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Musculoskeletal System > The Shoulder > Flashcards

The Shoulder Flashcards

1
Q

What forms the glenohumeral joint - bones and any cartilagenous structures

A

Head of humerus

Glenoid fossa of scapula

Glenoid labrum

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2
Q

What are the bursae found in the shoulder joint and what are their functions

A

Subacromial - supports deltoid and supraspinatus

Subscapular - reduceds wear and tear on subscapularis tedon during movement at joint

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3
Q

What are the ligaments of the shoulder joint and what are their functions

A

Glenohumeral (superior, middle, inferior) - stabilise anterior aspect of joint

Coracohumeral - supports superior part of joint

Transverse - holds tendon of long head of biceps in intertubercular groove

Coracoacromial - prevents superior displacement of humeral head

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4
Q

What are the movements of the shoulder joint and which muscles are responsible for them

A

Extension - posterior deltoid, latissimus dorsi, teres major

Flexion - biceps brachii, pectoralis major, anterior deltoid, coracobrachialis

Abduction - 0-15o supraspinatus, 15-90o deltoid (middle fibres), >90o trapezius and serratus anterior

Adduction - pectoralis major, latissimus dorsi, teres major

Medial rotation - subscapularis, pectoralis major, latissimus dorsi, teres major, anterior deltoid

Lateral rotation - infraspinatus, teres major

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5
Q

What does the scapula articulate to and what are the joint names

A

Humerus at glenohumeral joint

Clavicle at acromioclavicular joint

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6
Q

What features are present on the costal surface of the scapula

A

Subscapular fossa

Coracoid process

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7
Q

What features are present on the lateral surface of the scapula

A

Glenoid fossa

Supraglenoid tubercle

Infraglenoid tubercle

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8
Q

What features are present on the posterior surface of the scapula

A

Spine

Infraspinous fossa

Supraspinous fossa

Acromion

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9
Q

What are the three main functions of the clavicle

A

Attaches upper limb to the trunk

Protects underlying neurovascular structures supplying upper limb

Transmits force from upper limb to axial skeleton

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10
Q

What features are present on the sternal end of the clavicle

A

Large facet - articulation with manubrium of sternum (sternoclavicular joint)

Rough oval depression of inferior surface - for costoclavicular ligament

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11
Q

What muscles attach to the shaft of the clavicle

A

Deltoid, trapezius, subclavis, pectoralis major, sternocleidomastoid, sternohyoid

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12
Q

What features are present on acromial end of clavicle

A

Conoid tubercle - attachment point of conoid ligament

Trapezoid line - attachment point of trapeziod ligament

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13
Q

What are the proximal landmarks of the humerus

A

Head of humerus

Greater tubercle - lateral, attachment site for; supraspinatus, teres minor, infraspinatus

Lesser tubercle - medial, attachment site for subscapularis

Intertubercular sulcus - biceps brachii tendon runs through

Surgical neck

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14
Q

What are the bony landmarks on the shaft of the humerus and what muscles attach anteriorly and posteriorly

A

Deltoid tuberosity - roughened surface, lateral, deltoid muscle attaches

Radial groove - shallow depression, posterior surface, radial nerve and profunda brachii lie in groove

Anteriorly - coracobrachialis, deltoid, brachialis, brachioradialis

Posteriorly - medial and lateral triceps heads

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15
Q

What are the bony landmarks on the distal region of the humerus

A

Medial and lateral supraepicondylar ridges

Lateral and medial epicondyles

Trochlea

Three depressions - coronoid, radial and olecranon fossa

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16
Q

What are the extrinsic muscles of the shoulder

A

Superficial - trapezius, latissimus dorsi

Deep - Levator scapulae, major and minor rhomboids

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17
Q

What are the functions and innervations of the superficial extrinsic muscles of the shoulder

A

Trapezius - accessory nerve, upper fibres elevate and rotate scapula during arm abduction, middle fibres retract scapula, lower fibres pull scapula inferiorly

Latissimus dorsi - thoracodorsal nerve, actions; extends, adducts and medially rotates upper limb

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18
Q

What are the functions and innervations of the deep extrinsic muscles of the shoulder

