Shoulder Complex Flashcards
1
Q
During shoulder FLX and ABD, the GH joint accounts for ___% of the total movement of the shoulder complex.
A
50%
2
Q
A normal shoulder will have approx. ___ degrees of the total movement coming from the GH joint
A
90 degrees
3
Q
What is the order of a shoulder motion assessment?
A
- AROM
- (if AROM is limited) PROM
- (if PROM is limited) Isolated GH joint assessment
4
Q
How is pure motion occurring at the GH joint assessed passively?
A
By having the scapula stabilized
5
Q
If isolated GH joint FLX is present, use ____ and distraction to restore it.
A
lateral glides and distraction
6
Q
If isolated GH joint ABD is present, use ____ and distraction to restore it.
A
Inferior glides and distraction
7
Q
If isolated GH joint IR/ER is present, use ____ and distraction to restore it.
A
posterior glides and distraction
8
Q
The GH joint should have at least ___ degrees of motion when performing an isolated movement assessment for ER/IR.
A
70 degrees
9
Q
Describe the arthrokinematics of the AC joint with shoulder FLX and ABD.
A
Clavicle glides inferiorly and rotates posteriorly
10
Q
Describe the arthrokinematics of the AC joint with shoulder horizontal ADD.
A
Clavicle glides posteriorly
11
Q
With ipsilateral cervical ROT, the clavicle will GLIDE ___.
A
posteriorly
12
Q
With contralateral cervical ROT, the clavicle will GLIDE ____.
A
anteriorly
13
Q
What type of joint is the SC joint?
A
Saddle synovial joint
14
Q
The medial end of the clavicle is (concave/convex) on the anterior-posterior aspect and (concave/convex) on the superior-inferior aspect
A
concave, convex
15
Q
Describe the arthrokinematics for SC joint ELEV.
A
clavicle rolls superiorly and glides inferiorly on the manubrium
16
Q
Describe the arthrokinematics for SC joint DEP.
A
Clavicle rolls inferiorly and glides superiorly on the manubrium.
17
Q
Describe the arthrokinematics for SC joint PROT.
A
Clavicle rolls AND glides anteriorly on the AND
18
Q
Describe the arthrokinematics for SC joint RET.
A
Clavicle rolls and glides posteriorly on the manubrium
19
Q
What is the open pack position of the SC joint?
A
anatomical position
20
Q
What is the closed pack position of the SC joint?
A
Full shoulder ELEV
21
Q
What is the 3rd most common MSK pathology assessed by a PCP?
A
Shoulder pain
22
Q
definition: pinching or compression of structures in the subacromial space between the humeral head and coracoacromial arch during movement
A
primary subacromial impingement
23
Q
Causes:
- repetitive overhead activity
- narrowing of subacromial space from degeneration, osteophyte spurring, abnormal acromion
- capsular tightness
- muscle imbalance
- decreased mobility of CT junction and upper ribs and T-spine.
A
Primary subacromial impingement
24
Q
Pts with primary subacromial impingement syndrome are normally what age?
A
> 35 y/o
25
Pts with primary subacromial impingement syndrome often have pain on the ______ aspect(s) of the shoulder.
anterior and lateral aspects
26
A painful arc is normally around the range of __-__ degrees of shoulder ELEV
80-110 degrees of shoulder ELEV
27
definition: pinching or compression of a structure in the subacromial space due to INSTABILITY of the shoulder
secondary subacromial impingement syndrome
28
Causes:
- congenital laxity of ligaments
- labral tears
- RTC tears
- scapular winging
- poor muscular control of RTC and scapular stabilizers
- trauma
Secondary subacromial impingement syndrome
29
Pts with secondary subacromial impingement syndrome are normally what age?
< 25 y/o
30
Pts with secondary subacromial impingement syndrome often have pain on the ______ aspect(s) of the shoulder.
anterior or lateral aspects
31
What are the special tests for shoulder impingement?
Hawkins-Kennedy
NEER
Empty-can (jobe)
Cross-body ADD
Painful Arc sign
Resisted ER strength test
32
What is the CPR cluster for shoulder impingement?
(+) Hawkins-Kennedy
(+) painful arc sign btwn 60-120 degrees
(+) infraspinatus muscle strength test/ unable to resist ER
33
What makes up approximately 70% of all shoulder issues seen by a PT?
RTC tear
34
What is the most common muscle torn in the RTC? What is the second most common?
1. supraspinatus
2. infraspinatus
35
What are the stages of RTC tears?
1. tendinopathy
2. partial thickness tear
3. full thickness tear
36
What are the causes of RTC tears?
- compression
- tensile overload
- macrotrauma
37
Pts with RTC tears are normally what age?
> 45 y/o
38
Pts with RTC tears often have pain on the ______ aspect(s) of the shoulder.
lateral aspect
39
Shoulder hiking is present with what shoulder complex pathology?
RTC tear
40
What is Cluster 1 for CPR of a RTC tear?
