Shoulder Flashcards
1
Q
head of humerus faces
A
med, post, lat
2
Q
axis of head of humerus forms angle
A
130-150 degrees
3
Q
head of humerus angled post
A
30-40 degrees
4
Q
post capsule
A
under tension when shoulder in flexion, adduction, and/or IR
5
Q
sup GH ligament
A
under tension when shoulder in adduction, inf and post translation of humerus
6
Q
middle GH lig
A
under tension with shoulder in ER, rests ant translation
7
Q
Inf GH lig 3 parts
A
ant taut when shoulder abducted, ext, and or ER
post taut when shoulder IR and or abducted
axillary pouch taut in 90 flex
primary restraint against ant and post dislocated
8
Q
coracohumeral ligament
A
post band limits ER and flex of GH and inf and post translation humeral had
ant band limits ER and ext of GH and inf and post translation humeral head
9
Q
suprahumeral space width
A
9-15 mm
10
Q
suprahumeral space boundaries
A
inf- tuberosity of humeral head
anteromedial- coracoid process
sup- coracoacromial arch (accordion process, coracoacromial lit, coracoid process)
11
Q
suprahumeral space contents
A
long head of biceps tendon sup joint capsule supraspinatus upper margins subscapularis and infraspinatus subacromial bursa
12
Q
type 1 acromion
A
flat
13
Q
type 2 acromion
A
normal
14
Q
type 3 acromion
A
curved, more problematic, causes impingement
15
Q
GH joint open packed
A
55 degrees abd, 30 degrees horizontal adduction, neutral rotation
16
Q
GH closed packed position
A
full abduction, full external rotation
17
Q
GH capsular pattern
A
ER limited more then abduction, limited more than IR, limited more than flexion
ER>ABD>IR>Flex
18
Q
AC Joint must rotate ? for full elevation
A
40-50 degrees
19
Q
coracoid clavicular ligament tense during
A
arm elevation resulting in post rotation at SC joint
20
Q
AC joint open packed position
A
arm by the side
21
Q
AC joint closed pack position
A
90 degrees GH abduction
22
Q
AC joint capsular pattern
A
pain at extremities of ROM, especially horizontal adduction and full elevation
23
Q
Sternoclavicular joint open packed position
A
arm by side
24
Q
SC closed pack
A
max arm elevation and protraction
25
SC capsular pattern
pain at extremes ranges of motion, especially full arm elevation and horizontal adduction
26
during full arm elevation, scapular should have ? ER, ? UR, ? post tilt
15-25 ER, 60 UR, 15-30 post tilt
27
scapulothoroacic open pack position
arm by side
| scapula in average 30-45 degrees IR, slight UR, 5-20 degrees ant tilt
28
scapulothoracic mechanics during full arm elevation
60 UR
15-30 post tipping
15-25 ER
29
Biomechanics of elevation 0-90
supraspinatus contracts to initiate abduction
remaining RC contract to pull humeral head into glenoid fossa
around 20-30 degrees, scapular upward rotation begins with concurrent clavicular elevation and axial rotation
at 90 degrees, upper extreme of GH abduction is reached and clavicular elevation creases due to tension of costoclavicular ligament
at this point the scapular has rotated upwardly around 30 degrees
30
biomechanics of elevation 90-150
scapula UR 60 degrees with scapular contribution peaking between 90-140 degrees
120 humeral elevation
75 degrees of GH ER needed
UR accompanied at SC and AC by 30-40 degrees of post clavicular axial rotation and clavicular elevation of 30-36
31
biomechanics of elevation 150-180
abduction beyond 150 requires adequate motion of upper thorax and cervical spine, while bilateral abduction requires thoracic ext and increase in lumbar lordosis
32
strengthening should be preformed in ? plane
scapular
33
adhesive capsulitis
```
frozen shoulder
restriction in active and passive ROM
female
>40
trauma
diabetes
prolonged immobolization
thyroid
stoke or MI
autoimmune
follows capsular pattern
can take 1-3 years to resolve
```
34
adhesive capsulitis stages of progression
1. mild signs and symptoms
35
adhesive capsulitis intervention per stage
- determine degree of inflammation and irritability
1. actue- relieve pain and gentle stretch to capsule
- low grade mob, pendulum exercises, passive stretching upper trap and levator scapulae, postural awareness
2. subacute- more agressive ROM exercises, strengthening with isometrics then concentric
3. stages 3 and 4- grade IV mob, low load long duration stretching
36
glenohumeral instability continuum
- instability- abnormal symptomatic motion of the Gh joint that affects normal joint kinematics and results in pain, subluxation, or dislocation
- subluxation- joint contact lost but capsule not necessarily torn, might just be stretched, UE paralysis, multiple dislocations
- dislocation- complete separation of the joint surfaces, usually ANT, concern axillary N injury
37
how is glenohumeral instability classified?
