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Musculoskeletal Exam 3 > 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, by 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

36
Q

What ligament is the primary support of the AC joint?

A

Coracoclavicular ligament

37
Q

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

A

Arm at the side

38
Q

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

A

Maximum arm elevation and protraction

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 flexion60-120 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

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

82
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
83
Q

Is greater laxity expected more anteriorly or posteriorly, why?

A

Posterior, because we already sit in a slouched position

84
Q

What are the 3 Upper Limb Tension Tests?

A
  • ULTT 1: Median Nerve
  • ULTT 2: Radial Nerve
  • ULTT 3: Ulnar Nerve
85
Q

In what plane should you rehab the shoulder? Why?

A

In the scapular plane as it is more functional

Musculoskeletal Exam 3 (6 decks)

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