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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
Q

SC Closed Packed Position

A

Maximum arm elevation and protraction

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26
Q

SC Capsular Pattern

A

Pain at extremes ROM

Especially full arm elevation and horizontal adduction

27
Q

Scapulothoracic Joint during full arm elevation

A

15-25 degrees ER
60 degrees upward rotation
15-30 degrees posterior tilt

28
Q

Scapulothoracic Joint Open Packed Position

A

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
Q

Biomechanics of Elevation 0-90

A
  • 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
Q

Biomechanics of Elevation 90-150

A

-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
Q

Biomechanics of Elevation 150-180

A

Abduction >150 requires upper thorax/Cspine motion

Bilateral abduction requires thoracic ext and increased lumbar lordosis

32
Q

Adhesive Capsulitis

A

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
Q

Adhesive Capsulitis Stage 1

A

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
Q

Adhesive Capsulitis Stage 2

A

“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
Q

Adhesive Capsulitis Stage 3

A

“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
Q

Adhesive Capsulitis Stage 4

A

“Thawing stage”, capsular remodeling

Slow/steady recovery ROM, capsular end-feel reached before pain

37
Q

Adhesive Capsulitis Treatment

A

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
Q

GH Instability

A

Abnormal symptomatic motion of GH joint that affects normal joint kinematics and results in pain, subluxation, or dislocation

39
Q

GH Subluxation

A

Joint contact lost but capsule not necessarily torn, might just be stretched

40
Q

GH Dislocation

A

Complete separation of joint surfaces

*Usually anterior

41
Q

Bankart Lesion/Repair

A

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
Q

Hill-Sachs Lesion

A

Compression fracture of the posterior humeral head at the site where the humeral head impacted the inferior glenoid rim

43
Q

SLAP Lesion

A

Superior labral lesion that is both anterior and posterior

Insertion of biceps pulls associated portion of superior labrum away creating bucket-handle lesion

44
Q

AC Joint Sprain

A

Acute: fall onto shoulder with arm adducted at side
Chronic: general OA, inflamm arthritis, mechanical probs

45
Q

RC Tear Mechanisms

A

Compression: reduction size of subacromial space
Tensile overload: throwing, hammering
Macrotrauma

46
Q

RC Examination

A

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
Q

Subacromial Impingement Syndrome

A

Increased superior translation of humeral head –> decreased space in coracoacromial arch and produces compression of suprahumeral structures

48
Q

Primary Impingement

A

Intrinsic degenerative process in structures of subacromial space
Anterior impingement
Limited horizontal abduction, IR
Posterior capsule tightness

49
Q

Secondary Impingement

A

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
Q

Shoulder Arthritis

A

Humeral head migrating superior–>degeneration

Loss of ROM and strength

51
Q

Total shoulder arthroplasty

A

Replace glenoid fossa and head of humerus

52
Q

Hemiarthroplasty

A

Replace head of humerus

53
Q

Reverse total shoulder

A

Inverted prosthesis so ball is on the scapula and concavity is on humerus

Creates new line of force when RC is not slavagable

54
Q

Subacromial-Subdeltoid Bursitis

A

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
Q

Three types of Bursitis

A

Related to activity/trauma
Calcific due to little bone projections from acromion
Infectious

56
Q

How do you differentiate bursitis and tendonitis?

A

If always able to reach overhead without restriction in motion: tendonitis

57
Q

Clavicle fracture

A 
Childhood
FOOSH or direct blow
Difficulty elevating arm >60
Painful horizontal adduction
Clavicular deformity
58
Q

Proximal Humerus Fractures

A

Direct blow to ant, lat, or posterolateral humerus or FOOSH
Osteopenic bone with minimal trauma
Lung metastasis

59
Q

Scapular Fracture

A

Direct blow or trauma

60
Q

Brachial Plexus Injury

A 
Entrapment from "cervical rib"
Stretch injury
Radiation
Clavicular fractures
Compression by soft tissue (scalenes, pec minor)
61
Q

Thoracic Outlet Syndrome

A

Brachial plexus AND subclavian artery

Compression of tight muscles (scalenes, pec minor) or clavicle and first rib

62
Q

Axillary nerve injury

A

Decreased abduction strength (deltoid)
Decreased ER and elbow ext strength (teres minor, triceps)
Varying loss of sensation

63
Q

Reflex Sympathetic Dystrophy

“Complex Regional Pain Syndrome”

A 
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
Q

Reflex Sympathetic Dystrophy Stages

A

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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