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Musculoskeletal > Shoulder Complex > Flashcards

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%

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2
Q

A normal shoulder will have approx. ___ degrees of the total movement coming from the GH joint

A

90 degrees

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3
Q

What is the order of a shoulder motion assessment?

A
  1. AROM
  2. (if AROM is limited) PROM
  3. (if PROM is limited) Isolated GH joint assessment
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4
Q

How is pure motion occurring at the GH joint assessed passively?

A

By having the scapula stabilized

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5
Q

If isolated GH joint FLX is present, use ____ and distraction to restore it.

A

lateral glides and distraction

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6
Q

If isolated GH joint ABD is present, use ____ and distraction to restore it.

A

Inferior glides and distraction

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7
Q

If isolated GH joint IR/ER is present, use ____ and distraction to restore it.

A

posterior glides and distraction

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8
Q

The GH joint should have at least ___ degrees of motion when performing an isolated movement assessment for ER/IR.

A

70 degrees

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9
Q

Describe the arthrokinematics of the AC joint with shoulder FLX and ABD.

A

Clavicle glides inferiorly and rotates posteriorly

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10
Q

Describe the arthrokinematics of the AC joint with shoulder horizontal ADD.

A

Clavicle glides posteriorly

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11
Q

With ipsilateral cervical ROT, the clavicle will GLIDE ___.

A

posteriorly

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12
Q

With contralateral cervical ROT, the clavicle will GLIDE ____.

A

anteriorly

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13
Q

What type of joint is the SC joint?

A

Saddle synovial joint

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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

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15
Q

Describe the arthrokinematics for SC joint ELEV.

A

clavicle rolls superiorly and glides inferiorly on the manubrium

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16
Q

Describe the arthrokinematics for SC joint DEP.

A

Clavicle rolls inferiorly and glides superiorly on the manubrium.

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17
Q

Describe the arthrokinematics for SC joint PROT.

A

Clavicle rolls AND glides anteriorly on the AND

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18
Q

Describe the arthrokinematics for SC joint RET.

A

Clavicle rolls and glides posteriorly on the manubrium

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19
Q

What is the open pack position of the SC joint?

A

anatomical position

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20
Q

What is the closed pack position of the SC joint?

A

Full shoulder ELEV

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21
Q

What is the 3rd most common MSK pathology assessed by a PCP?

A

Shoulder pain

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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

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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

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24
Q

Pts with primary subacromial impingement syndrome are normally what age?

A

> 35 y/o

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25
Q

Pts with primary subacromial impingement syndrome often have pain on the ______ aspect(s) of the shoulder.

A

anterior and lateral aspects

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26
Q

A painful arc is normally around the range of __-__ degrees of shoulder ELEV

A

80-110 degrees of shoulder ELEV

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27
Q

definition: pinching or compression of a structure in the subacromial space due to INSTABILITY of the shoulder

A

secondary subacromial impingement syndrome

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28
Q

Causes:
- congenital laxity of ligaments
- labral tears
- RTC tears
- scapular winging
- poor muscular control of RTC and scapular stabilizers
- trauma

A

Secondary subacromial impingement syndrome

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29
Q

Pts with secondary subacromial impingement syndrome are normally what age?

A

< 25 y/o

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30
Q

Pts with secondary subacromial impingement syndrome often have pain on the ______ aspect(s) of the shoulder.

A

anterior or lateral aspects

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31
Q

What are the special tests for shoulder impingement?

A

Hawkins-Kennedy
NEER
Empty-can (jobe)
Cross-body ADD
Painful Arc sign
Resisted ER strength test

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32
Q

What is the CPR cluster for shoulder impingement?

A

(+) Hawkins-Kennedy
(+) painful arc sign btwn 60-120 degrees
(+) infraspinatus muscle strength test/ unable to resist ER

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33
Q

What makes up approximately 70% of all shoulder issues seen by a PT?

A

RTC tear

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34
Q

What is the most common muscle torn in the RTC? What is the second most common?

A
  1. supraspinatus
  2. infraspinatus
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35
Q

What are the stages of RTC tears?

A
  1. tendinopathy
  2. partial thickness tear
  3. full thickness tear
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36
Q

What are the causes of RTC tears?

A
  • compression
  • tensile overload
  • macrotrauma
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37
Q

Pts with RTC tears are normally what age?

A

> 45 y/o

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38
Q

Pts with RTC tears often have pain on the ______ aspect(s) of the shoulder.

A

lateral aspect

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39
Q

Shoulder hiking is present with what shoulder complex pathology?

A

RTC tear

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40
Q

What is Cluster 1 for CPR of a RTC tear?

A
  1. Weakness of ER
  2. Age >65 y/o
  3. night pain
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41
Q

What is cluster 2 for CPR of a RTC tear?

A
  1. weakness of supraspinatus
  2. weakness of ER
  3. (+) impingement sign

98% change of RTC tear if triad is present

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42
Q

What imaging is used to diagnose RTC tears? What is the issue with MRI when looking for RTC tears?

