscapular
What does Yergason’s Test assess
Bicipital groove tendonitis
This muscle is a main GH-joint extender
latissimus dorsi
What special test evaluates for a shoulder labral tear
O’Brian’s test
What special tests evaluate for a shoulder dislocation
Apprehension test, jobe relocation, posterior apprehension test
What special test evaluates for a shoulder impingement syndrome
Hawkins-kennedy Test
What is a Bankart Lesion
A Bankart lesion is a tear to the anterior inferior labrum where the glenohumeral ligament attaches
How is the relocation test conducted?
posteriorly directed force is applied to the humeral head with patient in abduction and ER (Apprehension Test Position). Positive result is relief of the feeling of impending dislocation
How is the apprehension test conducted?
examiner applies anteriorly directed force to the humeral head with the shoulder in abdcution and ER. Positive result is the patient feeling that the shoulder is going to dislocate
Bony Bankart Lesion
Fracture of the inferior glenoid rim
What is a Hills-Sachs Lesion
Impression fracture at the humeral articular surface
Bankart Lesions signs and symptoms
Clicking, popping, sense of instability, repeat dislocation, achiness
What is the most common mechanism of injury to the shoulder?
Acute anterior dislocation
What does SLAP stand for?
Superior Labrum Anterior Posterior
Most likely reason for case study diagnosis to be a POSSIBLE SLAP lesion?
Tear didn’t show on MRI
What is the biceps anchor?
Where the biceps tendon attaches to the superior aspect of glenoid (Superior Genoid Tubercle).
Coined the name SLAP lesion and established four classifications
Stephen Snyder
Why has detection and accuracy in diagnosis increased in past decades?
Advances in imaging
How many types of tears are there?
7
Type one tear is…
fraying of superior labrum
Type two tear is…
biceps tendon and superior labrum are torn from glenoid
Type three tear is…
bucket-handle tear
Type four tear is…
bucket-handle tear extending into biceps tendon
Type five tear is…
Tear extending into inferior labrum
Type six tear is…
“flap” of the superior labrum
Type seven tear is…
tear that extends into the capsule
Two types of injury onset
Acute and chronic
What type of athlete gets SLAP lesions most often?
Baseball pitcher
Action of latissumus dorsi
Depression of shoulder girdle, IR, EXT, and ADD of Humerus
Action of Levator Scapulae
Elevation, downward rotation of scap, EXT and rotation of C-spin
Action of Rhomboid Major
Scapular retraction and elevation, and downward rotation of scapula
Action of Rhomboid Minor
Scapular retraction and elevation
Action of Serratus Anterior
Upward rotation, protraction, depression, elevation, and fixation of scap to thorax
Action of Trapezius (upper 1/3)
Elevation and upward rotation of scap, rotation and EXT of C-spine
Action of Trapezius (middle 1/3)
Retraction of scapula and fixation of thoracic spine
Action of Trapezius (lower 1/3)
Depression and retraction of scap, fixation of throracic spine
Action of Pectoralis Major
Depression of shoulder girdle, ADD, horizontal ADD, flexion, and IR of Humerus
Action of Pectoralis Minor
Forward (anterior) tilting
Origin and insertion of Latissumus Dorsi
O: Spinous process of T6-T12, posterior iliac crest, and the lumbar vertebrae via fascia.
I: Intertubercular groove of Humerus
Origin and insertion levator scapulae
O:Transverse processes of cervical vertebrae C1-C4
I:Superior medial angle of scap
Origin and insertion rhomboid major
O:Spinous process of T2,T3,T4, and T5
I:Vertebral border of scapula (Lower 2/3)
Origin and insertion rhomboid minor
O:Inferior portion of the ligamentum nuchae and spinous processes C70C1
I:Vertebral border of scap
Origin and insertion serratus anterior
O:Anterior portion of the ribs and aponeroses of the intercostal muscles.
I:Costal surface of the:superior angle of scap, vertebral border of scap, and inferrer angle of scapus
Origin and insertion Trapezius (upper1/3)
O:Occipital protuberance, superior nuchal line, upper portion of ligamentum nuchae, and spinous process of C7
I:Distal/lateral 1/3 of clavicle, acromion process, and scapular spine
Origin and Insertion Trapezius (middle 1/3)
O:Lower portion of ligamentum nuchae, spinous process of the 7th cervical vertebral and T1-T5.
