the shoulder complex Flashcards
the humerus
spherical, shallow contricted neck, it faces upward, inward, backwards articulating with the scapulas glenoid fossa
sternoclavicular joint
articulation between the clavicle and the sternum
it functions to shock absorb against medial forces and helps prevent any displacement upward
clavicle can move up, down, forward, backward and rotate
acromioclavicular joint
irregular joint between acromion process of scapula and the lateral clavicle a thin, fibrous, capsule surrounds the joint
glenohumeral joint
the synovical ball and socket joint of the shoulder made stronger and deeper by the labrum as well as surrounding deltoid and rotator cuff
scapulothoracic joint
not a true joint
the area that provides movement of the scapula over the back side of the ribcage
allows for scapular elecvation, depression, protraction, retraction, abduction and adduction
sternoclavicular joint ligaments
anterior sternoclavicular ligament: which prevents upward displacement
posterior: prevents upward displacement
interclavicular: prevents lateral displacement
costoclavicular: prevents lateral and upward displacement
AC joint ligaments
acromioclavicular
coracoclavicular
conoid
trapezoid
*all try to keep AC joint together- most importantly keeping the joint from going superior
pec major
O: medial clavicle, sternum, costal cartilage of upper 6 ribs and aponeurosis of external oblique
I: greater tubercle of the humerus
A: flexes, adbucts and internally rotates shoulder
N: median and lateral pectoral
latissimus dorsi
O: SP of lower 6 thoracic and the lumbar vertebrae and posterior iliac crest and thoracolumbar fascia
I: medial margin of interbercular groove of humerus
A: extend, adduct and internal rotation
N: thoracodorsal
deltoid
O: lateral third clavicle, aromion process and spine of scapula
I: deltoid tuberosity of humerus
A: abducts the shoulder, anterior: flexion and internal rotation, posterior: extension, and external rotation
N: axillary
supraspinatus
O: supraspinatus fossa of scapula
I: greater tubercle of humerus
A: abducts and slight external rotation
N: suprascapular
infraspinatus
O: infraspinatus fossa of scapula
I: greater tubercle of humerus
A: external rotation and slight adduction
N: suprascapular
subscapularis
O: subscapular fossa of scapula
I: lesser tubercle of humerus
A: internal rotation
N: suprascapular
teres major
O: dorsal surface of inferior angle of scapula
I: lesser tubercle of the humerus
A: adduction, extension and internal rotation
N: subscapular
teres minor
O: axillary border of scapula
I: greater tubercle of humerus
A: external rotation
N: axilary
coracobrachialis
O: coracoid process of scapula
I: middle of humerus, medial surface
A: adduction, flexion of GH
N: musculocutaneous (c5-7)
trapezius
O: occipital bone, ligamentum nuchae, SP of the c7 and all tspine
I: lateral third of clavicle, acromion process and spine of scapula
A: upper: elevation; lower: depression, rotate, adducts and stabilizes the scapula; middle retraction and downward rotation
N: spinal accessory nerve CN11
rhomboid major
O: sp of 7 cervical and first thoracic vertebrae
I: vertebral border of scapula below the spine
A: rotates and retracts scapula, stabilizes and adducts
N: dorsal scapular
rhomboid minor
O: sp of 2-5 thoracic vertebrae
I: vertebral border of the scapula at the base of the spine of the scapula
A: adducts, stabilizes, rotates scapular, lowering its lateral angle
N: dorsal scapular
nerve supply to the shoulder
brachial plexus
branches to axillary, musculocutaneous, subscap, supra, dorsal scap, pectoral, and radial
blood supply to shoulder
subclavian and axillary arteries
brachial artery
levator scapulae
O: tp of c1-c4
I: vertebral border of scapula, above the spine of the scapula
A: elevates and adducts scapular, side bends neck when scap is fixed
N: dorsal scapular
pectoralis minor
O: anterior surface of rib 3-5
I: coracoid process of scapula
A: draws scapular anteriorly and downward rotation
N: medial pectoral
- would cause tilt to scapula if in dysfunction*
- not to be confused with serratus anterior which would cause winging*
serratus anterior
O: outer surface of ribs 1-9
I: entire length of vertebral border of scapula
A: protracts, and rotates scapula, stabilizes
N: long thoracic nerve
scaption
movement of the humerus away from the body in the scapular plane
glenohumeral abduction in a plane 30 to 45 degrees between the sagittal and front planes
load and shift test
- grasp shoulder w one hand to stabilize
- grasp humeral head with thumb over posterior head and fingers over anterior head with other hand
- load the head by compressing into shoulder and translate forward P-A
- load the head by compressing into shoulder and translate backward A-P
- bilateral
-pos: excessive translation in the fossa
-ind:
Grade 1: translation up to 50% of the diameter of the head or up to rim of glenoid
Grade 2: head is pushed beyond rim by >50% of diameter of head, reduces spontaneously
Grade 3: head remains dislocated after translation
anterior drawer for shoulder
check anterior glenohumeral stability
pt supine
arm abducted 45degrees, horizontal abduction 10degrees, and 10 degrees of external rotation
scapula is stabilized and the umeral head is glided anteriorly white slight distraction is applied to the glenohumeral joint.
