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General Orthopedics > Shoulder > Flashcards

Shoulder Flashcards

1
Q

Four important bones of the shoulder

A
  • Humerus
  • Scapula
  • Calvicle
  • Sternum
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2
Q

What is the top of the humerus called?

A

Humeral Head

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3
Q

Where is the Bicipital Groove and what’s important about it (which tendon attaches here?)

A
  • on the humerus, groove between the tuberosities (greater and lesser tubercle)
  • long head of biceps tendon
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4
Q

What are 3 important functions of the clavicle?

A
  • attaches the shoulder to the axial skeleton
  • elevates and rotates to allow for greater degree of motion
  • prevents excessive anterior displacement of the scapula
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5
Q

Which part of the clavicle is convex and which part is concave?

A
  • proximal 2/3 - convex anterior
  • distal 1/3 flattens while curving concave
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6
Q

What is the importance of the convex/concave anatomy of the clavicle?

A

The transition point where it bends is anatomically weak and is a common site of fracture

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7
Q

What is the ossification date of the clavicle?

A

The medial clavicular epiphysis is one of the last to ossify and fuse at ~24 yo

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8
Q

What are the 4 important boney landmarks of the scapula?

A
  • Scapular spine
  • Acromion process -articulates with the clavicle
  • Coracoid process
  • Glenoid fossa
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9
Q

What is plane of the scapula

A
  • glenoid fossa angles 30 degrees from the frontal plane
  • face assumes a downward direction
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10
Q

What is the importance of the plane of the scapula?

A
  • provides more functional full arc of motion
  • places the rotator cuff muscles in options length tension relationship
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11
Q

What are the 4 joints of the shoulder?

A
  • Glenohumeral joint
  • Acromioclavicular joint
  • Sternoclavicular joint
  • Scapulothoracic joint (not a true joint)
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12
Q

What are two important facts about the stability of the shoulder joint?

A
  • lacks intrinsic boney stability of other joints
    - inherently unstable
    - anatomically weak capsular structures
  • relies on muscular to provide stability
    - depends more on muscles than any other joint
    - needs musculature for proprioception
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13
Q

What are the motions of the sternoclavicular joint?

A
  • elevation and depression
  • protraction and retraction
  • internal rotation and external rotation
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14
Q

What are the motions of the acromioclavicular joint?

A

AC joint is a synovial joint with gliding type motion

Motions:
- scapular rotation
- scapular winging
- scapular tipping

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15
Q

What causes scapular winging asymmetry?

A

Muscle imbalance
Nerve entrapment

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16
Q

Why isn’t the scapulothoracic joint a real joint?

A
  • no synovium, no fibrous or cartilaginous connection to ribs
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17
Q

What are the motions of the scapulothoracic motions?

A

Elevation and depression
Protraction and retraction
upward and downward rotation

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18
Q

What type of joint is the glenohumeral joint?

A

Shallow ball and socket

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19
Q

What are the motions of the glenohumeral joint?

A
  • flexion and extension
  • abduction and addition
  • internal and external rotation
  • horizontal abduction and abduction (not true anatomically motions)
  • circumduction
  • elevation and depression
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20
Q

Importance of the glenoid leabrum?

A
  • helps deepen the articulation
  • increases the articulate surface
  • dense fibrous connective tissue
  • injury of glenoid labrum is associated with recurrent shoulder instability
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21
Q

Glenohumeral Joint Capsule importance?

A
  • broad and large volume
  • allows the joint to be distracted from fossa
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22
Q

What are the ligaments of the shoulder capsule?

A
  • Gelnohumeral ligaments - superior, middle, inferior
  • Coracohumeral ligament
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23
Q

What is the most stable position of the shoulder?

A

Closed packed position
- humerus abducted to 9o and externally rotated

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24
Q

What are the muscles that make up the rotator cuff ?

A
  • subscapularis
  • supraspinatus
  • infraspinatus
  • trees minor
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25
Q

What are the functions of the rotator cuff muscles?

A
  • IR and ER of the humerus
  • stabilized the head in the glenoid fossa
  • in late abduction, it provides a downward pull so the head of the humerus clears the acromion
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26
Q

What is the consequence of damage/weakening of the rotator cuff muscles?

A

Impingement of rotator cuff and long head of he biceps tendon between the humeral head, subacromial bursa, and acromion process

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27
Q

What is the motion of the subscapularis?

