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uppers > Uppers Shoulder > Flashcards

Uppers Shoulder Flashcards

1
Q

shoulder clinical anatomy

  • static vs. dynamic stability
  • common MOI
A 
complex
greatest ROM of any joint in the body
static vs. dynamic stability
-static: inert structures (labrum, ligaments, bony structures)
-dynamic: muscles, nerves
common MOI
-direct force
-indirect force
--falling on an outstretched arm
--overuse injury
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2
Q

shoulder joints

A

sternoclavicular joint
acromioclavicular joint
glenohumeral joint
scapulathoracic articulation

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3
Q

SC joint

  • motions
  • SC disc
A 
only connection of upper extremity to axial skeleton
gliding joint
very little bony stability
motions
-elevation/depression
-protraction/retraction
-IR/ER
SC disc
-between distal end of clavicle and sternum
-like the meniscus of the SC joint
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4
Q

SC joint ligaments

A 
A/P SC ligaments
-prevents A/P displacement
interclavicular ligament
-attaches clavicles
-attaches to superior border of sternum
costoclavicular ligament
-attaches to first rib
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5
Q

AC joint

-motions

A 
joint distal end of clavicle to acromion
motions
-IR/ER
-upward/downward rotation
-A/P scapular tipping
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6
Q

AC joint ligaments

A

acromioclavicular
coracoacromial
coracoclavicular
-conoid and trapezoid

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7
Q

GH joint

  • type of joint
  • motions
  • combined movements
  • angle of inclination
A 
ball and socket joint
-motion > stability
motions
-flexion and extension
-abduction and adduction
-internal and external rotation
-horizontal abduction and adduction
-circumduction
over 16,000 combined movements
angle of inclination
-angle from shaft of humerus to head of humerus
-130-150 degrees
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8
Q

GH joint

  • glenoid labrum
  • joint capsule
  • ligaments
A

glenoid labrum
-cartilage ring that runs around the edge of the glenoid fossa
-deepends socket of shoulder
–provides stability
-long head of biceps tendon attaches on the glenoid at the labrum
joint capsule
-volume of the joint capsule is twice the volume of the humeral head
–not much stability
ligaments
-GH ligaments
–superior, middle, and inferior
–actually thickenings of the joint capsule
-coracohumeral ligament

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9
Q

GH joint

  • coracoacromial arch
  • plane of scapula
A 
coracoacromial arch
-formed by the coracoacromial ligament
-protects the top of the humeral head
-protects the rotator cuff tendons
-protects the bursa
plane of the scapula
-the most functional plane of the rotator cuff is 30-45 degrees from the frontal plane
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10
Q

scapulothoracic articulation

  • scapular movement
  • scapulothoracic rhythm
A

“false joint”
moves in response to other joints
requires great dynamic stability
scapular movement
-superior/inferior (elevation/depression)
-anterior/posterior (forward/backward tipping)
-upward/downward rotation
-ER/IR
-medial/lateral movement (protraction/retraction)
scapulothoracic rhythm
-GH and scapulothoracic articulation must function together
–2:1 ratio GH:STA

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11
Q

bursae

A

subacromial bursa
-above supraspinatus tendon
-buffer between rotator cuff and acromion
subdeltoid bursa

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12
Q

muscles acting on the scapula

  • functions
  • muscles
A 
functions
-control position of glenoid
-fix the scapula to give a stable base of support for the rotator cuff
muscles
-rhomboid major and minor
-levator scapulae
-serratus anterior
-trapezius
-latissimus dorsi
-pectoralis major
-pectoralis minor
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13
Q

rhomboids

A

downward rotation
retraction
elevation

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14
Q

levator scapulae

A

elevation
retraction
upward rotation (small)

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15
Q

serratus anterior

A

protraction
upward rotation
long thoracic nerve

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16
Q

trapezius

A 
upper
-upward rotation
-elevation
middle
-retraction
lower
-upward rotation
-retraction
-depression
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17
Q

latissimus dorsi

A

depression (on scapula)

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18
Q

pectoralis major

A

depression (on scapula)

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19
Q

pectoralis minor

A

depression

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20
Q

muscles acting on the humerus

A 
rotator cuff
-subscapularis
-supraspinatus
-teres minor
-infraspinatus
deltoid
pectoralis major
latissimus dorsi
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21
Q

rotator cuff functions

A 
subscap
-IR - extension - horizontal adduction
supraspinatus
-abduction
teres minor
-ER - horizontal abduction
infraspinatus
-ER - horizontal abduction
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22
Q

force couples

A

two muscles that pull in two different directions to provide stability
best example
-deltoid/rotator cuff
–deltoid pulls up on humerus
–rotator cuff pulls down on humerus
–both function to keep the humeral head depressed within the glenoid

