shoulder Flashcards by Shawn McAward

Which portion of GHJ capsule is redundant for increased mobility

inferior capsule

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What motion is limited by superior GHJ ligament

inferior translation with arm adducted

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What motions are limited by middle GH ligament

anterior translation in mid range abd

and ER in adduction

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What vertebral level does the scapula sit at

T2-T7

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What plane does the scapula sit in (rotation and tilt)

upward rotation of 10-20*

anterior tilt of 10-20*

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What is the concavity of the clavicle

concave AP

convex superior/lateral

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Which ligament provides the most support for the SC joint?

posterior sternoclavicular ligament

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What does the conoid portion of the coracoclavicular ligament resist

clavicle elevation and protraction

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what is primary function of trapezoid portion of coracoclavicular ligament

compress AC joint

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How much does pressure on coracoacromial arch increase with poor functioning rotator cuff?

60%

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what force couple elevates humerous

deltoid/rotator cuff

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what is role of supraspinatus in deltoid/rotator cuff force couple?

provide GHJ compression to offset vertical pull of deltoid

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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

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What muscles are primary components of upward rotation at 90+ degrees elevation

LT and SA

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What causes LT to have greater influence on upward rotation/stability at increasing degrees of elevation?

longer lever arm

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What condition is most likely seen with an anterior tilted scapula

SAI

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What condition may have medial scapular border dysfunction as a s/s?

GHJ instability

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What condition may lead to elevated scapula?

RC weakness or other force couple imbalance

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How will the humeral head sit with IR ROM loss?

increased anterior translation

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Tightness where may lead to IR ROM loss at GHJ?

posterior capsule

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In 90/90 position, where will humeral head shift with tight posterior capsule?

posterior/superior

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What should the ratio of anterior to posterior translation at GHJ be?

1:1

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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

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Where is most common location for GH labrum tear?

anterior-superior (60%)

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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