Test 1 Shoulder Flashcards
6 muscles that support and move the scapula
1) trapezius 2) rhomboids 3) levator scapulae 4) serratus
anterior 5) Latissimus Dorsi 6) Pectoralis Minor
3 types of acromion morphology
1) flat undersurface
2) slightly convex
3) hooked, which
can predispose the
shoulder to rotator
cuff pathology
Coracoid process is a lever for the ___ to help stabilize the ___
pectoralis major
scapula
What attaches at the greater tuberosity of humerus?
Supraspinatus, infraspinatus, teres minor
What attaches at lesser tuberosity?
Subscapularis
Superior GH ligament limits which motions?
external rotation and inferior translation of humeral head with arm at the side
Middle GH ligament limits which motions?
External rotation and anterior translations of humeral head with arm in 0 degrees and 45 degrees of abduction
Inferior GH ligament consists of a __ and __ band and an ___ with varying functions
Anterior
Posterior
Axillary pouch
Coracohumeral ligament covers the __ ligament ___, and fills the space beween the tendons of __ and __ muscles, uniting these tendons to complete the rotator cuff in this area.
GH
anterior-superiorly
supraspinatus
subscapularis
Coracoacromial ligament function
Prevents separation of A-C joint surfaces
What forms the coracoacromial arch?
Anterior-inferior sapect of acromion, coracoacromial ligament, inferior surface of AC joint
When is the Suprahumeral/subacromial space at it’s narrowest?
Between 60-120 degrees of scaption
Muscle imbalances or capsular contractures can cause increases in superior translation in __ and narrow the suprahumeral soace, leading to ___.
humeral head
Subacromial impingemet syndrome
Impingement syndrome definition
pain in subacromial space when the humerus is elevated or internally rotated
What are the ranges of the pain arc of abduction (glenohumeral joint)?
from 45-60 degrees to 110-120 degrees
What are the ranges for the acromioclavicular painful arc?
170-180 degrees
Impingement syndrome: During ___ ___ the ___ tendon and __ become entrapped between the __ corner of the ___ and ___.
humeral flexion supraspinatus bursa anteroinferior acromion greater tuberosity
Where is the hypovascular zone of the supraspinatus tendon?
Critical zone just proximal to the supraspinatus insertion point
Once the supraspinatus (and infraspinatus) tendon is disrupted there will often be further impingement and irritation which can lead to __ and further ___
biceps tendonitis
rupture
Impingement Syndrome pain is often worse at ___, as the ___ becomes ___
night
subacromial bursa
hyperemic
Subacromial Bursa provides two smooth ___ layers, one of which adheres to the overlying ___ muscle and the other to the ___ beneath.
serosal
deltoid
rotator cuff
Erbs palsy is an ____ brachial plexus injury can be from forceful ___ of the shoulder during birth or trauma later in life. Patient presents with a ___ and ___ shoulder. ___ reflex is lost.
Upper depression internally rotated adducted biceps
Klumpke’s Palsy is a ___ brachial plexus injury from forceful pulling of the ___ during birth. This impairs ___ ___ and movements of the ___ muscles of the ___
Lower (C8 & T1) upper arm wrist flexion intrinsic hand
Vascular supply to the rotator cuff muscles
Thoracoacromial A
Suprahumeral A
Subscapular A
The ___ artery provides the dominant arterial supply to each of the two heads of the biceps.
brachial
Describe the close packed position of the GH joint
90 degrees of glenohumeral abduction and full external rotation, or full abduction and external rotation
Describe the open packed position of the GH joint.
55 degrees of semi-abduction and 30 degrees of horizontal abduction
The AC joint serves as the main articulation suspending the upper extremity from the trunk, and it is at this joint about which the ___ moves
scapula
The ___ and ___ ligaments are the primary support for the AC joint. These ligaments provide mainly ___ stability, with control of ___ and ___ translation as well as ___ ___ rotation
Conoid Trapezoid vertical superior anterior anterior axial
AC joint innervation
Suprascapular N
Lat. Pectoral N
Axllary N.
AC joint blood supply
Branches of Suprascapular and Thoracoacromial Arteries
At the SC joint in close-packed position, the joint is maximum arm ___ and ___
elevation
protraction
At the __ joint in open-packed position is yet to be determined, but is likely to be when the arm is by the ___.
SC
side
Name the ligaments that support the SC joint
Anterior Sternoclavicular
Posterior Sternoclavicular
Interclavicular
Costoclavicular
Tzitze’s Syndrome AKA ___: Etiology is ___. Pain and swelling of one or more ___ may occur gradually or suddenly. Pain may radiate to (3). ___ and ___ can irritate the junctions.
