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UE Extremity part 1 > UE - Shoulder Region > Flashcards

UE - Shoulder Region Flashcards

1
Q

Pigeon chest sternum deformity
Sternum is displaced?

A

Pectus carinatum
displaced anteriorly and inferiorly

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2
Q

Sternum aka?
T2
T4/T5 OR 2ND RIB
T6
T10
T9

A

jugular notch
sternal angle of louie
xiphoid dermatomal
xiphoid anatomical
xiphisternal

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3
Q

Funnel chest
displacement?

A

pectus excavatum
displaced posteriorly, overgrowth ribs

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4
Q

Barrel chest
Increase in?
sternum displaced?

A

increased AP diameter
displaced superiorly

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5
Q

Latissimus Dorsi
Aka:
O
I
N
A

A

Aka: broadest ms, swimmer’s ms
Important crutch walking ms
O: Iliac crest, L5-T7 SP, Inf angle of scap
I: Floor of bicipital groove
N: Thoracodorsal nn
A: EXADIR

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6
Q

Latissimus Dorsi
How to check for LOM:

A
  1. Supine hooklying – PPT
  2. B arm elevate 180 c ER

(+): inability to perform or APT
Indic: Tight LD

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7
Q

Latissimus Stretching

A

Stabilize Sup aspect of pelvis OR Lat
aspect of thorax
Bring Sh to FABER

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8
Q

Teres Major Stretching

A

Stabilize Axillary border of Scap
Bring Sh to FABER

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9
Q

Levator Scapulae

Nerve?
Action?
How to isolate contraction?
Stretching?

A

N: Dorsal scapular nn
A: Elevation & Scapular DR

How to isolate contraction:
Forearm at the back then shrug

Stretching: C/L LF, C/L Rot
Michael Jackson

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10
Q

Rhomboids
Nerve?
Action?

Strength testing?

A

N: DSN
A: Scap Add/Retraction & DR

  • raise hand away from back
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11
Q

Deltoids
Active in all Sh motions except?

Nerve?
Action?

A

Active in all Sh motions except ADDUCTION

N: Axillary nn
A: Ant – Flex & IR
Mid – pure Abd
Post – Ext & ER

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12
Q

ACCESSORY JOINTMOTION
0
1 –
2 –
3 –
4 –
5 –
6 –

A

0- ankylosis
1 – Considerable hypomobility
2 – Slightly hypomobility
3 – Normal
4 – Slightly hypermobility
5 – Considerable hypermobility
6 – unstable joint

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13
Q

TRUE RIBS:
* FALSE RIBS:
* FLOATING RIBS:

A

TRUE RIBS: 1-7
* FALSE RIBS: 8-10
* FLOATING RIBS: 11-12

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14
Q

3 JOINTS Ribs

A

Costotransverse Joint
= Ribs + TP
Costochondral Joint
= Ribs + cartilage
Costovertebral Joint
= Ribs + vertebra

Ct
Cc
Cv

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15
Q

Murphy’s Percussion Test

aka?

Procedure?
(+)
Indication

A

a.k.a. test for costovertebral tenderness

Px: Sitting/Prone
Percuss at CV angle (12th rib &
V column)
(+): back/flank pain
Indic: kidney/renal dysfxn

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16
Q

Clavicle (Collar Bone)

Orientation?

MOI

A

Orientation:
Laterally – concave forward
Medially – convex forward

MOI: FOOSH

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17
Q

Most commonly fractured bone?

A

Clavicle (Collar Bone)

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18
Q

Scapula (Shoulder Blade)

Function:

Orientation
Glenoid Fossa:
Humeral Head:

A

Function: attachment to many ms

Orientation
Glenoid Fossa: SAL
Humeral Head: MPS

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19
Q

Scapula (Shoulder Blade)

(N) distance from vertebral body:
Acromion:
Coracoid process:
Suprascapular notch:

A

(N) distance from vertebral body:
6 cm/ 2-3fingerbreadths
Acromion: highest point of shoulder
Coracoid process:
-pecs Mn insertion
-SA of biceps origin
Suprascapular notch:

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20
Q

Scapula (Shoulder Blade) Landmarks:

T2-
T3-
T7-

A

T2-superior angle
T3-spine
T7-inferior angle

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21
Q

Humerus

Function:
Neck-shaft angle:

Crutch Palsy
Acute =
Chronic =

Surgical Neck:
1
2

Spiral Groove:
1
2

Ulnar Groove:

A

Function: attachment to many ms
Neck-shaft angle: 135 degrees

Crutch Palsy: Acute = Axilllary nn
: Chronic = Radial nn

Surgical Neck:
-Common site of stable Fx
-Axillary nn

Spiral Groove:
-Radial nn
-(Triceps spared)

Ulnar Groove: Ulnar nn

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22
Q

X-RAY Identification

Least to Highest

A

AIR
FAT
WATER
SOFT TISSUE
BONE
METAL IMPLANTS

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23
Q

Joints of the shoulder region

1.
2.
3.
4.

