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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
Q

Labrum

Susceptible to?

A

The labrum is susceptible to injury with trauma or overuse

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26
Q

Labrum

Common types of tears?

A

Two common types of labral tears are:
* “SLAP” lesion
* “Bankart” lesion

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27
Q

Labrum

SLAP lesion frequently seen with?

A

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

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28
Q

Labrum

SLAP commonly seen at?

A

This tear is commonly seen at the top of the shoulder socket where the long head of the bicep tendon inserts

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29
Q

Labrum

Bankart lesion commonly occurs with?

A
  • 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
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30
Q

Labrum

Bankart lesion - occurs to what portion?

A

The tear occurs to portion of the labrum called the inferior glenohumeral ligament

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31
Q

Labrum

Bankart tear leads to?

A
  • When the inferior glenohumeral ligament is torn, this is called a Bankart tear
  • This in turn leads to an increased shoulder instability
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32
Q

Labrum

Bankart tear - patients complain that?

A

Patients will often complain that their shoulder feels that it is about to dislocate if their arm is placed behind their head

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33
Q

Range of Motion

Rotator cuff role?

A

The rotator cuff or S.I.T.S. muscles play an important role in shoulder movement

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34
Q

Range of Motion

Movement of shoulder?

A
  • Flexion
  • Extension
  • Abduction
  • Adduction
  • Internal and external rotation
  • At 90 degrees, horizontal abduction (extension) and adduction (flexion)
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35
Q

Range of Motion

Movements do not make reference to?

A

The movements do not make reference to the specific movements of the scapula

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36
Q

Range of Motion

Also should be examined? These include?

A
  • There are also combined movements which should be examined
  • These include abduction and external rotation and adduction and internal rotation (Appley’s Scratch Tests)
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37
Q

Range of Motion

During ROM problems include?

A
  • 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
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38
Q

Range of Motion

Reasons for issues?

A

The reasons for this are usually mechanical, causing a “pinching” mechanism at certain ranges

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39
Q

Range of Motion

Ratio of movement with ABDUCTION

A

With abduction, after the first 20 degrees, movement occurs at the glenohumeral (GH) and scapulothoracic (ST) articulations at a ratio of 2:1

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40
Q

Range of Motion

Condition of frozen shoulder - occurs?

A

The condition of “frozen shoulder” occurs when there is injury causing little GH movement, only ST movement in abduction

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41
Q

The Rotator Cuff

Plays important role in?

A

The rotator cuff or SITS muscles play an important role in helping provide movement and stability of the glenohumeral joint

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42
Q

The Rotator Cuff

Rotator cuff muscles?

A

The rotator cuff muscles are:
* Supraspinatus
* Infraspinatus
* Subscapularis
* Teres minor

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43
Q

The Rotator Cuff

Muscles - their role in movement and tested by?

A
  • Each of these muscles has a specific role in movement
  • Can be tested by resisting that movement
44
Q

The Rotator Cuff

Muscles can develop?

A

These muscles can develop:
* Tendonitis
* A strain
* In the case of supraspinatus, it can become involved in an “impingement” syndrome mechanism

45
Q

The Rotator Cuff

Key role of supraspinatus

A

The key role of the supraspinatus is the initiation of abduction

46
Q

The Rotator Cuff

Key role of infraspinatus and teres minor

A

The infraspinatus and teres minor are external rotators

47
Q

The Rotator Cuff

Key role of subscapularis

A

Subscapularis is an internal rotator muscle

48
Q

The Rotator Cuff

Codman’s Drop Arm Test

A

The Codman’s Drop Arm Test is a general test which evaluates for a rotator cuff tear (supraspinatus bias)

49
Q

The Rotator Cuff

Empty Can Test and Initiation of Abduction

A

The supraspinatus muscle can be isolated by resisting the initiation of abduction or using the empty can test

50
Q

The Rotator Cuff

External Rotation - what muscle?

A

The infraspinatus muscle is isolated by resisting external rotation

51
Q

The Rotator Cuff

Hornblower’s Test or Sign

A

The teres minor muscle is also an external rotator but also isolated by using the “Hornblower’s Test or Sign”

52
Q

The Rotator Cuff

Resisting Internal Rotation or Lift Off Sign/Test

A

The subscapularis muscle is an internal rotator and is tested by resisting internal rotation or weakness with the lift off sign/test

53
Q

Impingement Syndrome

A common?

A

Impingement syndrome is a common overuse shoulder condition seen with overhead sporting activity

54
Q

Impingement Syndrome

Etiology?

A

The etiology involves the compression of three structures underneath the tight coraco-acromial arch

55
Q

Impingement Syndrome

Structures include?

A

These structures include:
* Supraspinatus tendon
* Long head of biceps tendon
* Subdeltoid/subacromial bursa

56
Q

Impingement Syndrome

What activity? What impinges the structures?

A

With repeated overhead activity, the greater tuberosity of the humerus impinges these structures leading to pain and inflammation with any overhead activity

57
Q

Impingement Syndrome

Tests reproduce?

A

The tests for this condition reproduces this mechanism

58
Q

Impingement Syndrome

Tests?

A
  • Neer’s Test
  • Hawkins-Kennedy Test
59
Q

Long Head of the Biceps Brachii

How many heads? Arising from?

A
  • 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
Q

Long Head of the Biceps Brachii

Muscle action?

A

This muscle supinates the forearm and flexes the elbow

61
Q

Long Head of the Biceps Brachii

Provides?

A

The long head of the biceps, along with the rotator cuff muscles provides dynamic stability in the shoulder

62
Q

Long Head of the Biceps Brachii

Frequently involved in? Why?

