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Ortho Dx > Shoulder > Flashcards

Shoulder Flashcards

1
Q

Instructions for Dugas Test

A

Patient Seated
Examiner instructs patient to place the hand of the affected side on the opposite shoulder and bring the affected elbow to the chest.

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2
Q

State Positives for Dugas Test

A

Inability to touch the opposite shoulder and/or inability of the elbow to touch the chest.

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3
Q

What does Dugas Test indicate?

A

Acute dislocation of the glenohumeral joint

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4
Q

Instructions for Anterior Apprehension Test

A

Patient Seated
Examiner abducts the patient’s shoulder, flexes the patients elbow and then gradually externally rotates the patient’s shoulder

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5
Q

Positive Anterior Apprehension Test

A

Patient will have noticeable look of apprehension or alarm on their face with possible pain

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6
Q

What does a positive Anterior Apprehension Test indicate?

A

Chronic anterior dislocation of the glenohumeral joint

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7
Q

What is a confirmation test for a positive anterior apprehension test?

A

Dugas Test

Radiography

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8
Q

Instructions for Posterior Apprehension Test

A

Patient Supine
Examiner flexes patient’s shoulder, flexes patient’s elbow and internally rotates the shoulder.
Examiner places his/her hand on the patient’s distal humerus and gradually applies increasing posterior pressure

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9
Q

Positive Posterior Apprehension Test

A

Apprehension

Pain

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10
Q

What does a positive Posterior Apprehension Test indicate?

A

Chronic posterior dislocation of the glenohumeral joint

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11
Q

Instruction for Drop Arm Test

A

Patient Seated
Examiner passively abducts patients arm to slightly over 90 degrees and removes support, if patient can maintain arm, then instructs patient to slowly lower their arm

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12
Q

Positive Drop Arm Test

A

Patient will not be able to lower the arm slowly or the arm drops suddenly

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13
Q

What does the Drop Arm Test indicate?

A

Rotator cuff tear, usually supraspinatus

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14
Q

Confirmation test for Drop Arm test

A

Apley Scratch

Impingement

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15
Q

Instructions for Dawbarn Test

A

Patient Seated
Examiner applies pressure below the affected acromial process with fingertips. Note for pain or tenderness.
Examiner continues to apply pressure while abducting the patient’s arm PAST 90 degrees

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16
Q

State the positive for Dawbarn Test

A

Decrease in pain and or tenderness

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17
Q

What does a positive Dawbarn Test indicate?

A

Subacromial bursitis

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18
Q

How can you confirm a positive Dawbarn Test

A

MRI

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19
Q

What is another name for Yergason Test

A

Cipriano

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20
Q

Instructions for Yergason Test

A

Patient Seated
Examiner flexes patient’s elbow to 90 degrees. Examiner stabilizes patient’s elbow with one hand and exerts slight inferior traction.
Examiner uses their other hand and grasps slightly above patient’s wrist
Examiner offers resistance while patient is instructed to externally rotate his/her humerus and slightly supinate the forearm

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21
Q

Positives for Yergason Test

A

Localized pain or tenderness at the bicipital groove

Audible click or the bicep tendon sub luxes or dislocates

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22
Q

What does a positive Yergason Test indicate?

A

Tendinitis

Instability of the biceps tendon possibly associated with a torn transverse humeral ligament

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23
Q

Tests to confirm a positive Yergason Tests?

A

Speed Test

Abbott-Saunders Test

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24
Q

Abbott-Saunders Test instructions?

A

Patient Seated
Examiner fully abducts and externally rotates the patient’s affected arm.
Examiner places his fingers on patients bicipital groove and then slowly lowers the patients affected arm to their side

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25
Q

What is a positive Abbott-Saunders Test

A

Palpable and or audible click

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26
Q

What does Abbott-Saunders Test indicate?

