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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
What is a positive Abbott-Saunders Test
Palpable and or audible click
26
What does Abbott-Saunders Test indicate?
Subluxation or dislocation of the biceps tendon (rupture of transverse ligament or tendon subluxation beneath subscapularis muscle belly)
27
Confirmation test for Abbott-Saunders Test
Speed Test | Yergason Test
28
Instruction for Speed Test
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.
29
State the positive for Speed Test
Pn or tenderness @ bicipital groove
30
Speed test indicates?
Bicipital Tendinitis
31
What tests can confirm a positive Speed Test
Abbot-Saunders Test | Yergason Test
32
Instructions for Apley Test
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
33
Positive Apley Test
Exacerbation of Pain
34
+ Apley Test indicates?
Degenerative tendinitis of rotator cuff tendons - usually supraspinatus
35
Impingement Sign instructions
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)
36
+ Impingement Sign indicates?
Overuse injury to the supraspinatus and possible biceps tendon
37
ROM Flexion (forward) of shoulder
180 degrees
38
Extension ROM of shoulder
60 degrees
39
Abduction ROM of shoulder
180 degrees
40
Adduction ROM of shoulder
50 degrees
41
T or F | Internal rotation of shoulder (from horizontal abduction of arm) is 90 degrees
False! 90=external 70=internal
42
T or F | Scapular protraction is seen in movements like reaching
True
43
Name the rotator cuff muscles
Supraspinatus Infraspinatus Teres Minor Subscapularis
44
Name the 16 muscles that attach to the scapula
``` 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
What are the primary functions of the shoulder?
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
What is scaption?
Movement of the scapula -> lateral, superior and anterior
47
The should joint complex consists of what bones and joints?
3 bones: humerus, clavicle, and scapula | 3 joints: SC, AC & GH
48
Name the pseudo joint of the shoulder
ST articulation
49
Name the physiological area of the shoulder complex
Suprahumeral or subacromial space
50
What type of joint is the GH joint?
True synovial lined diathrodial joint
51
Name the structure that makes the Glenoid Fossa 50% deeper
Fibrocartilage called the Labrum
52
Name the 2 primary functions of the humeral head and glenoid fossa contact
1. Spreads the joint loading over a broad area | 2. Permits movement with minimal friction and wear
53
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
30 3 20
54
What are the 3 types of acromion morphology
Flat Undersurface Slightly Convex Hooked
55
What morphology of the acromion predisposes the shoulder to rotator cuff pathology?
Hooked
56
What muscles originate on the coracoid process?
Coracobrachialis and short head of biceps.
57
The lateral attachment of the GH joint capsule attaches where?
The anatomical neck of the humerus
58
Medially the GH joint capsule attaches where?
To the periphery of the glenoid and its labrum
59
The greater tuberosity serves as an attachment for what muscles?
Supraspinatus Infraspinatus Teres Minor
60
What muscle attaches on the lesser tuberosity?
Subscapularis
61
What runs in the intertubercular groove?
The long head of the biceps tendon
62
What is an aka for the G-H ligaments?
Z ligaments
63
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
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
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?
Coracohumeral Ligament.
65
What is the main function of the Coracoacuromial Ligament?
Prevents separation of the AC joint surfaces
66
The Coracoacuromial arch is also known as??
Supraspinatus Outlet
67
Describe the action of the Supraspinatus tendon when the arm is elevated and internally rotated compared to elevated and externally rotated
Internally rotated = supraspinatus tendon passes under the coracoacromial ligament Externally rotated = the tendon passes under the acromion itself.
68
The Subacromial/Suprahumeral space is at its narrowest between what degrees of caption?
60-120
69
Name the contents of the Subacromial Space
``` Long head of biceps tendon Supraspinatus Upper margins of subscapularis Infraspinatus Subdeltoid - subacromial bursa ```
70
What/Where is the Hypovascular Zone of the Supraspinatus tendon?
It is a critical zone just proximal to the supraspinatus insertion point.
71
Impingement Syndrome is thought to cause what other problems in the shoulder?
Thought to precipitate attritional (degenerative) changes in the rotator cuff leading to rotator cuff tears.
