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OCS > Shoulder > Flashcards

Shoulder Flashcards

1
Q

How far does the scapula rest from the vertebral column?

A

About 5 cm

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2
Q

What ligaments stabilize the AC joint?

A
  1. Conoid- resist clavicular elevation and protraction

2-Trapezoid-Secondary roll of resisting elevation and protraction

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3
Q

Grading for humeral translation?

A
  1. Grade 1-Translation of the humeral head With in the gleniod
  2. Grade2-Translation of humeral head up over the glenoid rim with spontaneous return on removal of stress
  3. Grade 3-Translation of humeral head over the glenoid rim without relocation upon removal of stress
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4
Q

What causes intrinsic tension overload?

A

Heavy, repetitive eccentric forces incurred by the posterior rotator cuff musculature during the deceleration and follow-through phases of overhead sport activities.

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5
Q

What causes excessive scapular elevation during arm elevation?

A

Rotator cuff weakness and force couple in balance.

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6
Q

What is the plane of the scapula?(degrees)

A
  1. The joint is angled about 30 to 45° in coronal plane.

2. Puts glenoid foss more anterior.

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7
Q

Two types of tests for shoulder instability?

A

Humoral head translation tests and provocation test.

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8
Q

What are compressive force in the shoulder?

A
  1. .42 times body wt
  2. Peak forces 85-136 degrees
  3. Abrasions to supraspinatus, infraspinatus, and biceps tendon
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9
Q

Upper trap/serrated anterior force couple (6)

A
  1. Allows for rotation of the scapula maintaining the glenoid service for optimal positioning
  2. Maintain an efficient length tension relationship for deltoid
  3. Prevents impingement of the rotator cuff
  4. Provide a stable scapular base for recruitment of scapulohumeral muscles
  5. Lower trap and serratus anterior are the primary component of upper rotation
  6. Patient with impingement have decreased levels of serratus anterior and delayed firing of lower trap
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10
Q

What is inferior angle scapular dysfunction?

A
  1. Inferior border of the scapula very prominent
  2. Anterior tipping of the scapula in the sagittal plane
  3. Rotator cuff impingement
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11
Q

What does the inferior glenohumeral ligament restrain?

A
  1. Anterior and posterior band “hammock”
  2. Anterior band limits anterior translation in either direction with at 90° abduction
  3. During ER and abduction limits anterior translation
  4. Posterior band limit post your translation in internal rotation
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12
Q

What does the middle Glenohumeral ligament restrain?

A
  1. Restrain anterior translation with arm and mid range abduction 45°
  2. Limits external rotation with arm at side.
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13
Q

What does the superior glenohumeral ligament restrain?

A

Restrained inferior translation with arm in adducted position.

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14
Q

What will a chronic rotator cuff tear present on shoulder x-ray?(3)

A
  1. Irregularities of the greater tuberosity
  2. Sclerosis of the underside of the acromion
  3. Elevated to humeral head due to deltoid muscle been unopposed from rotator cuff
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15
Q

What is the deltoid/rotator cuff force couple? (2)

A
  1. Vertical force of deltoid is offset by horizontal force of rotator cuff as they act in opposite directions
  2. pressure from humeral head into coracoacromial arch increase 60% when rotator cuff is not working.
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16
Q

Stage one of RTC primary Impingement according to Neers?(4)

A
  1. Edema and hemorrhage
  2. Mechanical irritation of tendon incurred with overhead activities
  3. Reversible condition with conservative management
  4. Sign-positive impingement sign, painful arch of movement, and varying degrees of muscle weakness.
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17
Q

What does soft tissue conditions are seen in shoulder radiographs? (2)

A

Calcifications and rotator cup tears.

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18
Q

Stage three of RTC primary Impingement according to Neers?(4)

A
  1. Bone spurs and tendon ruptures
  2. Continue mechanical irritation cause full thickness tears, partial thickness tears, bicep tendon lesions, and bony alterations of acromion
  3. Sign-positive impingement sign, painful arch of movement, and varying degrees of muscle weakness.
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19
Q

What are the standard imaging series in a shoulder x-ray? (3)

A

AP (IR/ER), scapular Y, and scullery view

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20
Q

Why are CT scans used for shoulders? (4)

A
  1. Complex or subtle fractures
  2. Arthritic changes
  3. Loose bodies
  4. Hill-Sachs and reverse Hill-Sachs lesions
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21
Q

What are the two most common labral detachments

encountered clinically?

