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631: Clinical Management of the Musculoskeletal System I > The Shoulder > Flashcards

The Shoulder Flashcards

1
Q

What is the primary function of the shoulder complex?

A

To position the hand in space, allowing interaction with the environment

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2
Q

What are the 3 secondary functions of the shoulder complex?

A
  • Suspend the upper limb
  • Provide sufficient fixation so that motion of the UE or trunk can occur
  • Serve as a fulcrum for arm elevation
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3
Q

What 3 things are shoulder mobility dependent upon?

A
  • A healthy articular surface
  • Intact muscle-tendon units
  • Supple capsuloligamentous restraints
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4
Q

What 3 things are shoulder stability dependent upon?

A
  • Intact capsuloligamentous structures
  • Proper function of the muscles
  • Integrity of the osseous articular structures
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5
Q

What type of joint is the GH joint?

A

a true synovial-lined diarthrodial joint

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6
Q

In what position does the humerus face?

A

Medially, Posteriorly, and Superiorly

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7
Q

In what position does the glenoid fossa face?

A

Laterally, Anteriorly, and Superiorly

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8
Q

What makes the glenoid fossa deeper?

A

The labrum, but 50%

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9
Q

What does the labrum attach to?

A

The glenoid cavity, joint capsule, and lateral potion of the biceps

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10
Q

What percentage of long head of the biceps fibers originate from the superior labrum?

A

50%

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11
Q

At any given point during elevation, what percentage of the humeral head is in contact with the glenoid?

A

25-30%

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12
Q

What 3 positions most significantly reduce humeral head contact with the glenoid?

A
  • Adduction, flexion and IR
  • Abduction and elevation
  • Adducted at the side with downwardly rotated scapula
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13
Q

What are the GH dynamic stabilizers?

A

RC muscles among other force couples

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14
Q

What are the GH static stabilizers?

A
  • Joint capsule
  • Joint cohesion
  • Ligamentous support
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15
Q

Scaption is considered arm elevation with the arm held __-__ degrees anterior to the frontal plane

A

30-45

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16
Q

How many muscles attach to the scapula? How many of those are involved in support and scapular movement and how many are involved in GH motion?

A

16

- Six of these support and move the scapula
- Ten of these are concerned with GH motion
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17
Q

Describe the lateral, medial, inferior, and superior attachments of the GH joint capsule

A
  • Laterally attaches to the neck of the humerus
  • Medially attaches to the periphery of the glenoid and its labrum
  • Inferiorly attaches to the inferior portion of the glenoid
  • Anteriorly is reinforced by the Z ligaments and the RC tendons
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18
Q

Why is the inferior aspect of the GH joint capsule loose?

A

To allow for gliding during elevation

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19
Q

When is the anterior GH ligament under tension?

A

when the shoulder is in extension, ABD and/or ER

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20
Q

When is the posterior GH ligament under tension?

A

when the shoulder is in flexion and ER

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21
Q

When is the inferior GH ligament under tension?

A

when the shoulder is ABD, extended and/or ER

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22
Q

When is the posterior GH ligament under tension?

A

when the shoulder is flexed and ER

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23
Q

Which GH ligament is the primary restraint against anterior and posterior humeral head dislocation?

A

Inferior GH ligament

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24
Q

What structures are found within the coracoacromial arch?

A
  • Head of the humerus
  • Long head of the biceps tendon
  • Superior aspect of the joint capsule
  • Supraspinatus and upper margins of the subscapularis - and infraspinatus
  • Subdeltoid bursa
  • Subacromial bursa
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25
Q

What is the normal size of the GH joint in height?

A

10-11 mm

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26
Q

What nerves are found in the anterior should joint?

A

axillary, subscapular and lateral pectoral

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27
Q

What nerves are found in the posterior should joint?

A

suprascapular nerve, small branches of the axillary nerve

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28
Q

What artery supplies the shoulder complex for the most part?

A

axillary artery

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29
Q

What is the open-packed position of the GH joint?

A

55 degrees of abduction and 30 degrees of horizontal adduction

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30
Q

What is the closed-packed position of the GH joint?

A

Abduction and full ER

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31
Q

What is the capsular pattern of the GH joint?

A

ER > ABD > IR

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32
Q

What is the open-packed position of the AC joint?

A

arm by the side

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33
Q

What is the closed-packed position of the AC joint?

A

90 degrees of abduction

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34
Q

What is the capsular pattern of the AC joint?

A

extremes of ROM cause pain

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35
Q

What joint serves as the main articulation that suspends the UE from the trunk?

