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EPHE 355 - Lecture Slides > Shoulder Complex > Flashcards

Shoulder Complex Flashcards

1
Q

The shoulder girdle is composed of what three things?

A

scapula
clavicle
manubrium

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2
Q

Mobility is at the expense of ______ _______

A

structural stability

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3
Q

What joint is the only bony joint connecting the upper limb to the trunk?

A

sternoclavicular

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4
Q

Labrum deepens socket by __%

A

50%

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5
Q

Glenoid fossa is tilted __ degrees upward relative to vertebral border

A

5

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6
Q

vertebral (medial) border is located between?

A

T2-7

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7
Q

The forward convexity at the sternal end of the clavicle is the path for what?

A

upper extremity neurovascular bundle

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8
Q

How is the head of the humerus oriented inside the labrum?

A

faces medially, superiorly and is rotated posteriorly

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9
Q

What is the angle of inclination of the humerus and what is is measured relative to?

A

135 degrees; measured relative to the long axis of the shaft

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10
Q

Angle of torsion in humerus is retroverted ___ degrees in transverse plane

A

30

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11
Q

The condyles of humerus are located _____ relative to head of humerus. What does this allow?

A

anteriorly; allows head to be in scapular plane while elbow is in neutral and it also allows for greater ROM in abduction and external rotation before impingement occurs

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12
Q

Pectoral girdle joints consists of 2 bony articulations and 1 false articulation. What are they?

A
  • Acromioclavicular
  • Sternoclavicular

False:
-Scapulothoracic

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13
Q

Classification of sternoclavicular joint

A
  • synovial, complex, modified stellar
  • can also be classified as planar with multiplanar motion
  • 3 DOF
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14
Q

What are the two articulations of the sternoclavicular joint?

A

manubrium and sternal end of clavicle

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15
Q

Movements of the sternoclavicular joint?

A
  • elevation/depression
  • protraction/retraction
  • rotation
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16
Q

osteokinematics of sternoclavicular joint?

A

swing

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17
Q

________ ligament prevents upward displacement of the clavicle

A

interclavicular ligament

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18
Q

ARTHROKIN:

-Elevation of clavicle = _____ clavicular roll with ____ clavicular slide

A

superior

inferior

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19
Q

ARTHROKIN:

-Protraction of clavicle = _____ roll and slide

A

anterior

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20
Q

classification of acromioclavicular joint

A
  • planar synovial joint

- multiplanar motion

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21
Q

osteokinematics of acromioclavicular joint?

A

translation

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22
Q

what muscular connections move the AC joint?

A

none!

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23
Q

Primary function of the AC joint?

A

assist the scapula in maintaining thoracic contact throughout ROM

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24
Q

Two articular surfaces of the AC joint?

A

acromial end of the clavicle and medial margin of the acromion of the scapula

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25
Q

What is the AC joint lined with?

A

fibrocartilage

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26
Q

2 accessory ligaments for the AC joint?

A

acromioclavicular and coracoclavicular ligaments

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27
Q

Which is stronger: coracoclavicular or acromioclavicular ligament

A

coraco

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28
Q

What is the coracoclavicular ligament composed of, and what stability do they provide?

A

Trapezoid - prevents lateral mvmt of clavicle on acromion

Conoid - checks superior mvmt of clavicle

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29
Q

GH joint has limited _____ stability

A

osseous

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30
Q

Approximately __% of head of humerus fits into glenoid cavity

A

25%

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31
Q

REMEMBER: THERE IS A DIFFERENCE BETWEEN GLENOID LABRUM AND GLENOID CAVITY

A

labrum deepens the cavity.

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32
Q

transverse ligament goes from lesser to greater tuberosity and creates a tunnel for what?

A

tendon of biceps brachii muscle

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33
Q

The GH ligaments reinforce the ___ and ___ joint capsule ; most common point of dislocation is at __ or __ o’clock.

A

anterior and inferior

4 or 5 - more to do with the mechanism of injury than anything else

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34
Q

Part of coracohumeral ligament blends with tendon of the ____ on lesser tubercle

A

subscapularis

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35
Q

How does the coracohumeral ligament strengthen the capsule?

A

Strengthens the superior capsule counteracting downward pull of the arm

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36
Q

Superior and middle GH ligaments assist the coracohumeral ligament in strengthening the capsule how?

A

counteracting downward pull of arm

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37
Q

The ____ ____ ligament converts the intertubercular groove of humeral head into a tunnel for the tendon of the long head of biceps brachii

A

transverse humeral ligament

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38
Q

What soft tissue structures are stretched with external rotation?

A

anterior capsule

GH ligament

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39
Q

What soft tissue structures are stretched with internal rotation?

