The Shoulder Flashcards
Diagram: Identify the 4 joints
Left to Right, Top to Bottom
- Sternoclavicular
- Acromioclavicular
- Scapulothoracic
- Glenohumeral
Content: Passive/static glenohumeral stability (5)
- Bones
- Cartilage
- Capsule
- Labrum
- Ligaments
Content: Active/dynamic glenohumeral stability (2)
- Deep muscles (rotator cuff)
- Neuromuscular balance between deep and superficial muscles
Diagram: Ligaments
Top to bottom
- Conoid
- Trapezoid (with conoid = coracoclavicular
- Acromioclavicular
- Coraco-acromial
- Coraco-humeral
- Transverse humeral
- Superior GHL
- Middle GHL
- Inferior GHL
Content: Superficial muscles (6)
- Deltoid
- Pectoralis
- Biceps
- Trapezius
- Latissimus dorsi
- Serratus anterior
Content: Deep muscles/rotator cuff (4)
- Supraspinatus
- Infraspinatus
- Teres minor
- Subscapularis
Q: What is the ratio for glenohumeral/scapulothoracic movement?
5:4
Q: What is the ratio for humeral/scapular movement?
2:1
Q: When does scapulohumeral rhythm begin?
After 30 degrees of abduction
Q: What 3 movements occur at the clavicle?
- Protraction/Retraction
- Elevation/Depression
- Posterior rotation/Anterior rotation
Q: What movements occur at the ST joint?
- IR/ER
- Upward/lateral rotation/Downard/medial rotation
- Posterior tilting/Anterior tilting
Q: What is roll and glide for humeral flexion?
R = ant
G = post
Q: What is roll and glide for humeral horizontal adduction?
R = ant
G = post
Q: What is roll and glide for humeral IR?
R = ant
G = Post
Q: What is roll and glide for humeral extension?
R = post
G = ant
Q: What is roll and glide for humeral horizontal abduction?
R = post
G = ant
Q: What is roll and glide for humeral ER?
R = post
G = ant
Q: What is roll and glide for humeral abduction?
R = superior
G = inferior
Q: For what degrees of motion does elevation through abduction occur?
170-180
Q: For what degrees of motion does elevation through forward flexion occur?
160-180
Q: For what degrees of motion does elevation through the plan of the scapula occur?
170-180
Q: For what degrees of motion does ER occur?
80-90
Q: For what degrees of motion does IR occur?
60-100
Q: For what degrees of motion does extension occur?
50-60
Q: For what degrees of motion does adduction occur?
50-75
Term: A mechanical impingement of the subacromial structure, esp. the rotator cuff tendons, beneath the atnerior-inferior poriotn of the acromion
Impingement syndrome
Defn: Shoulder impingement syndrome
Term: A mechanical impingement of the subacromial structure, esp. the rotator cuff tendons, beneath the atnerior-inferior portion of the acromion
Q: What are the symptoms of shoulder impingement syndrome? (2)
- Pain in the anterosuperior part of the shoulder
- weakness and stiffness
Q: What is outlet impingement syndrome?
Occurs when the coracoarcomial arch encroaches on the supraspinatus outlet
Q: What is non-outlet impingement syndrome?
Occurs secondary to thickening or hypertrophy of the bursa or the rotator cuff tendons
Content: Intrinsic classification of impingement syndrome (4)
- Primary or secondary
- Rotator cuff weakness
- Overuse of the shoulder
- Degerenative tendinopathy
Q: Why can a pt. not hold up there arm when you perform a drop test?
If the supraspinatus is ruptured, it can not compress the shoulder joint/engage it to allow the deltoid to due it’s job.
Content: Extrinsic classifcation of impingement syndrome (6)
- Primary or secondary
- Shape of the acromion
- Instability (classic)
- Degeneration of the AC joint
- Impingement by the coracoacromial ligament or coracoid process
- Os acromiale (3 types)
Diagram: types of os acromiale
Q: If your scapula is anteriorly tilted you stretch ____________ and strengthen ___________.
Pectoralis minor, lower trap
Content: Stage 1 of impingement syndrome (2)
- Characterized by edema and hemorrhage of the bursa and cuff
- Pts. < 25 yo
Content: Stage 2 of impingement syndrome (2)
- Represents irreversible changes (fibrosis/teninitis) of the rotator cuff
- pts. 25-40 yo
Content: Stage 3 of impingement syndrome (2)
- Marked by more chronic changes (partial/complete tear) of rotator cuff
- Pts. > 40 yo
Content: Shoulder impingement differential diagnoses (6)
- Instability (secondary impingement)
- Adhesive capsulitis
- Glenohumeral arthritis
- Biceps tendonosis
- Labral pathology
- Cervical radiculopathy
Content: MOI for shoulder impingement (8)
- Age
- Position of the arm during activites
- Repetitive overhead
- Muscle imbalances
- Capsular tightness
- Postural imbalance
- Structural asymmetry
- Impaired scapular kinematics
Q: What is the diagnosis for a pt. > 40 yo with overuse and painful arc symptoms?
Primary impingement
Q: What is the diagnosis for a pt who is young with repetitive overhead/athletic activity with painful arc symptoms?
Secondary impingement