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23
Q

adhesive capsulitis

  • MOI
  • 4-step progression
  • capsular pattern
  • end-feel of shoulder
  • Tx
  • most common population
A 
MOI
-thickening (fibrosis) of the joint capsule
4-step progression
-pain at deltoid insertion
-night pain
-pain at end range of motion (begin to see joint stiffness)
-stiffness without pain
capsular pattern
-ER is the MOST limited
-abduction is MODERATELY limited
-IR is LESS limited
end-feel of shoulder
-IR/ER has hard/locking end feel
Tx
-will occasionally self-resolve, but not common
-steriod injection
-joint mobilizations
occurs commonly post-op or after severe injury
over the age of 50, white females
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24
Q

GIRD

-total arc of motion

A

common in overhead athletes, especially baseball
15-20 degree deficit when compared bilaterally
total arc of motion
-typically someone may make up for a deficit in one direction with extra mobility in the other direction
risk for other injuries
Tx
-stretching and mobilization

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25
Q

why is the scapula important?

A
  • “core of the shoulder”
  • provides a stable base of support for the shoulder and arm
  • large role in stabilizing humerus
  • -position of scapula positions the humerus
26
Q

scapular dyskinesis

A 
poor scapular function
-abnormal motion
-abnormal position
--scapular winging
-decreased stability
often diagnosed secondary to another pathology
27
Q

scapular dyskinesis

-clinical presentation

A

clinical presentation

  • tenderness
  • -coracoid, pec minor, superior and medial scap borders, AC joint, posterior GH joint line, subacromial space (linked with impingement syndrome)
  • muscle spasm
  • upper trap
  • posterior cervical musculature
  • levator scapulae
  • static position
  • depression
  • protraction
  • anterior tipping
  • ROM
  • -GIRD
  • -posterior shoulder tightness
  • MMT
  • -weak middle trap/lower trap
  • -weak serratus anterior
  • -weak rotator cuff
28
Q

scapular dyskinesis

-intervention

A 
dynamic function assessment
intervention
-associated pathology
-modify activity as needed
-rehabilitation
always address scapular function
29
Q

impingement syndrome

-types

A

decrease in available space
types
-external (primary and secondary)
-internal

30
Q

external

  • primary structures
  • onset
  • causes
  • cycle of dysfunction
A 
occurs in subacromial space
primary structures
-rotator cuff tendons
-LHBT
-subacromial bursa
insidious onset
causes
-overuse
-postural insufficiencies
cycle of dysfunction
-rotator cuff is pinched
-as it is impinged it becomes inflamed
-leads to more pinching
31
Q

primary external impingement

A

occurs from change in acromion
types of acromions
-type 1: flat, plenty of space for movement
-type 2: slight curvature off bottom of acromion
-type 3: more of a hook
-type 4: multiple bone spurs (highest risk)
can require surgical intervention to shave down the acromion

32
Q

secondary external impingement

A 
modifiable factors
risk factors
-GIRD, rotator cuff weakness, scapular dyskinesis, poor posture, GH instability
S/S
-pain beneath the acromion
-possible radiating pain (lateral arm)
-possible mechanical symptoms
ROM-pain with AROM/PROM, RROM above 90 degrees
-active abduction from 70-120 degrees in painful
--activates the supraspinatus
-intervention
--treat symptoms
--activity modification
--strengthen and stretch
33
Q

internal impingement

A 
between humeral head and glenoid
most common
-posterosuperior impingement
-infraspinatus and supraspinatus impinged during abduction and ER
sources
-GIRD
-GH instability
-repetition
Tx
-rehabilitation
-scapula control
-posture
34
Q

rotator cuff tendinopathy

A 
supraspinatus is at most risk
insidious onset
early - pain after activity
progresses to pain during activity
finally pain with ADLs and pain may radiate into lateral arm
contributing factors
-muscular imbalance
-capsular laxity
-poor scapular control
-impingement
Tx
-decrease inflammation and pain
-address scapular stability
-address weakness and motion issues
-surgical intervention for tears
35
Q

rotator cuff tears

A

may result from a single trauma or repetitive trauma
a partial tear may develop into a full-thickness tear if unaddressed
clinical presentation
-lack of control with lowering out of abduction
-significant pain and weakness

36
Q

clavicle fractures

A 
MOI
-direct blow to the shoulder
-indirect force
S/S
-pain
-deformity and point tenderness
-crepitus
-inability to raise arm
Tx
-immobilization, referral
-surgery is rare
most common fracture point is approximately 2/3 distally
37
Q

humerus fracture

A 
most common at surgical neck
-transverse fracture
radial nerve involvement
MOI
-high velocity impact
-FOOSH
S/S
-pain
-deformity
-dysfunction
Tx
-splint
-refer
38
Q

