2: GH Joint Flashcards
(132 cards)
1
Q
What joints and articulations make up the shoulder complex?
A
Glenohumeral joint
Acromioclavicular joint
Sternoclavicular joint
Scapulothoracic articulation
2
Q
What is the origin of Teres major?
A
Inferior angle of scapula and inferior 1/3 of the lateral border
3
Q
What is the origin of teres minor?
A
Middle 1/3 of lateral border of scapula
4
Q
During all movements, the humerus obeys the ____
A
Convex rule
5
Q
What is the convex rule?
A
Roll and glide are in opposite directions
6
Q
What is the open-packed position for the glenohumeral joint?
A
55 degrees of ABduction in the scapular plane
7
Q
Where is the scapular plane?
A
30 degrees anterior to the coronal plane
8
Q
What is the close-packed position for the glenohumeral joint?
A
Full ABduction and external rotation
9
Q
A low grade mobilization stretches the tissue (TRUE/FALSE)?
A
FALSE
10
Q
A low grade mobilization is used when ____ is the dominant symptom?
A
Pain
11
Q
A high grade mobilization stretches tissues (TRUE/FALSE)?
A
TRUE
12
Q
A high grade mobilization is used when ____ is the dominant symptom?
A
Stiffness or joint restriction
13
Q
High grade mobilizations can involve oscillations and small amplitude thrusts (TRUE/FALSE)?
A
TRUE
14
Q
What are the most common causes of mechanical shoulder pain in the office?
A
GH joint disorders
Rotator cuff disorders
AC joint disorders
GHJ instability
15
Q
Impingement syndrome involves a ____ muscle?
A
Rotator cuff
16
Q
A distraction is an example of a (Low/High) grade mobilization in the (Closed/Open) packed position?
A
Low, Open
17
Q
A glide or rotation is an example of a (Low/High) grade mobilization that is (More/Less) aggressive?
A
High, More
18
Q
What is osteoarthritis?
A
A progressive non-inflammatory disease characterized by degenerative pathological changes in the articular cartilage and its related components
19
Q
Osteoarthritis is inflammatory (TRUE/FALSE)?
A
FALSE
20
Q
Male patient age 62 presents with shoulder pain that has been progressively getting worse over the past year and a half. The pain is a 3/10 at rest but becomes a 6/10 during activity. Physical exam reveals decreased active and passive ROM in the GH joint in all planes as well as crackling sounds when the GH joint is mobilized. What is a likely working diagnosis?
A
Osteoarthritis of the GHJ
21
Q
Osteoarthritis of the GH joint presents with decreased ____ and ____ ROM?
A
Active, passive
22
Q
How will osteoarthritis present on a radiograph?
A
Decreased joint space
Subchondral sclerosis
Osteophyte formation
23
Q
What conservative treatment can be done for osteoarthritis of the GH joint?
A
Mobilization or manipulation
Ice or heat
Passive stretching
Strengthening of muscles
24
Q
(Distraction/Glide) techniques are often better tolerated in patients with OA of the GH joint?
A
Distraction
25
What is adhesive capsulitis commonly known as?
Frozen shoulder
26
What is adhesive capsulitis?
A chronic disorder of the GH joint capsule and synovial lining in which an initial inflammatory process is followed by reactive joint capsule fibrosis
27
Primary adhesive capsulitis arises spontaneously and is not associated with or caused by a previous disease (TRUE/FALSE)?
TRUE
28
Secondary adhesive capsulitis is associated with an earlier disease or disorder (TRUE/FALSE)?
TRUE
29
What is the most common cause of secondary adhesive capsulitis?
Systemic disorders
30
What systemic disorders can cause adhesive capsulitis?
Diabetes mellitus (10-36%)
Thyroid disease
Autoimmune disease
31
What shoulder disorders can cause adhesive capsulitis?
Rotator cuff disease
Prolonged shoulder immobilization
Shoulder trauma
32
What non-shoulder disorders can cause adhesive capsulitis?
Chest or breast surgery
Myocardial infarction
Non-shoulder surgery
33
How old is a typical patient with adhesive capsulitis?
40-60
34
Stage one of adhesive capsulitis is painful (TRUE/FALSE)?
TRUE
35
Stage one of adhesive capsulitis is characterized by inflammation of the ____
Synovial lining
36
In what stage is adhesive capsulitis most commonly misdiagnosed?
Stage one
37
What is stage two of adhesive capsulitis?
Frozen stage resulting in fibrosis and contracture of the joint capsule with stiffness
38
Stage two of adhesive capsulitis is characterized by joint capsule ____ and ____
Fibrosis, contracture
39
Stage two of adhesive capsulitis is the pain stage (TRUE/FALSE)?
FALSE
40
What motion is most restricted first in stage two of adhesive capsulitis?
External rotation
41
What is the ROM loss pattern in adhesive capsulitis?
EXT ——> ABduction ——> INT
42
What is stage three of adhesive capsulitis?
Thawing stage where the joint capsule gradually remodels and stretches
43
Stage three of adhesive capsulitis is characterized by ____ and ____
Remodeling, stretching
44
A radiograph of a patient with adhesive capsulitis will be unremarkable (TRUE/FALSE)?