A
  1. MRI and MRA
  2. It can lead to a false positive
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43
Q

What are special tests for RTC tear of the supraspinatus?

A
  • drop arm test (codman’s)
  • Empty can (jobe)
  • full can
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44
Q

What are the special tests for RTC tear of the infraspinatus and teres minor?

A
  • ER lag sign
  • ER resistance test
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45
Q

What are the special tests for RTC tear of the subscapularis?

A
  • belly press test
  • lift off test (gerber lift off test)
  • IR lag sign
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46
Q

If a bicipital groove is too wide, what can happen?

A

Excessive medial/lateral movement of the LHOB tendon leading to inflammation (bicipital tendinopathy)

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47
Q

If the bicipital groove is too narrow, what can happen?

A

Compression of the LHOB tendon which leads to inflammation (bicipital tendinopathy)

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48
Q

What are the causes of bicipital tendinopathies?

A
  • anatomical variation of bicipital groove
  • anteriorly placed HH
  • repetitive/sudden shoulder FLX and elbow FLX
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49
Q

Pts with bicipital tendinopathies often have pain on the ______ aspect(s) of the upper arm.

A

anterior aspect

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50
Q

Those with bicipital tendinopathy have pain with what movements?

A
  • shoulder FLX/EXT AROM
  • resisted shoulder FLX
  • resisted elbow FLX
  • resisted SUP
51
Q

Who is most likely to experience a biceps rupture?

A

males 40-60 y/o

52
Q

What are special tests to assess for biceps tendinopathy?

A
  • Speed’s test
  • Yergason’s test
  • transverse humeral ligament test (booth and marvel test)
  • upper cut test
53
Q

The AC joint is a ___ joint.

A

triaxial joint

54
Q

What are the movements of the AC joint?

A

Inferior Border winging (FLX/EXT)
Medial Border Winging (IR/ER)
Lateral border Winging (ABD/ADD)

55
Q

What is the close packed position of the AC joint?

A

90 degrees of shoulder ABD

56
Q

What muscles/structures does the superior AC ligament blend into?

A

Traps, deltoid, articular disc

57
Q

What does the inferior AC ligament attach?

A

inferior clavicle and acromion

58
Q

What does the superior AC ligament attach?

A

superior clavicle and acromion

59
Q

What are the parts of the coracoclavicular ligament?

A
  • conoid ligament
  • trapezoid ligament
60
Q

What does the conoid ligament provide?

A

posterior stability of the AC joint

61
Q

What does the trapezoid ligament provide?

A

anterior stability of the AC joint

62
Q

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.

A

AC joint trauma

63
Q

With AC joint trauma, the force drives the Acromion ____ into the clavicle.

A

Inferiorly under the clavicle

64
Q

What makes up 40-50% of sport-related shoulder injuries?

A

AC joint trauma

65
Q

Contractile testing for AC joint trauma will be ___ and ___.

A

painful and limited

66
Q

The rockwood injury classification is used to stage _______.

A

AC joint trauma

67
Q

Pts with AC joint degenerative arthritis are normally _____ y/o.

A

> 50 y/o

68
Q

Intra-articular disc degeneration can start in a person’s ____.

A

40s

69
Q

What pathology has an increased incidence in weightlifters?

A

AC joint degenerative arthritis

70
Q

Those with AC joint degenerative arthritis have painful and limited AROM and PROM with what movements?

A

-shoulder FLX, ABD, and Horiz. ADD

71
Q

Those with AC joint degenerative arthritis will have pain on the ___ aspect(s) of the shoulder.

A

superior aspect of the shoulder.

72
Q

Those with AC joint degenerative arthritis will have a decrease in ___ or ___ joint glide of the clavicle.

A

inferior or posterior

73
Q

What are special tests for the AC joint?

A
  • active compression test
  • cross body ADD test
  • AC joint resisted EXT test
  • AC joint TTP test
  • Paxino’s sign
74
Q

Often the AC joint can manifest as a painless ____ which can cause the other joints of the shoulder complex to compensate and move excessively.

A

hypomobility

75
Q

What is the hallmark sign of AC joint hypomobility?

A

clicking and popping of hypomobility in ONE direction

–> other direction will present with hypermobility

76
Q

What AC joint mobilization is used to restore limited shoulder FLX and ABD?

A

Inferior glide of the clavicle

77
Q

What AC joint mobilization is used to restore limited shoulder horiz. ADD?

A

Posterior glide of the clavicle

78
Q

What AC joint mobilization is used to restore all limited movements of the shoulder?

A

AC joint distraction

79
Q

(true/false) subscapularis tears are commonly paired with supraspinatus or infraspinatus tears

A

True

80
Q

During RTC special tests, the LHOB can become impinged when performing what motion?

A

IR

81
Q

What special test is useful to identify full thickness tears of the supraspinatus?

A

drop arm (codman’s test)

82
Q

Weakness of ___ motion is a sign of possible supraspinatus tear.