A

Subluxation or dislocation of the biceps tendon (rupture of transverse ligament or tendon subluxation beneath subscapularis muscle belly)

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27
Q

Confirmation test for Abbott-Saunders Test

A

Speed Test

Yergason Test

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28
Q

Instruction for Speed Test

A

Patient Seated
Forearm supinated and elbow flexed to 45 degrees
Examiner places fingertips on patient’s bicipital groove with their opposite hand on the patients forearm.
Instruct the patient to flex his/her shoulder, maintain supination and completely extend the elbow as the DC applies resistance.

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29
Q

State the positive for Speed Test

A

Pn or tenderness @ bicipital groove

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30
Q

Speed test indicates?

A

Bicipital Tendinitis

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31
Q

What tests can confirm a positive Speed Test

A

Abbot-Saunders Test

Yergason Test

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32
Q

Instructions for Apley Test

A

Patient Seated
Have them place the affected hand behind the head and touch the opposite superior angle of the scapula = Apley Scratch Superior.
Then instruct patient to place the hand behind the back to touch the inferior angle of scapula = Apley Scratch Inferior

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33
Q

Positive Apley Test

A

Exacerbation of Pain

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34
Q

+ Apley Test indicates?

A

Degenerative tendinitis of rotator cuff tendons - usually supraspinatus

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35
Q

Impingement Sign instructions

A

Patient Seated
Arms at side & examiner slightly abducts patient’s arm (hand pronated) and moves it fully through flexion (will jam greater tuberosity and anterior/inferior surface of the acromion)

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36
Q

+ Impingement Sign indicates?

A

Overuse injury to the supraspinatus and possible biceps tendon

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37
Q

ROM Flexion (forward) of shoulder

A

180 degrees

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38
Q

Extension ROM of shoulder

A

60 degrees

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39
Q

Abduction ROM of shoulder

A

180 degrees

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40
Q

Adduction ROM of shoulder

A

50 degrees

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41
Q

T or F

Internal rotation of shoulder (from horizontal abduction of arm) is 90 degrees

A

False!

90=external
70=internal

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42
Q

T or F

Scapular protraction is seen in movements like reaching

A

True

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43
Q

Name the rotator cuff muscles

A

Supraspinatus
Infraspinatus
Teres Minor
Subscapularis

44
Q

Name the 16 muscles that attach to the scapula

A 
Serratus Anterior
Supraspinatus
Subscapularis
Trapezius
Teres Major
Teres Minor
Triceps Brachii long head
Biceps Brachii
Rhomboid Major
Rhomboid Minor
Coracobrachialis
Omohyoid inferior belly
Lattisimus Dorsi
Deltoid
Levator Scapula
Infraspinatus
Pectoralis Minor
45
Q

What are the primary functions of the shoulder?

A
  1. Position hand in space
  2. suspend the upper extremity
  3. provide some point of fixation so motion can occur
  4. Serve as a fulcrum for arm elevation
46
Q

What is scaption?

A

Movement of the scapula -> lateral, superior and anterior

47
Q

The should joint complex consists of what bones and joints?

A

3 bones: humerus, clavicle, and scapula

3 joints: SC, AC & GH

48
Q

Name the pseudo joint of the shoulder

A

ST articulation

49
Q

Name the physiological area of the shoulder complex

A

Suprahumeral or subacromial space

50
Q

What type of joint is the GH joint?

A

True synovial lined diathrodial joint

51
Q

Name the structure that makes the Glenoid Fossa 50% deeper

A

Fibrocartilage called the Labrum

52
Q

Name the 2 primary functions of the humeral head and glenoid fossa contact

A
  1. Spreads the joint loading over a broad area

2. Permits movement with minimal friction and wear

53
Q

The scapula lies along the thoracic cage at ___ degrees to the frontal plane, ____ superiorly relative to the transverse plane, and ___ degrees forward in the sagittal plane

A

30
3
20

54
Q

What are the 3 types of acromion morphology

A

Flat Undersurface
Slightly Convex
Hooked

55
Q

What morphology of the acromion predisposes the shoulder to rotator cuff pathology?

