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MSK 1 > Shoulder > Flashcards

Shoulder Flashcards

1
Q

What directions does the humerus face?

A

Medially
Posteriorly
Superiorly

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2
Q

What angle does the head of humerus form with the long axis of the humerus?

A

130-150 degrees

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3
Q

The head of the humerus is angled posteriorly ___ degrees

A

30-40

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4
Q

What directions does the glenoid fossa face?

A

Laterally
Superiorly
Anteriorly

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5
Q

How much of the surface of the humeral head does the glenoid fossa cover?

A

1/3 - 1/4

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6
Q

Labrum of the GH Joint

A

Fibrocartilagenous ring
Makes glenoid fossa ~50% deeper
Attached to margin of glenoid cavity and joint capsule
Lateral portion of the biceps anchors superiorly

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7
Q

Posterior Capsule of the GH Joint

A

Flexion
Abduction
IR

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8
Q

Anterior GH Ligament

A

Extension
Abduction
ER

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9
Q

Inferior GH Ligament

A

Extension
Abduction
ER
*Primary restraint against anterior and posterior dislocations

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10
Q

Middle GH Ligament

A

Flexion

ER

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11
Q

Coracohumeral Ligament Posterior Band

A

Flexion of GH

Inferior and posterior translation of humeral head

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12
Q

Coracohumeral Ligament Anterior Band

A

Extension of GH

Inferior and posterior translation of humeral head

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13
Q

Suprahumeral Space Size and Boundaries

A

9-15 mm
Inferior: tuberosity of the humeral head
Anteromedial: coracoid process
Superior: coracoacromial arch

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14
Q

Suprahumeral Space Contents (5)

A 
Long head of biceps tendon
Superior joint capsule
Supraspinatus
Upper margins subscapularis and infraspinatus
Subacromial bursa
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15
Q

GH Open Packed Position

A

55 degrees abduction
30 degrees horizontal adduction
Neutral rotation

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16
Q

GH Closed Packed Position

A

Full abduction

Full ER

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17
Q

GH Capsular Pattern

A

ER > abduction > IR > flexion

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18
Q

The AC Joint must rotate approximately ___ degrees for full elevation to occur; if this does not happen, elevation is limited to ____

A

40-50 degrees

~110 degrees

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19
Q

Coracoclavicular Ligaments

A

Arm elevation resulting in posterior rotation at SC joint

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20
Q

AC Open Packed Position

A

Arm by the side

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21
Q

AC Closed Packed Position

A

90 degrees GH abduction

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22
Q

AC Capsular Pattern

A

Pain at extremes of ROM

Especially horizontal adduction and full elevation

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23
Q

Sternoclavicular Ligamentous Support

A

Anterior and posterior sternoclavicular ligaments
Interclavicular ligament
Costoclavicular ligament