1. Weakness of ER
2. Age >65 y/o
3. night pain
41
What is cluster 2 for CPR of a RTC tear?
1. weakness of supraspinatus
2. weakness of ER
3. (+) impingement sign
*98% change of RTC tear if triad is present*
42
What imaging is used to diagnose RTC tears? What is the issue with MRI when looking for RTC tears?
1. MRI and MRA
2. It can lead to a false positive
43
What are special tests for RTC tear of the supraspinatus?
- drop arm test (codman's)
- Empty can (jobe)
- full can
44
What are the special tests for RTC tear of the infraspinatus and teres minor?
- ER lag sign
- ER resistance test
45
What are the special tests for RTC tear of the subscapularis?
- belly press test
- lift off test (gerber lift off test)
- IR lag sign
46
If a bicipital groove is too wide, what can happen?
Excessive medial/lateral movement of the LHOB tendon leading to inflammation (bicipital tendinopathy)
47
If the bicipital groove is too narrow, what can happen?
Compression of the LHOB tendon which leads to inflammation (bicipital tendinopathy)
48
What are the causes of bicipital tendinopathies?
- anatomical variation of bicipital groove
- anteriorly placed HH
- repetitive/sudden shoulder FLX and elbow FLX
49
Pts with bicipital tendinopathies often have pain on the ______ aspect(s) of the upper arm.
anterior aspect
50
Those with bicipital tendinopathy have pain with what movements?
- shoulder FLX/EXT AROM
- resisted shoulder FLX
- resisted elbow FLX
- resisted SUP
51
Who is most likely to experience a biceps rupture?
males 40-60 y/o
52
What are special tests to assess for biceps tendinopathy?
- Speed's test
- Yergason's test
- transverse humeral ligament test (booth and marvel test)
- upper cut test
53
The AC joint is a ___ joint.
triaxial joint
54
What are the movements of the AC joint?
Inferior Border winging (FLX/EXT)
Medial Border Winging (IR/ER)
Lateral border Winging (ABD/ADD)
55
What is the close packed position of the AC joint?
90 degrees of shoulder ABD
56
What muscles/structures does the superior AC ligament blend into?
Traps, deltoid, articular disc
57
What does the inferior AC ligament attach?
inferior clavicle and acromion
58
What does the superior AC ligament attach?
superior clavicle and acromion
59
What are the parts of the coracoclavicular ligament?
- conoid ligament
- trapezoid ligament
60
What does the conoid ligament provide?
posterior stability of the AC joint
61
What does the trapezoid ligament provide?
anterior stability of the AC joint
62
definition: injury to the joint or ligaments due to a fall or direct blow to the shoulder, typically with the arm in an ADDUCTED position.
AC joint trauma
63
With AC joint trauma, the force drives the Acromion ____ into the clavicle.
Inferiorly under the clavicle
64
What makes up 40-50% of sport-related shoulder injuries?
AC joint trauma
65
Contractile testing for AC joint trauma will be ___ and ___.
painful and limited
66
The rockwood injury classification is used to stage _______.
AC joint trauma
67
Pts with AC joint degenerative arthritis are normally _____ y/o.
> 50 y/o
68
Intra-articular disc degeneration can start in a person's ____.
40s
69
What pathology has an increased incidence in weightlifters?
AC joint degenerative arthritis
70
Those with AC joint degenerative arthritis have painful and limited AROM and PROM with what movements?
-shoulder FLX, ABD, and Horiz. ADD
71
Those with AC joint degenerative arthritis will have pain on the ___ aspect(s) of the shoulder.
superior aspect of the shoulder.
72
Those with AC joint degenerative arthritis will have a decrease in ___ or ___ joint glide of the clavicle.
inferior or posterior
73
What are special tests for the AC joint?
- active compression test
- cross body ADD test
- AC joint resisted EXT test
- AC joint TTP test
- Paxino's sign
74
Often the AC joint can manifest as a painless ____ which can cause the other joints of the shoulder complex to compensate and move excessively.
hypomobility
75
What is the hallmark sign of AC joint hypomobility?
clicking and popping of hypomobility in ONE direction
--> other direction will present with hypermobility
76
What AC joint mobilization is used to restore limited shoulder FLX and ABD?
Inferior glide of the clavicle
77
What AC joint mobilization is used to restore limited shoulder horiz. ADD?
Posterior glide of the clavicle
78
What AC joint mobilization is used to restore all limited movements of the shoulder?
AC joint distraction
79
(true/false) subscapularis tears are commonly paired with supraspinatus or infraspinatus tears
True
80
During RTC special tests, the LHOB can become impinged when performing what motion?
IR
81
What special test is useful to identify full thickness tears of the supraspinatus?
drop arm (codman's test)
82
Weakness of ___ motion is a sign of possible supraspinatus tear.