A

Hooked

56
Q

What muscles originate on the coracoid process?

A

Coracobrachialis and short head of biceps.

57
Q

The lateral attachment of the GH joint capsule attaches where?

A

The anatomical neck of the humerus

58
Q

Medially the GH joint capsule attaches where?

A

To the periphery of the glenoid and its labrum

59
Q

The greater tuberosity serves as an attachment for what muscles?

A

Supraspinatus
Infraspinatus
Teres Minor

60
Q

What muscle attaches on the lesser tuberosity?

A

Subscapularis

61
Q

What runs in the intertubercular groove?

A

The long head of the biceps tendon

62
Q

What is an aka for the G-H ligaments?

A

Z ligaments

63
Q

T or F

The superior Z ligament limits external rotation and anterior translation of the humeral head with the arm in 0 degree and 45 degrees of abduction

A

False
* this was describing the middle Z ligament.

Superior = Limits external rotation and inferior translation of the humeral head with the arm at the side

64
Q

What is the name of the structure that covers the GH ligament anterior-superiorly and fills the space between the tendons of the supraspinatus and subscapularis muscles?

A

Coracohumeral Ligament.

65
Q

What is the main function of the Coracoacuromial Ligament?

A

Prevents separation of the AC joint surfaces

66
Q

The Coracoacuromial arch is also known as??

A

Supraspinatus Outlet

67
Q

Describe the action of the Supraspinatus tendon when the arm is elevated and internally rotated compared to elevated and externally rotated

A

Internally rotated = supraspinatus tendon passes under the coracoacromial ligament

Externally rotated = the tendon passes under the acromion itself.

68
Q

The Subacromial/Suprahumeral space is at its narrowest between what degrees of caption?

A

60-120

69
Q

Name the contents of the Subacromial Space

A 
Long head of biceps tendon
Supraspinatus
Upper margins of subscapularis 
Infraspinatus 
Subdeltoid - subacromial bursa
70
Q

What/Where is the Hypovascular Zone of the Supraspinatus tendon?

A

It is a critical zone just proximal to the supraspinatus insertion point.

71
Q

Impingement Syndrome is thought to cause what other problems in the shoulder?

A

Thought to precipitate attritional (degenerative) changes in the rotator cuff leading to rotator cuff tears.

72
Q

Describe the clinical findings of Impingement Syndrome

A

Pain will often become worse at night, as the subacromial bursa becomes hyperaemic after activity or use.

73
Q

The shoulder complex is embryologically derived from what spinal nerve roots?

A

C 5-8 except the AC joint which is derived from C 4

74
Q

The sympathetic nerve supply to the shoulder originates primary in what region of the spine?

A

Thoracic region from T2-T8

75
Q

This condition results from an upper brachial plexus (C5-C6) injury and can be from forceful depression of the shoulder during birth or trauma to the shoulder later in life.

A

Erb’s Palsy aka Erb-Duchenne Paralysis

76
Q

How will a patient with Erb’s Palsy present?

A

Internally rotated and adducted shoulder

Biceps relex is lost and there is muscle wasting

77
Q

The vascular supply to the rotator cuff muscles of the shoulder consists of what main sources?

A
  1. Thoracoacromial artery
  2. Suprahumeral artery
  3. Subscapular artery
78
Q

Describe the closed packed position of the GH joint

A

90 degrees of GH abduction & full external rotation
OR
full abduction and external rotation (depending on source)

79
Q

Describe open packed position of the GH joint

A

No internal or external rotation traditionally has been cited as 55 degrees of semi-abduction and 30 degrees of horizontal adduction.

