Shoulder Lecture Flashcards
What is the most mobile joint in the body?
Shoulder
GH joint brings shoulder to what angle?
90 degrees
Shoulder is comprised of what joints?
- GH (ball and socket synovial)
- Sternoclavicular (cartilaginous)
- AC (cartilaginous)
Muscles of shoulder girdle
3 groups:
- Rotator cuff (SITS)
- Trap, serrat anterior, rhomboids, lev scapulae
- Pec major and minor, lat dorsi
Rotator cuff muscles
SITS
- Supraspinatus (superior most)
- Infraspinatus (posterior)
- Teres minor (posterior)
- Subscapularis (anteiror)
Which muscles attach the scapula to the trunk and RAISE the scapula?
- Trap
- Serratus anterior
- Rhomboids
- Levator scapulae
Which muscles internally rotate the shoulder?
- Pec major
- Pec minor
- Lat dorsi
Inspection of the shoulder:
- Trauma or scars
- Muscular symmetry
- Clavicles for symmetry
- Lumps over AC joint (previous AC separation)
- Scapular winging (weakness in serrat anterior muscle)
What causes scapular winging?
Weakness in serratus anterior muscle (long thoracic nerve)
Bony palpation of shoulder:
- Suprasternal notch (immediately lateral to this is SC joint)
- Along the clavicle
- Outer third of clavicle but before AC joint, lower finger and may be able to palpate coracoid process
- Acromion
- Proximal humerus
How to palpate proximal humerus?
- Bicipital groove is here (long head of biceps tendon)
- Pt ER arm to facilitate
- Palpate tendon gently (it is sensitive)
How to palpate rotator cuff?
- Stand behind pt
- Passively extend shoulder (this moves supraspinatus out from under acromion for palpation)
- Cup hand over top of shoulder to palpate subacromial bursa
The shoulder ROM includes:
- Abduction (180 degrees)
- Adduction (60 degrees)
- Extension (60 degrees)
- Flexion (160-180 degrees)
- ER (75-90 degrees)
- IR (60 degrees)
Easiest way to assess AROM of the shoulder?
Apley Scratch test
Describe Apley Scratch test
- Used to test AROM of shoulder
- Pt touches opposite shoulder (adduction/IR), behind head (adduction/IR), and behind back
9 motions of the shoulder
- Flex
- Extension
- Abduction
- Adduction
- ER
- IR
- Scapular elevation
- Scapular retraction
- Scapular protraction
Which muscles help flex the shoulder?
Coracobrachialis
Pec major
Anterior deltoid
Biceps
Which muscles help extend the shoulder?
Lat dorsi
Teres major/minor
Posterior deltoid
Triceps
Which muscles help abduct the shoulder?
Deltoid
Supraspinatus
Serratus anterior
Which muscles help adduct the shoulder?
Pec major
Lat dorsi
Teres major
Deltoid
Which muscles help ER the shoulder?
TIP
Teres minor
Infraspinatus
Posterior deltoid
Which muscles help IR the shoulder?
Subscapularis Pec major Lat dorsi Teres major Deltoid
Which muscles help with scapular elevation?
Trap
Levator scapulae
Rhomboids
Which muscles help with scapular retraction?
Rhomboids
Trapezius
Which muscles help with scapular protraction?
Serratus anterior
What is Speed’s test?
- Test for bicipital tendinitis
- Arm elevated to 90 degrees forward flex of shoulder w/elbow straight and arm supinated
- Push down on pt palm
- Positive: pain in anterior shoulder (bicipital groove)
What is the empty can test?
- Tests supraspinatus tendinitis/tear
- Pt puts arms out in front and “empties cans”
What is the impingement sign?
- Passively lift (forward flex) arm from 0 degrees up to 180
- Positive: pain between 90 and 150 degrees
- Sign of impingement from bursitis or chronic impingement
What is the apprehension sign of the shoulder?
- Bring pt’s arm up into throwing position (abducted/ER)
- Watch for apprehension
- Indicates instability due to torn labrum, Bankart lesion, or anterior dislocation of shoulder
What is the relocation sign of the shoulder?
- After establishing positive apprehension sign, lie pt prone on table
- Reproduce apprehension sign
- Reach underneath and push humeral head posteriorly
- Bring back to apprehension position
- If pt can tolerate this w/o apprehension, confirms anterior instability
What is the point of the relocation sign of the shoulder?
Temporarily stabilize shoulder through manipulation (resolving apprehension)
