Shoulder complex Flashcards
What bones make up the shoulder complex?
scapula, clavicle, humerus
What ligaments make up the shoulder complex?
coracoacromial; coracoclavicular- conoid/trapezoid acromioclavicular; glenohumeral; sternoclavicular
How many shoulder joints are there and what are they?
3: Glenohumeral, acromioclavicular, sternoclavicular
Where is the sternoclavicular joint?
between the sternum and manubrium
Where is the acromioclavicular joint?
between the clavicle and acromion process
Where is the glenohumeral joint?
Between the glenoid cavity of the scapula and the head of the humerus
Where is the coracovicular joint?
on the coracoid process and clavicle: made up of two ligaments–> trapezoid and conoid.
Where is the scapulothoracic joint?
runs along the medial border of the scapula and thorax
What are the muscles that make up the shoulder joint?
rotator cuff complex; triceps; biceps; latissimus dorsi; pectoralis major/minor; deltoid; trapezius
What muscle acting on the humerus abducts the arm with slight external rotation ?
supraspinatus
what muscle acting on the humerus externally rotates the arm with slight adduction?
infraspinatus
what muscle acting on the humerus internally rotates the arm?
subscapularis
what muscle acting on the humerus adducts, extends and internally rotates the arm?
teres major
what muscle acting on the humerus externally rotates the arm?
teres minor
What muscle acting on the humerus flexes and adducts the arm?
coracobrachialis
What muscles acting on the humerus flexes, adducts, & internally rotates the arm?
pectoralis major
What muscle acting on the humerus extends, adducts & internally rotates the arm; also pulls the shoulder down?
latissimus dorsi
What muscle acting on the humerus abducts the arm, with anterior fibers flexing & internally rotating and posterior fibers extending & externally rotating?
deltoid
What muscle acting on the scapula elevates or depresses, rotates, adducts, & stabilizes the scapula?
Trapezius
What muscles acting on the scapula adducts, stabilizes, and rotates while lowering the lateral angle?
rhomboid major/minor
what muscle acting on the scapula elevates the scapula; allows neck side flexion when scapula is fixed?
levator scapulae
What muscle acting on the scapula draws the scapula anteriorly and downward?
pectoralis minor
what muscle acting on the scapula stabilizes, abducts, and rotates the scapula?
serratus anterior
where are the bursae located for the shoulder complex?
subacromial: lies in subacromial space; cushions rotator cuff muscles from acromion; compressed during overhead actions
subcoracoid;
subscapularis
what can you do to prevent shoulder injuries?
where proper protective equipment; do physical conditioning such as flexibility/mobility and strength; proper skill techniques when doing throwing or falling motions.
What is some functional anatomy of the shoulder complex?
it has the greatest degree of mobility but is the least stable joint.
what are the articulation points of the shoulder joint?
humeral head articulates with glenoid fossa
what provides dynamic stability?
rotator cuff muscles and long head of the biceps
what compresses the head while other rotator cuff muslces depress the humeral head during overhead motions?
supraspinatus
what is scapulohumeral rhythm?
180 degrees total from neutral to full abduction.
movement occurs in a 2-1 ratio
- 120deg glenohumeral
- 60deg scapulothoracic
how many degrees of abduction is glenohumeral?
20
What are acute injuries to the shoulder?
contusions (deltoid) sprains- SC, AC, GH strains- delts, bis, tris ruptures- bis fractures- clavicular, humeral GH dislocation/subluxations
What are chronic injuries to the shoulder?
rotator cuff impingement, bicipital tendonitis, subacromial bursitis
What causes a contusion to the shoulder?
direct blow
what are S&S of contusions?
pain on palpation, ecchymosis, swelling, pain with AROM, transitory paralysis and inability to use arm
How do you manage a contusion?
PIER, NSAIDs, protect with padding.
refer to physician if does not resolve or concerned with myositis ossificans
DO NOT MASSAGE
What is a common mechanism of injury for shoulders?
FOOSH
What does FOOSH stand for?
falling on out stretched hands
What occurs in a sterno-clavicular sprain?
- FOOSH
- traction force when arm is at 90 and then pulled forcefully away from body
- blunt trauma
What are severity levels of a SC Joint injury?
1st, 2nd, 3rd degree
What are signs and symptoms of a 1st degree SC joint sprain? How would you treat it?
pain & slight disability
PIER
What are signs and symptoms of 2nd degree SC joint sprain? how would you treat it?
pain, subluxation with deformity, swelling, point tenderness, decreased ROM.
