shoulder Flashcards
Which portion of GHJ capsule is redundant for increased mobility
inferior capsule
What motion is limited by superior GHJ ligament
inferior translation with arm adducted
What motions are limited by middle GH ligament
anterior translation in mid range abd
and ER in adduction
What vertebral level does the scapula sit at
T2-T7
What plane does the scapula sit in (rotation and tilt)
upward rotation of 10-20*
anterior tilt of 10-20*
What is the concavity of the clavicle
concave AP
convex superior/lateral
Which ligament provides the most support for the SC joint?
posterior sternoclavicular ligament
What does the conoid portion of the coracoclavicular ligament resist
clavicle elevation and protraction
what is primary function of trapezoid portion of coracoclavicular ligament
compress AC joint
How much does pressure on coracoacromial arch increase with poor functioning rotator cuff?
60%
what force couple elevates humerous
deltoid/rotator cuff
what is role of supraspinatus in deltoid/rotator cuff force couple?
provide GHJ compression to offset vertical pull of deltoid
What functions are provided by UT/SA force couple (4)
allow for upward rotation of scapula
maintain force tension relationship of deltoid
prevents SAI
provide stable base for scapular muscles
What muscles are primary components of upward rotation at 90+ degrees elevation
LT and SA
What causes LT to have greater influence on upward rotation/stability at increasing degrees of elevation?
longer lever arm
What condition is most likely seen with an anterior tilted scapula
SAI
What condition may have medial scapular border dysfunction as a s/s?
GHJ instability
What condition may lead to elevated scapula?
RC weakness or other force couple imbalance
How will the humeral head sit with IR ROM loss?
increased anterior translation
Tightness where may lead to IR ROM loss at GHJ?
posterior capsule
In 90/90 position, where will humeral head shift with tight posterior capsule?
posterior/superior
What should the ratio of anterior to posterior translation at GHJ be?
1:1
What can be done with subulxation/relocation testing to further evaluate if negative at end range ER and 90*?
Increase abd to 110 or 120
Where is most common location for GH labrum tear?
anterior-superior (60%)
Where is second most common location for GH labrum tear
posterior-superior (18%)
Is arthroscopic labral debridement effective long term
no, many patients have pain return due to underlying instability
How common is a Bankhart lesion in shoulder dislocation
85%
What ligament may have excessive force on it with SLAP, and why?
anterior band of inferior GH ligament
due to decreased ability to withstand rotational forces
What causes primary impingement?
compression of RC tendons between humeral head and arcomion, CA ligament, or AC joint
What ROM is force against acromion highest?
85 and 136 degrees
What type of acromion is most commonly associated with primary impingement
type 3 (hooked, 70%)
What causes secondary impingement
instability of GHJ leading to increased superior translation of humeral head
What aspect of throwing puts rotator cuff at risk?
repetitive, heavy, eccentric forces on posterior cuff
What is undersurface impingement?
pinching of supraspinatus/infraspinatus tendons at humeral head and posterior/superior glenoid rim.
What demographic usually gets undersurface impingement?
young athletes
what position puts a patient at risk for undersurface impingement?
90/90
What positions of shoulder increase pressure on posterior glenoid with throwing?
increased horizontal abd
Do submaximal isometrics increase perfusion and latent hyperemia
Hell yeah they do
What muscles force couple to allow for scapular upward rotation and stabilization during elevation?
SA, LT
Should patients with secondary impingement/tensile overload have accessory mobilizations performed?
Nope, may increase laxity
Should patients with primary impingement have accessory mobilizations performed?
Hell yeah, mob that shit
What position should posterior capsular mobilizations be performed?
30* elevation with IR
Which stretch led to more IR gains, cross body or sleeper?
cross body
What effect does towel roll for tband exercises have?
10% increase in infraspinatus activity
adduction increases SA space
For RC strengthening, what % of maximal effort maximized infraspinatus activity compared to deltoid
40%
What is normal ER/IR at GHJ
66%
Which side of the rotator cuff will tears associated with SAI be located?
superior (bursal)
What side of the RC will tears associated with GHJ instability or increased tensile loads?
undersurface (articular)
What leads to bursal side RC tears?
SAI
What leads to undersurface RC tears
GHJ instability, increased tensile loads
What benefits does scapular plane have for early RC rehabilitation?
little stress on anterior shoulder due to anterior capsular laxity in this position
bony congruity
What grades of AC joint injury can typically be treated conservatively?
Grades 1-3
What diseases increase risk for frozen shoulder
thyroid, diabetes
What causes frozen shoulder?
elevated cytokine levels leading to exaggerated inflammatory and fibrosis response
Stage 1 frozen shoulder pain?
end range pain
What is stage 1 frozen shoulder often mistaken for
SAI
Stage 2 frozen shoulder
beginning of connective tissue changes leading to contracture
Stage 3 frozen shoulder
mature adhesions
What is a hallmark sign that differentiates frozen shoulder from rotator cuff tendinopathy?
passive ER loss in neutral
Which muscle group will be relatively weaker in frozen shoulder compared to RC tendinopathy?
internal rotators
Are high grade mobilizations significantly better for ROM gains with frozen shoulder when compared to low grade mobs?
No, only slight difference present
What is the evidence for corticosteroids for frozen shoulder?
strong evidence for first 3-6 weeks for short term outcomes
Why would performing a traditional TSA be inadvisable in a RC deficient shoulder
eventual glenoid loosening
What elevation ROM is expected in shoulder hemiarthroplasty?
approximately 90-120 degrees
What muscle is important to protect in rehabilitating a TSA
subscapularis
Sensitive shoulder test for SAI
Hawkins Kennedy,
Neer
Horizontal ADD
Specific shoulder tests
Drop arm
Yergasons
Painful arc