A

Levator scapulae - dorsal scapular nerve, elevates the scapula

Rhomboids major and minor - dorsal scapular nerve, retract and rotate the scapula

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19
Q

What are the intrinsic muscles of the shoulder

A

Deltoid

Teres major

Rotator cuff muscles: supraspinatus, infraspinatus, subscapularis, teres minor

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20
Q

What is the innervation and function of the deltoid

A

Axillary nerve

Anterior fibres - flex arm at shoulder

Middle fibres - main abductor of arm

Posterior fibres - extend arm at shoulder

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21
Q

What is the innervation and function of the teres major

A

Lower subscapular nerve

Adducts at shoulder and medially rotates arm

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22
Q

What are the innervations and functions of the rotator cuff muscles

A

Supraspinatus - suprascapular nerve, abducts arm 0-15o

Infraspinatus - suprascapular nerve, laterally rotates arm

Subscapularis - upper and lower subscapular nerves, medially rotates arm

Teres minor - axillary nerve, laterally rotates arm

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23
Q

What are the four joints that form the shoulder girdle

A

Glenohumeral - humerus and glenoid fossa

Sternoclavicular - sternum and clavicle

Acromioclavicular - scapula and clavicle

Scapulothoracic - scapular and thoracic wall

24
Q

What is the regimental badge area

A

The area of skin supplied by the axillary nerve, overlying the insertion of the deltoid muscle

25
Q

What are the types of dislocations at the shoulder

A

Anterior

Posterior

Inferior

26
Q

What happens in an anterior shoulder dislocation and how does it present

A

Head of humerus usually dislocates in an anteroinferior direction and then either displaces in anterior direction (subcoracoid location) or lies antero-inferior to glenoid fossa (subglenoid location)

Arm is held in external rotation and slight abduction

27
Q

How might an anterior shoulder dislocation occur

A

Individual has arm abducted and externally rotated and injury forces arm further posteriorly, causing humeral head to dislocate antero-inferiorly from glenoid

Direct blow to posterior shoulder

28
Q

What can happen due to the force of the humeral head popping out and what is it called

A

The force often causes part of the glenoid labrum to be torn off as the humeral head pops out

Bankart lesion or labral tear

Sometimes a small piece of bone can be torn off with the labrum

29
Q

What is the name for a dent (indentation fracture) in the posterolateral humeral head and what causes it

A

Hill-Sachs lesion

Caused by the posterior aspect of the humeral head becoming jammed against the lip of the glenoid fossa posteriorly as the humeral head is dislocated anteriorly

30
Q

When do posterior shoulder dislocations occur

A

Violent muscle contraction due to epileptic siezure, electrocution or lightning strike

Blow to anterior shoulder

Arm is flexed across body and pushed posteriorly

31
Q

How does a posterior shoulder dislocation present

A

Arm internally rotated and adducted demonstrating flattening and squaring of shoulder with prominent coracoid process

Arm cannot be externally rotated

32
Q

Which injuries are commonly associated with a posterior shoulder dislocation

A

Fractures

Rotator cuff tears

Hill-Sachs lesions

33
Q

What happens in an inferior shoulder dislocation and how does it present

A

The humeral head displaces inferiorly to the glenoid fossa

Arm is held permanently upward or behind the head

34
Q

How does an inferior shoulder dislocation occur

A

Forceful traction on arm when it’s fully extended over the head

35
Q

Which injuries are associated with an inferior shoulder dislocation

A

Damage to nerves, rotator cuff tears and injury to blood vessels

36
Q

What are the complications of shoulder dislocation

A

Recurrent dislocation - damage to stabilising tissue surround shoulder

Damage to axillary artery

Nerve injuries - axillary nerve (mostly), cords of brachial plexus, musculocutaneous nerve, etc

Significant fractures

Rotator cuff tears

37
Q

Which bones are commonly affected in significant fractures from shoulder dislocation, and what increases the risk of fracture

A

Humeral head, greater tubercle, clavicle, acromion

More common when traumatic mechanism of injury, first-time dislocation, aged over 40

