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KINE 3575 > The Shoulder > Flashcards

The Shoulder Flashcards

1
Q

(INTRODUCTION)

The shoulder

Type of joint? Movement?

A

The shoulder is a multi-axial ball and socket joint, which has a great degree of movement

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2
Q

(INTRODUCTION)

The shoulder

What places stress on it?

A

Sport activities, especially those which involve overhead movement and throwing place a great deal of stress on the various structures of this joint

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3
Q

(INTRODUCTION)

The shoulder

What can shoulder injuries involve?

A

Shoulder injuries can involve many different types of degnerative conditions or musculoskeletal injuries including: tendonitis, impingement syndrome, tears (rotator cuff, long head of biceps), fractures, OA, labral tears, AC separations and dislocations

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4
Q

Joints of the shoulder

How many? What are they?

A

There are three joints and one articulation found in the shoulder.
* Sternoclavicular
* Acromioclavicular
* Glenohumeral
* Scapulothoracic Articulation

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5
Q

Sternoclavicular Joint

Type of joint?

A

The sternoclavicular (SC) joint is a saddle type of joint

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6
Q

Sternoclavicular (SC) Joint

Can be injured by?

A
  • A direct blow
  • An indirect axial compression through the humerus resulting in the tearing of supporting ligaments
  • The motion of the shoulder shrug can bring on the pain and instability of this joint
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7
Q

Acromioclavicular (AC) Joint

Type of joint?

A

The acromioclavicular (AC) joint is a plane synovial joint

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8
Q

Acromioclavicular (AC) Joint

Occupies the? Contains which ligaments?

A

It occupies the end of the clavicle and has a disc as well as two supporting ligaments:
* The acromioclavicular ligament
* The coraco-clavicular ligament (conoid and trapezoid ligaments)

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9
Q

Acromioclavicular (AC) Joint

Injury occurs by?

A

Injury to this joint occurs by:
* A direct blow to the tip of the shoulder
* An upward force on the humerus
* A fall
* Body check

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10
Q

Glenohumeral Joint

Type of joint?

A

The glenohumeral joint is a multi-axial ball and socket joint

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11
Q

Glenohumeral Joint

Depends on what for support?

A

Depends primarily on muscles for support

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12
Q

Glenohumeral Joint

Has a?

A

It has a “labrum” which articulates with the humeral head

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13
Q

Glenohumeral Joint

This joint can be?

A

This joint can be:
* Subluxed
* Dislocated
* Can cause damage to the surrounding muscles, ligaments and labrum

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14
Q

Scapulothoracic Articulation

Type of joint? Movement?

A

The scapulothoracic articulation is not a true joint. It is the movement of the scapula on the thoracic ribs

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15
Q

Scapulothoracic Articulation

Ratio of movement?

A
  • After the first 20 degrees, there should be a 2:1 ratio of movement
  • For every 2 degrees of GH joint movement, there is one degree of scapula movement on the thoracic ribs
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16
Q

Bony Palpation

Anterior View

A
  • AC/SC joints
  • Greater tuberosity/tubercle
  • Lesser tuberosity/tubercle
  • Bicipital groove
  • Coracoid process
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17
Q

Bony Palpation

Posterior View

A
  • Spine of the scapula (sits at level of 3rd thoracic vertebrae)
  • Supra/infraspinous fossa
  • T2-T7 levels
  • Cervical spine
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18
Q

Ligaments

Number of? Where?

A

There are a number of ligaments in the anterior and posterior shoulder region

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19
Q

Ligaments

Names?

A
  • Glenohumeral
  • Acromioclavicular
  • Coraco-clavicular
  • Coraco-acromial ligament/arch
  • Transverse humeral ligament
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20
Q

Ligaments

Glenohumeral forms?

A

Forms the joint capsule

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21
Q

Ligaments

Coraco-Arcomial Ligament/Arch

A
  • (Impingement syndrome)
  • Involves the supraspinatus and long head of biceps tendons along with the subdeltoid/subacromial bursa
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22
Q

Ligaments

Transverse humeral ligament

A

Holds the tendon of the long head of biceps in the groove between the greater and lesser tuberosity/tubercles

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23
Q

Labrum

Socket is?

