The Shoulder Complex Flashcards
The shoulder is made up of ___ joints and a ___-joint
three; pseudo
The shoulder girdle is composed of the ____, ___ & _____
scapula, clavicle & manubrium
What is the shoulder girdle heavily dependant on?
muscles and ligaments
what is the primary function of the shoulder girdle?
functionally positioning the hand
___ pain is the third most common consulted complaint
shoulder
Where does pain referred to the shoulder stem from?
Heart and spleen = left shoulder
liver and gallbladder = right shoulder
The GH joint is what type of joint?
a ball and socket joint
Where do shoulder separations usually happen?
Acromioclavicular (AC) joint
What is the only connection of the entire extremity to the upper skeleton?
sternoclavicular
what three tendons suck in the shoulder and hold it in place? are they lateral or medial? what tendon is opposite of them?
supraspinatus, infraspinatus, teres minor’ lateral; subscapularis (medial)
What bursa cushions rotator cuff muscles from acromion and compresses during overhead arm action?
subacromial bursa
The ___ ___ innervates the arm and comes off from the neck in __ branches
brachial plexus; 5
For every __ degrees your shoulder rises, your scapula should shift __ degree
2;1
“movement of scapula relative to the humerus”
scapulohumeral rhythm
initial 30 degrees of glenohumeral ______ setting phase in scapulohumeral rhythm
abduction
2: 1 scapulohumeral rhythm
- ___ deg. total ROM
- ___ deg. GH
- ___ deg. scapulothoracic
180
120
60
what type of scapular rotation gives people kinks in the neck in the morning?
downward
6 acute shoulder injuries?
- Contusions (Deltoid)
- Sprains (SC, AC, GH)
- Strains (deltoid, biceps, triceps)
- Ruptures (biceps)
- Fractures (clavicular, humeral)
- GH Dislocations/ Subluxations
3 chronic shoulder injuries?
- rotator cuff impingement syndrome
- biceptual tendonitis
- sub-acromial bursitis
FOOSH?
fall on out stretched hand
Etiology:
- FOOSH, fall on tip of shoulder or direct impact
- Occur primarily in mid- third
- Greenstick fracture
clavicular fracture
Signs and Symptoms:
- Generally presents w/ supporting of arm, head tilted towards injured side with chin turned away
- Clavicle may appear lower
- Palpation reveals swelling, pain, deformity, point tenderness
clavicular fracture
Management for clavicular fracture?
- treat for shock
- sling and swath
- transport to hospital
how long will clavicular fractures generally be braced for?
6-8 weeks
Etiology:
- Direct blow, or FOOSH
- Fracture locations in shaft, at surgical neck, supracondylar, or epiphyseal
- Proximal fracture may also be associated with dislocation
humeral fracture
where are common fracture sites for the humerus?
shaft, surgical neck, supracondylar or epiphyseal
Pain, swelling, point tenderness, decreased ROM are signs and symptoms for?
humeral fracture
____ fractures may be mistaken for contusion - check for pulse down low because if they lose this it is a problem!
humeral
management for humeral fracture
treat for shock, splint and sling prior to transportation
Etiology:
- Result of direct blow, fall on point of shoulder, FOOSH
- Graded 1-6 depending on severity
Acromioclavicular Sprain
Signs & Symptoms:
- Mild to severe pain
- Swelling
- Altered ROM (adduction/abduction)
- Step deformity
Acromioclavicular Sprain
management for Acromioclavicular Sprain? Grades 1-3 and 4-6?
-ice, stabilize and referral
-1 to 3: (nonoperative) 3-4 and 2 weeks of immobilization respectively
- 4 to 6: will require surgery
(aggressive rehab required for all grades)
Grade 1 AC joint sprain?
no disruption
Grade 2 AC joint sprain?
tear of AC lig. and partial displacement
Grade 3 AC joint sprain?
rupture of AC and CC ligaments
Grade 4 AC joint sprain?
post. separation of lateral clavicle
Grade 5 AC joint sprain?
complete lig. rupture; tearing of deltoid and trap attachments
Grade 6 AC joint sprain?
inferoposterior displacement
Etiology:
Indirect force, blunt trauma (may cause displacement)
Sternoclavicular sprain
Sternoclavicular sprain - pain and slight disability is grade _
1
Sternoclavicular sprain - pain, subluxation with deformity, swelling and point tenderness and decreased ROM is grade _
2
Sternoclavicular sprain - gross deformity (disloc.), pain, swelling, decreased ROM is grade _
3
management of sternoclavicular sprain?
RICE, reduction if necessary, immobilized for 3-5 weeks
sternoclavicular sprains can be ___ or ___
anterior or posterior
Etiology:
Forced abduction and/or external rotation or a direct blow
glenohumeral sprain
Signs and Symptoms:
- Pain during movement especially when re-creating MOI
- Decreased ROM & pain with palpation
GH sprain
Management for GH sprain:
- RICE for __-__ hours; sling
- Therapeutic modalities used for?
- Must be aware of potential development of _____ conditions
24-48; regaining ROM then regaining full strength; chronic
Etiology for Acute Subluxations/Dislocations:
- _____ dislocation (most common); forced into ____ & ____
- ____ dislocation: forced into ____ & ____ ; falling on an extended & internally rotated GH
- Least common is _____ (underneath armpit)
anterior; abduction and external rotation
posterior; adduction and internal rotation
inferior
Signs and symptoms:
-flattened deltoid, head in axilla; arm carried in slight abd’n & ER; moderate pain and disability
anteroinferior sublux/dislocation
Signs and symptoms:
- severe pain & disability
- arm carried in adduction & internal rotation
- acromion & coracoid prominent
- limited external rotation & elevation
posterior sublux/dislocation
What is a SLAP lesion?
tissue damaged with GH dislocation (damage to the labrum) - Superior Labral tear from Anterior to Posterior
“caused by compression of cancellous bone against anterior glenoid rim creating a divot in the humeral head (teacup ramming into saucer and actually causing a fracture)”
Hill Sachs lesion - tissue damage with GH dislocation
Etiology:
- Bursal inflammation compressing tendons; exacerbating factors
- Contributing factors include joint laxity, postural mal-alignments & repetitive over head motions.
Shoulder impingement - subacromial bursitis
Signs and Symptoms”
-Diffuse pain, pain on palpation; increased GH ER & decreased IR; positive ‘Painful Arc’ & impingement tests
Shoulder impingement - subacromial bursitis
Management for Shoulder impingement - subacromial bursitis?
- active rest
- ice
- instruct correct biomechanics
- NSAIDs
Etiology:
-Repetitive, overhead, ballistic activity that involves repeated stretching of biceps tendon causing irritation to the tendon and sheath; improper mechanics; impingement
bicipital tenosynovitis
Signs and Symptoms:
- Tenderness over bicipital groove, swelling, crepitus due to inflammation
- Pain when performing overhead activities
bicipital tenosynovitis
Management for ____ ____ includes:
- Rest, ice and therapeutic modalities to treat inflammation; NSAIDs
- Gradual program of strengthening and stretching
bicipital tenosynovitis
biceps brachii rupture etiology?
Result of a powerful contraction typically near muscle origin
Signs and Symptoms for ____ _____ rupture:
Patient hears a resounding snap; sudden and intense pain; deformity; weakness with elbow flexion & supination
biceps brachii
management for biceps brachii rupture?
- Ice for hemorrhaging, place arm in sling and refer to physician
- Patient will require surgery
why does a tear to the distal bicep require surgery?
When it is a tear in the distal bicep (inferior point) then they have to have surgery because it is the only connection to the radius/ulna