A

external rotators
posterior capsule
(no ligaments back there)

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40
Q

What soft tissue structures are stretched with extension?

A

flexor muscles
anterior capsule
ligaments

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41
Q

How is PROM limited in elevation thru abduction when internally rotated?

A

180 degrees with no rotation is limited to 120-140 degrees when internally rotated

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42
Q

Why is the scapulothoracic joint not considered a ‘true’ joint?

A

it represents an articulation between the shoulder blade and the thorax

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43
Q

What is between the scapula and thorax? (4)

A

bursa
serratus anterior
subscapularis
fascia

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44
Q

How does the scapulothoracic joint provide GH stability?

A

for overhead work; also prevents impingement

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45
Q

Where does the scapulothoracic joint prevent impingement?

A

under the acromion - if you can’t rotate acromion out of the way then your greater tuberosity bangs on the acromion and squishes anything in that space

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46
Q

scapulohumeral rhythm is approximately what ratio?

A

2:1
GH:Scapula

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47
Q

Phase 1 of scapulohumeral rhythm?

A

Humerus: 30 degrees abduction
Scapula: minimal movement - this is the setting phase
Clavicle: 0-5 degrees

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48
Q

Phase 2 of scapulohumeral rhythm?

A

Humerus: 40 degrees abduction
Scapula: 20 degree rotation, minimal protraction
Clavicle: 15 degrees elevation

49
Q

Phase 3 of scapulohumeral rhythm?

A

Humerus: 60 degrees abduction and 90 degrees lateral rotation

Scapula: 30 degrees rotation

Clavicle: 30-50 degrees posterior rotation and up to 15 degrees elevation

50
Q

When you are i n 90 degrees of abduction, how much is with humerus and how much is with scapula?

A

70 degrees humerus and 20 degrees scapula

51
Q

What is happening to scapulohumeral rhythm ratio if rhythm is faulty?

A

frozen shoulder or torn rotator cuff can lead to faulty rhythm - in this case, most of mobility generally comes from scapula movement, so GH movement is lacking

52
Q

How does the subscapular bursa communicate with joint capsule?

A

via synovial fluid

53
Q

Impingement of subacromial/subdeltoid bursa can be due to? (4)

A

-inflammation due to tendon damage
-Ca+ deposit
-faulty scapulohumeral rhythm
humerus not staying centered on glenoid

54
Q

____ bursa overlies the anterior joint capsule

A

subscapular

55
Q

The subscapular tendon lies beneath the tendon of what muscle?

A

subscapularis

56
Q

What bursa communicates with the joint capsule, helping to maintain negative pressure within the joint that contributes to GH joint stability?

A

subscapular bursa

57
Q

What nerves supply the trapezius?

A

CN XI, C3 and C4

58
Q

Reverse OI for Trap?

A

extend
ipsilateral flexion
contralaterally rotate neck

59
Q

nerve supply for levator scapulae?

A

dorsal scapular nerve

60
Q

reverse OI for levator scapulae?

A

extend
ipsilateral flexion
ipsilateral rot. of neck

61
Q

How do you stretch the levator scapulae?

A

contralateral flexion and ipsilateral rotation - double check in lab manual

62
Q

nerve supply for rhomboid?

A

dorsal scapular nerve

63
Q

nerve supply for serratus anterior?

A

long thoracic nerve

64
Q

Reverse OI for serratus anterior?

A

retracts trunk

elevates and depresses trunk

65
Q

nerve supply for the pec minor?

A

medial pectoral nerve

66
Q

What muscles upwardly rotate the scapula?

A

trapezius
serratus anterior
lower trapezius

67
Q

What muscles downwardly rotate the scapula?

A

levator scapulae
rhomboid major & minor
pectoralis minor

68
Q

nerve supply for pec major?

A

medial and lateral pectoral nerve

69
Q

what nerve innervates the coracobrachialis?

A

musculocutaneous

70
Q

what nerve innervates the deltoid?

A

axillary n.

71
Q

what nerve supplies lats?

A

thoracodorsal nerve

72
Q

what nerve innervates the teres major?

A

lower subscapular

73
Q

what nerve innervates the teres minor?

A

axillary nerve

74
Q

nerve that innervates supra- and infraspinatus?

A

suprascapular nerve

75
Q

what nerve supplies the subscapularis?

A

upper and lower subscapular nerve

76
Q

what nerve innervates the biceps brachii?

A

musculocutaneous nerve

77
Q

what nerve innervates the triceps brachii?

A

radial

78
Q

What three muscles insert at the intertubercular bicipital groove?

A

pectoralis major
latissimus dorsi
teres major

79
Q

Muscles of the rotator cuff? SITS

A

Supraspinatus
Infraspinatus
Teres Minor
Subscapularis

80
Q

What is the role of the rotator cuff muscles during arm movement?

