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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
What are the types of dislocations at the shoulder
Anterior Posterior Inferior
26
What happens in an anterior shoulder dislocation and how does it present
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
How might an anterior shoulder dislocation occur
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
What can happen due to the force of the humeral head popping out and what is it called
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
What is the name for a dent (indentation fracture) in the posterolateral humeral head and what causes it
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
When do posterior shoulder dislocations occur
Violent muscle contraction due to epileptic siezure, electrocution or lightning strike Blow to anterior shoulder Arm is flexed across body and pushed posteriorly
31
How does a posterior shoulder dislocation present
Arm internally rotated and adducted demonstrating flattening and squaring of shoulder with prominent coracoid process Arm cannot be externally rotated
32
Which injuries are commonly associated with a posterior shoulder dislocation
Fractures Rotator cuff tears Hill-Sachs lesions
33
What happens in an inferior shoulder dislocation and how does it present
The humeral head displaces inferiorly to the glenoid fossa Arm is held permanently upward or behind the head
34
How does an inferior shoulder dislocation occur
Forceful traction on arm when it's fully extended over the head
35
Which injuries are associated with an inferior shoulder dislocation
Damage to nerves, rotator cuff tears and injury to blood vessels
36
What are the complications of shoulder dislocation
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
Which bones are commonly affected in significant fractures from shoulder dislocation, and what increases the risk of fracture
Humeral head, greater tubercle, clavicle, acromion More common when traumatic mechanism of injury, first-time dislocation, aged over 40
38
Where do the majority of clavicle fractures occur and what are the commom causes
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
Clavicle fractures are mostly treated conservatively but some may require surgery to treat. What indicates that the fracture needs surgical intervention
Complete displacement Severe displacement causing tenting of skin Open fractures Neurovascular compromise Fractures with interposed muscle Floating shoulder
40
How does a clavicle fracture present
Shoulder is dropped and the arm positioned medially
41
How will shoulder dislocations present
Shoulder will be visibly deformed Visible swelling and/or bruising Movement of shoulder will be severely restricted
42
What is impingement syndrome, what causes the impingement and what is the most common form
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
What are the symptoms of impingement syndrome
A dull, lingering pain Reduced range of motion Grinding or popping sensation during shoulder movement
44
Give some examples of things which may cause further narrowing of the space between the humeral head and coracoacromial arch
Thickening of coracoacromial ligament Inflammation of supraspinatus tendon Subacromial osteophytes
45
What is a rotator cuff tear
A tear of one or more of the tendons of the four rotator cuff muscles
46
Which part of the rotator cuff muscles are torn more frequently and which is most frequently affected
The tendons are most frequently affected Supraspinatus tendon
47
What are the most common type of rotator cuff tears and how do they usually occur
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
What are the risk factors of rotator cuff tears
Recurrent lifting and repetitive overhead activity Sports involving repeated overhead motion Tear in one shoulder signals increased risk in opposite
49
How may a rotator cuff tear present
(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
What is calcific supraspinatus tendonitis/tendinitis
Presence of macroscopic deposits of hydroxyapatite in the supraspinatus tendon (Can be in other rotator cuff tendons but most commonly in supraspinatus)
51
What are the symptoms of calcific supraspinatus tendonitis
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
What is adhesive capsulitis
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
What are the risk factors of adhesive capsulitis
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
What is the treatment for adhesive capsulitis
Physiotherapy, analgesia, anti-inflammatory medication Manipulation under anaesthesia to break up adhesions and scar tissue Typically resolves with time
55
Where does osteoarthritis typically occur in the shoulder
Acromioclavicular joint more than glenohumeral
56
How is ostoarthritis treated (in the shouler)
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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