Shoulder Flashcards
Name the rotator cuff muscles, origins/ insertions, innervation and action
Supraspinatus - Supraspinous fossa to greater tubercle
Suprascapular nerve. early abduction
Infraspinatus - infraspinous fossa to greater tubercle
Suprascapular nerve. external rotation
Teres Minor - Lateral border of scapula to greater tubercle
Axillary nerve. external rotation and adduction
Subscapularis - subscapular fossa to lesser tubercle
Subscapular nerve. internal rotation
All stabilise glenohumeral joint
What movements occur at the shoulder and which muscles control them?
Flexion - anterior deltoid, bicep brachii, coracobrachialis
Extension- posterior deltoid, tricep brachii, latissimus dorsi, teres major/minor
Abduction - supraspinatus, deltoid, trapezius,
Adduction - pectoralis major, latissimus dorsi, teres major, triceps, and coracobrachialis
Horizontal Adduction - teres minor, pectoralis major, coracobrachialis
Horizontal Abduction - Posterior Deltoid, Trapezius, infrapsinatus, Middle Deltoid, Supraspinatus, Teres Minor, Rhomboid Major, Rhomboid Minor
Internal Rotation - teres major, subscapularis, pectoralis major, latissimus dorsi
External Rotation - teres minor, supraspinatus
Name the joints and major bony landmarks of the shoulder complex
Glenohumeral
Scapulothoracic
Acromioclavicular
Sternoclavicular
Inferior and Superior angle of Scapula Spine of scapula Subscapular fossa Supra/Infraspinous Fossa Bicipital/ intertubercular Groove Greater and Lesser tubercles Acromion process Coracoid process Anatomical and Surgical necks of Humerus Supraglenoid tubercle Infraglenoid tubercle
What are the key attributes of the shoulder complex
Designed for movement/mobility
Synovial ball and socket joint
3 degrees of freedom (moves in every plane)
shallow socket relying on support from rotator cuff muscles and Glenoid Labrum
Describe the SLAP test
SLAP provocation
Abduct to 90, externally rotate w/ elbow flexed to 90.
pronate forearm and extend elbow
Superior Labrum Anterior-Posterior.
Positive = SLAP lesion (labral tear) or long head of bicep issue
Describe the Apprehension test
Apprehension test
Pt supine w/ shoulder abducted 90-120, elbow flexed to 90. Externally rotate check for apprehension/increased motivation = anterior instability
Describe the Painful arc test
Painful Arc
Abduct shoulders - observe for pain/compensation
= impingement/RC cuff/ AC pathology
Describe the empty can test
Empty Can
Raise arms in scapular plane, rotate thumbs down ‘empty can’ then provide external resistance to upward movement
pain = injury/lesion of supraspinatus/impingement
Describe the Hawkins-Kennedy test
Hawkins- Kennedy
Pt seated shoulder abducted to 90, elbow flexed to 90
examiner internally rotates and horizontally adducts to pinch greater tuberosity of Humerus against acromion
(physio arm on Pt shoulder)
Pain = Supraspinatus impingement/ RC tear/ crepitus could indicate OA
Describe Neer’s test
Neers
Pt seated, fix scap position
examiner raises pt arm through full flexion in IR and ER
Pain on IR = supraspinatus impingement/ subacromial bursitis
pain on ER = Long head of Bicep impingement
Describe Sulcus sign
Sulcus
Pt seated/standing with arm at side. Physio applies long axis distraction to humerus.
positive = increased inferior ROM meaning inferior instability
Describe the 2 AC joint special tests
Scarf/ Cross body test
Pt seated w/ shoulder flexed to 90 and horizontally adducted across body. Physio stabilises and applies horizontal adduction force over elbow
superior shoulder pain over AC = AC joint pathology
posterior shoulder pain = infraspinatus/teres minor/posterior joint capsule lesion
Squeeze/shear test
compression of clavicle onto scapula to shear AC joint
pain over AC = AC joint dysfunction
Name common shoulder pathologies
- Subacromial Impingement
- Rotator cuff tears
- Labral tears
- AC Joint dysfunction
- Dislocation/ Subluxation
- Frozen shoulder/ Capsulitis
What is in the subacromial space? What can irritation of these structures cause?