frequency
magnitude/degree
direction
origin
38
bankhart lesion
```
GH instability
avulsion of the ant info labrum from the glenoid rim, occurs in lower part of labrum
inf GH ligament torn
tighten ant capsule
loss of 12 degrees of ER post procedure
```
39
Hill Sachs lesion
GH instability
| compression fracture of the post humeral head at the site where the humeral head impacted the info glenoid rim
40
GH instability history
```
most common complaint is pain
often result of trauma
repetitive microtrauma
joint laxity
ant instability (98%)
pain with over head movements
symptoms occurs in abduction and ER position
```
41
GH instability examination
```
ROM may be excessive (hyperbole)
patient may self limit provocative positions (ER and abd)
transient neuro symptoms
easy fatiguability
special tests:
provacative
apprehension test/relocation
load and shift
sulcus sign
```
42
GH instability intervention
```
functionally stabilize shoulder
-scap stability
-rotator cuff musculature
-neuromuscular control
work from stable to unstable positions
closed chain activation in early rehab
activity modifications
```
43
GIRD
glenohumeral internal rotation deficiency
| loss of IR (
44
SLAP lesion
sup labrum lesions that are both ant and post
| sup portion of biceps pulls sup labrum away creating bucket handle lesion
45
SLAP lesion history
```
single traumatic event to repetitive micro trauma
FOOSH
forceful biceps contraction
pain with overhead activities
NOT painful at REST
catching or locking in joint
```
46
SLAP lesion examination tests
O Briens
clunk/crank
yergasons
load and shift test
47
AC joint sprain
one of the most frequently injured joints
acute- fall onto shoulder with arm ADDUCTED at side
chronic-OA, inflammatory arthritis, mechanical problems
usually involved dislocation
48
6 types of AC joint sprain
1- tenderness and mild pain
2-slight visual change in acromion/clavicle, if displaced acromion
3- obvious gap between acromion and clavicle, inf displaced acromion
4- clavicle displaced posteriorly
5- large distance between clavicle and coracoid process, inf displacement acromion
6- often associated fracture of clavicle and upper ribs and injury brachial plexus
49
AC joint sprain examination
```
localized pain
step off deformity
pain at end range motions
crossover test
1- pain with resisted adduction
2- pain with resisted adduction and abduction
3- all active motions painful, esp ABDUCTION
immobilization 1,2,3
surgery for 4, 5, 6 bc displaced
```
50
rotator cuff pathology
50-70 % shoulder issues
SUPRASPINATUS most often affected (LOW blood supply)
injury mechanism: compression-reduction size subacromial space, tensile overload-throwing, hammering
macrotrauma
tendonitis- supra followed by infra
tears- more common in men than women
51
RC history
pain, weakness, loss of ROM
dull ache worse after activity, sleep on affected arm, reaching, putting on coat
loss of function, can't hold arm out (tear)
tendonitis- better after 3 weeks, full AROM and PROM but painful, DEEP FRICTION massage
tear- pop at injury, sudden onset, not better after 3 weeks
higher humerus, palpable defect at gr tuberosity, muscle atrophy, reverse scap humeral rhythm
52
RC exam
painful arc- mid range elevation pain b/c tissues most activated (supraspinatus pain most evident during abduction or caption 50-130 degrees)
resisted motion:
supraspinatus- pain with abduction and ER
infraspinatus- pain with ER
complete tear- positive drop arm test
partial tear-positive supraspinatus test
list off test- biceps tendon, subscapularis
ER lag- supraspinatus or infra
53
muscle contractile injuries painful when
passively stretched and actively shortened
54
subacromal impingement syndrome
increase in sup translation of humeral head results in decrease space in coracoacromial arch
intervention- isometrics-closed-open, RC strengthen, scapulothoracic
55
Primary SIS
primary-ANT impingement, intrinsic degenerative process in the structures occupying the subacromial space, mechanical encroachment, >40 yo, may be hypomobile
limited horizontal abduction, limited IR, post cap tightness, pain with over head activity
56
Secondary SIS
secondary- CORACOID impingement, lesser tuberosity of the humerus encroaches on the coracoid process (alters PICR, humerus migrates too sup), hyper mobility, instability
limited IR, excessive ER
57
shoulder arthritis
```
humeral head migrating sup or history of trauma can accelerate degenerative changes
loss of ROM and strength
capsular pattern
compression/sleeping can cause pain
AC joint most commonly affected
```
58
shoulder surgical options
TSA-replace glenoid fossa and head of the humerus
hemiarthroplasty-replace head of humerus
reverse total shoulder- invert prothesis so ball is on the scapula and concavity is on the humerus (when RC not salvageable)
59
subacromial bursitis
where friction between bone and tendon is typical
excessive friction can lead to inflammation
3 types: activity/trauma, calcified, infectious
can be seen with autoimmune disease
rubbing will make it worse
iontophoresis can help calcifications
60
bursitis history/exam
may or may not have MOI
aching over deltoid region
rapid onset with activity
pain reproduced with passive abduction at 180, passive IR, passive horizontal adduction (may feel empty end feel)
acute-may not be able to reach overhead
noncapsular pattern
palpation distal to AC joint with shoulder held in extension
61
if a pt has always been able to reach overhead without restriction (even with pain) it is more suggestive of...
tendonitis
62
clavicle fracture
MOST COMMONLY fractured bone in CHILDHOOD
usually from FOOSH, a fall or blow to shoulder or direct blow
difficulty elevating the arm >60 degrees
painful horizontal adduction
deformity
63
proximal humerus fx
direct blow to ant, lat, or postlat, FOOSH, osteoporosis, common site of metastasis of LUNG
64
brachial plexus injury
```
entrapment from cervical rib
stretch injury
radiation
clavicular fx
compression by soft tissue
```
65
TOS
involved brachial plexus and subclavian artery
compression of tight muscles
tingling in arm after carrying heavy objects
tight scalenes
66
peripheral nerve injuries
axillary-decreased abduction strength
decreased ER and elbow ext strength
varying loss of sensation
67
reflex sympathetic dystrophy
complex regional pain syndrome
pain out of proportion, cold clammy limbs,trauma,distal first
night pain
psychologicaal disturbances
discoloration
chronic edema
1- burning pain, tenderness, swelling, vasomotor changes
2- persistent aching, swelling w/ hardening. skin/nail bed changed
3- skin and subcutaneous atrophy, development contractures
