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Magee > Shoulder > Flashcards

Shoulder Flashcards

1
Q

What does Axillary pouch do

A

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

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2
Q

superior glenohumeral ligament

A

limiting inferior translation in adduction, restrains anterior translation and lateral rotation upto 35 degree abduction

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3
Q

middle glenohumeral ligament

A

absent in 30 % of population, limits lateral rotation between 45-90%

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4
Q

Excessive lateral rotation such as throwing may lead…

A

stretching of anterior portion of the ligament and capsule, increasing glenohumeral laxity

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5
Q

coracohumeral ligament primarily limits

A

inferior translation helps limit lateral rotation below 60 degree abduction

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6
Q

Which two tendons coracohumeral ligament unites

A

Supraspinatus and Subscapularis

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7
Q

Rotator interval consists

A

coracohumeral ligament, superior glenohumeral ligament, glenohumeral joint capsule, part of the tendons of supraspinatus and subscapularis

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8
Q

coracoacromio ligament limits

A

superior translation of glenohumeral joint

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9
Q

paratenonitis

A

outer covering of the tendon whether or not it is lined with synovium.

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10
Q

Tendinosis

A

actual degeneration of the tendon itself

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11
Q

Primary ligaments of the Glenohumeral joint and which is important

A

Superior, middle and inferior Glenohumeral ligament

Inferior glenohumeral ligament is most important, has anterior and posterior band with thin axillary pouch in between.

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12
Q

TUBS type instability

A

Traumatic onset, Unidirectional anterior with Bankart lesion responding to Surgery

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13
Q

AMBRI type instability

A

Atraumatic cause, Multidirectional with Bilateral shoulder findings with Rehabilitation as appropriate treatment and rarely Inferior capsular ship surgery

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14
Q

SICK scapula

A

malposition of Scapula prominence of Inferior medial border of scapula, Coracoid pain and malposition, and scapular dysKinesia

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15
Q

step deformity

A

acromioclavicular dislocation with the distal end of the clavicle lying superior to the acromion process. Indicates acromioclavicular and coracoclavicular ligaments have been torn

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16
Q

Fountain sign

A

welling anterior to acromioclavicular joint. indicating degeneration has caused communication between the acromioclavicular joint and swollen subacromial bursa underneath

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17
Q

sulcus deformity

A

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

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18
Q

scapular dyskinesia

A

aka scapular dysfunction, excessively protracted scapula during arm motion

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19
Q

Primary scapular winging

A

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

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20
Q

secondary scapular winging

A

normal movement of the scapula is altered because of pathology in the glenohumeral joint

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21
Q

Dynamic scapular winging

A

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

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22
Q

Spinal accessory nerve palsy

A

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

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23
Q

Long thoracic nerve palsy

A

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)

24
Q

Static winging

A

winging occuring at rest caused by a structural deformity of the scapula, clavicle, spine or ribs

25
Q

Sprengel’s deformity

A

most common congenital deformity of shoulder complex, poorly developed scapular mm or replaced by fibrous band

26
Q

open chain movement of shoulder

A

eating, reaching, dressiong

27
Q

close kinetic chain

A

crutch walking, pushing up from a chair

28
Q

scapulohumeral rhythm

A

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

29
Q

Reverse scapulohumeral rhythm

A

scapula moves more than humerus, for frozen shoulder

30
Q

crepitus is present during 90 degree abduction and rotation it is called

A

abrasion sign. Abrasion of torn tendon margins against coracoacromial arch

31
Q

GIRD and GERD

A

Glenohumeral internal/external rotation deficit. if ratio is greater than 1, patient will probably develop shoulder problems

32
Q

swallow tail sign

A

can’t extend arm due to injury to mm or axillary nerve

33
Q

snapping scapula

A

adducting, abducting scapula clicking or snapping caused by the scapula rubbing over the underlying ribs

34
Q

Spinal accessory nerve lesion

A

inability to abduct arm beyond 90 degree and pain in shoulder on abduction

35
Q

Long thoracic nerve

A

pain on flexing fully extended arm, inability to flex fully extended arm, winging starts at 90 forward flexion

36
Q

Suprascapular nerve

A

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

37
Q

axillary circumflex nerve

A

inability to abduct arm with neutral rotation

38
Q

musculocutaneous nerve

A

weak elbow flexion with forearm supinated

39
Q

what may limit full rateral rotation of GH

A

subcoracoid bursitis

40
Q

what may limit full abduction because of compression or pinching

A

subacromial bursitis

41
Q

what % consider normally for anterior and posterior translations of GH

A

anterior 25% (1/4 width of head)

Posterior 1/2 width of head

42
Q

which tests give best probability of impingement

A

Hawkins-kenedy, painful arc and positive infraspinatus test

43
Q

Which tests give best for full thickness rotator cuff tears

A

Painful arc, drop arm, and infraspinatus test

44
Q

Neer impingement

A

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.

45
Q

Primary impingement

A

impingement is the problem, rotator cuff degeneration or shape of the acromion, etc

46
Q

secondary impingment

A

result of altered muscle dynamics in the scapula or glenohumeral joint

47
Q

outlet impingement syndrom

A

anteiror area because in the supraspinatus outlet area

48
Q

internal impingement

A

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

49
Q

bankart lesion

A

the anteroinferior labrum is torn

50
Q

SLAP lesion

A

superior labrum

51
Q

axillary circumflex nerve

A

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

52
Q

Suprascapular nerve

A

(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)

53
Q

musculocutaneous nerve

A

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

54
Q

musculocutaneous nerve tunnel syndrome

A

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

55
Q

Long thoracic nerve

A

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

56
Q

Spinal accessory nerve

A

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

Magee (16 decks)

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