Costochondritis unknown costocartilages shoulder, neck, arm direct trauma coughing
What muscles are the scapular pivoters?
Trapezius
Serratus Anterior
Levator Scapular
Rhomboids
What muscles are the Shoulder Protectors?
Rotator Cuff muscles and Biceps Brachii
What muscles are the humeral positioners?
Three parts of deltoid
Frozen Shoulder is an an inflammation of the ___ layers causing and outpouring secretion of exudate which contains ___. The microscopic layers attach from adjacent synovial layers which then multiply, thickcn, and shorten (___ process)
synovial
protein
adhesive
With frozen shoulder, the patient will have no __ motion, only __ motion. Progressive limitation of motion continues until complete ___ stops the pain.
GH
ST
Ankylosing
During the first 30 degrees of upward rotation of the scapula, the __ and upper and lower divisions of the ___ muscle are the principle upward rotators.
serratus anterior
trapezius
3 possible causes of Shoulder Girdle Dysfunction
- Compromise of passive restraint components
- Compromise of neuromusular system’s production or control of motion
- Compromise of one or more of the neighboring joints
Most common complaints associated with shoulder pathology
Pain Instability Swelling Stiffness Deformity
Overhead exertion with repetitive motion is common in which Diagnoses?
Subacromial Bursitis
Impingement Syndromes
Rotor Cuff problems
FOOSH injuries can result in what Diagnoses?
Sprain/Strains AC separation Clavicular fx GH fx Dislocations
Most common dislocation of the GH joint
Anterior/Inferior
Recurrent dislocations after initial GH joint disloction is greater than __% in pts. aged 25 years or younger. Presents with __ shoulder appearance. Recurrent dislocations can lead to __ ___.
95
squared
degenerative Arthritis
Grade 2 and 3 AC separations cause a considerable amount of ___. Grade 3 separations usually cause a noticeable __ on the shoulder.
swelling
bump
MOI for clavicular fractures is usually __ injuries. Pt has difficulty __ the arm past __ degrees. Horizontal ___ is painful
FOOSH
elevating
60
adduction
What is one of the most common causes of numbness in the shoulder and down into the arm?
Cervical or upper thoracic nerve root involvement- either from segmental nerve roots or brachial plexus
What are possible causes of insidious shoulder pain?
RA Lupus Gallbladder Liver Disease Chronic Resp. and CV conditions
Sprengel’s Deformity is a ___ abnormality characterized by a partially ___ scapula. This condition develops prior to the ___ month of skeletal development and shows a __ ratio of female predominance.
Congenital
undescended
3rd
2:1
In Sprengel’s Deformity, pt. shows __ of scapula with reduction of ___ in the arm.
elevation
abduction
Scapular winging mode of injury is usually caused by stretching during ___, severance of the nerve during surgery (___), or a direct trauma to the side of the neck to the base of the ___.
heavy lifting
mastectomy
cervical vertebrae
Juvenile Kyphosis AKA
Scheuermann’s Disease
*Scheuermann’s Disease is evident in mid and lower thoracic regions in which at least ___ contiguous involved vertebrae are wedged ___ more than ___ degrees. Shows a slight __ predominance and is most common from __-__ years of age
3 anteriorly 5 males 13-17
Scheuermann’s Disease etiology is ___ and shows a cosmetic deformity with a predesposition thoracic disk ___ and premature ___ changes.
unknown
heniation
degenerative
Characteristic radiological features of Scheuermann’s include ___ wedging, irregular ___, and loss of Intervertebral disc ___.
Anterior
vertebral end plates
heights
Some __-__% of scoliosis cases occur in women. Initial complaint may be fatigue in __ region after sitting and standing for long periods. This may be followed by ___ backaches in area of strain, such as ___ pain. Pain may increase as irritation of ___ increases.
60-80 lumbar muscular lumbosacral ligaments
Many people with severe curvatures (scoliosis) suffer from __ and __ disease secondary to reduced ___ volume.
Cardiovascular
Pulmonary
Thoracic Cage
- Functional Scoliosis is a ___ problem. There are no extra structural parts or rib problems, but ___ result in muscular problems.
muscular
subluxations
*The etiology of Structural/Congenital scoliosis is ___ and results from insult to embryo at - weeks of gestation. Can be classified as failure of ___ or ___, or a combination of both.
unknown
6-8
formation
segmentation
