The Shoulder Flashcards
1
Q
Diagram: Identify the 4 joints
A
Left to Right, Top to Bottom
- Sternoclavicular
- Acromioclavicular
- Scapulothoracic
- Glenohumeral
2
Q
Content: Passive/static glenohumeral stability (5)
A
- Bones
- Cartilage
- Capsule
- Labrum
- Ligaments
3
Q
Content: Active/dynamic glenohumeral stability (2)
A
- Deep muscles (rotator cuff)
- Neuromuscular balance between deep and superficial muscles
4
Q
Diagram: Ligaments
A
Top to bottom
- Conoid
- Trapezoid (with conoid = coracoclavicular
- Acromioclavicular
- Coraco-acromial
- Coraco-humeral
- Transverse humeral
- Superior GHL
- Middle GHL
- Inferior GHL
5
Q
Content: Superficial muscles (6)
A
- Deltoid
- Pectoralis
- Biceps
- Trapezius
- Latissimus dorsi
- Serratus anterior
6
Q
Content: Deep muscles/rotator cuff (4)
A
- Supraspinatus
- Infraspinatus
- Teres minor
- Subscapularis
7
Q
Q: What is the ratio for glenohumeral/scapulothoracic movement?
A
5:4
8
Q
Q: What is the ratio for humeral/scapular movement?
A
2:1
9
Q
Q: When does scapulohumeral rhythm begin?
A
After 30 degrees of abduction
10
Q
Q: What 3 movements occur at the clavicle?
A
- Protraction/Retraction
- Elevation/Depression
- Posterior rotation/Anterior rotation
11
Q
Q: What movements occur at the ST joint?
A
- IR/ER
- Upward/lateral rotation/Downard/medial rotation
- Posterior tilting/Anterior tilting
12
Q
Q: What is roll and glide for humeral flexion?
A
R = ant
G = post
13
Q
Q: What is roll and glide for humeral horizontal adduction?
A
R = ant
G = post
14
Q
Q: What is roll and glide for humeral IR?
A
R = ant
G = Post
15
Q
Q: What is roll and glide for humeral extension?
A
R = post
G = ant
16
Q
Q: What is roll and glide for humeral horizontal abduction?
A
R = post
G = ant
17
Q
Q: What is roll and glide for humeral ER?
A
R = post
G = ant
18
Q
Q: What is roll and glide for humeral abduction?
A
R = superior
G = inferior
19
Q
Q: For what degrees of motion does elevation through abduction occur?
A
170-180
20
Q
Q: For what degrees of motion does elevation through forward flexion occur?
A
160-180
21
Q
Q: For what degrees of motion does elevation through the plan of the scapula occur?
A
170-180
22
Q
Q: For what degrees of motion does ER occur?
A
80-90
23
Q
Q: For what degrees of motion does IR occur?
A
60-100
24
Q
Q: For what degrees of motion does extension occur?
A
50-60
25
Q: For what degrees of motion does adduction occur?
50-75
26
Term: A mechanical impingement of the subacromial structure, esp. the rotator cuff tendons, beneath the atnerior-inferior poriotn of the acromion
Impingement syndrome
27
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
28
Q: What are the symptoms of shoulder impingement syndrome? (2)
1. Pain in the anterosuperior part of the shoulder
2. weakness and stiffness
29
Q: What is outlet impingement syndrome?
Occurs when the coracoarcomial arch encroaches on the supraspinatus outlet
30
Q: What is non-outlet impingement syndrome?
Occurs secondary to thickening or hypertrophy of the bursa or the rotator cuff tendons
31
Content: Intrinsic classification of impingement syndrome (4)
1. Primary or secondary
2. Rotator cuff weakness
3. Overuse of the shoulder
4. Degerenative tendinopathy
32
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.
33
Content: Extrinsic classifcation of impingement syndrome (6)
1. Primary or secondary
2. Shape of the acromion
3. Instability (classic)
4. Degeneration of the AC joint
5. Impingement by the coracoacromial ligament or coracoid process
6. Os acromiale (3 types)
34
Diagram: types of os acromiale
35
Q: If your scapula is anteriorly tilted you stretch ____________ and strengthen \_\_\_\_\_\_\_\_\_\_\_.