72
Describe the clinical findings of Impingement Syndrome
Pain will often become worse at night, as the subacromial bursa becomes hyperaemic after activity or use.
73
The shoulder complex is embryologically derived from what spinal nerve roots?
C 5-8 except the AC joint which is derived from C 4
74
The sympathetic nerve supply to the shoulder originates primary in what region of the spine?
Thoracic region from T2-T8
75
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.
Erb's Palsy aka Erb-Duchenne Paralysis
76
How will a patient with Erb's Palsy present?
Internally rotated and adducted shoulder | Biceps relex is lost and there is muscle wasting
77
The vascular supply to the rotator cuff muscles of the shoulder consists of what main sources?
1. Thoracoacromial artery 2. Suprahumeral artery 3. Subscapular artery
78
Describe the closed packed position of the GH joint
90 degrees of GH abduction & full external rotation OR full abduction and external rotation (depending on source)
79
Describe open packed position of the GH joint
No internal or external rotation traditionally has been cited as 55 degrees of semi-abduction and 30 degrees of horizontal adduction.
80
A number of ligaments provide support for the SC joint. Please list them
Anterior sternoclavicular ligament Posterior sternoclavicular ligament Interclavicular Costoclavicular
81
Name the scapular pivoter muscles
Trapezius, serratus anterior, levator scap, rhomboids
82
Lat D, pec major and minor are grouped together as ________ _________
Humeral propellers
83
Name the humeral positioner muscles
the 3 parts of the deltoid
84
What muscles are the shoulder protectors
Rotator cuff muscles and biceps brachii
85
A study by Inman determined that a ______ ratio occurs between the motion at the GH joint and scapula respectively
2:1
86
What does Reverse Scapulohumeral rhythm mean?
The scapula moves MORE than the humerus | This patient will likely hike the shoulder this condition is called Frozen Shoulder
87
What muscles are the principle movers during the first 30 degrees of upward rotation of the scapula?
Serratus Anterior | Upper & Lower divisions of the Trapezius
88
What are the 3 possible causes of Shoulder girdle dysfunction
- 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
What type of movements are commonly seen with subacromial bursitis, impingement syndromes and rotator cuff problems?
Overhead exertion with repetitive motion
90
FOOSH means?
Falling on outstretched hand
91
Falling on the tip of the shoulder is a common cause for what shoulder pathology?
A/C separations
92
With a FOOSH injury describe the force path through the shoulder complex
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
T or F | The most common dislocation of the G/H joint is Anterior/Superior
False Anterior/Inferior
94
What is the chance of a recurrent dislocation after the initial event?
95% in patients 25 years old or younger.
95
With an AC separation does the shoulder look more sunk in or squared off?
Squaring off
96
What is the Ruler of Hamilton?
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
How many degrees of separation must occur for an A/C joint separation?
6 degrees
98
A patient with a clavicle fracture will have difficulty elevating their arm past how many degrees?
60
99
T or F | Horizontal adduction is painful with clavicular fractures
True
100
Systemic causes of insidious shoulder pain include?
``` RA Lupus Gallbladder Liver Disease Chronic respiratory and cardiovascular conditions ```
101
Discuss pain and the associations with systemic signs that could indicate referred pain from a malignancy
Severe progressive pain not affected by movement. Persistent, constant throughout the day and night
102
T or F | Frozen shoulder involves lack of motion in the GH and ST articulations
False ST will still have motion
103
What age of men and women are usually more susceptible to experiencing frozen shoulder?
``` Women = 40-50 Men = 50-60 ```
104
When a patient is standing where is the scapula located in relation to the spine and describe vertebral levels
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
Name the muscles of the shoulder that are prone to tightness (10)
``` Upper Trapezius Levator Scapulae Pec Major and Minor Upper Cervical Extensors SCM Scalenes Trees Major and Minor ```
106
What shoulder complex muscles are prone to inactivity or lengthening?
``` Middle and lower Trapezius Rhomboids Serratus Anterior Deep Neck Flexors Subscapularis Supra and Infraspinatus ```

Ortho Dx (17 decks)

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