shoulder pre class Flashcards
glenohumeral joint - joint type
multaxial ball and socket synovial joint
labrum deepens glenoid fossa by 50%
GHJ resting position
55 abduction, 30 horizontal adduction
GHJ close pack
full abduction, ER
GHJ capsular pattern
ER, Abd, IR
GHJ ROM - flexion
0-180
GHJ ROM - extension
0-60
GHJ ROM - abduction
0-180
GHJ ROM - IR
0-70
GHJ ROM - ER
0-90
GHJ inferior capsule
extends down humerus
does not add much stability
least supported
GHJ capsule attaches
to circumference of glendoid fossa and spans to anatomical neck of humerus
GH ligaments
superior, middle, inferior
superior GH lig
blends w/ labrum along head of biceps
suspends humerus
superior GH lig resists
inferior glide and ER during first 60 deg abduction
middle GH lig
variable present
restrains ER between 0-90 deg abduction
inferior GH lig
anterior, posterior, axillary pouch
-ant is primary restraint to anterior translation at 90 degrees abduction
coracohumeral ligament limits
inferior glide and ER below 60 deg abduction
coracohumeral ligament found in
rotation interval (ant border of supraspinatus tendon and superior border of subscap tendon)
coracoacromial ligament
limits superior glide
forms arch over humeral head
what ligament forms roof over bicipital groove?
transverse humeral lig
scapulohumeral muscles
deltoid
teres major
coracobrachialis
rotator cuff (SSIT)
scapulothoracic muscles
Serratus ant traps rhomboids levator scapulae pec minor
thoracohumeral
latts
pec major
what joint has more fractures than dislocations
sternoclavicular
sternoclavicular movements
elevation (around AP axis) depression protraction(around vertical axis) retraction rotation (around long axis)
moments at SC corresponding to scap movements
post glide - retraction - concave
ant glide - protraction - concave
inf glide - elevation - convex
sup glide - depression - convex
sc resting
arm at side
sc close pack
full elevation
sc capsular pattern
pain at extremes of ROM, esp horizontal adduction and full elevation
AC joint type
plane synovial w/ 3 deg freedom
acromion slides on clavicle in same direction as scapular movement
first ligaments to be injured when AC joint is stressed
acromioclavicular lig
primary support of AC joint
coracoclavicular lig
AC joint resting
arm by side
AC close pack
90 deg abduction
AC capsular pattern
pain at extremes of ROM, esp horizontal Add and full elevation
AC sprain type I
AC ligt stretched but stable
AC sprain type II
AC lig torn, coracoclavicular stretched
AC sprain type III
AV and coracoclavicular torn and eventually tears deltoids and traps
GHJ as humerus elevates
context rule
as humerus elevates from 30-60 deg, glides sup
then center of rotation remains fixed and spinning occurs
greatest force on inf GH ligament
abd, ER
what contributes the most to GH stability?
rotator cuff group
scapulothoracic joint
upward rotation is most important (serratus and traps)
resting position of scap
30 deg ant tilt, upward rotation 3 deg
scapulohumeral rhythm
first 30 deg “setting phase” variable
last 60 about 1:1
average is 2:1 GH:scap
scapulohumeral rhythm stage 1
humerus 30 deg ab
scapula minimal motion
clavicle 0-5 deg elvation
scapulohumeral rhythm stage 2
humerus 40 deg ab
scapula 20 deg upward rotation, min protraction or elevation
clavicle 15 deg elevation
scapulohumeral rhythm stage 3
humerus 60 deg ab, 90 deg ER
scapula 30 deg upward rotation
clavicle 30-50 post rotation 15 deg elevation
instantaneous center or rotation
moves from root of spine to acromion
early elevation
upper trap and serratus ant responsible for upward rotation and protraction
-as U trap loses MA, L trap kicks in, SA active throughout
ICR now at acromion
Bankart Lesion
Labrum avulses from
anterior inferior part of fossa, stripping the
capsule
Comparable sign
A combination of pain, stiffness and/or spasm that the therapist finds on examination and considers to be comparable to the patient’s symptoms
Hills-Sachs Lesion
A radiological finding thought to be a compression fracture of the posterior humeral head as it translates anteriorly over the sharp anterior lip of the glenoid rim
Hypermobility
Excessive ROM
with muscular control to provide
stability
Primary impingement-
Rotator cuff being
mechanically impinged underneath the
coracoacromial arch.