SC joint sprains

A

MOI
-longitudinal force on the clavicle
S/S
-pain with protraction, retraction, and horizontal adduction
-dislocation: displacement of the head of the clavicle
–lost of ligamentous stability
–little bony stability
-pain with GH elevation
-+ SC joint play
–grade 1: pain without laxity
–grade 2 and 3: laxity
posterior dislocations = medical emergency
–trachea, esophagus, subclavian artery and vein

39
Q

AC joint sprains

  • MOI
  • S/S
A 
"separated shoulder"
MOI
-FOOSH
-direct blow to acromion process
S/S
-pain over distal clavicle, AC joint, neck, superior scapula, deptoid
-step deformity
--occurs with grade 2 or higher
--drop off from clavicle down to acromion
-piano key sign
--rise or fall of distal clavicle with palpation/joint play
-pain with GH elevation
40
Q

AC joint sprain classifications

-based on

A

based on…

  • structures involved
  • degree of instability
  • direction of displacement
41
Q

AC joint sprain type I

A

damage to joint capsule

damage to AC ligament

42
Q

AC joint sprain type II

A

AC ligament rupture
coracoclavicular ligament involvement
slight laxity
potential mild deformity

43
Q

AC joint sprain type III

A

obvious deformity
AC ligament rupture
coracoclavicular ligament rupture

44
Q

AC joint sprain type IV

A

rupture of AC and CC ligaments
posterior displacement
possible deltoid and trap involvement

45
Q

AC joint sprain type V

A

superior displacement of clavicle

1-3x the height of the opposite side

46
Q

AC joint sprain type VI

A

inferior displacement of clavicle

47
Q

AC joint sprain treatment

A

splint and refer - if laxity
most treated non-surgically
-same outcomes for surgery and non-surgery
pad for RTP

48
Q

glenohumeral instability

  • anterior
  • MOI
  • Tx
A

laxity of anterior structures
anterior dislocation most common (most severe)
MOI
-abduction and ER
80-90% of young males who dislocate their humerus anteriorly will do it again
Tx
-strengthening
–rotator cuff
-if you have decreased static stability you need more dynamic stability
-surgery

49
Q

injuries secondary to anterior dislocation

A 
Bankart lesion
-damage to anterior or inferior labrum
Hill-Sachs lesion
-posterior humeral head
-catches on rim of glenoid and creates a lesion
Fx of glenoid rim
-may occur with Bankart lesion
50
Q

posterior instability

-MOI

A

uncommon
MOI
-flexion - IR - posterior longitudinal force
–classic carry of a football and fall on elbow
Reverse Hill-Sachs-Lesion

51
Q

inferior instability

A

greatest when arm elevated over 90 degrees

arm will appear stuck in an elevated position with inferior dislocation

52
Q

multidirectional instability

A

any two or more directional instabilities
problem: if you surgically go after one, you make the other worse
Tx
-modify lifting
–don’t push weight overhead

53
Q

bicipital tendinopathy

A

commonly concurrent with rotator cuff pathology/impingement

54
Q

SLAP lesions

A 
superior labrum anterior posterior
acute or repetitive trauma
S/S
-anteroposterior shoulder pain
-increased pain at 90 degrees of flexion and 90 degrees of external rotation
-clicking or catching
DDx
-impingement syndrome (clicking and catching)
55
Q

SLAP lesion types

-Tx

A

Type 1
-fraying of the labrum near the insertion of the LHBT
type 2
-avulsion of the labrum with an associated LHBT tear
OR
-isolated to just the anterior or posterior aspect
type 3
-bucket handle tear of the labrum
type 4
-bucket handle tear of the labrum and tearing of the LHBT
types 3 and 4 are associated with glenohumeral instability
Tx
-based on Sx

56
Q

shoulder examination history

A

past medical history

  • previous history
  • AC or GH injury can alter biomechanics
  • C-spine pathology
  • can radiate pain to upper extremity
57
Q

pain with throwing functional assessment

A 
pain in follow-through
-indicative of rotator cuff
pain in cocked position
-anterior instability/impingement (especially internal)
pain in deceleration
-biceps tendon
-SLAP lesion
loss of control and/or velocity
-internal impingement
58
Q

shoulder inspection

A

Sprengel’s deformity
-congenitally undescended scapula
rounded forward shoulders typically present with thoracic kyphosis

59
Q

SC joint play

A

anterior: SC ligament
posterior: SC ligament
inferior: interclavicular ligament
superior: costoclavicular ligament

60
Q

AC joint play

A

inferior: AC ligament
superior: conoid ligament, trapezoid ligament, AC ligament
anterior: AC ligament, coracoclavicular ligament
posterior: AC ligament, bony block

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