conditions of the shoulder

Question 1

what does the sternoclavicular joint attach

Answer 1

it attaches the axial skeleton to the appendicular skeleton (clavicle to the sternum)

Question 2

what muscles attach to the SC joint

Answer 2

pec major and SCM

Question 3

what mvt does the sc joint do

Answer 3

flex/ext, int and ext rotation, abd and add

Question 4

what injuries can occur at the sc joint

Answer 4

foosh (compression of that joint, protecting yourself while falling), direct trauma, contact to lateral sh (bumped into wall), sprain (ant and post, big could be torn 1 or 2 degrees) and dislocation (ant, post)

Question 5

which one is most common; ant dislocation of sc joint or post?

Answer 5

ant dislocation

Question 6

what is so bad about a post dislocation of the sc joint

Answer 6

it can compromise abc (lung, trachea and esophagus are there)

Question 7

S/S of sc joint sprain (7)

Answer 7

pain w mvt of gh joint (shearing forces)
pain w breathing (especially deep breathing; m. that help with breathing will move the clavicle too)
pain w upright posture (opposite w post sprain)
pain w sleeping on side (compressing the sc joint)
clicking sensation at sc joint (lig torn so b on b rubbing)
bruising or swelling maybe present (if n. is affected)

Question 8

where is the acromioclavicular joint

Answer 8

lateral aspect of the shoulder, clavicle and the acromion process of the scapula

Question 9

what ligs stop the clavicle from moving ant and post on the acromion

Answer 9

ac ligament

Question 10

what lig prevents the clavicle and acromion from moving post and inf

Answer 10

cc ligament

Question 11

if inf ac joint sprain what m. do you need to strengthen

Answer 11

deltoid and pec major

Question 12

what m. needs to relax if theres an inf ac joint sprain

Answer 12

utf

Question 13

what injuries can occur at the ac joint

Answer 13

sprain of ac lig and or cc lig
foosh (humerus jammed in subacromion)
direct blow to the lateral shoulder
blow to sup acromion (smt falls on side of sh)
separated sh (ac joint vs dislocation)

Question 14

structures involved and s/s of type 1 ac joint sprain

Answer 14

slight to partial damage of ac lig and capsule

point tenderness and no laxity or deformity

Question 15

structures involved and s/s of type 2 ac joint sprain

Answer 15

rupture of ac lig and partial damage to cc lig

slight laxity and deformity of ac joint, slight step deformity

Question 16

structures involved and s/s of type 3 ac joint sprain

Answer 16

complete tear of ac lig and cc lig, possible involvement of delts and traps fascia
obvious dislocation of the distal end of clavicle from acromion process

Question 17

structures involved and s/s of type 4 ac joint sprain

Answer 17

complete tearing of ac and cc lig and tearing of deltoid and trap fascia
post clavicular displacement into the insertion of the uft

Question 18

structures involved and s/s of type 5 ac joint sprain

Answer 18

complete tearing of ac and cc lig and tearing of deltoid and trap fascia (deformity is even larger than type 4)
displacement of the clavicle 3x height compared to other side

Question 19

structures involved and s/s of type 6 ac joint sprain

Answer 19

complete tearing of ac and cc lig and tearing of deltoid and trap fascia (deformity is even larger than type 5)
displacement of clavicle inferiorly under coracoid

Question 20

what types of ac joint sprain can’t be told appart by naked eye

Answer 20

type 3, 4 and 5 and diff by imaging

Question 21

common s/s of ac joint sprain (4)

Answer 21

pain w mvt of gh joint (especially limited rom in flex/abd/CROSS FLEXION)
STEP DEFORMITY
some bruising may be present
pin point pain on ac joint

Question 22

what is the most commonly fractured b of the upper body and where is it most commonly fx

Answer 22

clavicle and at the turn of it

Question 23

what are the moi possible w clavicular fx (3)

Answer 23

direct impact, impact to lateral shoulder and foosh

Question 24

diff btw clavicular fx and ac joint sprain

Answer 24

crepitus and if in the middle and not on the ac joint then its a fx

Question 25

what to do if athlete has equipment for a clavicular fx

Answer 25

pmsc, check rom (will move more if ac and no fx), brush hand to check for major deformity and then palpate only if minor deformity

