AMP 2 study shoulder Flashcards
(16 cards)
What is stanmore triangle
Categorises shoulder instability into 3 poles, recongising many patients dont fit neatly into one category but often sit somewhere in between
Polar type 1
Traumatic structural
- caused clear traumatic event (eg dislocation) leading structural damage
-Features labral tear, capsular stretch
- Management often by surgery followed by rehab
polar type 2
Atraumatic structural
-instability develops gradually and without major trauma
-often due to repetitive microtrauma of cogital laxity leading structural damage over time
-Features are general hypermobility and instability
- management primary rehab, strentghening and prioprioception
Polar type 3
Muscle patterning/ non structural
- caused abnormal muscle control or coordination, no structural damage
-can often have voluntarily dislocations, abnormal scapular control, often young individuals
- management with physiotherapy focusing on neuromuscular control
-surgery not indicated
Why use stanmore triangle
- help tailor treatment
- prevents inappropriate surgery, especially type 3
- encourages holistic approach acknowledging that both physical structures + muscle play crucial rolec
Red flags shoulder
Cancer
Infection
Cervical mylopathy
Traumatic RC tear
Trauma
Inflammatory pathologies
Heart
Vertebrobasilar insuffiency
Explain cervical mylopathy
Cervical myelopathy means there’s pressure on the spinal cord in the neck (cervical spine). This can happen due to things like arthritis, disc problems, or spinal narrowing.
⚠️ Why is it a Red Flag for Shoulder Pain?
Because it can look like a shoulder problem (e.g., weakness, numbness, pain), but the real issue is in the spinal cord.
If someone has shoulder pain plus any of these, it may be cervical myelopathy:
Weakness or clumsiness in hands (e.g., trouble doing up buttons)
Loss of balance or difficulty walking
Pins and needles or numbness in both hands or arms
Muscle wasting in hands or arms
Changes in bladder or bowel control (in severe cases)
Neck stiffness or pain
Explain Vertebrobasilar insuffiency
Vertebrobasilar insufficiency (VBI) means that blood flow to the back of the brain is reduced, usually because of narrowing or blockage in the vertebral or basilar arteries.
These arteries supply parts of the brain that control balance, vision, coordination, and vital functions.
🧠 Common Symptoms (especially with head/neck movement):
✅ The 5 D’s:
Dizziness
Drop attacks (sudden falls without warning)
Dysarthria (slurred speech)
Dysphagia (difficulty swallowing)
Diplopia (double vision)
✅ The 3 N’s:
Nausea
Nystagmus (jerky eye movements)
Numbness (especially in the face)
Red flags - acute rotator cuff tear
Trauma
Significant weakness and loss of funtion
Large hematoma
Acute loss AROM and PROM
why need to be careful with throwers test
Test assesses internal impingement + post sub labral pathology
-risk dislocation or subluxation
-increased pain + inflammation
-risk of exacerbating an existing injury
concave/ convex rule glenoid + humerus
The humeral head (convex) moves within the glenoid fossa (concave)
If convex surface moves, glide occurs in opposite direction to bone movement
If concave surface moves, glides occur in same direction as bone movement.
Factors lead dysfunction of scapulo-humeral rhytym
Muscular weakness
Tightness of GH capsule/ Joint stiffness
Nerve injury
Poor posture
Shoulder pathologies
Abnormal scapulo-humeral rhytym can lead to:
Shoulder impingement
RC dysfunction or tears
Loss shoulder strength + stability
Pain + inflammation
Serratus anterior winging or dykinisia
Force couple
A force couple is a pair of muscles pulling in opposite directions to create a stable, coordinated movement.
✅ Classic Example – Shoulder (Scapula Rotation):
During arm elevation (lifting your arm overhead):
The upper trapezius pulls upward on the scapula.
The lower trapezius pulls downward and inward.
The serratus anterior pulls around the ribcage (forward and outward)
distal force couple
A distal force couple is when two or more muscles near the ends of limbs pull in opposite directions to create smooth, stable movement.
✅ Example – Wrist Stability During Grip:
When you grip an object (like holding a cup):
The finger flexors (like flexor digitorum profundus) flex the fingers to grip.
At the same time, the wrist extensors (like extensor carpi radialis longus) extend the wrist slightly.
🌀 Even though they pull in opposite directions, they work together to:
Maximize grip strength
Prevent the wrist from collapsing into flexion
Provide a stable base for finger action
This coordination is a distal force couple at the wrist and hand.
Proximal force couple
A proximal force couple is when muscles close to the center of the body (like around the shoulder or hip) pull in opposite directions to create stable, coordinated movement or joint control.
✅ Example – Shoulder Joint:
During arm movement:
The deltoid pulls the arm upward.
The rotator cuff muscles (like supraspinatus and infraspinatus) pull the humeral head down and in.
🌀 Together, they center the shoulder joint and allow smooth movement without impingement — a classic proximal force couple.