A

The socket of the shoulder joint is extremely shallow and thus inherently unstable

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24
Q

Labrum

What compensates for the joint?

A

To compensate for this, the shoulder has a cartilage called a “labrum” which makes the ball and socket joint deeper

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25
# Labrum Susceptible to?
The labrum is susceptible to injury with trauma or overuse
26
# Labrum Common types of tears?
Two common types of labral tears are: * "SLAP" lesion * "Bankart" lesion
27
# Labrum SLAP lesion frequently seen with?
A SLAP lesion or tear (superior labrum anterior-posterior) is frequently seen with overhead throwing athletes such as baseball and tennis players. It is a repetitive injury
28
# Labrum SLAP commonly seen at?
This tear is commonly seen at the top of the shoulder socket where the long head of the bicep tendon inserts
29
# Labrum Bankart lesion commonly occurs with?
* The Bankart lesion is a labral tear which commonly occurs wuth shoulder dislocations (traumatic injury) * As the shoulder pops out of joint, it often tears the labrum, especially in younger patients
30
# Labrum Bankart lesion - occurs to what portion?
The tear occurs to portion of the labrum called the inferior glenohumeral ligament
31
# Labrum Bankart tear leads to?
* When the inferior glenohumeral ligament is torn, this is called a Bankart tear * This in turn leads to an increased shoulder instability
32
# Labrum Bankart tear - patients complain that?
Patients will often complain that their shoulder feels that it is about to dislocate if their arm is placed behind their head
33
# Range of Motion Rotator cuff role?
The rotator cuff or S.I.T.S. muscles play an important role in shoulder movement
34
# Range of Motion Movement of shoulder?
* Flexion * Extension * Abduction * Adduction * Internal and external rotation * At 90 degrees, horizontal abduction (extension) and adduction (flexion)
35
# Range of Motion Movements do not make reference to?
The movements do not make reference to the specific movements of the scapula
36
# Range of Motion Also should be examined? These include?
* There are also combined movements which should be examined * These include abduction and external rotation and adduction and internal rotation (Appley's Scratch Tests)
37
# Range of Motion During ROM problems include?
* During ROM, areas of pain, compensation or limitation may indicate a variety of injuries * Including: rotator cuff tendonitis, frozen shoulder (adhensive capsulitis) and acromio-clavicular problems
38
# Range of Motion Reasons for issues?
The reasons for this are usually mechanical, causing a "pinching" mechanism at certain ranges
39
# Range of Motion Ratio of movement with ABDUCTION
With abduction, after the first 20 degrees, movement occurs at the glenohumeral (GH) and scapulothoracic (ST) articulations at a ratio of 2:1
40
# Range of Motion Condition of frozen shoulder - occurs?
The condition of "frozen shoulder" occurs when there is injury causing little GH movement, only ST movement in abduction
41
# The Rotator Cuff Plays important role in?
The rotator cuff or SITS muscles play an important role in helping provide movement and stability of the glenohumeral joint
42
# The Rotator Cuff Rotator cuff muscles?
The rotator cuff muscles are: * Supraspinatus * Infraspinatus * Subscapularis * Teres minor
43
# The Rotator Cuff Muscles - their role in movement and tested by?
* Each of these muscles has a specific role in movement * Can be tested by resisting that movement
44
# The Rotator Cuff Muscles can develop?
These muscles can develop: * Tendonitis * A strain * In the case of supraspinatus, it can become involved in an "impingement" syndrome mechanism
45
# The Rotator Cuff Key role of supraspinatus
The key role of the supraspinatus is the initiation of abduction
46
# The Rotator Cuff Key role of infraspinatus and teres minor
The infraspinatus and teres minor are external rotators
47
# The Rotator Cuff Key role of subscapularis
Subscapularis is an internal rotator muscle
48
# The Rotator Cuff Codman's Drop Arm Test
The Codman's Drop Arm Test is a general test which evaluates for a rotator cuff tear (supraspinatus bias)
49
# The Rotator Cuff Empty Can Test and Initiation of Abduction
The supraspinatus muscle can be isolated by resisting the initiation of abduction or using the empty can test
50