Question 26

what structures are included in the gh joint and what type of joint is it

Answer 26

head of humerus and glenoid fossa of scap | dynamic joint; works w scap and clavicle to ensure full rom

Question 27

what structures make up the gh joint

Answer 27

``` labrum (reduces friction and increases rom, deepens the joint) gh lig (sup, middle/ant, inf, post) biceps, rotator cuff, pec major, delts, triceps, lat dorsi, coracobrachialis ```

Question 28

what instabilities are possible at the gh joint and what does that instability increase

Answer 28

ant, post, inf or multiple directions (some people can be hypermobile and born w it, can sublax no prob) it will increase laxity and so rom too

Question 29

instability at the gh joint is graded on what

Answer 29

joint play; mvt of head of humerus in glenoid fossa

Question 30

what types of stability are possible at the gh joint and what structures does each one involve

Answer 30

passive stability; capsular lig and gh lig (all blend in together) dynamic stability: ROTATOR CUFF M, and other gh muscles (pecs, traps, delts, biceps and triceps)

Question 31

what test can be done to test gh instability

Answer 31

apprehension test; ant mvt of head of humerus

Question 32

what is TUBS gh instability and how is it fixed

Answer 32

traumatic unidirectional instability usually treated w surgery (usually bankart lesion; little fx to rim of glenoid fossa= shearing forces)

Question 33

what is AMBRI gh instability and how is it fixed

Answer 33

atraumatic, multidirectional frequently bilateral treated w rehab and/or inf capsular shift (shrink capsule to make it tighter to keep head of humerus in)

Question 34

moi of gh instability

Answer 34

traumatic: - apprehension position (cte throwing motion) - foosh (ant/post) - direct trauma (missed tackle) chronic: - large strains or weakness of rc (should normally help keep hoh inside) - dysfunction of long head of biceps tendon (ant stabilizer of shoulder) - apprehension position- repetitive - genetics (hyperlax people)

Question 35

what are the diff types of shoulder dislocations and which is more common

Answer 35

anterior (more common) and posterior dislocations

Question 36

what can anterior instability of gh cause

Answer 36

laxity (middle gh lig, ant aspect of the inf lig) sprains dislocations

Question 37

what other problems can an anterior instability cause and what can be the s/s

Answer 37

brachial plexus problems; tingling, numbness on arm and always check pmsc

Question 38

what is the position of the humerus in a posterior instability of the gh joint

Answer 38

its flexed and internally rotated

Question 39

is a posterior instability common and is it more observed as a microtrauma or an acute inj

Answer 39

``` very rare (about 3% of all sh instabilities) more common as microtrauma (repeated blows to a flexed arm, follow thru phases of overhead throwing) ```

Question 40

what are the two types of multidirectional instabilities

Answer 40

congenital: generalized hyper laxity of the sh and other joints (hyperlax joints all over the body) acquired: participation in overhead activities that impose repetitive microtrauma (inj will happen at end rom so need to strengthen the m. to stabilize that end rom)

Question 41

s/s of gh instability (7)

Answer 41

- complains of instability feeling - moi of dislo or sublux - pain w mvt at gh joint (pain/apprehension in abd, ext rot = ant instability) (pain/apprehension w closed kinetic loading = post) - m. imbalances (inj makes m. shut down) - poor posture (limits rom when slouched) - weakness in rc m. and gh stabilizers (m. dont like to move when slouched position) - clicking or popping sensation (associated w labrum tear)

Question 42

how can you wrap an ant dislocation after rehab

Answer 42

to stop the apprehension position

Question 43

labrum tears are commonly injured with what type of instability

Answer 43

gh

Question 44

which lig attaches to the labrum

Answer 44

inf gh lig

Question 45

what tendon attaches to the labrum and how does its mvt affect the labrum

Answer 45

biceps tendon | during eccentric cnt of the biceps to slow elbow down from extension, the tension pulls on the labrum

Question 46

what is a bankart lesion and a reverse bankart

Answer 46

inj to ant labrum associated w ant sh instability ( 3 to 6 o'clock) reverse bankart: post aspect of labrum

