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ortho > shoulder functional anatomy and injuries > Flashcards

shoulder functional anatomy and injuries Flashcards

1
Q

bones composing the shoulder compelex

A

-clavicle
-scapula
-humerus

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2
Q

what are the two types of joints in the shoulder complex?

A

-structural joints
-functional joints

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3
Q

name the structural joints of the shoulder

A

-strenoclavicular joint
-acromioclavicular joint
-glenohumeral joint

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4
Q

name the functional joints of the shoulder

A

-scapulothoracic space
-subacromial (suprahumeral) space

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5
Q

what is the degree that the scapula is aligned to the frontal plane?

A

40 degrees

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6
Q

what is the degree that the clavicle is aligned to the frontal plane?

A

20 degrees

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7
Q

list all the scapular movements

A

-scapular abduction (protraction)
-scapular adduction (retraction)
-scapular apward rotation
-scapular downward rotation
-scapular elevation
-scapular depression
-scapular anterior tipping (of the superior scapula)
-scapular posterior tipping (of the superior scapula)

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8
Q

what happens to the shoulder ligaments during elevation of the clavicle

A

the costoclavicular ligament will be stretched (taut) while the sternoclavicular and interclavicular will be loose (lax)

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9
Q

what happens to the shoulder ligaments during depression of the clavicle

A

the costoclavicular ligament will be loose (lax) while the sternoclavicular and interclavicular will be stretched (taut)

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10
Q

the AC joint capsule is reinforced by ligaments, why?

A

because it is weak, and the ligaments will make it stable and strong

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11
Q

what are the ligaments reinforcing the AC joint capsule?

A

-superior AC
-inferior AC
-coracoclavicular (trapizoid, and conoid)

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12
Q

how is the humeral head positioned in the anatomical position?

A

it faces medialy, superiorly, and posteriorly

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13
Q

what is the angle of inclination of the humeral head?

A

130-150 in the frontal plane

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14
Q

what is the angle of torsion of the humeral head?

A

30 posterior torsion (posterior orientation, retrotorsion, retroversion)

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15
Q

glenoid labrum is attached to the periphery of the glenoid fossa, why?

A

because the glenoid fossa is shallow, so the labrum enhances its deoth by about 50%

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16
Q

what does the glenoid labrum serve as?

A

at attachment site for:
-GH capsule
-GH ligaments
-Tendon of long head of biceps

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17
Q

name the GH ligaments

A

-superior GH ligament
-middle GH ligament
-inferior GH ligament (anterior and posterior)

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18
Q

what are the functions of the glenoid labrum?

A

-resistance of the humeral head translation
-protection of the bony edges of the glenoid fossa
-reduction of joint friction
-dissipation of joint contact forces
-site of insertion for multipule structures (ex,long head of biceps)

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19
Q

with the arm at sides, the glenoid capsule is?

A

taut superiorly and slack anteriorly and inferiorly

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20
Q

RIC stands for

A

rotator interval capsule

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21
Q

what formes the RIC?

A

the suprior GH ligament and the coracohumeral ligament

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22
Q

what is the function of the RIC

A

it separates the supraspinatus and subscapularis muscle tendon

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23
Q

rotational movements of the GH joint do not occur as pure rolling, but have gliding movements, why?

A

due to having a larger convex humeral head rotating on a shallow concave fossa

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24
Q

what is the purpose of bursae?

A

the reductuion of friction forces between anatomical structures

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25
Q

name the GH bursae

A

-subacromial bursae
-subdeltiod bursae

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26
Q

what is the zero position of the shoulder?

A

the upper arm lies parallel to the trunk with the elbows extended and the thumbs pointing ventrally

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27
Q

what is the resting position of the shoulder? (loose pack)

A

-55 shoulder abduction
-30 horizontal adduction
-slight ER

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28
Q

what is the closed packed position of the shoulder?

A

-maximal shoulder abduction
-lateral rotaion
(causes GH anterior dislocation)

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29
Q

shoulder capsular pattern

A

-lateral rotation (ER)
-abduction
-medial rotaion (IR)

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30
Q

forced couple for scapular apward rotation

A

-serratus anterior
-coupled with (upper trapizius and lower trapizius)

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31
Q

forced couple for scapular downward rotation

A

-rhomboids
coupled with (pectoralis minor and levator scapulae)

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32
Q

what does forced couple help with?

A

making the movements smooth and easy

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33
Q

what is the difference between static and dynamic structures?

A

dynamic is muscles that help in stabelization
static is anything that doesnt contract such as tendons and ligaments

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34
Q

what do the rotator caff muscles act as?

A

dymanic stabelizers of the GH joint

35
Q

name the rotator cuff muscles

A

(SITS)
-supraspinatus
-infraspinatus
-teres minor
-subscapularis

36
Q

rotator cuff muscle inserted in the greater tubercle

A

-supraspinatus
-infraspinatus
-teres minor

37
Q

rotator cuff muscle inserted in the lesser tubercle

A

-subscapularis

38
Q

which muscles form force couple on the GH joint

A

-deltoid
-rotator cuff muscles

39
Q

what movement does the deltoid and rotaor cuff muscles produce on the GH joint using force couple?

A

rotation of humerus during abduction and flexion

40
Q

what is Allman’s classification for clavicular fractures is based on?