A

AC joint

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36
Q

What ligament is the primary support of the AC joint?

A

Coracoclavicular ligament

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37
Q

What is the open-packed position of the SC joint?

A

Arm at the side

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38
Q

What is the closed-packed position of the SC joint?

A

Maximum arm elevation and protraction

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39
Q

What is the capsular pattern of the SC joint?

A

Pain occurs at the extremes of ROM, esp. full arm elevation and horizontal adduction

40
Q

If held vertically, the proximal end of the clavicle is con___.

A

convex

41
Q

If held A/P, the proximal end of the clavicle is con___.

A

concave

42
Q

What are the 3 DOF at the SC joint?

A
  • Protraction/retraction
  • Elevation/depression
  • Upward/downward
43
Q

At the ST Joint:
__ degrees of upward rotation of the scapula
__-__ degrees of IR/ER
__-__ degrees of anterior/posterior tipping

A

60

40-60

30-40

44
Q

What is the capsular pattern of the scapulothoracic joint?

A

none

45
Q

What is the closed packed position of the scapulothoracic joint?

A

none

46
Q

What is the open packed position of the scapulothoracic joint?

A

30-45 degrees of IR, slight upward rotation and 5-20 degrees of anterior tipping

47
Q

What is the main function of the serratus anterior?

A
  • Protract and upwardly rotate the scapula

- Provide a strong, mobile BOS to position the glenoid for maximum efficiency

48
Q

What muscle provides eccentric control of the scapula during flexion and abduction?

A

Levator scapulae

49
Q

What muscle helps control scapular position, especially with horizontal flexion and extension?

A

Rhomboids

50
Q

Describe the movements that occur during the first 90 degrees of abduction

A

60 degrees of GH abduction

30 degrees of ST upward rotation

51
Q

The 30 degrees of ST upward rotation that occurs during the first part of abduction can be broken down into __-__ degrees of clavicular elevation and __-__ degrees of AC upward rotation

A

20-25

5-10

52
Q

Describe the movements that occur during the second 90 (90-180) degrees of abduction

A

60 deg of GH abduction

30 deg of ST upward rotation

53
Q

The 30 degrees of ST upward rotation that occurs during the late phase of abduction can be broken down into __-__ degrees of clavicular elevation and __-__ degrees of AC upward rotation

A

5-10

20-25

54
Q

Pain during __-__ degrees of abduction is deemed a “painful arc”. What may this indicate?

A

70-110

RC impingement/tearing or subacromial bursitis

55
Q

What does pain during 120-180 may indicate?

A

involvement of the AC joint

56
Q

Describe Humeral Superior Glide Syndrome

A

The humeral head glides superiorly during elevation, because the downward pull of the RC muscles is insufficient to counterbalance the upward pull of the deltoid

57
Q

ROM with unilateral elevation should be ____ than bilateral elevation

A

greater

58
Q

What test tests for IR AROM?

A

Apley’s Scratch Test

59
Q

Where should the thumb reach during Apley’s Scratch Test?

A

T5-T10 level

60
Q

During elevation, when does the scapula stop its rotation?

A

when the arm has been elevated to approximately 140 degrees

61
Q

What do resistive tests test?

A

Inert tissues for involvement before coming to the conclusion that only the M/T structure is at fault

62
Q

Pain with isometric muscle testing is generally considered a sign of what?

A

1st or 2nd degree musculotendinous lesion

63
Q

Pain that occurs during a muscle contraction is more likely to indicate what?

A

a lesion within a muscle belly

64
Q

Pain that occurs on release of the contraction is more likely to indicate what?

A

a lesion within the tendon

65
Q

What motions are required in order to eat?

A

70-100 of horizontal adduction

45-65 of abduction

66
Q

What motions are required in order to comb your hair?

A

30-70 of horizontal adduction

105-120 of abduction

90 of ER

67
Q

What motions are required in order to reach your perineum?

A

75-90 of horizontal abduction

30-45 of abduction

90 of IR

68
Q

What motions are required in order to tuck in your shirt?

A

50-60 of horizontal abduction

55-65 of abduction

90 of ER

69
Q

What motions are required in order to put your hand behind your head?

A

1-15 of horizontal adduction

110-125 of flexion

90 of ER

70
Q

What motions are required in order to put on item on a shelf?

A

70-80 horizontal adduction

70-80 of flexion

45 of ER

71
Q

What motions are required in order to wash your opposite shoulder?

A

60-90 of flexion

60-120 of horizontal adduction

72
Q

What are 5 of the most commonly used shoulder outcome scales?

