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SCS Mine > Shoulder > Flashcards

Shoulder Flashcards

1
Q

In volleyball: what type of serve creates the most IR torque?

A

Jump serve

then. ..
- Spike, Float serve, and roll shot

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2
Q

Pec Major

A

lat & med pectoral nerve; C5-T1

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3
Q

Which pitches in order from most to least forces and torque generated?

A

Fastball, curveball, slider, changeup

the fastball and curveball require more rotational movements, so more forces and torque are generated.

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4
Q

most Serratus EMG exercises

A

Prone Y = 97% EMG
prone ER 90 deg abd = 79% EMG
scaption = 61% EMG
prone T = 53% EMG
prone T + ER = 56%
wall flexion = 13

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5
Q

most force to shoulder during what throwing phase

A

deceleration

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6
Q

,Subclavius

A

nerve to subclavius, C5-6

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7
Q

Serratus anterior

A

long thoracic; C5-7

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8
Q

Trap

A

Spinal accessory nerve (XI), C3-4; XI, C3-C4

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9
Q

Lat

A

thoracodorsal nerve; C6-8

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10
Q

Levator scapulae

A

dorsal scapular nerve, C3-5

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11
Q

Rhomboids (minor & major)

A

dorsal scapular nerve, C4-5

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12
Q

subscap

A

Upper subscapular and lower subscap nerves, C5-6

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13
Q

supraspinatus

A

suprascapular nerve, C5-6

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14
Q

infraspinatus

A

suprascapular nerve, C5-6

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15
Q

Teres minor

A

axillary nerve, C5-6

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16
Q

deltoid

A

axillary nerve, C5-6

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17
Q

teres major n

A

lower subscapular nerve, C5-7

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18
Q

coracobrachialis

A

musculocutaneous, C5-7

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19
Q

Hills sachs lesion

A

depression fracture in posterolateral humeral head due to impaction of humeral head against anterior inferior glenoid rim

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20
Q

Hill sachs lesion Grading

A

I: defect in articular surface but not including subchondral bon
II: lesion includes subchondral bone
III: large defect in subchondral bone

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21
Q

Bankart lesion

A

lesion of anterior aspect of labrum due to repeated anterior subluxation/dislocation

humeral avulsion of IGHL

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22
Q

RTC special tests: highest SN

A

empty can, full can (pain & weak), lateral jobe (tear), shoulder shrug (tendinopathy > massive tear), whipple

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23
Q

RTC special tests: highest SP

A

ER lag sign for tear > tendinopathy, lift off (tendinopathy higher SP), lateral jobe (tear)

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24
Q

Supraspinatus special testing

A

Drop arm: .93 SP tendinopathy
Cross body .75 SN tendinopathy
Empty can 1.0 SP weak/pain
ER lag: .91+ SP tear
full can >.8 SN
painful arc .96 SN tear
HK .8-.77 SN tear

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25
Q

teres minor special testing

A

ER lag (tear) 1 SN, .93 SP

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26
Q

infraspinatus special testing

A

ER lag .97 SN/.93 SP
resisted ER (weak)=- tear .84 SN

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27
Q

subscap special testing

A

belly press, IR lag, resisted lift off (weak)

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28
Q

CPR for full thickness RTC

A
  1. painful arc
  2. drop arm
  3. infraspinatus muscle test

also:
1. age >65
2. weakness in ER
3. night pain

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29
Q

CPR for subacromial impingement

A
  1. positive HK
  2. painful arc
  3. infraspinatus MMT
30
Q

posterior/internal impingement

A

apprehension (posterior)
posterior impingement test

31
Q

labral special testing

A

speeds (.78 SP)
anterior slide (.86 SP)
crank (.75 for SLAP)
yergasons (.95 SP SLAP)
compression rotation (.78 SP)
dnyamic labral shear (.89 SN)
passive compression (.82-.86 SN & SP)
passive distraction (.94 SP)
active compression- lower SN/SP

