Shoulder OP

Question 1

What muscles make up the rotator cuff?

Answer 1

Supraspinatus, infraspinatus, subscapularis, teres minor

Question 2

Subscapularis

Answer 2

Rotator cuff muscle
Origin = subscapular fossa
Insertion = lesser tubercle of humerus
Actions = internal rotation

Question 3

Infraspinatus

Answer 3

Rotator cuff muscle
Origin = infraspinatus fossa of scapula
Insertion = greater tubercle of humerus
Actions = external rotation

Question 4

Supraspinatous

Answer 4

Rotator cuff muscle
Origin = supraspinatus fossa of scapula
Insertion = greater tubercle
Actions = abduction

Question 5

Teres Minor

Answer 5

Rotator cuff muscle
Origin = lateral border or scapula
Insertion = greater tubercle of humerus
Actions = lateral rotation, extension

Question 6

Teres Major

Answer 6

NOT a rotator cuff muscle - deep to teres minor
Origin = lateral border of scapula at inferior angle
Insertion = bicipital groove of humerus
Actions = medial rotation, extension, adduction

Question 7

Deltoid

Answer 7

Origin = distal clavicle, acromion process,
Insertion = deltoid tuberosity of humerus
Actions = abduction, extension, flexion, external rotation, internal rotation

Question 8

Biceps Brachii

Answer 8

Origin = long head > supraglenoid tubercle of scapula
Origin = short head > coracoid process of scapula
Insertion = radial tuberosity
Actions = flexion or arm and shoulder, supination

Question 9

Brachialis

Answer 9

Origin = anterior shaft of humerus
Insertion = coronoid process of ulna
Actions = elbow flexion

Question 10

Triceps Brachii

Answer 10

Antagonist to biceps brachii
Origin = long head > infraglenoid tubercle of scapula
Origin = medial head > posterior medial humerus
Origin = lateral head > posterior lateral humerus
Insertion = olecranon process of ulna
Actions = extension of elbow and shoulder

Question 11

Trapezius

Answer 11

Origin = nuchal ligament, spinous process of C7-T12, occipital bone
Insertion = clavicle, acromion process and spine of scapula
Actions = elevation, adduction, retraction, upward rotation, depression

Question 12

Levator Scapulae

Answer 12

Origin = transverse process of C1-C4
Insertion = superior medial border of scapula
Actions = elevation and downward rotation

Question 13

Pectoralis Major

Answer 13

Origin = rib 2-5 or 3-5
Insertion = coracoid process of scapula
Actions = flexion of arm at shoulder, extension of flexed arm, medial rotation of humerus, adduction of humerus

Question 14

Pectoralis Minor

Answer 14

Origin = medial clavicle and costal cartilages of rib 1-6
Insertion = bicipital groove of humerus
Actions = flexion of arm at shoulder, extension of flexed arm, medial rotation of humerus, adduction of humerus

Question 15

AC ligament

Answer 15

Origin = anteromedial head of acromion
Insertion = lateral aspect of clavicle

Question 16

GH ligament

Answer 16

Superior, middle, inferior
Origin = glenoid fossa
Insertion = neck of humerus

Question 17

CHL

Answer 17

Origin = lateral aspect of base of coracoid process
Insertion = greater and lesser tubercles of humerus

Question 18

CCL

Answer 18

Trapezius ligament
Origin = coracoid process
Insertion = 3cm from distal clavicle

Conoid ligament
Origin = coracoid process
Insertion = slightly posterior, 4.5cm from distal clavicle

Question 19

CAL

Answer 19

Origin = acromion
Insertion = lateral border of coracoid process

Question 20

THL

Answer 20

Origin/insertion = greater and lesser tubercles of humerus

Holds biceps long head tendon

Question 21

What plexus supplies the shoulder, arm and forearm. Name these nerves.

Answer 21

The brachial plexus (C5-T1)

Consists of the musculocutaneous, axillary, radial, ulnar and medial

Question 22

Which nerve is most commonly injured in shoulder injuries?

Answer 22

Axillary nerve

Question 23

What does the military patch tell you?

Answer 23

If the patient cannot feel you touching their deltoid area this is a sign of compression of the axillary nerve as the deltoid is innervated by it.

This is a sensory test

Question 24

What are the test for fractures of the shoulder girdle?

Answer 24

Piano key, tuning fork and tap test

Question 25

What is a step deformity?

Answer 25

This is a sign of an AC dislocation as the acromion process will be very prominent

Question 26

Name the special tests for GH subluxations

Answer 26

Apprehension and load and shift

Question 27

What is a special test for SLAP lesions? Describe how to perform it.

Answer 27

O’Briens test > flex shoulder about 90 degrees > adduction about 15 degrees > point thumb down and apply downward force > then face palm up and apply load = > pain with thumb down and not with palm up is a positive O’Briens test

Pay attention to where* patient is having pain
-anterior could mean its an AC joint injury
-SLAP lesion injuries usually elicit pain posteriorly

Question 28

Should special tests be performed on AC and GH dislocations?

Answer 28

No, they should not be performed on dislocations. If there is a dislocation, sling and go to hospital.

Question 29

Name the special tests for AC subluxation

Answer 29

AC compression/shear test and cross body O’Briens