Shoulder part 1 Flashcards
tenodesis
the surgical suturing of the end of a tendon to a bone. Like when the long head of the biceps is shortened and attached to the bicipital groove
What is the clinical relevance of palpating the clavicle
Clavicle is the most commonly fractured bone in the body.
It usually fractures at mid-third where it transitions from anterior convexity to posterior concavity.
PIP
proximal interphalangeal joint
DIP
Distal Interphalangeal joint
ACDJD
Acromioclavicular (AC) Degenerative Joint Disease
Often presents in older patients
Clinical Significance: anterior joint line (of GH joint)
cannot directly palpate, but do palpate area because if patient has had chronic subluxation or dislocations then this area could be problematic
Internal Rotation Muscles of GH joint (5)
- Latissimus dorsi
- Teres major
- Anterior deltoid
- Subscapularis
- Pectoralis major
External rotation muscles of GH joint (3)
- Infraspinatus
- Teres Minor
- Posterior Deltoid
Flexion muscles of GH joint (2 pectoral girdle, 2 arm)
- Anterior deltoid
- Pectoralis Major: Clavicular head
- Coracobrachialis?
- Biceps brachii; Long & Short heads?
Abduction muscles of GH joint (3)
- Middle Deltoid
- Supraspinatus
- Above 90 degrees: Pectoralis major, sternal head
Adduction muscles of GH joint (5-6)
- Subscapularis
- Anterior Deltoid (below 90 degrees?)
- Posterior Deltoid (below 90 degrees?)
- Teres Major
- Latissimus Dorsi
- Pectoralis major: Sternal head always, Clavicular head below 90 degrees
Extension muscles of GH joint (4)
- Subscapularis
- Posterior Deltoid
- Teres Major
- Latissimus Dorsi
Elevation muscles of scapulothoracic joint (2)
- Upper Trapezius
- Levator Scapulae
Upward rotation muscles of scapulothoracic joint (2-4)
- Upper, Middle, and Lower Trapezius
- Serratus Anterior
Scapular retraction muscles (2-3)
- Middle Trapezius
- Rhomboid major & minor
scapular depression muscles (3)
- Lower Trapezius
- Latissimus Dorsi
- Pectoralis minor
Downward rotation muscles of scapulothoracic joint (3-4)
- Rhomboid major & minor
- Levator scapulae
- Latissimus dorsi
Scapular protraction muscles (1)
Serratus anterior
os acromiale
failure of distal end of acromion to ossify
SAD
subacromial decompression
The most common shoulder surgery
Physis
- GROWTH plate
- Specialized cartilaginous tissue interposed b/w metaphysis & Epiphysis in LONG bones in children
- Provides GROWTH in LENGTH of long bone
physis
GROWTH plate Specialized cartilaginous tissue interposed b/w metaphysis & Epiphysis in LONG bones in children Provides GROWTH in LENGTH of long bone
What is the clinical significance of the suprasternal notch?
there is none
where is the anterior (GH) joint line
from coracoid process to the inferior axillary fold
Anterior Impingement syndrome
where the subscapularis get’s compressed against the coracoid process. I think it is also called coracoid impingement syndrome.
Could show up when palpating the coracoid process.
coracoid impingement syndrome
probably the same as anterior impingement syndrome.
Subscapularis gets compressed against the coracoid process.
what structure(s) can be palpated by moving fingers off the anteriolateral edge of the acromion onto the humeral head?
superior facet of the greater tubercle of the humerus (supraspinatus tendon).
If you slide fingers posteriorally, you should feel middle and inferior facet, where conjoined tendons of infraspinatus and teres minor attach.
Which tendon is most often involved in RCT? Which is the second?
- Supraspinatous tendon
- Infraspinatus tendon
When palpating, should the transition from superior to middle facet of the greater tubercle of the humerus jump out at you?
No! it is very subtle
What will you find about 1.5 - 2 body inches of the anterior (and lateral?) side of the acromion?
The Bicipital Groove and Transverse Humeral Ligament (THL) that covers it.
What is the clinical significance of palpating the long head biceps tendon?
the biceps is a common problem when you have impingement issues
Tendinopathy
The term tendinopathy is a generic descriptor of the clinical conditions ( both pain and pathological characteristics) associated with overuse in and around tendons
What 2 things might be involved/considered after finding pain over LHB tendon in bicipital groove upon palpation?
- Tendinopathy
- Tenodesis
tenodesis
the surgical suturing of the end of a tendon to a bone. In the LH biceps tendon it is attached to the bicipital groove
What is the clinical significance of the soft spot palpable just below the posterior lateral portion of the acromion?
it is where a lot of subacromial injections are done
it is a posterior arthroscipic portal site.
it is where internal impingement most commonly occurs.
For us it is a landmark
What is the clinical significance of palpating the superior angle of the scapula?
- Levator scapula attaches here
- Referral from C-spine (called something that sounds like flower sign)
- Rule out fractures
What is the clinical significance of palpating the medial border of the scapula?
check for pain and if something might be going on
Clinical significance for palpating axillary border of the scapula
Axillary border can be fractured, but it is not very common
Is it common for the SC joint to get injured?
No
What is the most common injury seen in SC joint and which population is it found in?
anterior subluxation in wrestlers
SC joint posterior subluxation
VERY SERIOUS because of underlying structures (trachea & carotid artery)
Also very rare!
What is the most common problem in AC joint?
AC sprain
Characteristics of AC sprain or AC problems?
Think of Ron (a class of 2017 classmate with this condition)
- Asymmetry(looks like clavicle is riding up, but really scapula is dropping down)
- AC OA is common
- AC DJD is common in older people
- AC osteolitis is another problem that we may find
OA is
Osteoarthritis
RA is
Rheumatoid arthritis
osteolysis
active resorption of bone matrix by osteoclasts.
Sometimes found in weight lifters
GH joint ligaments to palpate
- Anterior capsule
- Posterior capsule
- Transverse humeral ligament (over LHB tendon)
CA ligament
- it is the Coracoacromial ligament. Find between coracoid process and anterior edge of acromium.
- Doesn’t jump out of you
- Small fibrous band
- palpate inferior to superior
- one of the most vital ligaments in regards to impingement
What is the most vital ligament in subacromial impingment?
CA ligament (Coracoacromial ligament)