a positive test indicated insufficiency of the anterior joint capsule and the integrity of the anterior labrum
posterior drawer for shoulder
check posterior glenohumeral instability
pt supine 90 abduction, 20 horizontal adduction and 90 elbow flexion
scapula stabilized, humerus internally rotated as the humeral head is glided poteriorly.
a postive test indicates insufficency of the posterior capsule and possible damage to the posterior labrum
sulcus test
TESTING: Inferior instability (indicative of global instability)
POSITION: Grasp humerus, pull down, look at acromion for sulcus (+) TEST: Gap at sulcus and pain
clunk test
pt in supine. PT places one hand on the posterior aspect of the pt’s humeral head and other hand stabilizes the humerus proximal to the elbow. PT passively fully ABD and ER the arm f/b applying an anterior directed force to the humerus. (+) audible “clunk” or grinding while performing test. Identifies a glenoid labrum tear.
obriens test
Patient position: seated or standing
GH joint flexed to 90º and Hz adducted 15º from front
Full humeral internal rotation and pronated forearm
Examiner position: anterior to patient
One hand place over superior aspect of patient’s distal forearm
Patient Action: resists examiner’s downward force
Examiner Action
Pushes downward on forearm
Test repeated with humerus externally rotated and forearm supinated
Positive: Pain experienced with arm in internal rotation but is decreased during external rotation
Pathology: SLAP lesion
Be aware of “popping” at AC Joint
Rotator cuff pathology may give false positive
apprehension test
pt supine
arm abduct 90
shoulder is passively and gently moved into external rotation as far as patient will allow
watch face
relocation test
supine
shoulder 90 elbow 90
as shoulder is externally rotated pressure is applied posteriorly to stabilize the humeral head which allows for greater degree of external rotation
test is positive if apprehension or pain is relieved with his maneuver
neers test
forced flexion of the humerus in overhead position, impingement of structures between humeral head and coracoacromial arch
hawkins kennedy test
horizontal adduction with forced internal rotation of the humerus which prouduces impingement
a positive sign is pain or reaction with a grimace
drop arm
rotator cuff
patient abducts the arm as far as possible adn then slowly lowers it to 90
from this the pt with a torn supraspinatus muscle will be unable to lower the arm with control
if patient can hold arm at 90, pressure on on the wrist will cause the arm to drop
empty can
flexion 90 horizontal abduction 30 (scaption)
arm is internally rotated as far as possible
thumb pointing downward
pressure is applied inferior
weakness and pain can be detected
yergasons
TESTING: Stability of long head of biceps, integrity of transverse ligament, may identify biceps tendonitis
POSITION: Elbow flexed to 90˚ and tucked into side; forearm pronated, pt tries to supinate and flex while therapist resists
(+) TEST: Inability to hold original position and pain indicates bicep tendon irritation
speeds test
elbow extended, supinated and resistance applied as the humerus elevates to 60 (or whole ROM- above head)
test is positive if pt feels pain in the region of the bicipital groove- it may sublux out of groove
luddingtons
Hands interlocked behind head, have patient push against head, palpate the long head of biceps and note any deformity. Stand behind subject (Biceps tendonitis)
adsons maneuver test
thoracic outlet syndrome
subclavian artery between anterior and middle scalenes
pt standing
check radial pulse first when arm relaxed and then extended while patient elevates the chin and turn toward the extended hand and hold breath
positive is decreased or stopped pulse
hyperabduction
allen test
compressed behind pec minor and coracoid process
radial pulse
elbow flexed to 90 and shoulder extended and abducted and external rotation
rotate head away from arm
positive if pulse disappears
military brace test
Position:
patient standing
examiner palpates the patients radial pulse
patient retracts and depresses the shoulders as if coming to military attention, and extends the shoulder
(+) test:
diminished or disappearance of radial pulse
Indication:
thoracic outlet syndrome
costoclavicular syndrome test
compression between first rib and clavicle
both arms abducted to 90 and externally rotated
pt open and closes hands and fingers, making fists for 3 minutes
loss of strength in hand or loss of sensation is a positive test
phase of throw
wind up cocking acceleration deceleration follow through
deceleration phase
lasts from ball release until max shoulder IR, ERs of rotator cuff contract eccentrically to decelerate humerus, rhomboids contract eccentrically to decelerate scapula
most dangerous phase of through due to repetitive nature how difficult/dangerous it is to deceleration such force so quickly and controlled as it does so often