# The Rotator Cuff External Rotation - what muscle?
The infraspinatus muscle is isolated by resisting external rotation
51
# The Rotator Cuff Hornblower's Test or Sign
The teres minor muscle is also an external rotator but also isolated by using the "Hornblower's Test or Sign"
52
# The Rotator Cuff Resisting Internal Rotation or Lift Off Sign/Test
The subscapularis muscle is an internal rotator and is tested by resisting internal rotation or weakness with the lift off sign/test
53
# Impingement Syndrome A common?
Impingement syndrome is a common overuse shoulder condition seen with overhead sporting activity
54
# Impingement Syndrome Etiology?
The etiology involves the compression of three structures underneath the tight coraco-acromial arch
55
# Impingement Syndrome Structures include?
These structures include: * Supraspinatus tendon * Long head of biceps tendon * Subdeltoid/subacromial bursa
56
# Impingement Syndrome What activity? What impinges the structures?
With repeated overhead activity, the greater tuberosity of the humerus impinges these structures leading to pain and inflammation with any overhead activity
57
# Impingement Syndrome Tests reproduce?
The tests for this condition reproduces this mechanism
58
# Impingement Syndrome Tests?
* Neer's Test * Hawkins-Kennedy Test
59
# Long Head of the Biceps Brachii How many heads? Arising from?
* The biceps brachii has two heads * The short head arising from the apex * The long head originating from the supraglenoid tuberosity of the scapula
60
# Long Head of the Biceps Brachii Muscle action?
This muscle supinates the forearm and flexes the elbow
61
# Long Head of the Biceps Brachii Provides?
The long head of the biceps, along with the rotator cuff muscles provides dynamic stability in the shoulder
62
# Long Head of the Biceps Brachii Frequently involved in? Why?
Because this tendon is intra-articular, it is frequently involved with shoulder injuries
63
# Long Head of the Biceps Brachii Held in place by?
The tendon of the long head is firmly in place in the intertubercular (bicipital) groove between the greater and lesser tubercles by the overlying transverse humeral ligament
64
# Long Head of the Biceps Brachii Subject to?
The long head of the biceps is subjected to a number of stresses and can result in the following: * Tendonitis * Tear (powerful eccentric or concentric contraction can cause a tear, usually near the origin) * Tear of the transverse humeral ligament causing the long head to sublux out of the intertubercular groove
65
# Long Head of the Biceps Brachii Tests to pick up conditions?
The tests which will pick up these conditions include: * Speed's Test (Tendonitis) * Yergason's Test (Subluxing Long Head)
66
# Speed's Test Originally designed to? Utilized in?
* Was originally designed to assess for pathology of the long head of biceps in its groove * Also been utilized in the assessment for SLAP (labral) lesions
67
# Speed's Test Positive test result suggests?
A positive Speed's test result is usually thought to suggest inflammation or lesions related to the biceps/labral complex
68
# Speed's Test Tenderness on palpation of bicipital groove
Tenderness on palpation of the bicipital groove also indicates bicipital tendinitis
69
# Yergason's Test Designed to?
The Yergason's test is designed to assess the ability of the transverse humeral ligament to hold the biceps tendon in the bicipital groove
70
# Yergason's Test Test is done?
With the elbow flexed to 90 degrees, the evaluator resists internal and external rotation and feels for the long head of the biceps to sublux in its groove
71
# Yergason's Test Another factor?
The shape of the bicipital groove can also be a factor
72
# Acromioclavicular (AC) Separations/Sprains Located? Articulates?
The acriomioclavicular or AC joint is located at the distal clavicle and articulates with the acromion process of the scapula
73
# Acromioclavicular (AC) Separations/Sprains Joint (strength)? Held together by?
* This is a weak joint * Held together by ligaments and a joint capsule
74
# Acromioclavicular (AC) Separations/Sprains Fibrocartliginous disk role?
There is also a fibrocartliginous disk present which separates the two bones of the acromion and clavicle
75
# Acromioclavicular (AC) Separations/Sprains Damage to ligaments creates?
When there is damage to one or more of these supporting ligaments the clavicle separates or dislocated, creating a "step" or "piano key" deformity