Pectoralis minor, lower trap
36
Content: Stage 1 of impingement syndrome (2)
1. Characterized by edema and hemorrhage of the bursa and cuff
2. Pts. \< 25 yo
37
Content: Stage 2 of impingement syndrome (2)
1. Represents irreversible changes (fibrosis/teninitis) of the rotator cuff
2. pts. 25-40 yo
38
Content: Stage 3 of impingement syndrome (2)
1. Marked by more chronic changes (partial/complete tear) of rotator cuff
2. Pts. \> 40 yo
39
Content: Shoulder impingement differential diagnoses (6)
1. Instability (secondary impingement)
2. Adhesive capsulitis
3. Glenohumeral arthritis
4. Biceps tendonosis
5. Labral pathology
6. Cervical radiculopathy
40
Content: MOI for shoulder impingement (8)
1. Age
2. Position of the arm during activites
3. Repetitive overhead
4. Muscle imbalances
5. Capsular tightness
6. Postural imbalance
7. Structural asymmetry
8. Impaired scapular kinematics
41
Q: What is the diagnosis for a pt. \> 40 yo with overuse and painful arc symptoms?
Primary impingement
42
Q: What is the diagnosis for a pt who is young with repetitive overhead/athletic activity with painful arc symptoms?
Secondary impingement
43
Q: In what ROM does the glenohumeral painful arc occur?
45-60 to 120 and beyond 170 degrees
44
Q: What 4 tests can be done during a OE to confirm/refute a shoulder impingement diagnosis?
1. Painful arc
2. Neer's test
3. Hawkin's test
4. "Empty can" test
45
Q: What is an education plan for a pt. with a shoulder impingement?
Avoid overhead activities and postitions of shoulder impingement
46
Q: What is a modalities plan for a pt. with a shoulder impingement? (3)
1. Ice
2. Ultrasound
3. Electrical currents
47
Q: What is a therapeutic exercise plan for a pt. with a shoulder impingement? (3)
1. Postural corrections
2. ROM/stretching
3. Strengthening
48
Q: What is a manual therapy plan for a pt. with a shoulder impingement?
Inferior and posterior glides
49
Q: What is an assistvie device plan for a pt. with a shoulder impingement?
sling when acute
50
Q: What is a HEP plan for a pt. with a shoulder impingement?
Pendulum exercises and others based on the TherEx program
51
Q: What is name of a traumatic shoulder instabiltiy lesion?
Bankart
52
Q: What ligaments are injuried in a non-traumtic shoulder instability injury?
IGHL and AGHL
53
Q: What are the symtpoms for traumatic shoulder instability?
Recurrent shoulder dislocation (chronic phase)
54
T/F: With traumatic shoulder instability a apprehension test is negative.
False: positive
55
Q: What are the symptoms of non-traumatic shoulder instabiltiy?
1. Tendinitis
2. Sensation of instability and laxity
56
T/F: With non-traumatic shoulder instabiltiy an apprehension test will be negative.
True
57
Q: What is an education plan for shoulder instability?
Avoid MOI and overhead activities
58
Q: What is a modalities plan for shoulder instability? (3)
1. Ice,
2. Electrical currents
3. Diathermy (SWD)
59
Q: What is a therapeutic exercise plan for shoulder instability? (2)
1. Scapular stabilization exercises
2. Rotator cuff strengthening
60
Q: What is an manual therapy plan for shoulder instability?
Depends on exam findings, may not be applicable
61
Q: What is an assistvie device plan for shoulder instability?
Sling when acute
62
Q: What is a HEP plan for shoulder instability?
Follow the presribed TherEx
63
Q: What is SLAP lesion?
Injury to the glenoid labrum
64
Q: What does SLAP stand for?
Superior Labral tear from Anterior to Posterior
65
Diagram: SLAP lesions classificaiton
66
Content: MOI for SLAP lesions (2)
1. Sudden eccentric biceps contraction as in trying to grap an object while falling from a height or a FOOSH
2. Repetitive overhead activity (overhead athletes) - esp. baseball players
67
Q: What deficits are seen in baseball players with SLAP lesions?
IR with should in 90 degrees of abduction, which predisposes excessive ER
68
Content: Symptoms of a SLAP lesion (2)
1. Pain
2. Feeling of instability/lack of control (when overhead/abd ER)
69
Q: What is an education plan for SLAP lesions?
Avoid MOI and overhead activites
70
Q: What is a modality plan for SLAP lesions?
Diathermy (SWD)
71
Q: What is a therapeutic exercise plan for SLAP lesions? (2)
1. Scapular stabilization exercises
2. Posterior capsular stretching
72
Q: What is a manual therapy plan for SLAP lesions?
Depending on exam findings - inferior/anterior glides
73
Q: What is an assistive device plan for SLAP lesions?