A

Bankart lesion and SLAP lesion

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22
Q

What is tensile overload of the shoulder?

A
  1. Repetitive eccentric forces by the posterior rotator cuff during the deceleration and follow through phase of overhead sports activity.
  2. Pathological changes angiofiblastic hyperplasia-Degenerative process
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23
Q

Anterior posterior rotator cuff force couple

A
  1. Subscapularis and Infraspinatus/trees minor work together
  2. Create inferior dynamic stability (depressed humeral head)
  3. Compresses humeral head in to Gleniod
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24
Q

What causes macrotraumatic tendon failure?

A
  1. Single traumatic event per history
  2. Full-thickness tears of RTC with bony avulsions of the greater tuberosity can result from single traumatic episodes
  3. 30% or more of the tendon must be damaged to produce a substantial reduction in strength.
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25
Q

What is normal distance in the subacromial space?

A
  1. 9-10 mm in normal shoulders
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26
Q

What would indicate a subluxation or dislocation of shoulder in the x-rays

A

More than 7 mm to 8 mm of distance between the bottom of the acromion and top of humeral head.

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27
Q

Three different types of a acromions?

A
  1. Type I-flat, Type II-curved, Type III hooked

2. Type III acromion was found in 70% of cadaver shoulder with rotator cuff tears. 3% RTC tears with Type I

28
Q

What is medial border dysfunction?

A
  1. The medial border posteriorly displaced from the thoracic wall
  2. Internal rotation of the scapula in the transverse plane
  3. Glenohumeral joint instability
29
Q

What does the acromion do?

A
  1. Lever arm for deltoid

2. Articulates with the clavicle and ACJ

30
Q

What is a calcification in the shoulder?

A

Calcifications of the supraspinatus is a common condition in which a bloody hemorrhage has coagulated and calcified.

31
Q

What are the 3 force couples of the shoulder?

A
  1. Deltoid/rotator cuff
  2. Upper trap/serrated anterior
  3. Anterior/posterior rotator cuff
32
Q

What are two functional shoulder tests?

A
  1. Close kinetic chain upper extremity stability test

2. Functional throwing performance index

33
Q

What is the ER/IR ratio?

A
  1. Objective measure of agonist/antagonist muscular ratios.
  2. 66% in healthy adults
  3. Shoulder pts and overhead athletes may get gross imbalances
  4. Over developed IR
34
Q

Stage two of RTC primary Impingement according to Neers?(4)

A
  1. Fibrosis and tendinitis
  2. Mechanical inflammation may include thickening or fibrosis of subacromial bursa
  3. typical age 20-40y.o
  4. Sign-positive impingement sign, painful arch of movement, and varying degrees of muscle weakness.
35
Q

What does Tightness of the posterior capsule cause? (2)

A
  1. Increase superior migration of the humeral head and shoulder elevation.
  2. The humeral head will shift in an anterior-superior direction.
36
Q

What is a force couple?

A

Two groups of muscles that work together to produce motion and provide joint stability.

37
Q

What ligament are tested in the sulcus test? (2)

A

Integrity of the superior Glenohumeral ligament and the coracohumeral ligament.

38
Q

What is a Bankart lesion and cause? (3)

A
  1. .Labral detachment-found in as many as 85%
    of dislocations
    2.labral detachment occurs between 2 o’clock and 6 o’clock on a R shoulder and between the 6 o’clock and 10 o’clock positions on a L shoulder
  2. anterior-inferior detachment decreases GH joint stability by interrupting the continuity of the glenoid labrum and compromising the GH capsular ligaments.
39
Q

What is primary compressive disease or impingement of the shoulder?

A

Compression of the rotator cuff tendons between the humeral head and overlying 1/3 of the acromion, coracoacromial ligament, coraciod, or ACJ.

40
Q

What is secondary compression disease?

A
  1. Impingement results from underlying instability of the GH joint.
  2. Anterior instability causes biceps and RTC to become impinge
41
Q

Between what vertebrae does the scapula sit?