A

IR

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28
Q

What is the motion of the supraspinatus?

A

Abduction and external rotation

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29
Q

What is the motion of the infraspinatus?

A

ER and horizontal abduction

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30
Q

What is the motion of the Teres Minor?

A

ER, horizontal abduction and extension

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31
Q

What does the term scapulothoracic rhythm refer to?

A

Motions of the GH joint, scapular, AC and SC joints are coupled and must occur in combination to get full shoulder ROM

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32
Q

MOI for SC Joint injury

A

Falling on outstretched hand
Forceful distraction of arm

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33
Q

What type of SC Joint injury is a medical emergency

A

Posterior dislocation

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34
Q

Tests for SC Joint Injury

A

ROM: pain with end range ABD, flexion, horizontal abduction, SC glide tests

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35
Q

Treatment for SC Joint Injury

A
  • palliative measures
  • arm sling
  • progression to PT
36
Q

MOI of AC joint injury

A

Falling on shoulder
Landing on AC joint
FOOSH -falling on outstretched hand
Long force to clavicle

37
Q

Symptoms of AC joint injury

A

Pain with elevating humerus and protraction/retraction

38
Q

Test for AC joint injury

A
  • AC traction
  • AC compression
  • Apley’s test - pain above 90 degrees
39
Q

What are the 3 associations of anterior Glenohumeral instability

A
  • GH ligaments
  • Bankart lesion
  • Boney Bankart Lesions
40
Q

What is Bankart lesion

A
  • tear of the inferior GH ligament off the labrum
41
Q

What is the boney Bankart lesion?

A

Avulsion during a Bankart lesion

42
Q

With glenohumeral instability, how does the shoulder usually dislocate?

A

Anterior and inferior

43
Q

Why is superior dislocation of the shoulder rare?

A

Presence of the acromion, coracoid process and rotator cuff

44
Q

What is a Hill-Sachs lesion

A
  • occurs with an anterior GH dislocation
  • posterior humeral head articulate cartilage defect
  • impact of humeral head on glenoid fossa as it tries to relocate
45
Q

Rotator Cuff tendon it is considerations

A
  • relatively poor vascularization of tendons
  • most commonly injured is supraspinatus
  • in overhead throwing, infraspinatus and terese minor are affected
46
Q

What is rotator cuff impingement

A

Decrease in space between the coracoacromial arch and humeral head

47
Q

What structures are in the area of a rotator cuff impingement

A
  • rotator cuff tendons: supraspinatus
  • long head of biceps tendon
  • subacromial bursa
  • GH capsule
48
Q

Main cause of rotator cuff tear

A

Repetitive overhead motions and repetitive eccentric activity increases risk

49
Q

What is a SLAP tear

A

Superior Labrum Anterior to Posterior
Rarely in isolation
More prone after age 35 because labrum is less firmly attached

50
Q

Which tendon is involved in SLAP tear?

A

Bicep tendon

51
Q

MOI of SLAP tear

A
  • FOOSH
  • repetitive throwing
  • hyperextension
  • heavy lifting
  • direct trauma
  • repetitive overhead activities
52
Q

Where does biceps tendinitis occur?

A

Bicipital groove, typically in conjunction with rotator cuff dysfunction

53
Q

Which tendon van be affected in biceps tendinitis and what’s it function

A

Transverse humeral Ligament
- hold tendon in the groove
- can be injured with sudden forefoot ext/ER
- leads o subluxation of tendon

54
Q

What is thoracic outlet syndrome

A
  • pressure on neurovascular bundle - subclavian artery and vein
55
Q

Sources of thoracic outlet syndrome?

A
  • presence of accessory cervical rib
  • ironing event btw the clavicle and 1st rib
  • compression btw the pec minor and ribs
  • tightness of anterior and middle scalene muscles
56
Q

Symptoms of nerve related TOS

A

Numbness, pain, paresthesia

57
Q

Symptoms of Arterial related TOS

A

Cold skin, pallor, cyanosis of fingers, weakness

58
Q

Symptoms of venous TOS

A

Stiffness, edema, thrombophlebitis

59
Q

What is the Apley’s Scratch test - what are the 3 actions and corresponds motions produced

A
  • patient touches opposite shoulder by crossing chest —> GH abduction, horizontal abduction and IR, scapular protraction
  • Patient reaches behind the head and touches the opposite shoulder from behind —> GH abduction, ER, scapular elevation and upward rotation
  • Patient teaches behind the back and touches the opposite scapular —> GH abduction and IR, scapular retraction and downward rotation
60
Q