A

the anatomical location of the fracture

41
Q

classification of clavicular fractures

A

group 1
group 2: type1, type 2 (a,b), type3
group 3

42
Q

etiology of clavicular fractures

A

-fall on outstretched arm
-fall on the tip of the shoulder
-direct impact

43
Q

what are the signs and symptoms of clavicular fractures

A

-supporting of the arm
-head tilted toward the injured side with chin turned away
-clavicle my appear lower
-palpation rerveals pain, swelling, deformity and point tenderness

44
Q

how are clavicular fractures managed conservitavly?

A

-clossed reduction using sling and swathe
-immobelize with figure of 8 brace for 6-8 weeks

45
Q

in calvicular fractures, what should the removal of brace be followed by?

A

-joint mobelization
-iosometric exercises
-using sling for 3 weeks

46
Q

what determines if the clavicular fracture management should be conservative or non-conservative?

A

the amount of displacement
- conservatice <100% dispalced
-operative >100% dispalced

47
Q

when is ORIF need for clavicular fractures?

A

if it was displaced, plating is also used

48
Q

what is the most common area of clavicular fractures?

A

middle third

49
Q

where do green stick fractures of the clavicle often occur?

A

in young athletes

50
Q

types of scapular fractures

A

body:
-scapular spine fracture
-glenoid fossa fracture

extra-articular fractures:
-acromial fracture
-coracoid fracture
-scapular neck farcture/ clavicle fracture

51
Q

how are most scapular fractures treated?

A

conservitavely, even if the fracture is moderatly displaced

52
Q

classification of proximal humerus fractures

A

typeI: one part fracture
typeII: two part fracture
typeIII: three part fracture
typeIV :four part fracture
typeV:antrtior or posterior fracture dislocation
head spliting fractures

53
Q

types of humeral shaft fractures

A

-simple
-wedge
-complex

54
Q

how is complex humeral shaft fracture treated?

A

with paltes and screws

55
Q

what is a better type of fixation, plates or rods for humeral shaft fractures?

A

plates (palting of the humerus is better than an IM rod)

56
Q

how are humeral shaft fracture treated in the majority of cases?

A

consevitavely

57
Q

what nerve could be affected with humeral shaft fractures?

A

radial nerve, causing radial nerve palsy, which is common

58
Q

what will cause the adduction of the proximal fragment of shaft of humerus if it was fractured?

A

if the fracture was in the proximal third of the shaft (distal to pec major attachment and proximal to to deltoid tubrosity)

59
Q

what will cause the shortining of the fracture and abduction of the proximal fragment of shaft of humerus if it was fractured?

A

if the fracture was distal to the deltoid tubrosity, due to the pull from the deltoid muscle and the shortining will be due to pull from the bicpes and triceps

60
Q

etiology of hemeral fractures

A

proximal and humeral shaft fractures due to:
-direct blow
-fall on outstretched arm
-dislocation (only proximal)

61
Q

where are epiphysial fractures more common in?

A

young athletes

62
Q

etiology of epiphysial fractures of humerus

A

-direct blow
-indirect blow travilling aliing long axis of humerus

63
Q

signs and symptoms of humeral fractures

A

-pain
-swelling
-point tenderness
-decreased ROM

64
Q

consevarive management of humeral fratures

A

-immidiate application of splint
-treat for shock
-refer

65
Q

conservative management for proximal humeral fractures

A

incapcitation 2-6 months

66
Q

conservative management for humeral fractures

A

remove from activity for 3-4 months

67
Q

conservative management for epiphysial fractures

A

quick healing - 3 weeks

68
Q

what supports the SC joint?

A

strong ligaments;
-sternoclavicualr ligaments
-costoclavicular ligaments

69
Q

etiology of SC joint sprain

A

-indirect force
-blunt trauma (may cause displacement)

70
Q

signs and symptoms of SC joint sprain grade1

A

pain and slight disability

71
Q

signs and symptoms of SC joint sprain grade2

A

-pain
-subluxation with deformity
-sweliing
-point tenderness
-dereased ROM

72
Q

signs and symptoms of SC joint sprain grade3

A

-gross deformity (dislocation)
-pain
- swelling
-decrease ROM

73
Q

when could SC joint sprain be life-threatning?

A

if it was disclocated posteriorly

74
Q

consevative management of SC joint sprain

A

-RICE
-reduction if necessary
-immobilize for 3-5 weeks followed by graded reconditioning

75
Q

AC joint sprain classification

A

typeI: sprain
typeII: partail tear
typeIII: complete tear
typeIV: clavicle dispalced posteriorly
typeV: high clavicle displacement
typeVI: inferior clavicle displacement

76
Q

AC joint sprain etiology

A

-direct blow (from any direction)
-upward force from humerus

77
Q

AC joiunt sprain is graded depending on what?

A

severity of the sprain

78
Q

what causes step deformity?

A

AC joint sprainwh

79
Q

what causes sulcus sign?

A

inferior dislocation of GH joint

80
Q

conservative management of AC joint sprain

A

-ice, stabelization, referral to physician
-aggresive rehab (required with all grades)

81
Q

management of grade 1-3 AC joint sprain

A

-non-operative:
-3-4 days of immobilization for grade 1
-2 weeks of immobilization for grade 2

82
Q

treatment of grades 4-6 of AC joint sprain

A

they require surgery

83
Q

what does AC joint rehab include?

A

-joint mobolization, flexibilty exercises, and strengthining should occur immediately
-padding and protection may be required until pain free ROM returns

84
Q

in AC joint rehab, how should the progress be?

A

it should be as the athlete tolerates without pain and swelling

ortho (6 decks)

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