A

ER

83
Q

(true/false) Older patients with a biceps rupture may not get choose to get surgery if they have decent shoulder function

A

True

84
Q

When performing Yergason’s test, subluxation of the LHOB tendon is an indication for what?

A

tear of the transverse humeral ligament

85
Q

What movement can cause subluxation of the LHOB in the bicipital groove?

A

Supination

86
Q

definition: abnormal translation of the HH

A

instability

87
Q

What type of instability is most commonly seen?

A

Anteroinferior instability

88
Q

causes:
- trauma/previous injury to shoulder
- excessive overhead movements
- connective tissue disorders that create ligamentous laxity
- labral tears
- RTC tears

A

glenohumeral instability

89
Q

Repetitive overhead sports leads to ligamentous (tightness/laxity in the ANTERIOR capsule and (tightness/laxity) in the POSTERIOR capsule of the GH joint.

A

laxity, tightness

90
Q

What are the passive restraints for GH stability?

A
  • GH ligaments
  • coracoacromial ligament
  • coracohumeral ligament
  • capsule
  • labrum
91
Q

What are the active restraints for GH stability?

A
  • RTC muscles
  • LHOB
  • deltoid
  • Scapular stabilizers (rhomboids, middle/lower traps, serratus anterior, etc)
92
Q

All 3 bands of the GH ligament provides ___ stability.

A

Passive anterior joint stability

93
Q

All 3 bands of the GH joint are taut in what motions?

A

ABD and ER

94
Q

The superior GH ligament provides passive stability with ___ when the arm is by the side.

A

ADD

95
Q

The middle GH ligament provides passive stability with ___ and ___.

A

COMBINED FLX and ER

96
Q

What is the most important GH ligament? Why?

A

Inferior because it helps prevent anterior AND posterior dislocations of the HH

97
Q

What GH ligament is the primary stabilizer for overhead athletes?

A

inferior GH ligament

98
Q

The anterior band of the inferior GH ligament is the primary stabilizer at ___ degrees of ABD.

A

45 degrees

99
Q

The posterior band of the inferior GH ligament is the primary stabilizer at ___ degrees of ABD.

A

90 degrees

100
Q

What muscle does the coracohumeral ligament blend into?

A

The subscapularis muscle at the lesser tuberosity.

101
Q

What does the coracohumeral ligament help restrain?

A

excessive FLX and EXT of the shoulder

102
Q

What ligament is known as the “roof of the shoulder?”

A

coracoacromial ligament

103
Q

What does the coracoacromial ligament do?

A

stabilizes the AC joint and prevents it from separating

104
Q

What are the 2 major categories of GH instability?

A

AMBRII and TUBS

105
Q

What does AMBRII stand for?

A

Asymmetrical
Multidirectional instability
Bilateral
Responds to rehab
If rehab fails –> Inferior capsular shift surgery is indicated

106
Q

What does TUBS stand for?

A

Trauma
Unidirectional instability
Bankart OR Hill Sachs lesion
Surgery is usually required

107
Q

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

A

AMBRII

108
Q

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

A

TUBS

109
Q

What is the most common pathology seen with ANTERIOR GH instability?

A

Bankart Lesion

110
Q

definition: avulsion of the labrum in the ANTEROINFERIOR quadrant; disruption of the inferior GH ligament

A

Bankart Lesion

111
Q

definition: Impression fracture of the POSTEROLATERAL humeral head that is commonly seen with traumatic GH instability

A

TUBS

112
Q

What are the tests for GH instability?

A
  • GH ligament tests
  • apprehension test (posterior and anterior)
  • relocation test (fowler sign, jobe relocation test)
  • sulcus sign
  • load and shift test
113
Q

The labrum is a ___ structure.

A

fibrocartilaginous structure

114
Q

The inferior labrum is (loosely/firmly) attached to the glenoid and the superior labrum is (loosely/firmly) attached to the glenoid.

A

firmly, loosely

115
Q

What structures connect to the superior labrum?

A
  • superior and middle GH ligaments
  • LHOB
116
Q

___% of shoulders have a hole or opening between the labrum and glenoid

A

73%

117
Q

What is a SLAP Tear?

A

Superior Labrum Anterior and Posterior Tears

118
Q

Causes/clinical presentation:
younger population
- overhead athletes
- “dead arm” syndrome (baseball players)
- GH instability/shoulder dislocation

older adults
- trauma

A

SLAP Tear

119
Q

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.

A

eccentric

120
Q

Those with AMBRII GH instability have pain or apprehension with what movements that cause Posterior instability?

A

Shoulder FLX and IR

121
Q

Those with AMBRII GH instability have pain or apprehension with what movements that cause anterior instability?

A

Shoulder ABD and ER

122
Q

What movement does inferior glide of the clavicle (AC joint treatment) help restore?

A

Shoulder ELEV

123
Q

What movement does posterior glide of the clavicle (AC joint treatment) help restore?

A

Shoulder Horiz. ADD

Musculoskeletal (23 decks)

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