TRUE
45
In what stages of adhesive capsulitis is the chiropractor most effective?
Stages two and three
46
A CT or MRI in stage one of adhesive capsulitis may show what?
Inflammation and edema
47
A CT or MRI in stage two or three of adhesive capsulitis may show what?
Thickened joint capsule
48
What treatment can be provided during stage one of adhesive capsulitis?
Low grade mobilization, Codman's pendulum exercises and TENS unit
49
Which type of mobilization is best for treating stage 2 adhesive capsulitis?
Low grade
50
What motion is lost primarily in adhesive capsulitis and lost first?
External rotation
51
What are the two main functions of the rotator cuff muscles?
Rotation of the humerus and stabilization of the glenohumeral joint
52
How do the rotator cuff muscles rotate the humerus?
Contraction of individual RC muscles or force coupling in opposite reactions
53
What is the action of supraspinatus?
Abduction of the arm
54
What is the action of subscapularis?
Internal rotation of the humerus
55
What is the action of infraspinatus and teres minor?
External rotation of the humerus
56
What muscles aid in flexion and abduction through force coupling in the shoulder?
Infraspinatus, teres minor, subscapularis, and the deltoid
57
What is a force couple?
Two forces of equal magnitude acting in opposite directions to rotate a body around its axis of motion
58
What muscle group is the most important stabilizer of the glenohumeral joint in the mid-ranges of motion?
Rotator cuff muscles
59
Through what mechanism does the rotator cuff complex stabilize the glenohumeral joint?
Concavity compression stability mechanism
60
A shallow glenoid fossa with a small concavity would need (Weak/Strong) compression by the rotator cuff to maintain joint stability?
Strong
61
A deep glenoid fossa with a large concavity would need (Weak/Strong) compression by the rotator cuff to maintain joint stability?
Weak
62
What is the most commonly dislocated joint in the body?
Glenohumeral joint
63
What is the most common cause of shoulder pain in patients over 35?
Rotator cuff disorders
64
What is tendinopathy?
A broad term used to describe any pathology involving a tendon and is inclusive of several different tendon pathologies including tendinitis, tendinosis, and tenosynovitis
65
Tendinosis is (Inflammatory/Non-inflammatory)?
Non-inflammatory
66
What is tendinitis?
An inflammatory condition of a tendon
67
What is tendinosis?
A non-inflammatory degenerative change in a tendon commonly due to aging, micro trauma, vascular compromise, or failed healing
68
Tendinitis is (Inflammatory/Non-inflammatory)?
Inflammatory
69
What is tenosynovitis?
Inflammation of the synovial sheath that surrounds some tendons
70
What is the number one tendon injured in a rotator cuff tendinopathy?
Supraspinatus tendon
71
Rotator cuff tendinopathy usually affects what age group?
Patients over 35
72
Patients under 35 years old with rotator cuff tendinopathy are mostly ________________?
Athletes
73
What are the major causes of rotator cuff tendinopathy?
Major trauma
Age-related degeneration
Tension overload
Impingement
74
What is a FOOSH injury?
Fall on an outstretched hand
75
What is the likely cause of age-related rotator cuff tendon degeneration?
Poor vascular supply of the supraspinatus tendon in the critical zone
76
Age-related degeneration as a cause of rotator cuff tendinopathy is often asymptomatic (TRUE/FALSE)?
TRUE
77
Tension overload of the rotator cuff tendon is most commonly seen in what population?
Overhead athletes (baseball, football, throwing)
78
What is the most common cause of symptomatic rotator cuff tendinopathy?
Subacromial impingement
79
What is subacromial impingement?
Compression of the tissue in the subacromial space between the humeral head and the undersurface of the coracoacromial arch
80
What is the subacromial space?
Space between coracoacromial arch and humeral head
81
What forms the coracoacromial arch?
Anterior 1/3 of acromion
AC joint
Coracoacromial ligament
Coracoid process
82
When are tissues in the subacromial space NORMALLY compressed?
60 degrees shoulder abduction
83
What tissues are located in the subacromial space?
Subacromial bursa
Supraspinatus tendon
Long head of biceps tendon
84
What can cause narrowing of the subacromial space?
Functional narrowing
Structural narrowing
Swelling
85
What tissue is most commonly impinged in the subacromial space?
Subacromial bursa
86
What is the most common type of narrowing of subacromial impingement?
Functional narrowing of the SAS
87
What can cause functional narrowing of the subacromial space?
Strength imbalance between rotator cuff and deltoid
Tight GHJ POSTERIOR capsule
Tight GHJ INFERIOR capsule
Poor upward rotation of the scapula during elevation
88
How can a strength imbalance between the rotator cuff and deltoid be determined?
Absolute or relative weakness of the rotator cuff compared to the deltoid
89
If strength of the deltoid overwhelms the concavity-compression stability mechanism of the RC, the humerus is pulled ____ during flexion or abduction causing impingement?