A
  • UCLA Shoulder Rating Scale
  • Simple Shoulder Test
  • Shoulder Pain and Disability Index
  • Disabilities of the Arm, Shoulder and Hand (DASH)
  • Penn Shoulder Score
73
Q

Describe DASH

A

It is an outcome measure that reflects the impact on function of a variety of musculoskeletal diseases and injuries in the UE

74
Q

What are grade I and II oscillations used for?

A

pain

75
Q

What are grade III and IV mobilizations used for?

A

to increased ROM

76
Q

In what direction does GH distraction occur?

A

Lateral, anterior and inferior direction

77
Q

What are the 3 passive accessory motion GH tests?

A
  • Anterior glide
  • posterior glide
  • inferior glide
78
Q

What are the 4 passive accessory motion ST tests?

A
  • Superior Glide
  • Inferior Glide
  • Medial Glide
  • Lateral Glide
79
Q

Describe movement of the clavicle during GH abduction or shoulder elevation

A
  • Lateral end of the clavicle moves superiorly
  • Medial end slides and rolls inferiorly
  • Clavicle rotates anteriorly
80
Q

Describe movement of the clavicle during GH adduction or shoulder depression

A
  • Lateral end of the clavicle moves inferiorly
  • Medial end rolls and slides superiorly
  • Clavicle rotates posteriorly
81
Q

What are the 4 tests for shoulder impingement?

A
  • Neer Impingement Test
  • Hawkins-Kennedy Impingement Test
  • Yocum Test
  • Painful Arc Test
82
Q

What are the 7 tests that test RC integrity?

A
  • Drop Arm Test
  • Empty Can Test
  • External Rotation Lag Sign
  • Lift Off Test
  • Internal Rotation Lag Sign
  • Posterior Impingement Sign
  • Hornblower’s Sign
83
Q

What are the 2 tests for a biceps tear?

A
  • Speed’s Test

- Yergason’s Test

84
Q

What are the 6 tests for a superior labral tear?

A
  • Clunk Test
  • Crank Test
  • Jerk Test
  • O’Brien’s Test (aka Active Compression Test)
  • Anterior Slide Test
  • Compression Rotation Test
85
Q

What are the 3 tests that test for AC pathology?

A
  • O’Brien’s Test
  • Crossover Impingement/Horizontal Adduction Test
  • Acromioclavicular Resisted Extension Test
86
Q

What are the 4 tests that test for anterior instability?

A
  • Load and Shift
  • Apprehension Test
  • Jobe Subluxation/Relocation Test
  • Rockwood Test
87
Q

What are the 2 tests that test for inferior/multidirectional instability?

A
  • Sulcus Sign

- Feagin Test

88
Q

How is Sulcus Sign graded?

A

Graded by measuring the inferior margin or acromion to the humeral head

  \+1 sulcus implies distance of less than 1cm
  \+2 sulcus implies distance of 1-2cm
  \+3 sulcus implies distance of more than 2cm
89
Q

What are the 3 tests that test for posterior instability?

A
  • Load and Shift Test

- Posterior Apprehension or Stress Test

90
Q

Describe the 3 grades of shift (anterior or posterior)

A
  • Grade I: up to 50% of humeral head translation with head riding up onto glenoid rim and spontaneous reduction
  • Grade II: greater than 50% of humeral head translation with head riding over glenoid rim and spontaneous reduction
  • Grade III: humeral head rides over glenoid rim and does not reduce spontaneously
91
Q

Is greater laxity expected more anteriorly or posteriorly, why?

A

Posterior, because we already sit in a slouched position

92
Q

What are the 3 Upper Limb Tension Tests?

A
  • ULTT 1: Median Nerve
  • ULTT 2: Radial Nerve
  • ULTT 3: Ulnar Nerve
93
Q

In what plane should you rehab the shoulder? Why?

A

In the scapular plane as it is more functional

94
Q

What type of mobilization with movement should be performed for patient’s with decreased elevation?

A

1) Clinician places one hand over the scapula and one hand over the anterior aspect of the head of the humerus
2) The patient is asked to elevate the arm while the clinician applies a posterior glide to the humeral head

95
Q

What type of mobilization with movement should be performed for patient’s with decreased IR?

A

1) Clinician places one hand in the crease of the patient’s elbow and the web space of other hand in the patient’s axilla using a lumbrical grip
2) Clinician glides the humerus inferiorly using the hand at the elbow
3) Clinician applies an adduction force by pressing their abdomen against the patient as the patient internally rotates the shoulder

631: Clinical Management of the Musculoskeletal System I (19 decks)

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