A
  1. SC - sternoclavicular
  2. AC - acromioclavicular
  3. GH - glenohumeral
  4. ST – scapulothoracic (not a truejoint)
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24
Q

Sternoclavicular Joint

Type of joint?
Degrees of freedom?

MOI?
Special Test?

Joint Mob:
Protract/Retract:
Elevation /Depression:

A

Type of joint: Saddle
Degrees of freedom:
-Elevation/Depression
-Protraction/Retraction
-Rotation: (abd beyond 90)

MOI: Fall on Lat aspect of Sh
ST: AC Crossover Test

Joint Mob:
Protract/Retract: Same
Elevation /Depression: opposite

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25
Q

Sternoclavicular Joint

OPP
CPP
CP

A

Open Pack Position: Arms at side

Close Pack Position: Full Elevation and Protraction

Capsular Pattern: Pain at extremes of range of motion
especially horizontal adduction and full elevation

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26
Q

Ligaments of the Sternoclavicular Joint
Limits?
1.
2.
3.
4.

A

Limits Clavicle
1. Interclavicular – Limits depression
2. Ant SC ligament – Limits retraction
3. Post SC ligament –Limits protraction
4. Costoclavicular ligament
- Most impt (strongest)
- Both – Limits elevation
- Ant band – Limits retraction
- Post band – Limits protraction

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27
Q

Supraspinatus

Nerve?
Action?

A

N: Suprascapular nn
A: Initiates Abd

**prone to injury
(supraspinatus tendinitis)

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28
Q

Supraspinatus/Empty Can/Jobe Test

1st
2nd
(+):
Indic

A

1st = Abd 90 c neutral rot then
PT resist Abd
2nd = IR & angled forward to
30 then PT resist Abd
(+): weakness or pain
Indic: Supraspinatus ms or
tendon tear or Suprascapular
nn neuropathy

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29
Q

Drop arm test/
Codman test

1st
(+):
Indic

A

Abd 90
❑ Ask px to slowly drop the arm
❑ (+) unable to slowly drop = no
eccentrics of rotator cuff
❑ Indic: RC tear

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30
Q

Infraspinatus

Nerve?
Action?

A

N: Suprascapular nn
A: ER esp. strongest if arms
are at the sides

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31
Q

Infraspinatus Test:

Procedure
(+):
Indic

A

❑ Arms at the side, elbow 90, Sh
IR 45 degrees
❑ PT applies medial rotation force
while px resists by doing ER
❑ (+): pain or inability to resist IR
❑ Indic: Infraspinatus strain

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32
Q

Lateral Rotation Lag Sign
(Infrapinatus “Spring Back” Test)

Procedure
(+):
Indic

A

❑ T. Minor/ Infraspinatus
❑ Sitting/Standing
❑ PT passively Abd Sh to 90
and ER to end range
❑ Ask px to hold the position
❑ (+) inability or hand “springs
back” or “lags” ant to the
midline
❑ Infra/T. Minor weakness

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33
Q

Teres Minor

Nerve?
Action?

A

N: Axillary nn
A: ER

To isolate: Elbow 90, Sh Abd 90,
ER resist

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34
Q

Hornblower’s
Aka: Patte’s, Signe de Clairon Test

Procedure
(+):
Indic

Modification?

A

A:
❑ Sh 90 deg of scaption
❑ Ask px to ER against resistance
❑ (+): inability to perform
❑ Indic: T Minor tear

B: Modification
❑ Ask px to bring hand to mouth s Abd
❑ (+) Abd moment = (+) Hornblower sign
❑ Indic: Massive RC tear

35
Q

Subscapularis

Nerve?
Action?

