Shoulder pathologies Flashcards
GH ligament actions
anterior band-static restraint to ant rot at 90-90 (abd/ER)
middle- static restraint to ant translation in the mid range of shoulder elevation
superior-prevent excessive rotation and inf translation with the arm at side
TUBS vs AMBRI
TUBS- Traumatic onset, Unidirectional (ant), Bankart lesion (usually present), Surgery
AMBRI- Atraumatic, Multidirectional in nature, Bilateral (usually), Rehab, Inferior capsular shift
HAGL
uncommon avulsion of humeral attachment at GH ligament.
Cause is dislocation.
Bankart Lesion
detachment of the anchoring point of the and band of the inferior GH lig and middle GH lig from glenoid tubercle.
Results in ant dislocaion of GH joint
SLAP tears
SUPERIOR LABRUM ANTERIOR AND POSTERIOR
“zipper effect”
usually results from a sudden downward force or a supinated outstretched UE or fall on the lateral shoulder
Complain of popping and sliding of the shoulder, especially overhead activities
Avg time to dx is 2.5 yrs
Hawkins GH ant translation grading scheme
Grade I- 50% of humeral head translation (does not move over rim edge)
Grade II- >50% humeral head translation (humeral head moves over glenoid rim edge but reduces with release)
Grade III- the head remains dislocated on release
Hill-Sachs lesion
Think ant shoulder dislocation. Impression fracture of the post-lateral margin of the humeral head caused by impaction of the rim on the glenoid during an ant shoulder dislocation
Labral anatomy variations
sublabral foramen- sulcus between a well developed ant sup portion of the labrum and glenoid (from 1 to 3:00)
sublabral recess- sublabral foramen and a cordlike middle GH ligament (from 11-1:00)
buford complex- the complete absence of labral tissue at the ant-sup aspect of labrum (from 1-3:00)
Types of acromia
type I-flat undersurface (3% RCT)
type II-curves downward (27% with RCT)
type III-hooked downward (70% with RCT)
Impingement: sy/sx
overlap with RC lesion
tipping scapula may play role in genesis
chronic: develops over months/yrs
pt over 40 yo
weakness and stiffness secondary to pain
pain/aggravated with overhead activity
Neer RC/Impingement Classification
Stage I- edema and hemorrhage 20
Stage II- fibrosis and tendinitis 25-40
Stage III-bone spur and tendon rupture >40 could b e surgical
Stage IV- cuff tear arthroplasty >60 could be shoulder replacement
Posterior impingement
impingement of the supraspinatus against the post glenoid/labrum
primary overhead athletes
may see GHJ hypermobility or instability
pain with abduction/ER/horizontal abd (cocking to throw)
test: pain with above position, IRRST
Bursitis
rare for bursa to be PRIMARY source of pain
common in RA, tuberculosis, gout, and pyogenic infections
direct insult can be a mechanism
typically subacromial/subdeltoid bursa
repetitive microtrauma
prevalent 25-40 yo
RCT presentation
weakness of > than 50% abd strength in 10 deg shoulder abd is indicative of a large to massive RTC tear
history of shoulder pain with overhead positions and ER
can radiate to biceps mm region
pain typically later shoulder and can radiate down arm
severe RCT, can have numbness and tinging in UE. Axillary likely involved.
labral involvement with trauma
Biceps tendinopathy
pain and weakness with shoulder flx, ebow flx, supination, and abd with ER
impingement signs typically +
pain with activity
relief with rest
yergason’s test
speed’ test
