Shoulder Flashcards
clavicle - acromial extremity
convex posteriorly
clavicle - sternal extremity
convex anteriorly
Sternoclavicular joint - capsule
strong - ant, post, sup
Sternoclavicular joint - ligaments - sternoclavicular
ant, sup
Sternoclavicular joint - ligaments - costoclavicular
limits scapula laterally
Sternoclavicular joint - ligaments - interclavicular
depression/inf glide of head of clavicle
Motion at sternoclavicular joint
45 elevation 15 depression 15 protraction 15 retraction 30-45 up/down rotation
Acromioclavicular joint - movement
does not move freely
Acromiocalvicular joint - type
gliding joint with flat articular surfaces
Sternoclavicular joint - type
triaxial, ball and socket
saddle like
diarthritic
Acromioclavicular joint - supporting structures
weak capsule
AC ligaments - horizontal stability
Coracoclavicular ligaments - horizontal stability
Acromioclavicular joint - motion
20 elevation/tipping
25 up/down rot
35 protraction/winging
35 retraction
Acromioclavicular joint - winging
Medial edge of scapula lifts off the ribcage
forward rotation is included
Scapulothoracic joint
not a true joint
Scapulothoracici joint - motion
60 elevation
10 depression
60 up rotation
10 down rot
Motion - scapulothoracic - what occurs when
retraction before adduction
abduction before protraction
Scapular elevation - mm
Upper trap
Levator scap
Rhomboid major and minor
Scapular depression - mm
Lower trap Lower SA Pec minor Lat dorsi Lower pec major
Scapular abduction - mm
pec major/minor
SA
Scapular add - mm
rhomboids
trap
Scapular up rotation
upper/lower trap
upper/lower SA
Scapular downward rotation
levator scap
rhomboids
pec minor
GH joint - type
ball and socket
3 DOF
GH joint - capsule
large, loose capsule
tight superiorly
GH ligament
FILL IN
GH ligament - coracohumeral
FILL IN
GH ligament - coracoacromial
FILL IN
GH - motion
flex 120 ext 30 80 IR 90 ER 30 horizontal abd 140 horizontal add 60 abd with IR 120 abd with ER
Rotator cuff
Supraspinatus
Infraspinatus
Subscapularis
Teres Minor
Humeral retroversion
30-40 degrees is norm
Greater = more ER, less IR
Increased angle means more mobility at SC joint - injury to RTC will impact this angle
Coracoacromial arch - made up of
CA lig
CC lig
CH lig
Transverse humeral ligament
Coracoacromial arch - what passes through
Biceps tendon and supraspinatus
Coracoacromial arch - impingement
Can become impinged when head of humerus goes against the acromial part
If you dont glide down with roll up during abduction
Coracoacromial arch - load in abduction
HIGH! need teres minor and subscap and infraspinatus to help
Force couples means what
2 forces that are equal but opposite in direction - produce rotation
Force couples - Upper trap with
Low trap and SA
Force couple - humeral abd
deltoid and supraspinatus, infraspinatus, teres minor, subscap
Force couple - fownward rot
lat dorsi and teres major, pec major, rhomboids
Single joint mm
Needs other mm to supply stability on the scapula
2 joint mm
can act directly on the arm without needing other help to stabilize the scap
Scapulohumeral rhythm
GH joint moves 2 degrees for every 1 degree of scapular motion
Scapulohumeral rhythm - phases
phase 1 = setting - 30 degrees GH
phase 2 = setting to 90 degrees, 30-45 degrees GH and 30 degrees SC
phase 3 = 90 to 180 degrees, 50-60 GH, 30 AC, 10-20 spine
Arthrokinematics - superior rolling is directed by the
Supraspinatus
Bursae - largest
Subdeltoid - largest in body
Bursae - subscapularies
between subscap tendon and neck of scapula
Bursae - infraspinatus
between inrspintus tendon and joint capsule
To avoid subluxation due to gravity - need what
upward slope of glenoid cavity
To avoid upward subuxation of humerus - what do you need
