Week 10 Flashcards
What joints make up the shoulder (pectoral) girdle?
- glenohumeral
- acromioclavicular
- sternoclavicular
- scapulothoracic
Role of the glenoid labrum
- deepens socket and increases congruency in joint
- allows for more stability
Ligaments of the pectoral girdle
- acromioclavicular
- coracoacromial
- coracohumeral
- transverse humeral
- coracoclavicular (conoid and trapezoid ligaments)
Bursa of the pectoral girdle
- lies in subacromial area
- cushions area
Tendons of the pectoral girdle
- long head of biceps tendon
- rotator cuff tendons
Pectoral muscles
- pectoralis major (sternal head and clavicular head)
- pectoralis minor (causes a lot of issues if tight)
Other relevant anatomy of the pectoral girdle
- brachial plexus
- subclavian artery and vein
Muscles acting on the scapula
- levator scapulae
- rhomboid minor
- rhomboid major
- trapezius
- latissimus dorsi
Muscles of the rotator cuff
- supraspinatus
- infraspinatus
- teres minor
- subscapularis
Roles of the rotator cuff muscles
- dynamic stabilizer of the shoulder
How many insertion points does the latissimus dorsi have ?
11
Physiological ROM of the glenohumeral joint
- abduction
- adduction
- flexion
- extension
- internal rotation (0 and 90 degrees abd)
- external rotation (0 and 90 degrees abd)
- horizontal adduction (cross-flexion)
- horizontal abduction (cross-extension)
What happens if the accessory movements (roll, spin, glide) dont occur?
- dysfunction leading to injury
Dislocations of glenohumeral joint
- head of humerus translates completely out of the glenoid
Sublaxations of the glenohumeral joint
- a partial or incomplete dislocation of the glenohumeral joint
Types of shoulder dislocations
- anterior (most common)
- posterior
- inferior (rare)
Special test for anterior glenohumeral dislocation
- apprehension test
What does SLAP lesions/tears stand for?
- superior labrum anterior and posterior
What is a SLAP lesion/tear?
- injury to superior aspect of labrum from anterior to posterior
What could also be injured in a SLAP lesion/tear?
- biceps tendon
4 types of SLAP lesions/tears
- type I
- type II
- type III
- type IV
SLAP lesions MOI
- repetitive overhead movements, falling on outstretched hand (FOOSH), sudden traction to the arm, dislocation of glenohumeral joint
Signs and symptoms of SLAP lesions
- clicking/catching/locking
- pain moving arm overhead
- pain lifting heavy objects
- pain deep in joint or in back of joint
- anterior shoulder pain if biceps involved
Bankart lesion
- injury to the anterior-inferior glenoid labrum
- secondary to anterior dislocation
Signs and symptoms of bankart lesion
- pain and limited ROM with most shoulder movements
- clicking
- catching
- grinding
- popping
- subluxation
Hills-sachs lesion
- a divot type fracture of the head of the humerus following a dislocation
- head of humerus gets compressed against the rim of the glenoid
Rotator cuff injuries
- impingement
- tendonitis
- rotator cuff tears
MOI of rotator cuff impingement
- overuse
- poor mechanics
MOI of rotator cuff tendonitis
- overuse
- poor mechanics
MOI of rotator cuff tears
- acute or overuse
Acromioclavicular (AC) separations/sprains MOI
- FOOSH
- fall/tackle
- landing on side of shoulder
- checked into boards
Signs and symptoms of AC separations/sprains
- pain
- step deformity at AC
- weakness in shoulder/arm
Acute management of AC separations/sprains
- PIER
- sling
- swath
- refer if severe deformities
- AC tape job to support healing and decrease pain
Treatment of acute shoulder injuries
- PIER, sling for support
- AC tape job to approximate joints and ligaments
- rehab to promote tissue healing and regain mobility & stability
When is surgery of the shoulder considered?
- middle third clavicle fractures
- type III AC sprains in active people
- types IV, V and VI AC sprains
- first time GH dislocation in young athletes
- full thickness rotator cuff tears
- displaced or unstable proximal humerus fractures
When is urgent surgical referral required for shoulder?
- posterior sternoclavicular dislocations
Why is urgent surgical referral required for posterior sternoclavicular dislocations?
- important structures that sit behind
ie. vasculature
Subacromial impingement syndrome (shoulder impingement) MOI
- overuse
- biomechanical imbalances
What is occurring with a shoulder impingement?
- pinching and subsequent inflammation of structures under the coracoacromial ligament
What structures may be affected with a shoulder impingement?
- supraspinatus tendon
- long head of biceps tendon
- subacromial bursa
Signs and symptoms of shoulder impingement
- pain & weakness in painful arc of abduction (ie. reaching)
- catching/clicking
- pain with sleeping on affected side
- pain putting jackets/sweaters on
Special test for shoulder impingement
- painful arc
Positive painful arc test
- pain during GH abduction btwn 60 and 120 degrees
- pain clears beyond 120 degrees
Where does referred pain occur with a shoulder impingement?
- supraspinatus pattern down middle deltoid
What athletes is a shoulder impingement common in?
- swimmers
- tennis
- pitchers
- quarterbacks
MOI of humerus fractures
- high energy direct blow
Signs and symptoms of humerus fractures
- pain
- swelling
- bruising
- unable to move arm or grinding when they do
What is the most common fracture site on the humerus?
- surgical neck
What percent of humerus fractures are not-displaced?
- 80%
- non-surgical
Acute management of humerus fractures
- PIER
- sling
- treat for shock
send to emerge if stable-otherwise call EMS
Management of humerus fracture
- sling
- pain management
- start treatment early to avoid frozen shoulder
Scapula fractures MOI
- high energy blunt trauma
- fall from height
Signs and symptoms of scapula fractures
- extreme pain with arm movements
- localized swelling
- bruising/trauma to area
Management for scapula fractures
- sling
- most are non-surgical
When is surgery indicated for scapular fractures?
- displaced fractures of glenoid
- displaced fracture at neck of scapula
- acromion fractures causing impingement
Separation
AC joint
Clavicle fractures MOI
- force to lateral shoulder (tackle, check into boards)
- FOOSH
- direct trauma
Signs and symptoms of clavicle fractures
- severe pain & swelling over site
- deformity
- unwillingness to move arm
Acute management of clavicle fractures
- tube sling (to avoid pressure)
- PIER
Treatment for clavicle fractures
- sling or figure 8 brace
- PIER
- pain management
- alleviate associated spasm
Treating the shoulder girdle
- consider the anatomy and how complex it is (ie. 3 joints and many muscles spanning multiple joints)
Important considerations when treating the shoulder girdle
- thoracic spine mobility
- scapular mobility
- scapular stability
- upper limb proprioception