A

N: Upper & lower subscapular nn
A: IR

36
Q

Lift-off sign/ Gerbers Test

Procedure
(+):
Indic

A

❑ Dorsum of hand at the back
❑ Lift hand away from the
back
❑ (+): inability to perform
❑ Indic: Subscapular lesion

37
Q

Modified Lift-offsign or
Subscapularis/Medial Rotation - Spring Back/Lag Test

Procedure
(+):
Indic

A

❑ Passively IR at end range
❑ Ask px to hold position (A)
❑ (+): inability to hold position
or “springs back” ant (B)
❑ Indic: Subscapularis
affectation

38
Q

Abdominal Compression Test
aka Belly Press / Napoleon Test

Procedure
(+):
Indic

A

❑ PT & px place hand at belly
❑ (+) inability to maintain pressure on
examiner’s hand
❑ (+) compensates thru wrist ext, Sh ext,
or moving of elbow forward
❑ Indic: Subscapularis tear

39
Q

Holds the humeral head tightly against the glenoid to prevent subluxation when carrying weight in the hand

A

Rotator Cuff Dynamic Stabilization

40
Q

Rotator Cuff Muscles?

A
  • Supraspinatus
  • Infraspinatus
  • Teres minor
41
Q

Teres Major

Nerve?
Action?

A

N: Lower subscapular nn
A: EXADIR

42
Q

Biceps brachii

Nerve?
Action?

A

N: Musculocutaneous nn
A: Elbow flex, FA supination, &
weak Sh flex

May act as an Abd when Sh is in ER
Palpation: EXABER

43
Q

May act as an Abd when Sh is in ER

A

Biceps brachii

44
Q

Triceps Brachii

Nerve?
Action?

A

N: Radial nn
A: Elbow ext & weak Sh ext

45
Q

Biceps brachii

2X?
4X?

A

2X Stronger than supinator at full elbow extension
4X Stronger than supinator at 90 deg elbow flexion

46
Q

Supinator supinates best at full elbow ___________

A

Supinator supinates best at full elbow flexion

47
Q

Ligaments of the Sternoclavicular Joint
1.
2.
3.
4.

A
  1. Interclavicular – limits depression
  2. Anterior SC ligament -limits retraction
  3. Posterior SC ligament - limit protraction
  4. Costoclavicular ligament
    - BOTH: limits elevation
    - Anterior band - retraction
    - Posterior band – protraction
48
Q

Acromioclavicular Joint

Type of joint:
Degrees of freedom: (3)

MOI:
LIGAMENTS:

A

Type of joint: Plane
Degrees of freedom:
Elevation/Depression
Abduction/Adduction
Rotation

MOI: Direct blow/trauma to the Sh

(Rugby players)

LIGAMENTS:
Anterior
Posterior
Coracoclavicular (strongest) – Trapezoid & Conoid

49
Q

Acromioclavicular Joint

OPP:
CPP:
CP:

Painful Arc?
AC
GH

A

Open Pack Position: Arms at the side

Close Pack Position: 90 degrees of abduction

Capsular Pattern: Pain at extremes of range of motion

Painful Arc:
*AC
170-180 Abd
Last 10° of Abd

*GH: 60-120

50
Q

Acromioclavicular Crossover

Aka:
Crossbody Test
Horizontal Adduction Test

Procedure
(+):
Indic

A

❑ Most sensitive (Gold Standard) for
AC Jt
❑ Actively reach opposite Sh OR
Passive F Flex & H Add
❑ (+): localized pain @ AC jt
❑ Can be (+) for SC patho (localized
pain @ SC jt)

51
Q

Acromioclavicular Joint

OPP:
CPP:
CP:

Painful Arc AC:
Painful Arc GH:

A

Open Pack Position: Arms at the side

Close Pack Position: 90 degrees of abduction

Capsular Pattern: Pain at extremes of range of motion

Painful Arc:
*AC
-170-180 Abd
-Last 10° of Abd

*GH: 60-120

52
Q

Acromioclavicular Crossover

Aka:
Crossbody Test
Horizontal Adduction Test

Procedure
(+):
Indic

A

❑ Most sensitive (Gold Standard) for
AC Jt
❑ Actively reach opposite Sh OR
Passive F Flex & H Add
❑ (+): localized pain @ AC jt
❑ Can be (+) for SC patho (localized
pain @ SC jt)

53
Q

Rockwood Classification of AC Jt Injury

1.
2.
3.
4.
6.

A

Grade 1- sprained AC, intact CC
Grade 2- ruptured AC, sprained CC
Grade3-RupturedAC&CC
Grade4- Ruptured AC & CC (posteriorly displaced)
Grade5- Ruptured AC & CC (superiorly displaced)
Grade 6- Ruptured AC & CC (inferiorly displaced)

54
Q

Deformity that causes the distal end of clavicle is superior to the acromion process

causes?

