Shoulder Flashcards
Joints involved in the shoulder
- Glenohumeral (GH)
- Acromioclavicular (AC)
- Sternoclavocular (SC)
- Scapulothoracic (ST)
Injuries to what structure are critical and can restrict breathing
injuries to sternum
ligaments in the shoulder
- Coracoacromial ligament
- Acromioclavicular ligament
- Coracoclavicular ligament
- Glenohumeral ligaments (joint capsule)
Which shoulder ligaments hold the clavicle down
Coracoacromial and Coracoclavicular
which shoulder ligament is mostly commonly injured, name the injury
Acromioclavicular
- Split shoulder
Characteristics of GH joint
- Ball and socket joint
- greatest mobility, least stability (glenoid fossa is shallow and concave)
- no bony constraints to motion
What structures give the GH joint stability
- Glenoid labrum
- joint capsule (protective covering)
- Rotator cuff muscles
Labral injury characteristics
- tears in labrum cause instabiltiy
- slap or banchart lesion
- surgery not always required
List rotator cuff muscles
- Supraspinatus
- Infraspinatus
- Teres minor
- Subscapularis (anterior_
Actions of rotator cuff muscles
- abduction and external rotation of GH joint
- Subscapularis –> only muscle that internally rotates in rotator cuff
Subacromial bursa symptoms
pain when arm is abducted ~60 degrees
- humerous can’t “drop”
Shoulder movement restrictions
- joint capsule has inherent level of laxity
- Stabilizes when muscles tighten at end of ROM –> Flexion, extension, internal and external rotation, horizontal abduction and adduction
When does the shoulder have greater ROM in shoulder abduction
When shoulder is externally rotated vs. internally rotated
MOI of AC joint sprain/separated shoulder
- Direct blow to lateral aspect shoulder
- downward blow to acromion
- Fall on an out-stretched arm (FOOSH)
- joint composed of 2 convex bony surfaces
S&S of first degree AC joint sprain
- stretch or partial damage in Ac ligaments
- no displacement
- pain with cross body flexion and abduction past 90 degrees
- local tenderness
- recovery –> 10-14 days
S&S of second degree AC joint sprain
- Rupture of AC ligaments
- Clavicle shift slightly superior (“step”)
- pain with compression of distal clavicle and passive horizontal adduction
- Recovery –> 3-6 weeks
S&S of third degree AC joint sprain
- Rupture of AC and CC ligaments
- very painful
- minimum recovery –> 8-16 weeks
Clinical tests for functional evaluation of AC joint sprains
Push ups and cross flexion
What occurs during a shoulder dislocation
head of humerus is no longer in the socket and remains out of place
What type of dislocation is more common, what is the MOI
Anterior dislocations
- excessive force moving abducting, external rotating and extending shoulder
- Vulnerable in apprehension position
- Humeral head lodges anterior-inferior to glenoid fossa
- can be recurrent
Damaged structure in shoulder dislocation
- Significant ligament and capsule damage/rupture
- possible labrum damage (SLAP lesion)
S&S of anterior shoulder dislocations
- Pain
- Tingling and numbness of arm
- notable and obvious deformity (sharp contour, loss of “roundness”, prominent acromion)
- very limited arm movement
- Athlete supporting an elbow on the affected side
MOI of posterior GH dislocations
- fall or blow to anterior shoulder
- forces humeral head posteriorly
S&S of posterior GH dislocations
- Pain
- Prominent coracoid process
- Anterior shoulder looks flat
- Bulge posteriorly
- Arm carried against torso
Dislocation management
- immobilize joint in position found
- support arm with pillow or towels, apply sling, maybe ice
- check distal pulse (vascular bundle compressed)
- transport to ER (but don’t always need ambulance)
why is the GH joint unstable
very mobile, sacrifices stability
levels of GH join instability
- Acute (immediate)
- long term (chronic)
- Recurrent (repeated)
what device can be used to support GH joint
sully shoulder brace (common in sports)
consequences of shoulder instability
- Subluxation (joint goes in and out on its own)
- dead arm syndrome (result of subluxation tingling, C4,5,6 issue)
- Dislocation, instability (surgery)
- impingement syndrome
- Tendonitis
- Labral tear
Exercise considerations
- avoid excessive shoulder ROM (horizontal abduction, flexion, apprehension position, DB chest flys)
- Focus on rotator cuff strength and endurance (teres minor, strategic strengthening - pull muscles, low/mid trap fibers)
- AT/PT/MD clearance for stretching execising
Name of Bursitis in shoulder
- Subacromial bursa (Hawkin’s test, point tenderness in subacromial space)
Types of Tendonitis in shoudler
- Rotator cuff tendonitis ( empty can/”Jobe” test –> supraspinatus)
- Bicep tendonitis (speed’s test, pain/tenderness over bicipital groove, increased pain in stretching, active supination and elbow flexion)
Risk of prolonged tendonitis in shoulder
degenerative tearing (drop arm test)
MOI - GH tendonitis and bursitis
- repetitive overuse and overhead activities –> irritation/impingement of structures in subacromial space (abduction reduces size)
- Weak scapular stabilizers, rotator cuff (GH decelerators) and postural tightness in subscapularis
- compression or elevation within joint
- possible inflamed, impinged subacromial bursa
- X-ray may be required to rule out bone spur
S&S of GH tendonitis and bursitis
- pain with activity
- referred pain to deltoid tuberosity
- impingement positive test
- weakness at 90 degree abduction and external rotation
- “painful arc” –> 60-120 degree abduction pain
- hard to sleep on affected side
Location of scapular plane
- plane where scapula lies
- 40 degrees from frontal plane in the anterior direction
affect of abduction and corrective exercises in scapular plane
abduction –> reduces impingement of subacromial space
corrective exercises –> address muscule imbalances (important for recovery)
What is Scapulo-thoracic rhythm
- how scapula travels along rib cage
- position and movement impacted by muscle control
- traditional rotator cuff exercises don’t emphasize scapular plane instead long lever and neutral