Neer’s stages 1
Impingement
Edema and hemorrhage
Neer’s stage 2
Impingement
Fibrosis and tendinitis
Neer’s stage 3
Tear of rotator cuff, biceps rupture, bone changes
Secondary impingement
Impingement as a result of GH or functional scapular instability
Secondary impingement causes
- decrease in SAS due to instability
- high demand of overhead sport —> GHJ lax —> superior migration of HH
- kyphosis TSpine and protracted scap
- poor force coupling at small -> decreased upward rotation
Instability leads to
Excessive displacement anterior or posterior of humeral head in relationship to glenoid fossa
TUBS
Traumatic Unidirectional anterior
instability with Bankart lesion requiring
Surgery
AMBRII
Atraumatic Multidirectional
Bilateral laxity Rehabilitation Inferior
capsule and rotator Interval
GHJ instability grade 0
No translation
GHJ instability grade 1
Mild
Humeral head moves slightly up face of glenoid
0-1cm translation
GHJ instability grade 2
Moderate
Humeral head rides up glenoid face but not over the rim
1-2 cm translation
GHJ instability grade 3
Severe
Humeral head rides up and over the glenoid rim
Usually reduces when stress removed
Main remain dislocated when stress removed
>2cm translation
Painful arc
Range of 60-120 deg shoulder elevation
SLAP lesion
Superior Labrum Anterior
Posterior (superior labrum avulsion at the
biceps insertion)
Subluxation
partial loss of joint
congruency, but can be normally controlled
with dynamic stabilizers
Joints of shoulder and shoulder girdle
Glenohumeral joint • Acromioclavicular joint • Sternoclavicular joint • Scapulothoracic joint
Key functional movement limitations if shoulder not working properly
Reaching above head – Reaching behind back – Lifting (flexion or extension) – Pushing forward or backward – Throwing/over head hitting
Arthro of SC protraction
Concave rule
Role ant
Slide ant
Arthro of SC retraction
Concave rule
Post roll
Post slide
Arthro of SC elevation
Convex rule
Sup roll
Inf slide
Arthro of SC depression
Convex rule
Inf roll
Sup slide
Weight of dependent arm
Causes scap downward rotate, ab, forward tipping
Balanced by U trap, SA (forward tip by rhomb, M trap)
Dynamic scapular stability
Flexion or ab
U and L trap w/ SA caused upward rotation
Dynamic pushing activities
Scapular protraction by SA
Dynamic pulling activities
Retraction and D rotation by: rhomb, lats, T major, rotator cuff
Faulty scapular postures forward tilt
tight pec minor, weak SA (ab/IR humerus)
Clavicular elevation and rotation
As scap rotates upward
- clavicle first elevates 30 deg
- coracoclavicular tights and rotation takes place, 38-50 deg
- allowing xtra 30 deg of scap upward rotation
Humeral ER
Must occur for full AB
Allows greater tubercle to clear coracoacromial arch
Humeral IR and passive shoulder flexion
Starts at 50 deg of passive shoulder flexion
Ant capsule and lig tighten and pull humerus into IR
Countered by infraspinatus and teres minor
Scaption
30 deg anterior to frontal place
Less tension on capsule
No humeral rotation necessary for clearing greater tubercle
Many functional activities occur here
Telford and short rotator cuff
Delt alone - Upward translation of humerus
Combined short rotator cuff muscles compress head of humerus into glenoid fossa and prevent excess superior migration
Supraspinatus compress head into glenoid w/ slight upward translation
What is suggestive of recent or recurrent subluxations?
Bankart lesion
Adhesive capsulitis stage 1
0-3 months
Sig night pain
Pain w/ active and passive ROM
Limitation: forward flex, ab, IR, ER
Adhesive capusilitis stage 2
Freezing stage
3-9 months
Chronic pain w/ active and passive ROM
Sig limits of forward flex, ab, IR, ER,
Adhesive capsulitis stage 3
Frozen stage 9-15 mo
Minimal pain except at end ROM
Sig limitation of ROM w/ rigid end feel
Adhesive capsulitis stage 4
Thawing phase
15-24 mo
Minimal pain
Progressive improvement in ROM
Downward rotated
poor coordination of SA and U trap
Adducted
hypertrophied rhomboids
