Shoulder MSK Flashcards
Deltoid
C5,6, Posterior cord, Axillary nerve
Pec Major
C5,6,7,8,T1, Medial and lateral pectoral nerves
Biceps Brachii
C5,6, Lateral cord, Musculocutaneous nerve
Coracobrachialis
C5,6, Lateral cord, Musculocutaneous nerve
Latissimus Dorsi
C6,7,8, Posterior cord, thoracodorsal nerve
Teres Major
C5,6, Posterior cord, lower subscapular nerve; does whatever the lats do
Triceps
C6, 7,8, Posterior cord, Radial Nerve
Pectoralis Major
C5,6,7,8,T1, medial and lateral pectoral nerves
Shoulder flexion
Anterior deltoid, pectoralis major, Biceps, Coracobrachialis
Shoulder extension
Posterior deltoid, latissimus dorsi, teres major, triceps, pectoralis major
Shoulder abduction
middle deltoid, supraspinatus
Supraspinatus
C5,6, upper trunk, suprascapular nerve
Infraspinatus
C5,6, upper trunk, suprascapular nerve
Shoulder adduction
pectoralis major,
Inferior GH ligament
primary anterior ligament stabilizer above 90 degrees; prevents antero-inferior dislocations of humerus
Loose ligaments of shoulder , hyper mobile people what type of strengthening
isometric , not much movement of humeral head
triceps attachement
infraglenoid tuberosity
biceps long and short head attachments
long head- supraglenoid tuberosity
short head- coracoid process
shoulder internal rotation
subscapularis, teres major, lats
shoulder extension
rear deltoid, lats, teres major, triceps
Traumatic shoulder dislocation— TUBS
traumatic, unidirectional, bankhard, surgery
Atrauamtic shoulder dislocation- AMBRI
atraumatic, multidirectional, bilateral, rehab, if surg requred inferior capsular shift
Flex arm to 90 deg and internally rotate, then adduct arm across body, while pushing humerus posteriorly
jerk test- pt will jerk away if possible
flex arm upward and apply posterior inferior force (dont have to adduct or internally rotate)
Kim test
O brien
labral tear, supinating feels better than palm down against resistance
Posterior cutaneous nerve of thigh nerve roots
(S1-S3) part of sacral plexus.
Innervation of levator scapulae
Dorsal scapular
Function of piriformis
The piriformis muscle abducts, externally rotates, and extends the hip
Biceps femoris long head action
adducts hip
which carpal bone crosses both proximal and distal carpal rows
The scaphoid bone is the only carpal bone that crosses both carpal rows.
Function of iliofemoral ligament
The iliofemoral ligament is the strongest ligament of the body and limits extension, abduction, and external rotation of the hip.
Floor, roof, medial and lateral walls of Guyon’s canal
What structures traverse through Guyon’s canal ?
The floor- transverse carpal ligament
the roof is the volar carpal ligament
medial and lateral walls are formed by the pisiform and hook of hamate.
The canal houses both the ulnar nerve and the ulnar artery. Fractures or masses (eg, ganglion cyst) can compress the nerve or artery at this location.
The Lisfranc ligament connects what structures?
the base of the medial cuneiform to the base of the second metatarsal. It is injured or disrupted in a Lisfranc fracture.
Function of Peroneus tertius
dorsiflexes and everts the foot.
Function of Peroneus brevis
everts and plantar flexes the foot.
Function of tib anterior
ankle dorsiflexor and invertor.
Synovial joint types
Ball-and-socket joints (eg, hip joint [multiaxial], provide the most ROM. The saddle joint is a biaxial joint that provides the second most ROM. Hinge (elbow-uniaxial) Pivot (atlanto-axial joint-uniaxial) Condyloid joints (metacarpophalangeal joints-biaxial) Plane joints (acromioclavicular).
Function of semitendinosis
Internal rotation of hip
Obturator internus, Quad fem, Superior gemellus, glut max are all
External rotators of hip
Normal ROM of ankle
Normal ROM for the ankle is 50° of plantar flexion and 20° of dorsiflexion.
dorsal interroseous muscle function
abduct the digits and MCP flexion.
ACL function
It draws the femoral condyles anteriorly during flexion
Prevents hyperextension of the knee and backward sliding of the femur
Internal rotation of the femur tightens it, and external rotation loosens it
Prevents hyperextension of the knee and backward sliding of the femur
ACL
Internal rotation of the femur tightens it, and external rotation loosens it
ACL
It draws the femoral condyles anteriorly during flexion
ACL
The main flexor of the forearm
is the brachialis muscle (originates at the lower half of the anterior humerus and inserts at the ulnar tuberosity)
4 compartments of lower leg
The deep posterior, superficial posterior, lateral, and anterior compartment makes up the four compartments of the lower leg.
No medial compartment
Borders of carpal tunnel
The roof of the carpal tunnel is formed by the transverse carpal ligament; the floor is formed by the central carpal bones. The medial wall is formed by the hamate and the pisiform bones. The lateral wall is formed by the trapezius and scaphoid bones.
Which ligament can be mistaken for a tear of the posterior horn of the lateral meniscus on MRI?
Arcuate popliteal ligament complex
Arm and forearm articulations
The radial head articulates with the capitellum and the ulna articulates with the trochlea.