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24
Q

SC Open Packed Position

A

Arm by side

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25
SC Closed Packed Position
Maximum arm elevation and protraction
26
SC Capsular Pattern
Pain at extremes ROM | Especially full arm elevation and horizontal adduction
27
Scapulothoracic Joint during full arm elevation
15-25 degrees ER 60 degrees upward rotation 15-30 degrees posterior tilt
28
Scapulothoracic Joint Open Packed Position
Arm by the side --Scapula in 30-45 deg IR, slight upward rot, 5-20 ant tilit NOTE: no capsular pattern or closed packed position
29
Biomechanics of Elevation 0-90
- Supraspinatus initiates abduction - Remaining RC muscles pull humeral head into glenoid - ~20 deg: scapular upward rot with concurrent clavicular elevation and axial rotation - 90 deg: upper extreme of GH abduction is reached and clavicular elevation ceases (costoclavicular lig tension) - Scapula upwardly rotated 30 degrees
30
Biomechanics of Elevation 90-150
-Scapula upwardly rotates 60 degrees -Scapular contribution peaks between 90-140 degrees -Upward rotation accom at SC and AC by: 30-40 deg posterior clavicular axial rotation 30-36 deg clavicular elevation
31
Biomechanics of Elevation 150-180
Abduction >150 requires upper thorax/Cspine motion | Bilateral abduction requires thoracic ext and increased lumbar lordosis
32
Adhesive Capsulitis
Restriction in active AND passive ROM Female, >40, trauma, diabetes, prolonged inflamm, thyroid disease, stroke/MI, autoimmune disease Synovial inflammation w/ reactive capsular fibrosis Can take 1-3 years to resolve
33
Adhesive Capsulitis Stage 1
Mild signs/symptoms <3 months duration, loss of motion at this stage is due to pain and not capsular contracture Capsular Pattern, achy at rest and sharp at extreme ROM, pain with palpation of ant/post capsules, pain radiates to deltoid insertion
34
Adhesive Capsulitis Stage 2
"Freezing phase", 3-9 mo, motion loss reflects loss of capsular volume and response to pain Pain with palpation of ant/post capsules, radiates to deltoid insertion, loss of motion in all planes, pain in all parts of range
35
Adhesive Capsulitis Stage 3
"Frozen stage", 9-14 mo, synovial thickening and dense collagenous tissue Painful phase has resolved, stiff shoulder, poor scapulohumeral rhythm during arm elevation, dominant upper trapezius, decreased inferior glide GH
36
Adhesive Capsulitis Stage 4
"Thawing stage", capsular remodeling Slow/steady recovery ROM, capsular end-feel reached before pain
37
Adhesive Capsulitis Treatment
Acute phase: relieve pain and gentle stretch to capsule Subacute phase: more aggressive ROM, strengthen Stages 3/4: Grade IV mobs, low load/long dur stretch
38
GH Instability
Abnormal symptomatic motion of GH joint that affects normal joint kinematics and results in pain, subluxation, or dislocation
39
GH Subluxation
Joint contact lost but capsule not necessarily torn, might just be stretched
40
GH Dislocation
Complete separation of joint surfaces | *Usually anterior
41
Bankart Lesion/Repair
Avulsion of the anterior inferior labrum from the glenoid rim *Anterior dislocation, Inferior GH ligament torn Reattachment of humeral insertion of subscapularis and labrum to anterior glenoid Tighten anterior capsule Lose 12 degrees ER post procedure
42
Hill-Sachs Lesion
Compression fracture of the posterior humeral head at the site where the humeral head impacted the inferior glenoid rim
43
SLAP Lesion
Superior labral lesion that is both anterior and posterior | Insertion of biceps pulls associated portion of superior labrum away creating bucket-handle lesion
44
AC Joint Sprain
Acute: fall onto shoulder with arm adducted at side Chronic: general OA, inflamm arthritis, mechanical probs
45
RC Tear Mechanisms
Compression: reduction size of subacromial space Tensile overload: throwing, hammering Macrotrauma
46
RC Examination
Painful arc: supraspinatus pain during abduction/scaption from 50-130 degrees Resisted movement: -Supraspinatus: abduction and ER -Infraspinatus: ER Tendonitis: full active AND passive ROM Tear: humerus higher on affected side (deltoid pulls up), palpable defect at greater tuberosity, muscle atrophy, reverse scapulohumeral rhythm
47
Subacromial Impingement Syndrome
Increased superior translation of humeral head --> decreased space in coracoacromial arch and produces compression of suprahumeral structures
48
Primary Impingement
Intrinsic degenerative process in structures of subacromial space Anterior impingement Limited horizontal abduction, IR Posterior capsule tightness
49
Secondary Impingement
Lesser tuberosity of humerus encroaches on coracoid process Coracoid impingement History of traumatic instability, labrum damage, and/or posterior defect of humeral head Limited IR Excessive ER Anterosuperior humeral head migration (poor RC balance)
50
Shoulder Arthritis
Humeral head migrating superior-->degeneration | Loss of ROM and strength
51
Total shoulder arthroplasty
Replace glenoid fossa and head of humerus
52
Hemiarthroplasty
Replace head of humerus
53
Reverse total shoulder
Inverted prosthesis so ball is on the scapula and concavity is on humerus Creates new line of force when RC is not slavagable
54
Subacromial-Subdeltoid Bursitis
Common with inflammatory arthritis "Aching" over deltoid region Rapid onset with activity Pain with passive abduction at 180 deg, passive IR, passive horizontal adduction Painful arc Noncapsular pattern Palpation distal to AC joint with shoulder in extension
55
Three types of Bursitis
Related to activity/trauma Calcific due to little bone projections from acromion Infectious
56
How do you differentiate bursitis and tendonitis?
If always able to reach overhead without restriction in motion: tendonitis
57
Clavicle fracture
``` Childhood FOOSH or direct blow Difficulty elevating arm >60 Painful horizontal adduction Clavicular deformity ```
58
Proximal Humerus Fractures
Direct blow to ant, lat, or posterolateral humerus or FOOSH Osteopenic bone with minimal trauma Lung metastasis
59
Scapular Fracture
Direct blow or trauma
60
Brachial Plexus Injury
``` Entrapment from "cervical rib" Stretch injury Radiation Clavicular fractures Compression by soft tissue (scalenes, pec minor) ```
61
Thoracic Outlet Syndrome
Brachial plexus AND subclavian artery | Compression of tight muscles (scalenes, pec minor) or clavicle and first rib
62
Axillary nerve injury
Decreased abduction strength (deltoid) Decreased ER and elbow ext strength (teres minor, triceps) Varying loss of sensation
63
Reflex Sympathetic Dystrophy | "Complex Regional Pain Syndrome"
``` Associated with nerve trauma Intense, prolong pain out of proportion to cause Night pain Psychological disturbances Discoloration Hypersensitivity of skin Moist skin Chronic edema Atrophy Weakness ```
64
Reflex Sympathetic Dystrophy Stages
I (acute): burning pain, tenderness, swelling, vasomotor changes II: persistent aching, swelling w/ hardening, skin/nail bed changes III: skin and subcutaneous atrophy, development contractors

MSK 1 (15 decks)

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