ER
83
(true/false) Older patients with a biceps rupture may not get choose to get surgery if they have decent shoulder function
True
84
When performing Yergason's test, subluxation of the LHOB tendon is an indication for what?
tear of the transverse humeral ligament
85
What movement can cause subluxation of the LHOB in the bicipital groove?
Supination
86
definition: abnormal translation of the HH
instability
87
What type of instability is most commonly seen?
Anteroinferior instability
88
causes:
- trauma/previous injury to shoulder
- excessive overhead movements
- connective tissue disorders that create ligamentous laxity
- labral tears
- RTC tears
glenohumeral instability
89
Repetitive overhead sports leads to ligamentous (tightness/laxity in the ANTERIOR capsule and (tightness/laxity) in the POSTERIOR capsule of the GH joint.
laxity, tightness
90
What are the passive restraints for GH stability?
- GH ligaments
- coracoacromial ligament
- coracohumeral ligament
- capsule
- labrum
91
What are the active restraints for GH stability?
- RTC muscles
- LHOB
- deltoid
- Scapular stabilizers (rhomboids, middle/lower traps, serratus anterior, etc)
92
All 3 bands of the GH ligament provides ___ stability.
Passive anterior joint stability
93
All 3 bands of the GH joint are taut in what motions?
ABD and ER
94
The superior GH ligament provides passive stability with ___ when the arm is by the side.
ADD
95
The middle GH ligament provides passive stability with ___ and ___.
COMBINED FLX and ER
96
What is the most important GH ligament? Why?
Inferior because it helps prevent anterior AND posterior dislocations of the HH
97
What GH ligament is the primary stabilizer for overhead athletes?
inferior GH ligament
98
The anterior band of the inferior GH ligament is the primary stabilizer at ___ degrees of ABD.
45 degrees
99
The posterior band of the inferior GH ligament is the primary stabilizer at ___ degrees of ABD.
90 degrees
100
What muscle does the coracohumeral ligament blend into?
The subscapularis muscle at the lesser tuberosity.
101
What does the coracohumeral ligament help restrain?
excessive FLX and EXT of the shoulder
102
What ligament is known as the "roof of the shoulder?"
coracoacromial ligament
103
What does the coracoacromial ligament do?
stabilizes the AC joint and prevents it from separating
104
What are the 2 major categories of GH instability?
AMBRII and TUBS
105
What does AMBRII stand for?
Asymmetrical
Multidirectional instability
Bilateral
Responds to rehab
If rehab fails --> Inferior capsular shift surgery is indicated
106
What does TUBS stand for?
Trauma
Unidirectional instability
Bankart OR Hill Sachs lesion
Surgery is usually required
107
Clinical presentation:
- swimmers, gymnasts, baseball players, weightlifters
- young age
- shoulder pain with carrying objects
- pain with shoulder FLX/IR (posterior instability)
- pain with shoulder ABD/ER (anterior instability)
- hypermobility of multiple joints
AMBRII
108
clinical presentation:
- MOI is contact to the shoulder in a postition of ABD, EXT, and ER
- overhead sports in younger athletes
- falls in elderly population
- bankart lesion
- hill-sachs lesion
TUBS
109
What is the most common pathology seen with ANTERIOR GH instability?
Bankart Lesion
110
definition: avulsion of the labrum in the ANTEROINFERIOR quadrant; disruption of the inferior GH ligament
Bankart Lesion
111
definition: Impression fracture of the POSTEROLATERAL humeral head that is commonly seen with traumatic GH instability
TUBS
112
What are the tests for GH instability?
- GH ligament tests
- apprehension test (posterior and anterior)
- relocation test (fowler sign, jobe relocation test)
- sulcus sign
- load and shift test
113
The labrum is a ___ structure.
fibrocartilaginous structure
114
The inferior labrum is (loosely/firmly) attached to the glenoid and the superior labrum is (loosely/firmly) attached to the glenoid.
firmly, loosely
115
What structures connect to the superior labrum?
- superior and middle GH ligaments
- LHOB
116
___% of shoulders have a hole or opening between the labrum and glenoid
73%
117
What is a SLAP Tear?
Superior Labrum Anterior and Posterior Tears
118
Causes/clinical presentation:
younger population
- overhead athletes
- "dead arm" syndrome (baseball players)
- GH instability/shoulder dislocation
older adults
- trauma
SLAP Tear
119
Several studies have shoulder that during the later phase of throwing a baseball, the bicep works (concentrically/eccentrically) to decelerate the arm. Repetitive movement like this can lead to microtrauma and a SLAP tear.
eccentric
120
Those with AMBRII GH instability have pain or apprehension with what movements that cause Posterior instability?
Shoulder FLX and IR
121
Those with AMBRII GH instability have pain or apprehension with what movements that cause anterior instability?
Shoulder ABD and ER
122
What movement does inferior glide of the clavicle (AC joint treatment) help restore?
Shoulder ELEV
123
What movement does posterior glide of the clavicle (AC joint treatment) help restore?
Shoulder Horiz. ADD
