Shoulder Flashcards
What does Axillary pouch do
it supports the humeral head above 90 abduction, limiting inferior translation while anterior band tightens on lateral rotation and posterior band tightens on medial rotaion
superior glenohumeral ligament
limiting inferior translation in adduction, restrains anterior translation and lateral rotation upto 35 degree abduction
middle glenohumeral ligament
absent in 30 % of population, limits lateral rotation between 45-90%
Excessive lateral rotation such as throwing may lead…
stretching of anterior portion of the ligament and capsule, increasing glenohumeral laxity
coracohumeral ligament primarily limits
inferior translation helps limit lateral rotation below 60 degree abduction
Which two tendons coracohumeral ligament unites
Supraspinatus and Subscapularis
Rotator interval consists
coracohumeral ligament, superior glenohumeral ligament, glenohumeral joint capsule, part of the tendons of supraspinatus and subscapularis
coracoacromio ligament limits
superior translation of glenohumeral joint
paratenonitis
outer covering of the tendon whether or not it is lined with synovium.
Tendinosis
actual degeneration of the tendon itself
Primary ligaments of the Glenohumeral joint and which is important
Superior, middle and inferior Glenohumeral ligament
Inferior glenohumeral ligament is most important, has anterior and posterior band with thin axillary pouch in between.
TUBS type instability
Traumatic onset, Unidirectional anterior with Bankart lesion responding to Surgery
AMBRI type instability
Atraumatic cause, Multidirectional with Bilateral shoulder findings with Rehabilitation as appropriate treatment and rarely Inferior capsular ship surgery
SICK scapula
malposition of Scapula prominence of Inferior medial border of scapula, Coracoid pain and malposition, and scapular dysKinesia
step deformity
acromioclavicular dislocation with the distal end of the clavicle lying superior to the acromion process. Indicates acromioclavicular and coracoclavicular ligaments have been torn
Fountain sign
welling anterior to acromioclavicular joint. indicating degeneration has caused communication between the acromioclavicular joint and swollen subacromial bursa underneath
sulcus deformity
multidirectional instability or loss of muscle control due to nerve injury or a stroke, leading to inferior subluxation of the glenohumeral joint. This deformity is lateral to the acromion and should not be confused with a step deformity
scapular dyskinesia
aka scapular dysfunction, excessively protracted scapula during arm motion
Primary scapular winging
implies the winging is the result of muscle weakness of one of the scapular mm stabilizers that in turn, disrupts the normal mm force couple balance of the scapulothoracic complex
secondary scapular winging
normal movement of the scapula is altered because of pathology in the glenohumeral joint
Dynamic scapular winging
winging with movement may be caused by a lesion of the long thoracic nerve affecting serratus anterior, rhomboid weakeness, multidirectional instability, voluntary action or a painful shoulder resulting in splinting of the glenohumeral joint which in turn causes reverse scapulohumeral rhythm
Spinal accessory nerve palsy
CN XI AKA trapezius palsy, scapula to depress and move laterally with the inferior angle rotated laterally. If Trapezius is weak or paralyzed,the winging of the scapula occurs before 90 degree abduction and there is little winging on forward flexion
Long thoracic nerve palsy
AKA serratus anterior palsy: the scaupla to elevate and move medially with the inferior angle rotating medially. If the serratus anterior is weak or paralyzed, the winging of the scapula occurs on abduction and forward flexion (especially with a punch out forward against resistance)
Static winging
winging occuring at rest caused by a structural deformity of the scapula, clavicle, spine or ribs
Sprengel’s deformity
most common congenital deformity of shoulder complex, poorly developed scapular mm or replaced by fibrous band
open chain movement of shoulder
eating, reaching, dressiong
close kinetic chain
crutch walking, pushing up from a chair
scapulohumeral rhythm
first 30: no movement of scapula
30-90: 2:1 ratio
90-180: 2:1
Clavicle add 10 degrees of elevation after 90 degree, rotating posteriorly
Reverse scapulohumeral rhythm
scapula moves more than humerus, for frozen shoulder
crepitus is present during 90 degree abduction and rotation it is called