A

Superior T2 and inferior T7

42
Q

What is Posterior or “undersurface” impingement?(2)

A
  1. Posterior orientation of the supraspinatus and infraspinatus aligns them such that the undersurfaces of the tendons rub on the posterior-superior glenoid lip and become pinched or compressed between the humeral head and the posterior-superior glenoid rim.
  2. 90° of abduction and 90° or more of ER, typically from overhead positions in sport or industrial situations,
43
Q

What are goals for initial non op shoulder impingement rehabilitation? (3)

A
  1. Decrease in pain to allow for initiation of submaximal rotator cuff and scapular exercise,
  2. Normalization of capsular relationships through the use of specific mobilization and stretching techniques
  3. Early submaximal rotator cuff and scapular resistance training.
44
Q

Clinical prediction rules for full thickness rotator cuff tears?(3)

A
  1. Age > 65 y.o.
  2. Weak in ER
  3. Night Pain
45
Q

What are subscapularis precautions following surgery?(4)

A
  1. No external rotation past 30°
  2. No horizontal abduction
  3. No active internal rotation
  4. No body weight support for 12 weeks
46
Q

After a reverse total shoulder procedure patient should avoid what? How long?

A
  1. Internal rotation
  2. Adducation
  3. Extension
  4. 12weeks
47
Q

What is the rotator cuff interval? Pathology?(3)

A

1.Triangular space between-
tendons of subscapularis and supraspinatus and the base of the coracoid process.

  1. Pathology
    - rotator interval tear
    - long head of biceps tendon dislocation
    - rotator interval changes in adhesive capsulitis
48
Q

What is the quadrilateral space? (4)

Contents?(2)

A 
Boarders-
superior - subscapularis and teres minor
inferior - teres major
medial - long head of triceps brachii
lateral - surgical neck of the humerus

contents

  1. axillary nerve (C5 nerve root, posterior cord)
  2. posterior circumflex humeral artery
49
Q

What are static stabilizers of the shoulder?(5)

A
  1. Glenoid labrum
  2. joint capsule
  3. glenohumeral ligaments
  4. Coracohumeral ligament
  5. Coracoacrominal ligament
50
Q

What are active stabilizers of the shoulder?(5)

A
  1. Rotator cuff
  2. biceps
  3. deltoid
  4. pectoralis major
  5. latissimus dorsi
51
Q

What does the coracohumeral ligament do?

A

Resist in inferior translation but only in positions of external rotation.

52
Q

What positions of the shoulder cause subacromial Impingement?(3)

A
  1. Flexion
  2. Horizontal Adduction
  3. IR during the acceleration and follow through phase of throwing
53
Q

What is a Type I SLAP lesion?

A

Degneration/fraying of labrum, biceps and labrum attached firmly to glenoid

54
Q

What is a Type II SLAP lesion?

A

Superior labrum and biceps detached from superior glenoid – most common
(Dead arm syndrome)

55
Q

What is a Type III SLAP lesion?

A

Bucket handle type tear of labrum, intact biceps anchor

56
Q

What is a Type IV SLAP lesion?

A

Bucket handle tear that splits into the biceps Single traumatic event –
compression of superior labrum while subluxation occurs

57
Q

What are examples of the secondary OA?(2)

A
  1. Post traumatic i.e. interaarticular fracture

2. post surgical i.e. capsulorrhaphy

58
Q

What are examples of inflammatory arthritides?(3)

A
  1. RA
  2. Ankylosing Spondylitis
  3. Paoriatic Arthritis
59
Q

What are examples of other arthritides?(6)

A
  1. Atraumatic osteonecrosis or AVN
  2. Coracosteriod use
  3. Alcoholism
  4. Gaucher disease
  5. Sickle cell disease
  6. Irradiation
60
Q

What is the expected average forward elevation for pts with TSH with intact rotator cuff?(2)

A

Between 117 and 131deg

Or between 138 and 145deg

61
Q

Approximately how many pts that have a TSA for RA have a full thickness rotator cuff tear?

A

24%-30%

62
Q

What is the average forward elevation for patients with TSH due to RA?

A

Flexion avg 104-119deg

63
Q

In a TSA or HA, due to 3-4 part fracture, are functional outcomes poorer?

A
  1. Tuberosity and prosthetic placement
64
Q

What is the average elevation for PT’s with TSA or HA from acute fracture?

A

Avg elevation 101deg, ER 18deg,IR L3

65
Q

Risk factors for adhesive capsulitis?(4)

A
  1. Women over age of 40-65yo
  2. Previous episode on contralateral arm
  3. Diabetes I or II
  4. Thyroid disease (hypo or hyper)

OCS (18 decks)

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