76
# Acromioclavicular (AC) Separations/Sprains Injury occurs due to?
This injury occurs due to: * a direct blow to the tip of the shoulder * a fall * body check * an upward force on the humerus
77
# Acromioclavicular (AC) Separations/Sprains Two main supporting ligaments of this joint?
The two main supporting ligaments of this joint are: * Acromioclavicular (AC ligament) * Coraco-clavicular ligament, which is made up of the conoid and trapezoid ligaments
78
# Acromioclavicular (AC) Separations/Sprains AC separations graded as?
* Graded as 1-3rd degree (based on the number of ligaments torn) * 4-6 degrees depending on the position of the clavicle (Rockwood's classification)
79
# Acromioclavicular (AC) Separations/Sprains Tests for this injury
The tests for this injury involve: * Pinching * Opening * Gapping the AC joint
80
# Acromioclavicular (AC) Separations/Sprains Three commonly used tests?
Three commonly used tests are: * The Traction Test * The Cross Body or Horizontal Adduction Compression Test * The Shear Test
81
# Acromioclavicular (AC) Separations/Sprains Type I
Ligaments stretched
82
# Acromioclavicular (AC) Separations/Sprains Type II
Partial rupture of AC ligaments
83
# Acromioclavicular (AC) Separations/Sprains Type III
Complete rupture AC and CC ligaments
84
# Acromioclavicular (AC) Separations/Sprains Type IV
Clavicle displaced posterior over acromion
85
# Acromioclavicular (AC) Separations/Sprains Type V
Clavicle displaced just under skin
86
# Acromioclavicular (AC) Separations/Sprains Type VI
Clavicle underneath coracoid (very rare)
87
# Shoulder Dislocations Account for?
Shoulder dislocations account for up to 50% of all the dislocations found in the body
88
# Shoulder Dislocations Why are they common?
Due to the fact that the shoulder has a great degree of movement and that it relies on the surrounding musculature for support, shoulder dislocations are a common occurence
89
# Shoulder Dislocations Most common type?
The most common type of dislocation is an anterior and inferior dislocation
90
# Shoulder Dislocations Anterior and inferior dislocation results from?
* Direct impact * Fall on an outstretched hand (FOOSH) * Forced abduction and external rotation, forcing the head of the humerus out of the glenoid fossa
91
# Shoulder Dislocations Risk of?
With any type of dislocation, there is a high risk of fracture, ligament and muscle tear, labral injury, and neurovascular compromise
92
# Shoulder Dislocations Common direction?
Over 95% of all shoulder dislocations occur in the anterior and inferior direction
93
# Shoulder Dislocations Categorized by?
These dislocations are categorized by where the head of the humerus end up by X-ray diagnosis
94
# Shoulder Dislocations They can be:
* Sub-coracoid * Sub-glenoid * Sub-clavicular
95
# Shoulder Dislocations Three common tests for shoulder instability
* Sulcus Sign * Apprehension Test * Load and Shift Test
96
# Sulcus Sign What is it?
The Sulcus Sign is an orthopedic test for glenohumeral instability of the shoulder
97
# Sulcus Sign How is it performed?
With the arm straight and relaxed to the side of the patient, the elbow is grasped and traction is applied in an inferior direction
98
# Sulcus Sign Positive sign?
With excessive inferior translation, a depression occurs just below the acromion. The appearance of this sulcus is a positive sign
99
# Apprehension Test Evaluates?
The Apprehension Test evaluates for anterior glenohumeral stability
100
# Apprehension Test How is it performed?
With the patient in supine, the shoulder is abducted and externally rotated to 90 degrees to place stress on the glenohumeral joint
101
# Apprehension Test Positive test?
If the patient feels apprehensive that the arm may dislocate anteriorly, it is a positive test
102
# Load & Shift Test What is it?
The Load & Shift Test is a modification of the anterior and posterior drawer tests
103
# Load & Shift Test Performed?
The humerus is translated anteriorally and posteriorally and compared bilaterally
104
# Load & Shift Test Test assesses?
This test assesses the amount of translation but also provides an idea of the adequacy of the glenoid lip
105
# Load & Shift Test Important to?
It is important to compare the two shoulders to appreciate similarities or differences in translation

KINE 3575 (7 decks)

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