Shoulder COPY Flashcards
What are the scapular motions?
Upward rotation
External rotation
Posterior tilting
What is normal scapulohumeral rhythm?
2:1 relationship btwn GH elevation & scapular upward rotation
Scapular dyskinesia test
- test of manually repositioning the scapula to reduce or eliminate a painful arc
Similar tests: - forward flexion w/ a light dumbbell
- Light wall push with finger tips
What are the static stabilizers of the AC joint?
- AC ligament
- Coracoclavicular ligaments
(2 = trapezoid & conoid)
What 2 ligaments make up the coracoclavicular ligament?
- trapezoid
- conoid
What are the dynamic stabilizers of the AC Joint?
- deltoid
- trapezius
How are AC joint injuries classified?
Rockwood grading classification model
Grade I: AC joint sprain
Sprain of AC ligaments:
- AC & CC ligaments are intact
Grade II: AC joint sprain
- AC ligaments are ruptured
- CC ligaments are intact
- clavicle is unstable to direct stress tests
- often described as a “subluxation”
Grade III: AC joint sprain
- complete disruption of BOTH the AC & CC ligaments
- delto-trapezial fascia intact
- often described as a “dislocation”
- deformity present w/ clavicle appearing elevated
- clavicle unstable in both vertical and horizontal plane
Grade IV: AC joint sprain
Distal clavicle is posteriorly displaced into trapezius
- posterior deformity present
Grade V: AC joint sprain
More severe form of grade III
- both AC & CC ligaments disrupted
- delto-trapezial fascia disrupted
- Sx:
- downward displacement of scapula
- psedo lateral clavicle elevation
Grade VI: AC Joint sprain
Inferior displacement of the distal clavicle
- Severe trauma
What does an AC step deformity indicate?
@ least a Type III injury
Management for AC joint Injuries:
- Type I-II
- Type III
- Type IV-V
- Type I-II: Non-operative management
- Type III: Debated
- Type IV-V: Surgical repair recommended
What are the return to sport guidelines for AC injuries:
- Grade I:
- Grade II:
- Grade III:
Grade I: 2-4 weeks
Grade II: 4-8 weeks
Grade III: 6-8 weeks
Describe a Bankart lesion
- lesion to the anterior part of the glenoid labrum
- commonly seen w/ subluxations or dislocations
What type of Bankart lesion will be seen in a posterior dislocation?
Reverse Bankart
What are the 2 types of bankart lesions?
Soft tissue:
- anterioinferior labrum avulsion damage of the glenoid rim
- inferior GH ligament may be torn
Describe a bony bankart
Soft tissue damage + fracture of the anterioinferior glenoid rim
What is the primary ligamentous restraint of the GH joint in 90/90 position?
IGHL
- 3 bands
- superior, anterior and posterior
Describe the Internal Rotation Resistance Strength Test (IRRST)
- differentiates an intra-articular pathology from impingement syndrome
- TEST:
- tested in 90 deg ABD/ER
+ test if good strength w/ ER and weakness with IR
+ test = bankart lesion - test = classic impingement
Describe a hill sachs lesion
- dent in the back of the humeral head
What is the most common type of SLAP lesion?
Type II: detachment of the superior labrum & biceps from the glenoid rim
What age are you more likely to see more chances of tears/defects in the superior regions of the labrum?
Ages 30-50
What are the 2 most common MOIs of SLAP lesions?
- Falling on an outstretched arm
- Traction injury in the inferior direction
What is the clinical presentation of a SLAP lesion?
Pain:
- intermittent, overhead movements
- painful clicking and popping
- Pitchers may develop “dead arm” syndrome
What pathology may be tender within the rotator interval?
What is the rotator interval?
SLAP lesions
Rotator Interval:
- triangular shaped anatomic space btwn the supraspinatus tendon, the subscapularis tendon, and the coracoid process
- space contains:
- coracohumeral & SGH ligament
- bicep tendon
- anterior joint capsule
What tests are specific for SLAP lesion?
Speeds = most specific
Yergason’s test
Biceps load test II
What tests are sensitive tests for a SLAP lesion?
Compression rotation test
OBrian’s test = MOST sensative
Anterior apprehension test
What is recommended surgical management for an over 36 year old w/ SLAP lesion?
- Over 36 years old higher chance of failure
- recommend bicep tenodesis
What is the definition of shoulder instability?
Inability to maintain the humeral head in the glenoid fossa
TUBS
Traumatic
Unilateral
Bankart
Surgery
98% of the cases are anterior dislocation
Rate of reoccurance higher in younger population
- 90% chance of reoccurance if less than 20 years old
AMBRI
Atraumatic Multidirectional Bilateral Rehab Inferior Capsular shift (if non-responsive to rehab)
What are the primary dynamic stabilizers at the shoulder?
Primary:
- RC muscle
- Long head of biceps
- Deltoid
Secondary:
- Teres Major
- Lat Dorsi
- Pec Major
Glenoid labrum increases stability by___%?
50%
What scale is used to evaluate hypermobility?
Beighton scale
- score of 5/9 defines hypermobility
What tests would help to confirm a SLAP lexion?
- Crank test
- Resisted supination external rotation test
What is the clinical presentation of a rotator cuff tear?
- pain at night
- painful arc
- supraspinatus:
- ttp over greater tuberosity
- pain in the anterior shoulder
- sx down the arm
What muscle does the hornblower’s sign assess?
Teres Minor
- Axillary Nerve (C5-C6 innervation)
In non-op management of an anterior dislocation: how long should activity be restricted?
6-8 weeks
Primary impingement vs Secondary impingement
Primary Impingement: structural impingement
Secondary Impingement: (postural or movement) a relative impingement occurring in the presence of rotator cuff weakness or instability of the capsule
Lateral Scapular Slide Test
Used to assess weakness of the scapular stabilizers
- increased measurements on involved side
- scapula measured w/ shoulder abducted @ 0, 45 and 90 deg
What nerve is commonly injured in an anterior dislocation?
Axillary nerve:
- passes through quadrangular space
- Innervates:
- Deltoid muscle
- Teres Minor
- patch of skin over the lateral side of proximal humerus
How will a player present after an anterior dislocation?
Holding arm in slight ER & ABD
Sulcus sign maybe evident
What special tests are best for posterior instability?
Jerk test & Kim test
How long should a non-op posterior instability wait prior to performing UE CKC exercises?
6-8 weeks
What does the infraspinatus do?
ER & Extension
Which of the ligaments are the primary static restraints to inferior translation of the arm when the shoulder is in 0 degrees abduction and neutral rotation?
Superior glenohumeral and coracohumeral ligament
