The Shoulder Flashcards
What is the shoulder built for
mobility
when do shoulder injuries commonly occur?
involving overhead activties (swimming, tennis, volleyball)
Bones of the shoulder girdle (3)
scapula
clavicle
humerus
Ligaments of the shoulder (5)
-Coracoacromial ligament
-Superior acromialclavicular ligament
-coarcoclavicular ligament
-anterior sternoclavicular ligament
-Glenohumeral ligaments
Shoulder joints (4)
-Glenohumeral joint
-acromioclavicular
-sternoclavicular
-scapulothoracic
Main shoulder muscles (11)
subscapularis
supraspinatus
infraspinatus
teres minor
triceps
biceps
latissimus dorsi
pectoralis major
pectoralis minor
deltoid
trapezius
muscles of rotator cuff (4)
subscapularis
supraspinatus
infraspinatus
teres minor
Muscles acting on the humerus: Muscles (9)
-supraspinatus
-subscapularis
-infraspinatus
-teres major
-teres minor
-coracobrachilais
-pect major
-latissimus dorsi
-deltoid
Muscles acting on the humerus: Action Supraspinatus
abducts the arm (15 degrees)
slight external rotation
Muscles acting on the humerus: Action Infraspinatus
external rotation of arm
slight abduction
Muscles acting on the humerus: Action Subscapularis
internal rotation of arm
Muscles acting on the humerus: Action Teres major
adducts
extends
internally rotates
Muscles acting on the humerus: Action Teres minor
external rotation of arm
Muscles acting on the humerus: Action Coracobtachialis
flexes
adducts arm
Muscles acting on the humerus: Action Pectoralis major
flexes
adducts
internally rotates arm
Muscles acting on the humerus: Action Latissimus dorsi
extends
adducts
internally rotates
pulls shoulder downwards
Muscles acting on the humerus: Action Deltiod
Abducts arm past 15 degrees
(ant. fibres) flex & internally rotate
(post. fibres) extend & externally rotate
Muscles acting on the scapula (6)
trapezius
rhomboid major
rhomboid minor
levator scapula
pectoralis minor
serratus anterior
Muscles acting on the scapula: Action trapezius
elevates & depresses, rotates, adducts & stabilizes scapula
Muscles acting on the scapula: Action rhomboid major & minor
adduct
stabilize & rotate scapula
lowering at lateral angle
Muscles acting on the scapula: Action levator scapulae
elevates scapula
neck side flexion on fixed scapula
Muscles acting on the scapula: Action pectoralis minor
protracts scapula
internally & downward rotates scapula
Muscles acting on the scapula: Action serratus anterior
stabilizes
protracts upwards rotates the scapula
Movements of the scapula (6)
elevation
depression
abduction
adduction
upward rotation
downward rotation
2 critical instances for increased risk of injury when throwing
- cocking phase- when arm has not quite reached max (lateral rotation)
- just after ball release- when both a large compression force and a large horizontal abduction torque are generated at the shoulder
define scapohumeral rhythm
coordination of scapular and humeral movements to facilitate greater ROM at the shoulder
what is the scapohumeral rhythm ration?:
1:2
With every degree of ROM the scapothoracic joint moves the glenohumeral joint does double
-scapohumeral joint moves 60 degrees and the glenohumeral joint moves 120 degrees
Name the acute shoulder injuries (6)
contusions
sprains
strains
ruptures
fractures
GH dislocations/subluxation
name the chronic shoulder injuries (3)
-rotator cuff impingement syndrome
-bicipital tendonitis
-subacromial bursitis
Rotator cuff injury pathology (3)
-full and partial thickness tears
-rotator cuff tendonopathy
-impingment syndrome (external or internal)
GH extra articular pathology (outside the capsule) (3)
-acromioclavicular lesions
-long head of bicep injury
-pain reffered to the shoulder but not originating from shoulder
GH intra articular pathology (inside the capsule) (2)
- GH instabilities
- anterior
-posterior
-multidirectional - Labral pathology/associated
- SLAP lesion
-Bankart lesion
-Hill Sachs lesion
Sternoclavicular, clavicle and scapular pathology (3)
sprains
fractures
degenerative conditions
Contusions: MOI, S/S, Management
MOI: direct blow
S/S: pain on palpation (POP), bruising, swelling, pain w/AROM. Transitory paralysis/inability to move arm if radial nerve impacted
management: PIER, NSAIDs, protect w/padding. Do not massage (myositis ossificans)
sternoclavicular sprain: etiology