A

Because this tendon is intra-articular, it is frequently involved with shoulder injuries

63
Q

Long Head of the Biceps Brachii

Held in place by?

A

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
Q

Long Head of the Biceps Brachii

Subject to?

A

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
Q

Long Head of the Biceps Brachii

Tests to pick up conditions?

A

The tests which will pick up these conditions include:
* Speed’s Test (Tendonitis)
* Yergason’s Test (Subluxing Long Head)

66
Q

Speed’s Test

Originally designed to? Utilized in?

A
  • 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
Q

Speed’s Test

Positive test result suggests?

A

A positive Speed’s test result is usually thought to suggest inflammation or lesions related to the biceps/labral complex

68
Q

Speed’s Test

Tenderness on palpation of bicipital groove

A

Tenderness on palpation of the bicipital groove also indicates bicipital tendinitis

69
Q

Yergason’s Test

Designed to?

A

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
Q

Yergason’s Test

Test is done?

A

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
Q

Yergason’s Test

Another factor?

A

The shape of the bicipital groove can also be a factor

72
Q

Acromioclavicular (AC) Separations/Sprains

Located? Articulates?

A

The acriomioclavicular or AC joint is located at the distal clavicle and articulates with the acromion process of the scapula

73
Q

Acromioclavicular (AC) Separations/Sprains

Joint (strength)? Held together by?

A
  • This is a weak joint
  • Held together by ligaments and a joint capsule
74
Q

Acromioclavicular (AC) Separations/Sprains

Fibrocartliginous disk role?

A

There is also a fibrocartliginous disk present which separates the two bones of the acromion and clavicle

75
Q

Acromioclavicular (AC) Separations/Sprains

Damage to ligaments creates?

A

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
Q

Acromioclavicular (AC) Separations/Sprains

Injury occurs due to?

A

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
Q

Acromioclavicular (AC) Separations/Sprains

Two main supporting ligaments of this joint?

A

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
Q

Acromioclavicular (AC) Separations/Sprains

AC separations graded as?

A
  • 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
Q

Acromioclavicular (AC) Separations/Sprains

Tests for this injury

A

The tests for this injury involve:
* Pinching
* Opening
* Gapping the AC joint

80
Q

Acromioclavicular (AC) Separations/Sprains

Three commonly used tests?

A

Three commonly used tests are:
* The Traction Test
* The Cross Body or Horizontal Adduction Compression Test
* The Shear Test

81
Q

Acromioclavicular (AC) Separations/Sprains

Type I

A

Ligaments stretched

82
Q

Acromioclavicular (AC) Separations/Sprains

Type II

A

Partial rupture of AC ligaments

83
Q

Acromioclavicular (AC) Separations/Sprains

Type III

A

Complete rupture AC and CC ligaments

84
Q

Acromioclavicular (AC) Separations/Sprains

Type IV

A

Clavicle displaced posterior over acromion

85
Q

Acromioclavicular (AC) Separations/Sprains

Type V

A

Clavicle displaced just under skin

86
Q

Acromioclavicular (AC) Separations/Sprains

Type VI

A

Clavicle underneath coracoid (very rare)

87
Q

Shoulder Dislocations

Account for?

A

Shoulder dislocations account for up to 50% of all the dislocations found in the body

88
Q

Shoulder Dislocations

Why are they common?

A

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
Q

Shoulder Dislocations

Most common type?

A

The most common type of dislocation is an anterior and inferior dislocation

90
Q

Shoulder Dislocations

Anterior and inferior dislocation results from?

A
  • 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
Q

Shoulder Dislocations

Risk of?

A

With any type of dislocation, there is a high risk of fracture, ligament and muscle tear, labral injury, and neurovascular compromise

92
Q

Shoulder Dislocations

Common direction?

A

Over 95% of all shoulder dislocations occur in the anterior and inferior direction

93
Q

Shoulder Dislocations

Categorized by?

A

These dislocations are categorized by where the head of the humerus end up by X-ray diagnosis

94
Q

Shoulder Dislocations

They can be:

A
  • Sub-coracoid
  • Sub-glenoid
  • Sub-clavicular
95
Q

Shoulder Dislocations

Three common tests for shoulder instability

A
  • Sulcus Sign
  • Apprehension Test
  • Load and Shift Test
96
Q

Sulcus Sign

What is it?

A

The Sulcus Sign is an orthopedic test for glenohumeral instability of the shoulder

97
Q

Sulcus Sign

How is it performed?

A

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
Q

Sulcus Sign

Positive sign?

A

With excessive inferior translation, a depression occurs just below the acromion. The appearance of this sulcus is a positive sign

99
Q

Apprehension Test

Evaluates?

A

The Apprehension Test evaluates for anterior glenohumeral stability

100
Q

Apprehension Test

How is it performed?

A

With the patient in supine, the shoulder is abducted and externally rotated to 90 degrees to place stress on the glenohumeral joint

101
Q

Apprehension Test

Positive test?

A

If the patient feels apprehensive that the arm may dislocate anteriorly, it is a positive test

102
Q

Load & Shift Test

What is it?

A

The Load & Shift Test is a modification of the anterior and posterior drawer tests

103
Q

Load & Shift Test

Performed?

A

The humerus is translated anteriorally and posteriorally and compared bilaterally

104
Q

Load & Shift Test

Test assesses?

A

This test assesses the amount of translation but also provides an idea of the adequacy of the glenoid lip

105
Q

Load & Shift Test

Important to?

A

It is important to compare the two shoulders to appreciate similarities or differences in translation

KINE 3575 (7 decks)

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