abrasion sign. Abrasion of torn tendon margins against coracoacromial arch
GIRD and GERD
Glenohumeral internal/external rotation deficit. if ratio is greater than 1, patient will probably develop shoulder problems
swallow tail sign
can’t extend arm due to injury to mm or axillary nerve
snapping scapula
adducting, abducting scapula clicking or snapping caused by the scapula rubbing over the underlying ribs
Spinal accessory nerve lesion
inability to abduct arm beyond 90 degree and pain in shoulder on abduction
Long thoracic nerve
pain on flexing fully extended arm, inability to flex fully extended arm, winging starts at 90 forward flexion
Suprascapular nerve
increased pain on forward shoulder flexion, shoulder weakness (partial loss of humeral control), pain increases with scapular abduction, pain increases with cervical rotation to opposite side
axillary circumflex nerve
inability to abduct arm with neutral rotation
musculocutaneous nerve
weak elbow flexion with forearm supinated
what may limit full rateral rotation of GH
subcoracoid bursitis
what may limit full abduction because of compression or pinching
subacromial bursitis
what % consider normally for anterior and posterior translations of GH
anterior 25% (1/4 width of head)
Posterior 1/2 width of head
which tests give best probability of impingement
Hawkins-kenedy, painful arc and positive infraspinatus test
Which tests give best for full thickness rotator cuff tears
Painful arc, drop arm, and infraspinatus test
Neer impingement
fully abduct arm with medial rotation. Positive is oeveruse injury to the supraspinatus mm and sometimes biceps. If lateral rotation is positive, it is called acromioclavicular differentiation test and consider acromioclavicular joint.
Primary impingement
impingement is the problem, rotator cuff degeneration or shape of the acromion, etc
secondary impingment
result of altered muscle dynamics in the scapula or glenohumeral joint
outlet impingement syndrom
anteiror area because in the supraspinatus outlet area
internal impingement
or non outlet impingement. Found posteriorly rather than anteriorly, mostly in overhead athletes. it is contact of suprasupinatus and infraspinatus with posterosuperior glenoid labrum when the arm is abducted to 90 degree and laterally rotated fully
bankart lesion
the anteroinferior labrum is torn
SLAP lesion
superior labrum
axillary circumflex nerve
C5-C6
motor loss, inability to abduct arm (deltoid), weak to rotate laterally (may cheat with biceps), because of loss of teres minor, atrophy of the deltoind, sensory loss of deltoid insertion
Suprascapular nerve
(C5-C6) injured by a fall on the posterior shoulder, stretching repeated microtrauma, fracture of the scapula. injured as it passess through the suprascapular notch under the transverse scapular ligament or as it winds around spine of the scapula under the spinoglenoid ligament.
Sx include persistent rear shoulder pain and paralysis of the supraspinatus and infraspinatus, leading to decreased strength of abduction and lateral rotation of the shoulder. Wasting may also be evident. (volley ball, spiking pitching, people work with their arm over head)
musculocutaneous nerve
C5-C6, rare for injury, loss of elbow flexion, shoulder forward flexion, decreased supination strength. Sonsory branch is over antebrachial aspect of the forearm. Can be compressed by distal biceps tendon, resulting in musculocutaneous nerve tunnel syndrome
musculocutaneous nerve tunnel syndrome
result by hyperextension or repeated pronation (excessive screwdriving, backhand tennis srokes), may be misdiagnosed as tennis elbow. Sensory loss of forearm, pinched by distal biceps tendon
Long thoracic nerve
C5-8 heavy effort above shoulder height, pressure on the nerve from backpacking, vigorous upper limb activities, (shoveling, chopping, stretching) causing winging of scapula, pain and weakness of forward flexion of the extended arm.abduction above 90 is difficult because of scapular winging. recovery can be as long as 2 years
Spinal accessory nerve
C3-C4 it passes through posterior triangle but affect trap. Abnormal pressure from poorly fitting backpack. Shoulder drooping (scapula translated laterally and rotated downward) and scapular winging (medial superior portion) with medial rotation of the inferior angle, especially on abduction. Winging with abduction, but not forward flexion differentiating from long thoracic nerve palsy
