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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
name the GH bursae
-subacromial bursae -subdeltiod bursae
26
what is the zero position of the shoulder?
the upper arm lies parallel to the trunk with the elbows extended and the thumbs pointing ventrally
27
what is the resting position of the shoulder? (loose pack)
-55 shoulder abduction -30 horizontal adduction -slight ER
28
what is the closed packed position of the shoulder?
-maximal shoulder abduction -lateral rotaion (causes GH anterior dislocation)
29
shoulder capsular pattern
-lateral rotation (ER) -abduction -medial rotaion (IR)
30
forced couple for scapular apward rotation
-serratus anterior -coupled with (upper trapizius and lower trapizius)
31
forced couple for scapular downward rotation
-rhomboids coupled with (pectoralis minor and levator scapulae)
32
what does forced couple help with?
making the movements smooth and easy
33
what is the difference between static and dynamic structures?
dynamic is muscles that help in stabelization static is anything that doesnt contract such as tendons and ligaments
34
what do the rotator caff muscles act as?
dymanic stabelizers of the GH joint
35
name the rotator cuff muscles
(SITS) -supraspinatus -infraspinatus -teres minor -subscapularis
36
rotator cuff muscle inserted in the greater tubercle
-supraspinatus -infraspinatus -teres minor
37
rotator cuff muscle inserted in the lesser tubercle
-subscapularis
38
which muscles form force couple on the GH joint
-deltoid -rotator cuff muscles
39
what movement does the deltoid and rotaor cuff muscles produce on the GH joint using force couple?
rotation of humerus during abduction and flexion
40
what is Allman's classification for clavicular fractures is based on?
the anatomical location of the fracture
41
classification of clavicular fractures
group 1 group 2: type1, type 2 (a,b), type3 group 3
42
etiology of clavicular fractures
-fall on outstretched arm -fall on the tip of the shoulder -direct impact
43
what are the signs and symptoms of clavicular fractures
-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
how are clavicular fractures managed conservitavly?
-clossed reduction using sling and swathe -immobelize with figure of 8 brace for 6-8 weeks
45
in calvicular fractures, what should the removal of brace be followed by?
-joint mobelization -iosometric exercises -using sling for 3 weeks
46
what determines if the clavicular fracture management should be conservative or non-conservative?
the amount of displacement - conservatice <100% dispalced -operative >100% dispalced
47
when is ORIF need for clavicular fractures?
if it was displaced, plating is also used
48
what is the most common area of clavicular fractures?
middle third
49
where do green stick fractures of the clavicle often occur?
in young athletes
50
types of scapular fractures
body: -scapular spine fracture -glenoid fossa fracture extra-articular fractures: -acromial fracture -coracoid fracture -scapular neck farcture/ clavicle fracture
51
how are most scapular fractures treated?
conservitavely, even if the fracture is moderatly displaced
52
classification of proximal humerus fractures
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
types of humeral shaft fractures
-simple -wedge -complex
54
how is complex humeral shaft fracture treated?
with paltes and screws
55
what is a better type of fixation, plates or rods for humeral shaft fractures?
plates (palting of the humerus is better than an IM rod)
56
how are humeral shaft fracture treated in the majority of cases?
consevitavely
57
what nerve could be affected with humeral shaft fractures?
radial nerve, causing radial nerve palsy, which is common
58
what will cause the adduction of the proximal fragment of shaft of humerus if it was fractured?
if the fracture was in the proximal third of the shaft (distal to pec major attachment and proximal to to deltoid tubrosity)
59
what will cause the shortining of the fracture and abduction of the proximal fragment of shaft of humerus if it was fractured?
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
etiology of hemeral fractures
proximal and humeral shaft fractures due to: -direct blow -fall on outstretched arm -dislocation (only proximal)
61
where are epiphysial fractures more common in?
young athletes
62
etiology of epiphysial fractures of humerus
-direct blow -indirect blow travilling aliing long axis of humerus
63
signs and symptoms of humeral fractures
-pain -swelling -point tenderness -decreased ROM
64
consevarive management of humeral fratures
-immidiate application of splint -treat for shock -refer
65
conservative management for proximal humeral fractures
incapcitation 2-6 months
66
conservative management for humeral fractures
remove from activity for 3-4 months
67
conservative management for epiphysial fractures
quick healing - 3 weeks
68
what supports the SC joint?
strong ligaments; -sternoclavicualr ligaments -costoclavicular ligaments
69
etiology of SC joint sprain
-indirect force -blunt trauma (may cause displacement)
70
signs and symptoms of SC joint sprain grade1
pain and slight disability
71
signs and symptoms of SC joint sprain grade2
-pain -subluxation with deformity -sweliing -point tenderness -dereased ROM
72
signs and symptoms of SC joint sprain grade3
-gross deformity (dislocation) -pain - swelling -decrease ROM
73
when could SC joint sprain be life-threatning?
if it was disclocated posteriorly
74
consevative management of SC joint sprain
-RICE -reduction if necessary -immobilize for 3-5 weeks followed by graded reconditioning
75
AC joint sprain classification
typeI: sprain typeII: partail tear typeIII: complete tear typeIV: clavicle dispalced posteriorly typeV: high clavicle displacement typeVI: inferior clavicle displacement
76
AC joint sprain etiology
-direct blow (from any direction) -upward force from humerus
77
AC joiunt sprain is graded depending on what?
severity of the sprain
78
what causes step deformity?
AC joint sprainwh
79
what causes sulcus sign?
inferior dislocation of GH joint
80
conservative management of AC joint sprain
-ice, stabelization, referral to physician -aggresive rehab (required with all grades)
81
management of grade 1-3 AC joint sprain
-non-operative: -3-4 days of immobilization for grade 1 -2 weeks of immobilization for grade 2
82
treatment of grades 4-6 of AC joint sprain
they require surgery
83
what does AC joint rehab include?
-joint mobolization, flexibilty exercises, and strengthining should occur immediately -padding and protection may be required until pain free ROM returns
84
in AC joint rehab, how should the progress be?
it should be as the athlete tolerates without pain and swelling

ortho (6 decks)

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