PIER, reduction if necessary
What are S&S of 3rd degree SC joint sprains? What is treatment?
gross deformity(dislocation), pain, swelling, decreased ROM, possibly life threatening if it dislocates posteriorly
PIER; if unstable and neurological or vascularly compromised needs surgery
What causes acromioclavicular sprains?
FOOSH;
direct blow with the tip of the shoulder (ie. hitting boards in hockey, landing on shoulder in football)
How many grades of AC injuries are there?
6
What occurs at a grade 1 injury? What is the course of treatment?
mild tenderness over AC joint;
painful horizontal adduction;
no disruption of AC joint.
REST, ICE, immoblizize in cuff’n collar slight (1 week max continuously)
What are S&S of a grade 2 AC injury? What is the course of treatment?
tear or rupture of AC ligament;
partial displacement of lateral end of clavicle;
pain;
point tenderness;
decreased ROM (ABD/DD)
REST, ICE, Immobilization in cuffncollar slight
What are s&s for grade 3 AC injuries? What is the course of treatment?
severe pain;
moderate to severe step;
rupture of AC and CC ligaments.
rest, ice, immobilization unlesss surgery is required.
What are the S&S of a grade 4 AC injury? what is course of treatment?
posterior separation of clavicle
surgery
What are S&S of grade 5 AC injuires? Treatment?
loss of AC and CC ligametns; tearing of the deltoid and trap muscle attachments; gross deformity; severe pain; decreased ROM
Surgery
What are S&S of grade 6 AC injuries? Treatment?
displacement of clavicle behind the coracobrachialis
surgery required
What occurs in an anterior glenohumeral subluxation/dislocation?
humeral head displaces anteriorly/inferiorly
What is the MOI for a GH subluxation/dislocation?
FOOSH with arm externally rotated;
direct blow to the hand or forearm when the shoulder is abducted to 90 and the elbow is bent
What are S&S of an anterior dislocation of the GH?
flattened deltoid; prominent humeral head in the axilla; arm carried in slight ABduction/ER moderate pain and disability positive apprehension test sulcus sign
What occurs in a posterior GH dislocation?
humeral head displaces posteriorly and inferiorly
What is the MOI for a posterior GH dislocation?
FOOSH with arm internally rotated;
forced adduction and internal rotation
what are S&S of posterior GH dislocations?
severe pain and disability; arm carried in ADD & IR prominent acromion and coracoid process limited ER and elevation possible decreased radial pulse numbness or parsthesia into arm or hand due to compression of brachial plexus or axillary nerve
What is the apprehension test?
special test where shoulder is brought to 90 with external rotation
What tissues can be damaged with GH dislocations?
capsule, ligaments, tendon, labrum, blood vessels, nerves and potential fractures
What is the treatment for GH injuries?
immobliize with sling and swathe, immediate referral to physician for reduction
immobilized for 3 weeks following reduction
What are possible complications from shoulder dislocations?
bankart lesions- permanent anterior defect of labrum
hill sachs lesions- caused by compression of bone against anterior glenoid rim creating divot in humeral head
SLAP lesion- defect in superior labrum that impacts attachment of long head of biceps on labrum
brachial nerves/vessels compromised; rotator cuff injuries; fractures; bicipital tendon subluxation and transverse ligament rupture
What is the most common point of fracture for the clavicle?
middle 1/3 where the bone changes shape and direction
What are MOI for clavicular fractures?
direct impact
FOOSH
fall on tip of shoulder
What are S&S of clavicular fractures?
upward displacement of medial clavicular segment due to pull of SCM;
generally present with supporting arm, head tilted toward injured side
clavicle may appear lower
palpation- pain, swelling, point tenderness
what is treatment for clavicular fracture?
reassess athlete, sling/swathe in most comfortable position, transport to hospital
What questions should you ask during assessment of shoulder complex?
what is cause of pain, MOI, previous history, location, duration, intensity of pain;
crepitus, clicking, catching, numbness, tingling, heat;
weakness or fatigue
what provides relief
What are the ROM for shoulder complex assessment?
flexion, extension
abduction, adduction
IR/ER
What are the special tests for the shoulder complex?
sulcus test and apprehension test
What are the bony landmark palpations for the shoulder complex?
sternoclavicular joint clavicular shaft acromioclavicular joint coracoid process acromion process humeral head great/less tuberosity bicipital groove spine of scapula scapular medial/lateral borders superior/inferior angles of scapula
what are the wrapping techniques for the shoulder?
shoulder spica and 4S (spica/sling/swathe/support)