A

hold head of humerus centered in the glenoid cavity

81
Q

3 bony stabilizers of the GH joint?

A
  1. Glenoid
  2. coracoid process
  3. acromion
82
Q

What are the 4 types of passive stabilizers in the GH joint?

A
  1. Bony (osseous) - minimal support
  2. Glenoid labrum
  3. articular capsule
  4. ligaments
83
Q

The glenoid labrum is a _________ ring that deepens the socket by 50%

A

fibrocartilage

84
Q

what does the articular capsule do?

A

allows greater elevation and provides stability for end ROM

85
Q

Negative intraarticular pressure within the GH joint is influenced by communication with what?

A

subscapular bursae and intact labrum

86
Q

What are the dynamic stabilizers of the GH?

A

muscles and tendons

87
Q

At rest, the humeral head is suspended by?

A

ligaments (superior GH, coracohumeral) and negative intra-articular pressure

88
Q

What happens when you have head forward posture?

A

hyper fires the traps - they become tight and overactive

89
Q

What happens to scapula if you have tight levator scapulae?

A

it becomes difficult for scapula to upwardly rotate

90
Q

the primary function of the rotator cuff muscles are that they are _____ ______

A

compressive stabilizers

91
Q

How does biceps stabilize the shoulder?

A

compresses the humeral head

92
Q

How does the deltoid function as a dynamic stabilizer?

A
  • In initial elevation it shears the head of the humerus superiorly
  • as elevation proceeds, deltoid compresses
  • at full elevation, the deltoid and horizontal forces from RC provide stability
93
Q

Brachial plexus is what nerve roots?

A 
C5
C6
C7
C8
T1
94
Q

Axillary nerve comes from what nerve root?

A

C5-6

95
Q

Musculocutaneous nerve comes from what nerve root?

A

C5-7

96
Q

Median nerve comes from what nerve root?

A

C5-T1

97
Q

Ulnar nerve comes from what nerve root?

A

C8-T1

98
Q

Radial nerve comes from what nerve root?

A

C5-T1

99
Q

Dorsal scapular nerve supplies? (3)

A

Rhomboids Major and minor

levator scapulae

100
Q

subscapular nerve supplies? (2)

A

infra- and supraspinatus

101
Q

axillary nerve supplies? (2)

A

deltoid and teres minor

102
Q

medial and lateral pectoral nerves supply? (2)

A

pec major and minor

103
Q

long thoracic nerve supplies? (1)

A

serratus anterior

104
Q

Upper subscapular nerve supplies? (1)

A

subscapularis

105
Q

lower subscapular nerve supplies? (2)

A

teres major

subscapularis

106
Q

thoracodorsal nerve supplies?

A

latissimus dorsi

107
Q

musculocutaneous nerve supplies? (3)

A

biceps brachii
brachialis
coracobrachialis

108
Q

radial, ulnar and median nerve supplies - look at slide 82

A

:)

109
Q

what nerve supplies levator scapulae?

A

dorsal scapular n. (C3/4?)

110
Q

What nerves roots supply the trapezius? (3)

A

CN XI
C3
C4

111
Q

What muscles are working during crutch walking while you pull your GH joint from a flexed position to extended?

A

At the GH joint, extension and slight adduction are
occurring. Big muscles for this are Latissimus Dorsi, Teres Major, triceps (holding arm at elbow in extension), wrist co-contraction to create stability, rhomboids and lower scapula will depress scapula, need strong rotator cuff muscles that will hold humerus in glenoid cavity.

112
Q

What muscles would be weak during a push-up? Raising and lowering phase?

A

Raising:

  • -> GH is extended and abduct
  • -> serratus anterior holds scapula in retraction

Lowering:

  • -> GH is flexed and adducted: pec major
  • -> same muscles but the are working eccentrically
113
Q

What are the key muscles in the power phase of a butterfly swim stroke?

A
  • Extension and internal rotation

- Latissimus Dorsi and Teres Major are the big ones.

114
Q

With head forward posture and increased thoracic kyphosis, which movements would be limited?

A

Depression of scapula
Upward rotation of scapula - cause your downward rotators are tight

Go find which joints would have limited ROM and which muscles would be tight and weak?

115
Q

What are the primary causes of impingement?

A

overloaded overhead activity

116
Q

What are the secondary causes of impingement?

A

faulty scapulohumeral rhythm, rotator cuff/soft tissue imbalance

117
Q

WHat cases a faulty scapulohumeral rhythm?

A

overactive right muscle and/or weak muscle

118
Q

Poor stabilization of humerus in glenoid and altered arthrokinematics are caused by what weak muscles?

A

weak muscles - teres minor and infraspinatus

EPHE 355 - Lecture Slides (3 decks)

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