What is the anterior apprehension test

A

Passive ER of the GH joint, places the joint in the closets-pack position and replicates the mechanism of injury for anterior GH dislocations

61
Q

What is the procedure of the apprehension test

A
  • while supporting the humerus at 90 degrees abduction, the examiner passively externally rotates the GH joint by slowly applying pressure to the anterior forearm
62
Q

What is the relocation test

A

Examiner externally rotates the humerus until pain, discomfort or apprehension of a dislocation is experiences by the patient or the normal ROM is met. Posterior pressure is then applied to relocate the subluxed joint

63
Q

The anterior apprehension test is usually performed with what test

A

Reloacation test

64
Q

What is the posterior apprehension test

A

Humeral head is moved Posteriorly on the glenoid fossa. In the presence of posterior Glenohumeral laxity or instability the patient will abruptly stop the test

65
Q

What is the evaluate procedure of the posterior apprehension test

A

The examiner applies a longitudinal force to the humeral shaft, encouraging the humeral head to move Posteriorly on the glenoid fossa

66
Q

What is the sulcus sign test

A

Test for inferior glenohumeral laxity

67
Q

What is the evaluative procedure for sulcus sign test

A

A downward (inferior) traction force applied to humerus - look for indentation beneath the acromion process

68
Q

What is the jerk test /posterior stress test

A

Test for labral tears

69
Q

What is the evaluative procedure for the jerk test/ posterior stress test

A

Affected arm is passively horizontally adducted while the examiner applies a simultaneous axial load to the humerus, —> looking for clunk that may or may not be painful

70
Q

‘What is the drop arm test

A

Test for rotator cuff tears

71
Q

What is the evaluative procedure for stop arm test

A

-patient slowly lowers the arm to the side —> arm falls uncontrollably from a position of approximately 90 deg abduction to the side

72
Q

What is the gerber lift off test

A

Test for subscapularis pathology

73
Q

What is the evaluative procedure of the gerber lift off test

A

The patient attempts to actively lift hand off the spine while the humerus stays in extension

74
Q

What is the empty can test

A

For supraspinatus pathology

75
Q

What is the evaluative procedure of the empty can test

A

GH is abducted to 90 deg in scapular plane, the elbow extended and the humerus internally rotated and forearm pronated so that the thumb points downward. Evaluator resists abduction

76
Q

What is the yurgason’s test

A

Test for subluxation of the biceps tendon

77
Q

What is the evaluative procedure for the Yergason’s test

A

GH joint in anatomical position, elbow flexed to 90 deg, forearm positioned so that the lateral border of the radius faces upwards. Patient provides resistance while examiner concurrently moves the GH joint into external rotation and the proximal radioulnar joint into supination

78
Q

What is the speed’s test

A

Test for long head of the biceps brachi tendinitis

79
Q

What is the evaluative procedure of the speed’s test

A

Elbow e tending. Clinical resists flexion of the GH joint and elbow while palpating for tenderness over the Bicipital groove

80
Q

What is the ludingotn’s test

A

Test for biceps brachial pathology

81
Q

Evaluative procedure of the luidington’s test

A

Hands on top head with the fingers interlocked, patient contracts biceps brachial by applying force to the top of the head. Examiner palpates te long head of the biceps tendon, noting tension within the tendon

82
Q

What is the O’Brien test

A

GH joint flexed to 90 deg and horizontally adduced 15 deg from the sagittal plane. The humerus in full internal rotation and the forearm pronated. The patient resists the examiners downward force. Test is repeated with the humerus externally rotated and the forearm supinated

83
Q

AC traction test evaluative procedure

A

Examiner applied a downward traction on the humerus —>looking for humerus and scapular to move inferior to the clavicle, cause a step deformity, pain or both

84
Q

AC compression test

A

Examiner squeezes the hands together, compressing the AC joint —> looking for pain at AC joint or excursion of the clavicle over the acromion process

85
Q

Name the different shoulder pathologies

A
  • Bursitis
  • SC joint injury
  • AC joint injury
  • GH instability
  • Rotator cuff tendinitis
  • Rotator cuff tear
  • SLAP tear
  • Biceps tendinitis
  • Thoracic outlet syndrome

General Orthopedics (5 decks)

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