Sling when acute
74
Q: What is a HEP plan for SLAP lesions?
Follow prescribed TherEx
75
Term: a condition difficult to define, treat, and explain from the point of view of pathology
Adhesive capsulitis/frozen shoulder
76
Term: Inflammed and fibrotic condition of capsuloligamentous tissue
Adhesive capsulitis/frozen shoulder
77
Defn: Adhesive capsulitis or frozen shoulder
Inflammed and fibrotic condition of capsuloligamentous tissue
78
Diagram: Classification of frozen shoulder
79
Q: What is an education plan for frozen shoulder?
Explain the nature of the disease and prepare pt. for extended recovery
80
Q: What is a modality plan for frozen shoulder? (2)
1. Hotpacks
2. TENS
81
Q: What is a therapeutic exercise plan for frozen shoulder?
Stretching: progressive in the amount of stress and time (according with stage) - Hold/relax and LLLD
82
Q: What is a manual therapy plan for frozen shoulder? (2)
1. ER with inferior glide (rotator cuff interval - RIC)
2. Posterior glide and maneuvers for general mobility
83
Q: What is an assistive device plan for frozen shoulder?
Low load prolonged stress equipment
84
Q: What is a HEP plan for frozen shoulder?
Pendulum and AA exercise 3x/day
85
Q: What are 4 suggested modalities for shoulder pathologies?
1. Ultrasound
2. Diathermy
3. Laser
4. Eletrical currents
86
Q: What is ultrasound good for?
Decrease pain and speed healing process
87
Q: What effects does diathermy have?
Effects similar to subacromial corticosteroid injecitons
88
Q: What is laser good for?
Decrease pain and speed the healing process
89
Q: What is electrical currents good for?
Decrease pain
90
Term: In degenerate shoulders where there is fraying and roughening of the biceps anchor area
SLAP type 1
91
Term: Biceps anchor peels off from the supraglenoid tubercle with the associated detachment of the labrum extending for a variable distance anteriorly and/or posteriorly
SLAP type 2
92
Q: Which SLAP classification is most common?
Type 2
93
Term: Bucket handle tear ofthe superior labrum without involvement of the biceps anchor
SLAP type 3
94
Term: The labral tear extends into the biceps anchor na dtendon for a variable distance
SLAP type 4
95
Term: SLAP with a bankart lesion
SLAP type 5
96
Term: Flap tear of anterior labrum with detrachment of biceps anchor
SLAP type 6
97
Term: SLAP tear associated with anteriocapsuloligamentous tear involving the middle glenohumeral ligament (MGHL)
SLAP type 7
98
Content: Stages of Adhesive Capsulitis - Duration of Symptoms (4)
1: 0-3 mo
2: 3-9 mo
3: 9-15 mo
4: 15-24 mo
99
Content: Stages of Adhesive Capsulitis - Pain (4)
1: w/AROM & PROM
2: Chronic pain w/AROM & PROM
3: Min pain except at end ROM
4: Min pain
100
Content: Stages of Adhesive Capsulitis - Limitations (4)
1: Forward flexion, abduction, IR, ER
2: Significant limitation of forward flexion, abduction, IR, ER
3: Significant limitation of ROM with rigid end feel
4: Progressive inprovement in ROM
101
Content: Stages of Adhesive Capsulitis - Examination (4)
1: Pt. under anesthesia - norm/min loss of ROM
2: Pt. under anesthesia - ROM essentially identical to ROM when pt. is awake
3: Pt. under anesthesia - ROM identical to ROM when pt. is awake
4: Data not available
102
Content: Stages of Adhesive Capsulitis - Pathologic changes (3)
1: Hypertrophic, hypervascular synovitis, rare inflammatory cell infiltrates, normal underlying capsule
2: Hypertrophic, hypervascular synovitis with perivascular and subsynovial scar, fibroplasias and scar formation in the underlying capsule
3: "Burned-out" synovitis without significant hypertrophy or hypervascularity. Underlying capsule shows dense scar formation
103
Defn: Intrinsic Impingement
Intratendinous
104
Defn: Extrinsic Impingement
Extratendinous
105
Defn: Primary Impingement (2)
1. Structures that occupy the subacromial space
2. Causes the impingement
106
Defn: Secondary impingement (2)
1. Structures that DO NOT occupy the subacromial space
2. Instability or neurological disease
107
Defn: Subacromial space
Coracoacromial arch: coracoacromial ligament or coracoid process and greater tuberosity of the humerus