Supraspinatus
Long head bicep tendon
Subacromial bursa
Subacromial impingement syndrome
due to potential compression/ movement of humeral head/ inflammation of bursa/ irritation of tendon/ structural (hooked acromion)/ bone spurs/ osteoarthitis
What are common S+S of subacromial impingement syndrome?
- c/o pain on sleep, especially if sidelying
- Altered function
- Pain on movement
- Reduced ROM
- Positive pain provocation test
- Positive special tests – Painful arc, Neers, Hawkins Kennedy, Empty can
What are the treatment options of SAIS?
Physiotherapy management •Postural correction •NSAIDS and analgesia •Hot/ Cold therapy •Electrotherapy •Shoulder girdle stability exercises •Isometric and closed chain exercises for rotator cuff muscles •Regain active ROM •Subacromial steroid injection into bursa
Surgical management
• RC repair
• Subacromial decompression surgery
Describe labral tear MOI, S+S, and the 2 categories of.
Tear to fibrocartilage of socket, often secondary to dislocation and throwing injuries
S+S: click/clunk, pain, weakness, loss of rom, positive SLAP
SLAP - Superior Anterior
- Often caused by the long head of biceps pulling the labrum off from its origin on the supraglenoid tubercle
Bankart - Inferior Anterior
Often associated with dislocation
Describe shoulder features of dislocation
The glenohumeral joint can dislocate anteriorly, posteriorly or inferiorly
•If the joint becomes unstable for any reason it increases the chance of subluxation or dislocation
•Can be traumatic i.e following an injury, or atraumatic i.e. as a result of minimal force
•Anterior is the most common direction for dislocation
Could also cause Bankart/SLAP/ Hill-Sachs lesion: This is where the bone of the humeral head becomes damaged by the edge of the labrum, causing a dent in the bone
Describe MOI and S+S of AC joint dysfunction
Sprains or dislocations are the most common pathologies at this joint, usually due to falls - landing on point of shoulder/ contact injuries
Usually classified related to the extent of the injury
Signs + symptoms
•Determined by the severity of the injury
•Dislocation will appear ‘stepped’
•Player will immediately hold their shoulder
•Pain and inflammatory changes around injury site
•Difficulty lifting arm through full range – consider biomechanics of the AC joint
•Positive scarf and squeeze tests
Describe the stages and S+S of frozen shoulder/ capsulitis
Freezing – this is the most painful stage
Symptoms
Usually lasts between 3-9 months
•Painful at night, especially lying on painful side
•Active and passive ROM become restricted
•Typically associated with deep, achey pain progressing to acute pain with time
Pathology
•Increased vascularity and thickening of synovial membrane
•Normal capsular tissue
•Possibly associated with tendinitis and/or bursitis
•Some loss of muscle length and bulk in rotator cuff
Frozen stage – mostly pain and stiffness
Symptoms
Can last between 4-12 months
Pain can become more severe or can start to settle
•Significant loss of ROM in typical capsular pattern – external rotation, flexion, internal rotation
Pathology:
•Synovium continues to thicken, but is less inflamed
•Associated contraction of the capsule with loss of the axillary pouch
•Capsule becomes thickened and more collagenous
Thawing stage – predominantly stiffness
Symptoms
Lasts between 12 and 42 months
•Pain levels reduce considerably
•Gradual increase in ROM
Pathology
•Adhesions of scar tissue between capsule, synovial membrane and surrounding soft tissues
•No evidence of active inflammation
•Shortening and atrophy of muscles around the glenohumeral joint and pectoral girdle