Dorsal compartments of hand
I-extensor pollicis brevis, abductor pollicis longus; II-ECRB, ECRL III-EPL IV-ED, EI V- EDM VI- ECU
Tensor fasciae lata
Gluteus medius
Gracilis
are all
External rotators of the hip
AC ligament sprained, CC intact
AC joint intact without clavicular displacement
Type 1 AC joint separation, rehab
Complete tear AC
CC ligament sprained
AC joint disrupted with slight widening and mildly elevated
Type II, rehab
Complete tear AC
Ruptured CC
Clavicle elevated above superior border of the acromion
Type III, +/- surgery
Complete rupture AC
Complete Rupture CC
Clavicle displaced POSTERIORLY and superiorly
Type IV, Surgery
Complete rupture AC
Complete rupture CC
CC distance more than 100% of opposite side with severe shoulder droop on exam
Type V, surgery
Complete rupture AC, Complete rupture CC, distal clavicle inferior to coracoid
Type VI, rare, surgery
Jerk test (opposite of apprehension)
posterior GH instability, place arm in 90 deg flexion and max internal rotation with elbow flexed 90 degrees, adduct the arm across the body in the horizontal plane while pushing the humerus in a posterior direction.The patient will jerk awy when arm nears midline to prevent sublux.
shoulder fusion position
50 deg abduction 30 deg forward flexion 50 deg internal rotation
ROM to go first with adhesive capsulitis
external rotation and abduction
Most common area of humerus fx
surgical neck
in fracture at surgical neck what muscle is the principal abductor
supraspinatus (causes abduction of the proximal fragment of the humerus)
surgical neck fx axillary nerve may be injured, affecting which muscles and sensation distribution?
deltoid, teres minor, sensation of lateral arm/shoulder
AVN from humeral neck fractures secondary to interruption of the
humeral circumflex artery
little leagers shoulder
stress fx of epiphyseal growth plate in the proximal humerus
Proximal humerus fractures classification and treatment
Proximal humerus fractures are classified using the 4-part classification system.
In 1-part fractures, the humerus remains as one whole part (intact), with no elements displaced off the humerus. These are treated with a sling.
In 2-part fractures, one of the 4 “parts” (greater and lesser tuberosities, humeral head, humeral shaft) is displaced from the other 3, thus leaving 2 “parts” of bone existing in the proximal arm: the displaced fragment and the still intact other 3 parts.
In 3-part fractures, 2 of these parts are broken off
In 4-part fractures, all 4 of these parts are separated from one another. 2-4 part fractures require surgery,
Roos test
abduct and externally rotate their shoulders to 90 degrees and then begin opening and closing their hands over a 3-minute period….neurogenic thoracic outlet syndrome, lower brachial plexopathy
Hill Sach’s lesion treatment
referral to ortho
A true glenohumeral dislocation with an associated Hill Sachs lesion is an indication of instability of the shoulder joint. Absolute indications for an early orthopaedic consultation include a humeral head articular surface osseous defect of greater than 25%, greater than 50% rotator cuff tear, glenoid osseous defect greater than 25%, humeral head articular surface osseous defect greater than 25%, proximal humerus fracture requiring surgery, irreducible dislocation, interposed tissue or nonconcentric reduction, failed trial of rehabilitation, inability to tolerate shoulder restrictions, or inability to perform sport-specific drills without instability.
Absolute indications for an early orthopaedic consultation i
humeral head articular surface osseous defect of greater than 25%, greater than 50% rotator cuff tear, glenoid osseous defect greater than 25%, humeral head articular surface osseous defect greater than 25%, proximal humerus fracture requiring surgery, irreducible dislocation, interposed tissue or nonconcentric reduction, failed trial of rehabilitation, inability to tolerate shoulder restrictions, or inability to perform sport-specific drills without instability.
SLAP vs anterior-inferior labrum tear
question 109 in certification q bank
This patient presents with an anterior-inferior labrum tear related to chronic unidirectional anterior shoulder instability following a prior traumatic event (dislocation). This type of instability is common after a traumatic event as opposed to multidirectional instability, which is associated with congenital laxity or chronic repetitive microtrauma. Anatomically, unidirectional anterior instability involves disruption in the anterior-inferior glenohumeral joint capsule and anterior-inferior labrum with or without associated bony injury to the glenoid rim (Bankhart lesion) and humeral head (Hill-Sachs deformity). Superior labral anterior to posterior (SLAP) lesions may occur, but that possibility is less likely in this patient, because of his history and a negative O’Brien compression test.
Muscles that
tilts the glenoid cavity inferiorly:
tilt the cavity superiorly:
The levator scapula and rhomboids
Serratus anterior and trapezius
Three important spaces of the shoulder that are bordered by the triceps include
quadrangular space
triangular space
triangular interval
The axillary nerve passes through the quadrangular space. The scapular circumflex artery passes through the triangular space. The radial nerve and profunda brachii artery pass through the triangular interval.
quadrangular space borders
teres minor superiorly,
the long head of the triceps medially,
the teres major inferiorly,
and the surgical neck of the humerus laterally
axillary nerve passes through
triangular space borders
inferior: teres major
lateral: long head of triceps
superior: lower border of teres minor
scapular circumflex artery passes through
Triangular Interval Borders
superior: teres major
lateral: lateral head of the triceps or the humerus
medial: long head of the triceps
Contents profunda brachii artery and
radial nerve
GH to scapulothoracic
Superior glenohumeral, middle glenohumeral and inferior glenohumeral ligament
120 deg/ 60 deg
2:1 ratio
Rehab after shoulder athrodesis
Rehab after dislocated shoulder
The return of ROM should be gradual at about 10 degrees per week, which would put the return of ROM at 6-8 weeks.
Rehab for shoulder arthrodesis is slow, avoiding AROM until 8-12 weeks or more.
shoulder arthrodesis is 30 degrees abduction, 30 degrees flexion, 30 degrees internal rotation.
clavicle fx common
middle 1/3
For Group 1, non-displaced fractures, ROM exercises can begin at 2-4 weeks.
