Shoulder Flashcards
Resting position of the GH joint
40° to 55° abduction, 30° horizontal adduction
Close Packed Position of GH joint
Full abduction, lateral rotation
common missing ligament
middle GH Ligament
What type of pain is diffusing or throbbing
vascular
What is the provocation motion for each:
Anterior Impingement:
Posterior Impingement:
Anterior Impingement: IR
Posterior Impingement: AbER
What type of pain is sharp, lightning
nerve
What type of acromion morphology is most impinged?
Type 3 Hooked
*easy to fracture
Closed packed position of AC joint
90° abduction
Resting position of AC joint?
Arm resting by side in normal
What is the most common type of Acromion morphology?
Type 2 (Curved)
Resting and Closed Packed position of SC joint
Resting joint: arm resting by side in normal physiological position
Close packed position: Full elevation and protraction
What type of pain is deep aching pain
bone
Pain that is deep, boring toothache like pain that worsen in the night
A tear in a muscle, Rotator Cuff
What type of pain is deep, boring, toothache like pain
Thoracic Outlet Syndrome
Paratenonitis vs Tendinitis
Paratenonitis - inflammation of the paratenon (covering of the tendon); fascia ng tendon
Tendinitis - inflammation of the whole tendon, pathology related to tendon (inflamed, torned, etc)
Type of SLAP lession that is small tear on sup labrum
detached biceps tendon from supraglenoid
instability on labrum-biceps complex
TYPE II
TUBS vs AMBRI
TUBS: Traumatic onset Unidirectional anterior with a Bankart Lesion responding to Surgery
Trauma, Unidirectional, Bankart, Surgery
AMBRI: Atraumatic cause, Multidirectional with bilateral shoulder findings with rehabilitation as appropriate treatment and rarely inferior capsular shift surgery
What type of pain is dull, cramping
Muscle
T or F
if right handed, right shoulder is higher
FALSE
if right handed, right shoulder is lower
What age groups are prone to each of these conditions?
Rotator Cuff Degeneration:
Rotator Cuff Tear:
Rotator Cuff Degeneration: 40 - 60 y/o
Rotator Cuff Tear: Any Age
What is the Provocative motion for:
Anterior Instability & Bankart:
Posterior Instability & Slap Lesion:
Anterior Instability & Bankart: AbER
Posterior Instability & Slap Lesion: AdIR
Weakness of TRAPZ, CN 11 (ACCESSORY NERVE) Will result to what type of scapular winging?
TRAPZ, CN 11 (ACCESSORY NERVE) - Lateral Winging
If the injury/lesion is between the 3-7 o’clock position, it is?
If the injury/lesion is between the 3-7 o’clock position, it is Bankart
1 25 yo male was referred to you for evaluation and treatment. Patient complains of shoulder weakness and difficulty performing activities of daily living. Upon assessment, you noticed that the scapula depresses with the inf angle rotating laterally during shoulder abduction. this movement of the scapula becomes more prominent upon applying resistance at 90 degrees of shoulder abduction. Identify the possible cause of this deformity.
Spinal accessory nerve injury
, a depression above the humeral head and below the acromion process
SULCUS SIGN
If the injury/lesion is between 10-2 o’clock, it is a?
SLAP LESION
Weakness of SERRATUS ANTERIOR, LONG THORACIC NERVE will result to what type of scapular winggng?
SERRATUS ANTERIOR, LONG THORACIC NERVE - Medial Winging (tignan parati ang inferior angle)
Bankart lesion Type III vs Type IV
III: bucket handle tear on sup labrum;
labral biceps attachment
IV: bucket handle tear on sup labrum with tear on biceps tendon
Can occur due to an excessive protracted scapula during arm motion
SCAPULAR DYSKINESIA
In Kibler’s classification for scapular dyskinesia, What pattern is being described? What is the affected muscle?
lift away, classic winging
2
Weak Serratus Anterior
In Kibler’s classification for scapular dyskinesia, What is the affected muscle?
elevate
3
tight levator scapulae and upper trapezius
In Kibler’s classification for scapular dyskinesia, What is the affected muscle?
rotate laterally, rotate winging
4
Weak Upper trapezius
In Kibler’s classification for scapular dyskinesia, What is the affected muscle?
inferomedial border prominent at rest and the inferior angle tilts dorsally with movement, while acromion tilts anteriorly over the top of thorax
1
tight pectoralis minor
SCAPULAR WINGING
Primary vs Secondary
SCAPULAR WINGING
Primary
Muscle Weakness
Secondary
pathology in glenohumeral joint
SCAPULAR WINGING
Dynamic VS Static Winging at Rest
Dynamic
Winging with movement (due to muscle weakness, nerve injury)
Static Winging at Rest
(due to structural deformity - scapula, ribs, spine)
Malposition of Scapula, prominence of Inferior medial border of scapula, Coracoid pain and malposition, and scapular dysKinesia
“SICK” Scapula
1 25 yo male was referred to you for evaluation and treatment. Patient complains of shoulder weakness and difficulty performing activities of daily living. Upon assessment, you noticed that the scapula depresses with the inf angle rotating laterally during shoulder abduction. this movement of the scapula becomes more prominent upon applying resistance at 90 degrees of shoulder abduction. Identify the possible cause of this deformity.
Spinal accessory nerve injury
If the injury/lesion is between the 3-7 o’clock position, it is?
Bankart
If the injury/lesion is between 10-2 o’clock, it is?
SLAP LESION
in the painful arc how many degrees are,
Glenohumeral painful arc:
Acromioclavicular painful arc
Glenohumeral painful arc: (45-65) - 120
Acromioclavicular painful arc : 170 - 180
What phase in the SCAPULOHUMERAL RHYTHM is
60° abduction, 90° lateral rotation
30° rotation
30°-50° posterior rotation, up to 15°
Phase 3
Ssx of Possible Peripheral Nerve Involvement
Pain on flexing fully extended arm Inability to flex fully extended arm
Winging starts at 90° forward flexion
Long thoracic nerve
What phase in the SCAPULOHUMERAL RHYTHM is
Humerus; 30° abduction
Scapula; Minimal movement (setting phase)
CLavicle: 0°-5° elevation
Phase 1
Ssx of Possible Peripheral Nerve Involvement
Increased pain on forward shoulder flexion
Shoulder weakness (partial loss of humeral control)
Pain increases with scapular abduction Pain increases with cervical rotation to
opposite side
Suprascapular nerve
What phase in the SCAPULOHUMERAL RHYTHM is
Humerus: 40° abduction
Scapula: 20° rotation, minimal protraction or elevation, and possibly posteriorly tilt
Clavicle: 15° elevation and posterior rotation at sternoclavicular joint
Phase 2
Ssx of Possible Peripheral Nerve Involvement
Inability to abduct arm with neutral rotation
Axillary (circumflex)
Ssxof Possible Peripheral Nerve Involvement
Weak elbow flexion with forearm supinated
Musculocutaneous
nerve
If the scapula is fx what nerve could be affected?
If nafracture ang scapula pwedeng madale ang SUPRASCAPULAR NERVE dahil umiikot ito dito
Ssx of Possible Peripheral Nerve Involvement
Inability to abduct arm beyond 90°
Pain in shoulder on abduction
Spinal accessory nerve