Typically drives the proximal clavicle superior, medial and anterior disrupting the ligaments
sternoclavicular sprain: MOI
-Fall on out stretched hand (FOOSH)
-arm is at 90 degrees and then is pulled forcefully away from the body (forces arm back further when in a throwing motion)
-blunt trauma
Sternoclavicular sprain Degree of injury: First degree
(S/S & treatment)
S/S: pain & slight disability
Treatment: PIER, sling/swathe
Sternoclavicular sprain Degree of injury: second degree
(S/S & treatment)
S/S: pain, sublux with deformity, swelling, point tenderness, decreased ROM
Treatment: PIER, reduction if necessary
Sternoclavicular sprain Degree of injury: third degree
(S/S & treatment)
S/S: Gross deformity (dislocation), pain, swelling, decreased ROM
Treatment: PIER, most likely surgery
Acromioclavicular sprain: etiology + MOI
etiology: weak & easily injured. Acromion is driven away from the clavicle or vice versa
MOI:
-FOOSH
-direct blow with the point of the shoulder (hitting boards in hockey)
-direct blow
Grades of AC injury S/S + Treatment: grade 1
S/S: mild tenderness over AC, painful horizontal adduction, no disruption of AC joint
treatment: rest, ice, immobilize in cuff/ collar sling 1 week
Grades of AC injury S/S + Treatment: grade 2
S/S: tear/rupture of AC ligament, partial discplacement of lateral end of clavicle, pain, point tenderness, decreased add./abd. ROM
Treatment: rest, ice, immobilize in cuff/collar sling
Grades of AC injury S/S + Treatment: grade 3
S/S: severe pain, moderate to severe step. Rupture of AC & CC joint
Treatment: rest, ice, immobilize in cuff/collar sling
Grades of AC injury S/S + Treatment: Grade 4
S/S: posterior seperation of the clavicle
treatment: surgery
Grades of AC injury S/S + Treatment: grade 5
S/S: -loss of AC and CC ligaments
-tearing of deltiod & traps muscle attatchments,
-gross deformity
-severe pain
-decreased ROM
treatment: surgery
Grades of AC injury S/S + Treatment: grade 6
S/S: displacement of clavicle behind the coracobrachilais
treatment: surgery
GH sublux./dislocations: Anterior dislocation: MOI
-FOOSH w/arm externally rotated
-direct blow to hand or forearm when shoulder is abducted 90 degrees and elbow is bent
GH sublux./dislocations: Anterior dislocation: S/S
-flattened deltoid
-prominent humeral head in the axilla arm in slight ABD & ER
-moderate pain/disability
-positive apprehension test
-sulcus sign
GH sublux./dislocations: Posterior dislocation: MOI
-Forced adduction & internal rotation
- FOOSH with arm internally rotated
GH sublux./dislocations: posterior dislocation: S/S
-severe pain & disability
-arm carried in ADD & IR
-prominent acromion & coracoid process
-limited ER & elevation
Tissue damage with GH dislocation/sublux. (7)
-capsule
-ligaments
-tendon
-labrum
-blood vessels
-nerves
-potential fracture
GH treatment
-immobilize w/sling & swathe
-immediate refferal to physician
- 3 week immobilization following reduction
-return to activity when regained 20% of bodyweight for IR & ER
Complications for shoulder dislocations (3)
Bankart lesion
Hill sachs lesion
SLAP lesion
what is Bankart lesion
permanent anterior defect of labrum
-can chip off piece of the labrum & it never grows back
what is Hill sachs lesion
caused by compression of bone against anterior glenoid rim creating a divot in the humeral head
-occurs with bankart lesion
what is SLAP lesion
(Superior Labrum Anterior & Posterior)
Defect in superior labrum that begins posteriorly and extends anteriorly impacting attatchment of long head of biceps on labrum
-complete tear of labrum from posterior to anterior
what other injury can cause a SLAP lesion?
bicep tendonitis
Clavicular fracture: MOI
-direct impact
-FOOSH
-fall on tip of shoulder
most common point of fracture on a clavicle fracture & why
the mid 1/3 (third) this is where it changes shape & direction and it the clavicles weakest point
clavicle fracture: S/S
-point tenderness
-upward displacement of medial calvicular segment due to pull of the muscle
-falling forward to the same side of the shoulder
-generally presents w/supporting of the arm & head tilted towards injured side w/chin tucked away
clavicle fracture: treatment
-reassure athlete
-sling & swathe in most comfortable position
-have someone drive them to hospital
-(hospital) immobilize in modified fig 8 splint