A

STEP DEFORMITY

Causes: Step deformity resulting from AC dislocation

55
Q

Definition: (+) sulcus below the
acromion process

Causes:

A

SULCUS SIGN

Causes:
B. GH subluxation
(stroke/deltoid ms. paralysis)
C. Anterior dislocation at SC joint

56
Q

Types of
Acromion

1.
2.
3.
4.

A

A. Flat
B. Curved – most common
C. Hooked–commonly linked c shoulder impingement (rot cuff tear)
D. Upturn/convex – least common

57
Q

Glenohumeral Joint

Unstable d/t:
Dynamic Stability:
Static Stability:

A

Unstable d/t: Large HHead,
Small Glenoid Fossa
Dynamic Stability: Rot Cuff
Static Stability: Ligaments &
Labrum (deepens glenoid cavity)

58
Q

GLENOHUMERAL JOINT

Type of Joint: Enarthrodial jt

OPP:
CPP:
CP:

Movements:

A

Type of Joint:

Open Packed Position: 55 Abd, 30 H Add
Close PackedPosition: 90 Abd, Full ER
Capsular Pattern: ER>Abd>IR = F

Movements:

Abduction/Adduction
Flexion/Extension
IR/ ER

59
Q

GLENOHUMERAL JOINT

To increase flexion and IR =

To increase extension and ER =

To increase abduction =

**To increase ER in patients
with frozen shoulder =

A

To increase flexion and IR = posterior glide
To increase extension and ER = anterior glide
To increase abduction = inferior glide
**To increase ER in patients
with frozen shoulder = posterior glide

60
Q

Ligaments limits

  1. SGHL–
  2. MGHL –
  3. IGHL
    Ant:
    Post:
  4. CHL –
A
  1. SGHL– limitsER @ 0-45;
  2. MGHL – limits ER @ 45-60
  3. IGHL
    Ant: limits ER 45-180
    Post: limits IR 45-180
  4. CHL – limit ER 0-60
61
Q

Scapulothoracic Joint

Aka:

Function:

MOVEMENTS:

A

Aka:
Scapulohumeral/Scapulocostal

*not a true joint

Function: Adds mobility to GH joint

➢ELEVATION/ DEPRESSION
➢PROTRACTION/ RETRACTION
➢UPWARD/ DOWNWARD ROTATION
➢Landmark: Glenoid Fossa
➢ANTERIOR and POSTERIOR
TILTING/TIPPING
➢Landmark: Superior Scapula

62
Q

SCAPULOHUMERAL RHYTHM

REQUIREMENTS FOR FULL ARMELEVATION
* R –
* I –
* S –
* E –

Functions:
1.
2.
3.

A
  • R – Rotation of the clavicle posteriorly
  • I – Inferior translation of the HHead
  • S – Scapular stabilization
  • E – ER of the HHead

Functions:
1. Increase ROM of arm
2. Maintain articulation
3. Maintains length tension relationship

63
Q

SCAPULOHUMERAL RHYTHM
Divided into 3 phases:

PHASE 1
(Setting phase)

PHASE 2

PHASE 3

A

Definition-GH-ST-Clavicle

Pure GH only – 0-30 – No ratio – 30 - Elev 0-5

30-90 2:1 – 40 – 20 Elev – 10-15

90-180 2:1 – 60 – 30 – Elev 15 Post Rot 30-50

64
Q

Coracoacromial Arch

AKA:
Function:
1.
2.
3.

A

AKA: Suprahumeral arch

Function: Passageway of
important structures

  1. Supraspinatus tendon
  2. Subacromial bursa
    (lubrication, ↓ friction during
    Sh motion)
  3. Long head of biceps
65
Q

Lesser & greater tubercle
Holds long head of biceps with the help of _______ ligament.

A

Transverse humeral ligament

66
Q

Speed’s Test
aka: Biceps or Straight-Arm Test

Procedure
(+):
Indic

❑ Maybe (+) in px c __________

A

❑ Resist F Flex while elbow ext &
FA supinated 1st
❑ then pronated
❑ (+): tenderness in bicipital
groove (esp. supination)
❑ Indic: Bicipital
Paratenonitis/tendinosis

❑ Maybe (+) in px c SLAP Type 2
lesion

LBC - Labral Biceps Complex

67
Q

Yergason’s

❑ 1° tests the ability of _____ to hold the _______
❑ Palpate: _________
❑ 1st =
❑ 2nd =
❑ (+):

❑ (+): tenderness =

A

❑ 1° tests the ability of THL to hold the biceps tendon
❑ Palpate: bicipital groove
❑ 1st = Elbow flex 90, FA pronated, Sh IR (used to give way to step 2)

❑ 2nd = Px ER & supination c PT resist

❑ (+): popping out of biceps tendon from groove = Torn THL

❑ (+): tenderness = Bicipital paratenonitis

(+) = THL pathology

68
Q
  1. Pectoralis Major
  2. Pectoralis Minor

Nerve?
Action?