RTC mm contraction and coracoacromial lig
Impingement syndrome
Compresion of subacromial contents due to encroachment of the humerus nto the coracoacromial arch
Impingement syndrome - space should be
9-10 mm
pathologic if less than 6
Impingememnt syndrome - 1st degree
due to non mechanical reasons FOOSH tight post capsule bone spur rubbing along supraspinatus with elevation
Impingment syndrome - 2nd degree
due to instability, poor force couple balance, posture, poor motor control, training rrors
Impingement - stage 1
edema and hemorrhage less than 25 due to overuse painful arc 60-120 anterior lateral shoulder pain sharp with elevation no functional limtiations
Impingement - stage 2
fibrosis and tendonitis
25-40 yo
dec ROM ER and Abd
Impinge - stage 3
derangement of tendon (RTC) over 40 Weak in abd/ER significant functional limitations bone spurs less than 1cm RTC tear
Impingem - stage 4
complete thickness RTC tear
over 40
weakness, mm atrophy
cannot initiiate abd without substitutions
Special tests for impingement
Hawkins Kennedy
Neers
Cross over
Yokum
Special tests - hawkins kennedy
for impingement
passively flex GH to 90
Passively IR
Supraspinatus, biceps tendon, bursa
ST - Neers
for impingement
Stabilize scapular, passively elevate arm with thumb down
Supraspinatus, LH of biceps, burs
ST - cross over test
for impingement
stabilize scap, horiz add shoulder
Ant pain - subscap, supraspin, biceps tendon
Post pain - infraspinatus, teres minor, post capsule
Tendonitis
supraspinatus, LH of biceps are most common
Pain with ecc contraction, tender with palpation, strong but painful mm testing
Special tests for tendonitis
Empty can
Speeds
Yergason
ST - empty can
tendonitis
Active scaption to 90, thumbs down, resist downward force
Supraspinatus
ST - speeds test
tendonitis
Active flex to 90, elbow ext, forearm supinated, palpate bicipital groove, apply downward force
Biceps
ST - Yergason
tendonitis
90 elbow flex, full forearm pronation, resist against ER and supination
Biceps
ST for RTC tear
Drop arm test
Empty can test
Hornblowers
IR lag
Drop arm test
for RTC tear
Passively abd to 90
pt tries to slowly lower arm
supra and infra
Empty can test
for RTC tear
weak and painful
active scaption to 90, thumb down
supraspinatus
Hornblower sign
for RTC tear
passively 90 scap
resist ER
Teres minor
Adhesive capsulitis - who more common
F more than M
40-60 yo
non dominant arm more than dominant
Adhesive capsulitis - clinical presentation
Dec scapulohumeral rhythm
less than 90-135 elevation
50-60% of normal ER
Adhesive capsulitis - stages
Preadhesive - often misdiagnosed with impingement
Freezing - 10-36 wks
Frozen - 4 to 12 months
Thawing - 5 to 42 mo
AC joint sprain - types
1 = AC spran, joint intact 2 = AC and CCL sprain, unstable but intact joint 3 = AC and CCL torn, unstable joint, delt/trap disrupted, distal calvicle migration 4 = "..." post dislocated clavicle 5 = inf dislocated clavicle
Labral ST
Compression rotation test
Crank test
Obriens
Compression rotation test
Labral
90 abd
90 elbow flex
axial force to humerus with rotation and curcumduction
Crank test
Labral pt supine 160 scaption axial load through humerus IR/ER shoulder
Obrien
Labral pt seated 90 flex with elbow ext 10 horizontal add full IR/ER apply downward force IR pain greater than ER pain
Adsons test
Palpate radial pulse
ER, extend shoulder, turn head to test arm, extend head, hold breath
(+) if pulse goes away within 10 sec
Costoclavicular test
Palpate radial pulse
Retract/depress scapula
(+) if pulse goes away
Hyperabduction test
palpate radial pulse
passively hyperabd arm
(+) f pulse goes away
pec minor
Roos test
90 abd, full ER, open and close hands for 3 min
(+) asymmetrical swelling, pallor, pain, numbness