80
Q

A number of ligaments provide support for the SC joint. Please list them

A

Anterior sternoclavicular ligament
Posterior sternoclavicular ligament
Interclavicular
Costoclavicular

81
Q

Name the scapular pivoter muscles

A

Trapezius, serratus anterior, levator scap, rhomboids

82
Q

Lat D, pec major and minor are grouped together as ________ _________

A

Humeral propellers

83
Q

Name the humeral positioner muscles

A

the 3 parts of the deltoid

84
Q

What muscles are the shoulder protectors

A

Rotator cuff muscles and biceps brachii

85
Q

A study by Inman determined that a ______ ratio occurs between the motion at the GH joint and scapula respectively

A

2:1

86
Q

What does Reverse Scapulohumeral rhythm mean?

A

The scapula moves MORE than the humerus

This patient will likely hike the shoulder this condition is called Frozen Shoulder

87
Q

What muscles are the principle movers during the first 30 degrees of upward rotation of the scapula?

A

Serratus Anterior

Upper & Lower divisions of the Trapezius

88
Q

What are the 3 possible causes of Shoulder girdle dysfunction

A
  • Compromise of the passive restraint components of the shoulder girdle
  • Compromise of the neuromuscular system’s production or control of shoulder girdle motion
  • Compromise to one or more of the neighbouring joints that contribute to shoulder girdle.
89
Q

What type of movements are commonly seen with subacromial bursitis, impingement syndromes and rotator cuff problems?

A

Overhead exertion with repetitive motion

90
Q

FOOSH means?

A

Falling on outstretched hand

91
Q

Falling on the tip of the shoulder is a common cause for what shoulder pathology?

A

A/C separations

92
Q

With a FOOSH injury describe the force path through the shoulder complex

A

The source bounces off scapula as the scapula is strong and hits the anterior inferior part of the shoulder complex causing an anterior dislocation.

93
Q

T or F

The most common dislocation of the G/H joint is Anterior/Superior

A

False

Anterior/Inferior

94
Q

What is the chance of a recurrent dislocation after the initial event?

A

95% in patients 25 years old or younger.

95
Q

With an AC separation does the shoulder look more sunk in or squared off?

A

Squaring off

96
Q

What is the Ruler of Hamilton?

A

This is describing Anterior Dislocations of the G/H Joint where a straight edge can rest simultaneously on the acromial tip and the lateral epicondyle.

97
Q

How many degrees of separation must occur for an A/C joint separation?

A

6 degrees

98
Q

A patient with a clavicle fracture will have difficulty elevating their arm past how many degrees?

A

60

99
Q

T or F

Horizontal adduction is painful with clavicular fractures

A

True

100
Q

Systemic causes of insidious shoulder pain include?

A 
RA
Lupus
Gallbladder
Liver Disease
Chronic respiratory and cardiovascular conditions
101
Q

Discuss pain and the associations with systemic signs that could indicate referred pain from a malignancy

A

Severe progressive pain not affected by movement. Persistent, constant throughout the day and night

102
Q

T or F

Frozen shoulder involves lack of motion in the GH and ST articulations

A

False

ST will still have motion

103
Q

What age of men and women are usually more susceptible to experiencing frozen shoulder?

A 
Women = 40-50
Men = 50-60
104
Q

When a patient is standing where is the scapula located in relation to the spine and describe vertebral levels

A

Medial border = 5-9cm lateral to the thoracic sp
Spine of scapula = level of the T3 sp
Inferior angle = T7 sp standing T6 sp laying

105
Q

Name the muscles of the shoulder that are prone to tightness (10)

A 
Upper Trapezius 
Levator Scapulae
Pec Major and Minor
Upper Cervical Extensors
SCM
Scalenes
Trees Major and Minor
106
Q

What shoulder complex muscles are prone to inactivity or lengthening?

A 
Middle and lower Trapezius 
Rhomboids 
Serratus Anterior
Deep Neck Flexors
Subscapularis
Supra and Infraspinatus

Ortho Dx (17 decks)

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