Superior
90
A deltoid that is stronger than the rotator cuff will cause the humerus to pull ____
Superior
91
What is an absolute weakness of the rotator cuff muscle compared to the deltoid?
Rotator cuff is weak and the deltoid is strong
92
What is a relative weakness of the rotator cuff muscle compared to the deltoid?
Both muscles are strong but the deltoid is much stronger than the rotator cuff
93
How does a relative weakness of the rotator cuff compared to the deltoid occur?
Rotator cuff deconditioning, tendinopathy, or tear
94
A tight GHJ posterior capsule will pull the humerus ____ during flexion?
Anterior and superior
95
What vector would be used to correct a tight GHJ posterior capsule?
A—-P Glide
96
When asymmetric tightness of the capsule exists it causes abnormal translation of the humeral head away from the side of tightness (TRUE/FALSE)?
TRUE
97
A tight GHJ inferior capsule will pull the humerus ____ during shoulder abduction causing impingement?
Superior
98
What two factors determine the age of onset for a RC injury?
How often and how intense the rotator cuff muscles are worked
99
Decreased upward rotation of the scapula during ____ & ____ can cause functional narrowing of the SAS?
Flexion, abduction
100
What can cause structural narrowing of the SAS?
AC joint spur
Abnormal acromion shape
101
What can cause swelling in the SAS?
Tension overload (athletes with repetitive tearing and swelling)
Acute trauma (FOOSH)
102
A FOOSH injury will push the humerus ____
Superior
103
Where will pain present clinically in a patient with subacromial impingement?
Anterior/anterolateral shoulder pain
104
Where does pain often refer to in a patient with subacromial impingement?
Deltoid insertion
105
A patient with a subacromial impingement may have what history?
Athletics involving overhead sports (throwing, swimming, tennis, baseball)
Occupation involving overhead work
Older age (60+, if not as active)
106
A C5 radiculopathy will radiate to the (Medial/Lateral) arm?
Lateral
107
A C6 radiculopathy willl radiate to the (Medial/Lateral) forearm?
Lateral
108
What is a typical patient for subacromial impingement in terms of age?
Over 35
109
What is the major cause of a subacromial impingement?
Idiopathic (no precipitating event)
110
What is the diagnostic criteria for a subacromial impingement?
Functional or structure impingement combined with cumulative effects of repetitive impingement from overhead use
111
A patient with a single event causing subacromial impingement will have ____ in the SAS?
Swelling
112
What are possible areas of tenderness in a patient with a subacromial impingement?
AC joint
Anterolateral edge of acromion
Insertion of supraspinatus on greater tuberosity
Long head of biceps tendon
113
How is a supraspinatus strength test done?
Thumb up (full can) with the shoulder in 90 degrees of the scapular plane. Hold arms out and test muscle strength pushing downward
114
How is an infraspinatus or teres minor test done?
External rotation of the shoulder by bracing the hand and pushing on the arm and elbow to resist external rotation
115
How is a subscapularis test done?
Internal rotation test by pulling the arm into external rotation and having patient resist
OR
Lift-Off test: Have patient put hand behind back and apply some pressure P—-A
116
What muscles are internal rotators of the shoulder?
Subscapularis, pec major, latissimus dorsi, teres major
117
What are orthopedic tests for subacromial impingement?
Neer Test
Hawkins Test
Impingement Sign
118
How do orthopedic tests primarily produce subacromial impingement?
Holding the acromion down
119
What are the most common orthopedic tests for subacromial impingement?
Neer Test
Hawkins Test
120
How is a Neer test performed and what does it assess for?
Patient holds arm above head testing for subacromial impingement
121
How is a Hawkins test performed and what does it assess for?
Patients holds arm 90 degrees in front of them and the doctor pushes down on the hand and up on the elbow to lower the acromion testing for subacromial impingement
122
What is the supraspinatus press test?
Orthopedic test thumb down (empty can) for the supraspinatus
123
A supraspinatus press test is a (Full Can/Empty Can) orthopedic test?
Empty Can
124
A supraspinatus strength test is a (Full Can/Empty Can) strength test?
Full can
125
Which supraspinatus test is most likely to cause pain if an impingement is present?
Supraspinatus press test (Thumb down/empty can)
126
What GHJ mobilization techniques can be effective for treating subacromial impingement?
S-I glide and A-P glide
127
How should all shoulder mobilization techniques be performed?
Arm above 30 degrees abduction in the scapular plane to minimize stress
128
When should you refer out for a suspected subacromial impingement?
Severe pain (7/10 or difficulty sleeping)
Worsening pain, weakness, or dysfunction
No improvement after 4-6 weeks
129
Surgical treatment may be effective for ____ causes or swelling in the SAS but is NOT as effective for ____ causes of impingement?
Structural, functional
130
What is the most important method of GHJ stabilization by the RC muscles?
Compression of the humeral head into the glenoid fossa (C-C stability mechanism)
131
During 180 degrees of shoulder abduction and flexion how much does the humerus and scapula move?
Humerus moves 120 degrees and the scapula rotates upward 60 degrees
132
The four most common causes of functional narrowing of the subacromial space can all be effectively treated with ____
conservative care