32
Q

labral CPR

A

-compression rotation AND apprehension AND speeds

-anterior slide AND crank

-apprehension AND relocation

33
Q

Instability testing/CPR

A
  1. apprehension
  2. relocation
  3. anterior drawer
34
Q

biceps tendinopathy

A

bear hug .79 SN
upper cut .78 SP
yergasons .78-.89 SP (resisted supination w/ elbow flexed at 90 deg)

Speeds also

35
Q

adhesive capsulitis- risk factors, treatment

A
  1. presence of comorbidities (DM, thyroid)
  2. 40-65 yrs, female, previous episode in other side

intervention level of evident:
-steroid injection: A
-patient education, stretching: B
-modalities, joint mob, manip: C

36
Q

Axillary nerve

A

originates at brachial plexus, through quadrilateral space, to deltoid/teres minor

site of entrapment: humeral head compresses with abduction; compression in quad space; dislocation; pressure through axilla

37
Q

axillary nerve

A

-brachial plexus through quad space to deltoid/teres minor
-motor deltoid/teres minor
-entrapment: humeral head in extreme abd, axilla, shoulder dislocation, compress in quad space

38
Q

long thoracic nerve

A

merge of C5-7 travels between clavicle & first rib, through axilla. motor to serratus

-entrapment: shoulder traction; shoulder depression w/ contralat cervical flexion; prolonged compression “backpackers palsy”

39
Q

median nerve

A

brachial plexus in anterior arm, antecubital fossa nerve passes through radial tunnel, runs between 2 heads of pronator muscles, under FDS through carpal

motor issues: weak wrist flexion, no IP flexion of thumb/index/middle digits

motor issues: injury at wrist- weak thumb abd no motor deficit

site of entrap: radial tunnel, within pronator teres, under FDS, carpal tunnel

40
Q

musculocutaneous

A

C5-7 into lateral cord of plexus, through axilla, under coracobrachialis, through biceps and under deep fascia at elbow.

41
Q

radial

A

brachial plexus–>axilla -> posterior arm at spiral groove of humerus, down anterior arm through radial tunnel, divides into super ficial/deep branches

motor loss at axilla- weak elbow flexion, wrist/digit, supination weak

at radial tunnel- forearm pain but no motor loss

42
Q

spinal accessory

A

motor loss- upper trap

entrapment: superficial cose in posterior cervical or under trap

43
Q

suprascapular n

A

through posterior triangle, across superior scap through scap notch, down posterior scap across scap spine to supra/infra

motor loss of infra/supra, sensor loss to AC/GH joints

entrapment under transverse scapular ligament suprascapular notch

often assoc with posterior capsule tear

44
Q

ulnar n

A

brachial plexu down anterior arm, above medial epicondyle, passes to posterior compartment into cubital tunnel, into guyon canal, splits into deep and superficial branches (deep motor, sf sensory)

entrapment: cubital tunnel, MCL deficiency, guyon canal

45
Q

quadrilateral space

A

syndrome: compression of the axillary nerve and posterior humeral circumflex artery in the quadrilateral space.

location: lateral to triangular space and medial to triangular interval
boundaries
superior - teres minor
inferior - teres major
medial long head of triceps brachii
lateral - surgical neck of the humerus

contents:
**axillary nerve (C5 nerve root, posterior cord)
posterior circumflex humeral artery

46
Q

posterior triangle/ triangular space

A

Borders
inferior: teres major
lateral: long head of triceps
superior: lower border of teres minor

Contents:
scapular circumflex artery

47
Q

triangular interval

A

Borders
superior: teres major
lateral: lateral head of the triceps or the humerus
medial: long head of the triceps

Contents
profunda brachii artery
radial nerve

48
Q

clavicle fracture dislocation

A

mid shaft most common fracture

if displaced posteriorly- cupula of lung most at risk

49
Q

RTC least likely to succeed with PT

A

grade II bursal sided tear

50
Q

rotator cuff interval

A

subscap & supraspinatus

51
Q

SLAP testing- best test to confirm

A

-pitcher- biceps load I
-compressive injury: active compression, clunk
-traction injury: speeds

52
Q

parsonage turner syndrome

A

sudden onset of shoulder and upper arm pain followed by progressive (worsening over time) weakness and/or atrophy of the affected area

