shoulder Flashcards
what planes does the shoulder move in
3 planes
sagittal: flex, extend
frontal: ab/adduction
transverse: int/external rotation
scapulohumeral rhythm
muscle moves the scapula and humerus, giving greater ROM than if the scapula were fixed
1:2 ratio…for every 1deg motion at scapulothoracic jt, 2deg of motion at GH joint
the greater the def of ROM, the greater the scapula tilts to add to ROM
list the shoulder joints
sternoclavicular
coracoclavicular
acromioclavicular
scapulothoracic
glenohumeral
sternoclavicular joint
plane synovial, gliding
connected via costoclavicular and anterior SC ligs
prevents medial displacement of clavicle, allows some clav rotation
coracoclavicular joint
syndesmosis, connected via ligs
- minimal mvmnt
coracoclavicular lig has trapezoid and conoid branches
prevents upward mvmnt of clavicle and downward mvmnt of scapula
acromioclavicular joint
superior and inferior acromioclavicular ligaments
main injury when fall and arm adducted
scapulothoracic joint
connects scapula to thorax via muscle attachments
stablizes shoulder region and positions GH joint
differential diagnoses
smth else that could be attributing to the injury that’s UNLIKELY but still plausible
can rule in/out in future
rotator cuff muscles
SITS
- supraspinatus, infraspinatus, teres minor, subscapularis
role to stabilize GH joint and humerus
shoulder mvmnts and muscles assoc
flexion: deltoid, pec major
extension: lat dorsi, pec major, teres major
abduction: deltoid, supraspinatus
adduction: lats, pec major, teres major
med rotation: subscapularis, teres major
lat rotation: infraspinatus, teres major
sternoclavicular sprain
MOI = indirect force thru humerus, blow to clavicle
anterior and superior displacement: clav moves up and out, usually phys deformity
- 2nd deg = cannot horizontal adduct, holds arm close to body
- 3rd deg = most common, prominant deformity
posterior displacement: uncommon
- MEDICAL EMERGENCY
- diff swallowing, slow pulse, resp distress
- call EMS
- close to vessels
acromioclavicular sprain
MOI = direct blow, fall on outstretched arm
main sign is STEP DEFORMITY
classifications:
- type 1 = lig is stretched
- type 2 = partial tear, slight step deformity
- type 3 = full tear AC and CC lig
- type 4 = full tear, clavicle displaced posterior over acromion
- type 5 = full tear of ligs, clavicle only held by skin
- type 6 = rare, clavicle under coracoid
how to test for acromioclavicular sprain
distraction test: therapist’s hand stabilizes clavicle, and w other hand pulls arm down
- positive = pain and excess mvmnt
compression test: horizontal adduct arm, PRESSING BONES TGT
- can also squeeze joint
glenohumeral sprain
MOI = forceful abduction, can be plus external rotation
joint capsule stretches or tears, humeral head moves in an anterior and inferior direction
1st deg = AROM, slight limitation
2nd deg = swelling, bruise, dec ROM
SnNout and SpPin
SnNout = high sensitivity, a neg test rules out
SpPin = high specificity, post test rules in
anterior GH dislocation
intense pain that dec w reoccurance
paresthesia, deformity
arm held in abduction and external rotation
- won’t allow passive horizontal adduction or internal rotation
check pulse and sensation
apprehension test: lay down, 90deg abduction
relocation test: lay down and abduct arm, hand moves the head of humerus POSTERIORLY to glenoid fossa
- feels more comfy bcs returning to proper place
posterior GH dislocation
pain radiating to shoulder tip
arm held tight to chest and across trunk
side view: flat anterior shoulder, prominent coracoid process….posterior bulge
posterior load and shift test: stabilize shoulder tip, press humerus towards glenoid fossa
posterior apprehension test: lay down w arm in front of chest, try to push shoulder DOWN towards fossa
bankart lesion
damaged anterior lip of glenoid labrum
assoc w anterior dislocation and aging
SLAP lesion
superior labrum, anterior to posterior
tear of superior labrum with disrupted attachment of long head biceps tendon
hill-sachs
not labrum
posterior humeral head injury, often occurs alongside bankart lesion
reverse hill-sachs
lesion to anteromedial humeral head
how to test for glenoid labrum tears
clunk test: patient lies down and puts arm into abduction + ext rotation
- other hand pulls humerus forwards
- positive = clunk from instability
compression rotation test: apply compression upwards, positive if catching by humeral head
atraumatic osteolysis of distal clavicle
clavicle fracture from repetitive trauma or post-traumatic injury to distal clav or AC joint
bone resorption and erosion leads to continuous stress
S&S = prox fragment upwards, interferes w ADLs, pt tender, pain w hori adduction
traumatic clavicular fractures
MOI = in/direct force
S&S = upwards prox fragment, flat distal shoulder, deformity
manage w figure 8 brace
epiphyseal fracture
little league shoulder
- proximal humerus bcs of rep internal rotation and adduction
S&S = acute pain when throwing
manage w sling and doctor referral
humeral fractures
MOI = FOOSH, direct blow
S&S = inability to supinate, paralysis
impingement syndrome
microtear of rotator cuff and subacromial bursa against CA lig and greater tubercle
overuse injury of rotator cuff, MAINLY SUPRASPINATUS
S&S = deep pain, night pain (if bursa)
- PAINFUL ARC b/w 70-120deg (beginning and end of motion is fine)
painful bcs changing shape of subacromial space
contributing factors:
- rep overhead mvmnts i.e. carpentry
- thickened tendons i.e. high muscle
- limited subacromial space
- imbalanced strength/endurance
- tight muscles
subacromial space
contains:
- long head of biceps tendon
- supraspinatus tendon
- subacromial bursa
tests for impingement syndrome
neer test: patient flexes arm thru full ROM w therapist applying resistance
- changes subacromial space
hawkins-kennedy test: arm 90deg flex w bent inwards….tilt at angle so shoulder up
- squeezes supraspinatus
- pos = lean away, pain
empty can test: arms out w thumbs down, try to resist downwards motion
- weakness, pain
drop arm test: indicates supraspinatus tear…lift and drop arm, see if struggle to keep up
bicipital tendinitis
MOI = rep overhead w elbow flexion and supination
- tendon passes b/w groove
- can also be acute/direct blow bcs inflammation
S&S = pain w in/external rotation, painfdul passive stretch in shoulder extension
yergason’s test: neutral wrist, support joint and have try to flex arm plus supinate w ext rotation
speed’s test: tries to bring palm to shoulder, allow full ROM while resisting therapist
biceps tendon rupture
MOI = prolonged tendonitis, forceful flexion against resistance
- linesman pushing others
- load PLUS stretch
S&S = snap, intense pain, popeye defect in muscle belly
ludington’s test = put hands on head and apply load…see deformity or compensation
transverse humeral ligament test
thoracic outlet compression syndrome
can be a neurological or vascular syndrome
neurological: stretch or compression of lower trunk of brachial plexus
- S&S = aching pain, paresthesia, numb in side or back neck extending across shoulder to ulnar hand
- weak grasp and hand atrophy
vascular: compression of subclavian artery or vein
- S&S = if vein –> edema, stiff hand, cyanosis and large veins
- artery –> rapid onset of coolness, arm numb, fatigue w overhead activity, dec radial pulse
tests for thoracic outlet compression syndrome
allen test = palpate radial pulse, abduct shoulder w 90deg flexion, look to other shoulder
adson’s test = palpate rad pulse and have patient look up/extend head…lat rotate humerus
- pos if dec/no radial pulse
military brace test = palpate pulse, retract shoulder and hyperextend neck and abduct arm 30deg