I:Acromion process and spine of scapula.
Origin and Insertion Trapezius (lower 1/3)
O:Spinous processes and supraspinal ligaments of T8-T12.
I:Spine of the scapula
Origin and Insertion pectoralis major
O:Medial 1/2 of clavicle and anterolateral portion of the sternum
I:Greater tuberosity fo the humerus (lateral lip of bicipital groove)
Origin and Insertion pectoralis minor
O:Costal cartilage of ribs 6-7 and anterior portion of 3-5 ribs
I:Coracoid process of scapula
Action of biceps Brachii
flexion and ABD
Action of Coracobrachialis
flexion and ADD
Action of Deltoid (anterior 1/3)
Flexion, ABD, horizontal ADD, and IR
Action of Deltoid (middle 1/3)
ABD and flexion
Action of Deltoid (posterior 1/3)
EXT, horizontal ABD, ABD, and ER
Action of infraspinatus
ER, horizontal ABD, and humeral head stabilization
Action of subscapularis
IR and Humeral stabilization
Action of supraspinatus
ABD, ER, and humeral head stabilization
Action of trees major
EXT, IR, and ADD
Action of teres minor
ER and horizontal ABD
Action of triceps brachii
EXT and ADD
Origin and insertion of biceps brachii
O:Long Head: supraglenoid tuberosity of scap, Short head: coracoid process of scap.
I: Radial tuberosity and aponeurosis
Origin and Insertion of coracobrachialis
O:Coracoid process
I:Media shaft of the humerus, adjacent tot he deltoid tuberosity
Origin and Insertion of Deltoid (anterior)
O:Lateral 1/3 of clavicle
I:Deltoid tuberosity
Origin and insertion deltoid (middle)
O:Acromion process
I:Deltoid tuberosity
Origin and insertion deltoid (posterior)
O:Spine of scapula
I:Deltoid tuberosity
Origin and insertion of Infraspinatus
O:Infraspinous fossa of scap
I:Lateral portion of the greater tuberosity of humerus and GH joint capsule
Origin and insertion subscapularis
O:Anterior surface (subscapular fossa) and axillary border of the scap
I:Lesser tuberosity of the humerus and ventral portion of the GH joint capsule
Origina and Insertion teres major
O:Inferior angel of scap and lower 1/3 of axillary border of the scapula
I:Medial lip of the bicipital groove
Origin and Insertion teres minor
O:Lateral upper 2/3 of axillary border of the scapula
I:Lateral aspect of the greater tuberosity
Origin and Insertion triceps Brachii
O:Long head: infraglenoid tuberosity. Lateral head:lateral and posterior surface of the proximal one half of the humerus. Medial head: Distal 2/3 of medial and posterior humerus.
I:Olecranon process of ulna
Origin and Insertion supraspinatus
O:Supraspinous fossa of scap
I:Medial aspect of the greater tuberosity and the GH joint capsule
What causes bicipital groove tendinitis?
Irritation of the transverse humeral ligament which results in pain and GH dysfunction. It can also be caused by wear and tear, direct injury, or impingement and instability
What is a Hill-Sachs Lesion?
A cortical depression in the posterior superior head of the humerus bone resulting from forceful impact of the humeral head against the anteroinferior glenoid rim when the shoulder is dislocated anteriorly
Where is referred pain of the axillary nerve?
The deltoid muscle cap
What is the function of the transverse humeral ligament?
It acts as a retinaculum for the biceps brachia to prevent displacement
Name two bursae in the GH joint?
Subdeltoid bursa, subcoracoid bursa
What causes a torn rotator cuff?
Rotator cuff tendons often become inflamed from overuse, aging, or a fall on an outstretched hand or another traumatic cause. Sports or occupations requiring repetitive overhead motion or heavy lifting can also place a significant strain on rotator cuff muscles and tendons
Patients with chronic acromioclavicular pathology describe pain where?
pain is described in the upper trapezius region, especially at night
Pain in the deceleration phase of pitching relates to what structures?
SLAP lesion, biceps tendon pathology
Pain in the cocked position yield what underlying pathology?
Instability or impingement
What is Sprengel’s Deformity?
A congenitally undescended scapular. It may occur in both or one scapula.