53
Q

TOS

A

borders:
-scalene triangle- anterior/middle scalene attach to first rib
-costoclavicular space- 1st rib & clavicle
-pec minor space

types: arterial, venous, congenital (rib at C7)
-arterial: rest pain worse with activity, cold/pale into hands, ischemia signs

54
Q

TOS special tests

A

ROOS- 90/90 3 min open/close hands

Adsons- radial pulse, rotate head towards arm and tilt back, see if pulse disappears

-Allen test- 90/90 , turn head away and see if pulse disappears

55
Q

Little league shoulder

A

microtrauma from throwing/poor mechanics

typical 11-13

retroversion & IR deficit- some changes are normal, occur around this age

fatigue & overuse #1 risk factor

56
Q

Sprengel deformity

A

congenital elevation of hypoplastic scapula

often associated with other issues- Klenfeil (C spine fusion of 2 vert)

57
Q

sprengel deformity - scapular malposition classification

A

*results in inability to actively abduct

1: level shoulders, not visible when dressed
II: lumbar in web of neck when dressed. superomedial angle between T2 & C5
III: shoulder elevated 2-5cm, deformity easily seen, medial angle above transverse apophysis ofC5, surgery
IV: superior angle of scap near occipit, surgery

58
Q

clavicle fracture

A

middle shaft: 80%
group II: distal third
group III: medial third

59
Q

static stabilizers of shoulder

A

-GH capsule

-rotator interval- spcae between sup border of subscap to anterior margin of supra
inferior/posterior stability, large interval in MDI

-SGHL, MGHL, IGHL

60
Q

Superior GH ligament

A

limits ER at 0 deg abd

prevents inferior humeral head sublux

61
Q

MGHL

A

limits anterior translation at ER 45 deg abd

62
Q

IGHL

A

3 bands- post/ant/inf- stability at 90 deg abd

-anterior band: restricts abd/ER, fans out like hammock *strongest
-posterior: relatively thin,blends with RTC tendons, prevents posterior sublux

63
Q

SLAP grades

A

I: superior labrum frayed

II: frayed and detached, anchors often needed

III: bucket handle tear, displaces into joint, biceps attached

IV: bucket handle tear displaced, biceps subluxes into joint

64
Q

AC joint anatomy, grade injuries

A

coracromial arch- prevents superior HH displacement. SA space 10mm

stability- conoid & trapezius ligaments, coracromial ligament

6 grades:
I- sprain AC, ligaments intact
II- AC joint disrupted <50% displacement, sprain ligaments
III- AC & CC ligaments disruped, AC joint dislocated, CC space greater than normal, deltoid/trap detached from distal clavicle
IV: all of above plus clavicle displaced
V: all ligaments disrupted, bigger disparity between clavicle & scap (100-300%)
VI: surgery needed

65
Q

throwing phase most likely to have pain

A

-Max ER - 90 deg abd, ER 180 deg, high IR/anterior force
-ball release

66
Q

swimming phases, muscle involvement

A

-pull through, recovery, glide phases

-early phase- pec
-late pull through- high lat activity
-SA active in entire stroke

67
Q

throwing muscle EMG activity

A

-late cocking- subscap 99%, SA 106%

-acceleration: subscap 115%, lat/triceps/pronator >80%

-decel: low trap 78%, teres minor 84%, FCU 77%

68
Q

muscle EMG for common exercises:
-sidelying ER
-prone HABD at 120 deg, prone ER 90 deg
-SA exercises

A

-s/l ER: infra, teres
-low trap & mid trap: prone HABD 120 deg/prone ER 90 deg
-SA: push up plus, dynamic hug, supine serratus punch

69
Q

clavicle fracture locations

A

middle 1/3 = 80%

distal 1/3 = 15%

proximal/middle 1/3 = rare

70
Q

clavicle fracture classifications

A

for distal 1/3:

I: non displaced
II: displaced coracoclavicular lig –> upward dislocation of proximal segment
III: involves AC joint

71
Q

shoulder dislocation - Quebec decision

A

age 40 + humeral ecchymosis

age 40 + first episode

<40 and MOI other than a fall

SCS Mine (29 decks)

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