A
  1. Pectoralis Major
    N : Lateral & Med pectoral nn
    A : FADIR (clavicular fiber)
  2. Pectoralis Minor
    N : Med pectoral nn
    A : Elevates Ribs (Inspiration),
    Ant tilting of the scapula,
    Depress point of sh
69
Q

Pectoralis Major Contracture Test

Procedure
(+):
Indic

A

Px position:
Supine
Clasps hands behind the head then
PT lowers the elbow (EXABER)

(+): elbows did not touch the table

Indic: Pecs Major tightness

70
Q

Pectoralis Minor Contracture Test

Procedure
(+):
Indic

A

Px position:
Supine
Arms flexed 30 c bolster/foam roller
underneath then PT pushes coracoid
process towards table

(+): Scapula did not touch the table

Indic: Pecs Minor tightness

71
Q

Pectoralis Minor
Active Stretching

  2. 3.
A

Pectoralis Minor
Active Stretching

  1. Elevate coracoid process
  2. Posterior tilting of scapula
  3. Exhalation
72
Q

Serratus Anterior

Nerve?
Action?

A
  • N: Long thoracic nn
  • A: Protraction & UR scapula
73
Q

Medial winging (open book)

Muscle involved:
Nerve involved:
Degrees:
Affected in:
Pt will have difficulty in:

A

Medial winging

Muscle involved: SA
Nerve involved: LTN
Degrees: >90 deg
Affected in: Radical Mastectomy
Pt will have difficulty in: combing hair

74
Q

Lateral winging (closed door)

Muscle involved:
Nerve involved:
Degrees:
Affected in:
Pt will have difficulty in:

A

Muscle involved: Trapezius
Nerve involved: CN 11
Degrees: <90
Affected in:
Pt will have difficulty in:

75
Q

Downward rotators?

Upward rotators?

A

Downward rotators
- Lev scap
- pecs minor
- rhomboids

Upward rotators?
- Upper and Lower Trapezius
- SA

76
Q

Punch out test

❑ 1st =
PT applies
(+):
Indic:

❑ 2nd =
d/t _____palsy or ______

(+) winging =
(-) winging =

A

❑ 1st = F Flex 90 & IR
PT applies backward force
(+): winging
Indic: SA weakness

❑ 2nd = DDx if SA weakness d/t LTN palsy
or post instab
F Flex 90 & ER

(+) winging = LTN palsy
(-) winging = post instab

77
Q

Trapezius

Nerve?
Action?

A

N: Spinal Accessory nn (CN XI)
A: U: Elevates scap
M: Retraction
L: Depresses scap

78
Q

Latissimus Dorsi

Nerve?
Action?

Check for LOM:
1.
2.
(+):

A

N: Thoracodorsal nn
A: EXADIR

Check for LOM:
1. Supine hooklying – PPT
2. B arm elevate 180 c ER

(+): inability to perform or APT
Indic: Tight LD

79
Q

(+) Tightness of Lats if there is lordosis

A

hooklying c Faber and standing

80
Q

Biceps brachii

Nerve?
Action?

A

N: Musculocutaneous nn
A: Elbow flex, FA supination, &

weak Sh flex

May act as an Abd when Sh is in ER
Palpation: EXABER

81
Q

Triceps Brachii

Nerve?
Action?

A

N: Radial nn
A: Elbow ext & weak Sh ext

82
Q

Biceps Brachii
- Biceps as a FA ______________
- 2x stronger than Supinator ms at __________
- 4x stronger than Supinator ms at __________________

A
  • Biceps as a FA supinator
  • 2x stronger than Supinator ms at full elbow ext
  • 4x stronger than Supinator ms at 90 deg elbow flex
83
Q

Trapezius

MMT of
Upper trapz:
Lower trapz:
All fibers c SA –

A

U: Shrugs
M: prone, Abd 90 elbow flex 90 then ask
patient to retract
L: prone, thumbs up 120abd then ask
patient to retract
All fibers c SA – Scapular UR

UE Extremity part 1 (6 decks)

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