Shoulder Flashcards by Eleanor Barnard

What is the glenohumeral joint?

Articulation between glenoid fossa (scapula) and head of humerus

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Why isn’t the glenohumeral joint very stable?

Thin joint capsule, and poor articulation of surfaces

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What increases the stability of the GH joint? (4)

glenoid labrum
biceps tendon
rotator cuff muscles
ligaments

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Which 3 ligaments help to stabilise the GH joint?

Glenohumeral
Coracohumeral
Transverse humeral

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Where is the GH joint weakest?

Inferiorly

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What is the glenoid labrum?

Ring of cartlidge around the glenoid fossa - helps to improve the fit of the head of humerus

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What is the coracoacromial arch and what is its function?

Consists of acromion process, coracoid process and coracoacromial ligament.
-Prevents sup displacement of humerus

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What are the 2 bursae of the GH joint?

Subscapular

- Subacromial

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What can chronic inflammation of the bursa lead to?

Calcification of bursa

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What is painful arc syndrome?

Pain wh en upper limb is abducted between 50* and 130* due to calcific bursitis.

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What is the only connection of the scapula with the axial skeleton?

Clavicle

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Is the clavicle concave or convex?

Lat 1/3 = concave

Med 2/3 = convex (allows passage of neurovascular bundle to upper limb)

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What are the 4 rotator cuff muscles?

Supraspinatus
Infraspinatus
Subscapularis
Teres minor

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What do the tendons of the rotator cuff muscles do?

Keep head of humerus in glenoid fossa

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Where do the 4 rotator cuff muscles attach to the humerus?

Supraspinatus, infraspinatus and teres minor - Greater tubercle (sup/mid/inf facets)

Subscapularis - Lesser tubercle

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What is the origin, insertion and innervation of the supraspinatus muscles?

Origin - Supraspinous fossa (scapula)

Insertion - Greater tubercle of head of humerus Innervation - Suprascapular nerve(C5,C6)

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What is the action of the supraspinatus muscle and what is the test for its function?

Action: initiates abduction of the arm (first 15) and stabilizes the glenohumeral joint
Test: Abduct the arm against resistance (from 0)

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What is the origin, insertion and innervation of the infraspinatus muscle?

Origin: Infraspinous fossa (scapula)
Insertion: Greater tubercle of the head of the humerus Innervation: Suprascapular nerve (C5, C6)

What is the action of the infraspinatus muscle and what is the test for its function?

Action: Lat rotator of humerus and stabilizers the glenohumeral joint
Test: Lat rotate the arm against resistance

What is the origin, insertion and innervation of the teres minor muscle?

Origin: Mid of lat border of scapula
Insertion: greater tubercle of the head of the humerus Innervation: Axillary nerve (C5,C6)

What is the action of the teres minor muscle and what is the test for its function?

Laterally rotates and adducts the humerus (with infraspinatus) and stabilises the glenohumeral joint
Test: Laterally rotate the arm against resistance

What is the origin, insertion and innervation of the subscapularis muscle?

Origin: Subscapular fossa Insertion: Lesser tubercle of the head of the humerus Innervation: Upper and lower subscapular nerves (C5 - 6)

What is the action of the subscapularis muscle and what is the test for its action?

Action: Medial rotator and adductor of the humerus and stabilises the glenohumeral joint
Test: Place the dorsum of the hand to the mid lumbar spine then lift the dorsum of the hand off the back

What is the origin, insertion and innervation of the teres major?

Origin: inferior angle of the scapula
Insertion: Medial lip of intertubercular of humerus
Innervation: Lower subscapular nerve (C5-6)

What is the function of teres major?

Adducts and medially rotates humerus

What tendon is most commonly torn in rotator cuff tears?

Supraspinatus

What is the test for a rotator cuff tear?

Abduct arm fully, lower arm slowly - will fall suddenly at about 90*

What is the most common cause of GH joint dislocation? Which direction?

Excessive extension and lat rotation of humerus | Anteroinferior (inf is weakest point)

What nerve can be damaged by inferior dislocation at GH joint?

Axillary nerve

What 4 things does a patient with a damaged axillary nerve following dislocation of the gelnohumeral joint typically present with?

- prominent acromion process - flattened shoulder - prominent humeral head - anaesthesia in upper arm skin

What are the 4 movements of the GH joint?

- flexion/extension - abduction/adduction - circumduction - med & lat rotation

What muscles are involved in arem abduction?

- Supraspinatus (1st 15*) | - Deltoid

In abduction of the upper limb above 90 degrees muscles other than the supraspinatus and deltoid are involved, what are they and what is there action?

Teres minor - laterally rotates the humerus | Trapezius and serratus anterior rotate the scapula laterally

How does paralysis of suprspinatus impair abduction?

``` Suprascapular nerve (C5, C6) damage - supraspinatus is responsible for first 15*. Patient can compensate by leaning and allowing gravity to do it ```

How can the deltoid muscle become paralysed and what is the consequence of this?

``` Axillary nerve (C5,C6) damage due to shoulder dislocation/humerus fracture (surgical neck). Arm cannot be lifted above 90* ```

What structures travel through the quadrangular space?

- Axillary nerve | - Post circumfex humeral artery & vein

What are the boundaries of the quadrangular/quadrilateral space?

Lateral - surgical neck of the humerus Medial - Long head of triceps brachii (muscle) Superior - Teres minor Inferior - Teres major

What is quadrangular space syndrome? What are the symptoms?

Post humeral circumflex artery and axillar nerve blockage. | Shoulder pain and paraesthia down arm

What are the attachments of deltoid?

ORIGINS: inf edge of spine of scapula, lat margin of acromion, ant border of lat 1/3 of clavicle INSERTIONS: Deltoid tuberosity of humerus

What is the innervation of deltoid?

Axillary nerve (C5, C6)

What are the actions of the ant/post fibres of deltoid, and the muscle as a whole?

ANT - flew arm at GH joint POST - extend arm at GH joint WHOLE - abductor of arm above 15*

What is frozen shoulder syndrome?

Pain and limited movement at shoulder. May be due to injury/overuse/diaebetes.

How is frozen shoulder syndrome treated?

- Corticosteroids | - Capsular distension