38
Q

Where do the majority of clavicle fractures occur and what are the commom causes

A

Middle third of clavicle (mid-clavicular)/junction between medial 2/3rd and lateral 1/3

Caused by:

Falls onto affected shoulder

Falls onto outstretched hand

39
Q

Clavicle fractures are mostly treated conservatively but some may require surgery to treat. What indicates that the fracture needs surgical intervention

A

Complete displacement

Severe displacement causing tenting of skin

Open fractures

Neurovascular compromise

Fractures with interposed muscle

Floating shoulder

40
Q

How does a clavicle fracture present

A

Shoulder is dropped and the arm positioned medially

41
Q

How will shoulder dislocations present

A

Shoulder will be visibly deformed

Visible swelling and/or bruising

Movement of shoulder will be severely restricted

42
Q

What is impingement syndrome, what causes the impingement and what is the most common form

A

When the tendons of the rotator cuff muscles impinge on the coraco-acromial arch, causing irritation and inflammation

Impingement caused by anything that narrows space between humerus head and coracoacromial arch

Most commonly caused by impingement of supraspinatus tendon under acromion during shoulder abduction

43
Q

What are the symptoms of impingement syndrome

A

A dull, lingering pain

Reduced range of motion

Grinding or popping sensation during shoulder movement

44
Q

Give some examples of things which may cause further narrowing of the space between the humeral head and coracoacromial arch

A

Thickening of coracoacromial ligament

Inflammation of supraspinatus tendon

Subacromial osteophytes

45
Q

What is a rotator cuff tear

A

A tear of one or more of the tendons of the four rotator cuff muscles

46
Q

Which part of the rotator cuff muscles are torn more frequently and which is most frequently affected

A

The tendons are most frequently affected

Supraspinatus tendon

47
Q

What are the most common type of rotator cuff tears and how do they usually occur

A

Chronic tear

Age-related degeneration - with age, blood supply decreases so there is impaired repair. Age-related tendon damage, compounded by chronic microtrauma, results in partial tendon tears which develop into full rotator cuff tears

48
Q

What are the risk factors of rotator cuff tears

A

Recurrent lifting and repetitive overhead activity

Sports involving repeated overhead motion

Tear in one shoulder signals increased risk in opposite

49
Q

How may a rotator cuff tear present

A

(May be asymptomatic)

Anterolateral shoulder pain, often radiating down arm - with activity or at rest

Pain in shoulder when leaning on elbow and pushing down

Pain in shoulder when reaching forward

Weakness of shoulder abduction

50
Q

What is calcific supraspinatus tendonitis/tendinitis

A

Presence of macroscopic deposits of hydroxyapatite in the supraspinatus tendon

(Can be in other rotator cuff tendons but most commonly in supraspinatus)

51
Q

What are the symptoms of calcific supraspinatus tendonitis

A

Acute or chronic pain, aggravated by abduction or flexion of arm above shoulder level, or by lying on the shoulder

Stiffness, snapping sensation, catching or reduced range of shoulder movement (may present as mechanical symptoms)

52
Q

What is adhesive capsulitis

A

Painful disorder where capsule of glenohumeral joint becomes inflammed and stiff, greatly restricting movement and causing chronic pain

Pain usually constant, worse at night, exacerbated by movement and cold

53
Q

What are the risk factors of adhesive capsulitis

A

Being female

Epilepsy with tonic seizures

Diabetes mellitus

Shoulder trauma

Connective tissue disease

Thyroid disease

Cardiovascular disease

Chronic lung disease

Having it is one shouler - risk it can occur in other

54
Q

What is the treatment for adhesive capsulitis

A

Physiotherapy, analgesia, anti-inflammatory medication

Manipulation under anaesthesia to break up adhesions and scar tissue

Typically resolves with time

55
Q

Where does osteoarthritis typically occur in the shoulder

A

Acromioclavicular joint more than glenohumeral

56
Q

How is ostoarthritis treated (in the shouler)

A

Activity modification

Analgesia

Anti-inflammatories (NSAIDs)

Steriod injections - reduce swelling

Total shoulder replacement

Replacement of humeral head - hemiarthroplasty

Musculoskeletal System (13 decks)

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