Question 47

what is a SLAP lesion and what kind of mvt is it caused by

Answer 47

tear of the sup labrum ant to post (11 to 1 o'clock) may involve bicep tendon repetitive overhead mvt (ecc force on m. that pulls on its attachements)

Question 48

what is a type 1 slap lesion

Answer 48

degenerative fraying of sup labrum near insertion of LHBT bicep tendon intact

Question 49

what is a type 2 slap lesion

Answer 49

avulsion of glenoid labrum w associated tear of the LHBT

Question 50

what is a type 3 slap lesion

Answer 50

bucket handle type tear of sup labrum w displacement of the fragment w bicep anchor intact

Question 51

what is a type 4 slap lesion

Answer 51

bucket handle tear of sup labrum w extension into the bicep tendon, LHBT tear

Question 52

which slap lesion types require sx

Answer 52

type 3 and 4

Question 53

how to know if bicep is affected in slap lesion types

Answer 53

test mmt; will hurt and cause discomfort

Question 54

common s/s of labral tears

Answer 54

pain w gh mvt feeling of locking, clicking and clunking) pain in biceps tendon (attachment to sup labrum) limited rom pain feels deep in sh (usually felt on ant aspect, if it feels superficial than must be an ac joint inj)

Question 55

what do the rotator cuff m. do as a group

Answer 55

keep head of humerus a little inf and keep it in its socket (maintains head of humerus down when raise arms up to prevent impingement)

Question 56

what is an impingement and what are the most common ones

Answer 56

decreased space where the rc tendons pass thru the coracoacromial arch ``` subacromial bursa rotator cuff (supraspinatus) long head of bicep ```

Question 57

causes of impingement (4)

Answer 57

- irreg shaped acromion (some people have more hooked acromions that will decrease space) - enlarged bursa (if more friction=swelling and less space) - enlarged tendons (hypertrophy will decrease that space) - loss of humeral head depression/stabilization (if no inf glide=less space) - poor posture - repetitive overhead mvt (if too much training too fast= m. could shut down) - scapular dyskinesis (if scap doesnt move well when raise arms up= will hit top of glenoid fossa and reduce space) - rc weakness - gh instability (rotator cuff m. will fatigue)

Question 58

common s/s of impingements

Answer 58

- pinching sensation w rom, especially overhead - weakness in rc m. and/or biceps brachii (main cause for impingement) - pain at common origin of rc or below ac joint

Question 59

rotator cuff tendinopathy are caused by what type of contraction

Answer 59

eccentric cnt of rc m. (microtearing, larger tears- acute or due to micro tearing overtime)

Question 60

RCT is subjected to more of micro or macro trauma

Answer 60

microtrauma

Question 61

what kinds of tears can happen w RCT

Answer 61

``` partial (younger individuals), complete tears (30 +) and chronic tears (degeneration of tendons that can occur w aging over many years) ```

Question 62

what are the intrinsic factors that can contribute to RCT

Answer 62

- m. imbalances (chest m. > back m.) - m. weakness - poor posture - capsular laxity - poor scap control (like impingement) - impingement syndromes

Question 63

what are the extrinsic factors that can contribute to RCT

Answer 63

- training errors (need proper strength to prevent inj) - faulty technique (after time, can make other areas have to take in more load) - incorrect surfaces and equipment (surface = lower body more and equipment = more upper body) - poor environmental conditions (if ball slips, changing throwing pattern and throwing the m. off)

Question 64

partial and complete tears of the RC can be what kind of thickness and are they more commonly associated w overuse or single episode traumas

Answer 64

partial thickness tears and full thickness tears (may develop from untreated partial thickness tears or secondary to a single force trauma) overuse

Question 65

common s/s of RCT

Answer 65

- weakness in RC m. - poor posture - moi or repetitive mvt (too much too fast or too much repetition) - referred pain to deltoid tuberosity and/or lateral elbow - pain w palpation of the common insertion of rc m. - trigger points in the RC m. (when m. works too hard) - pain w gh mvt (especially flexion, abd, external rotation)

Question 66

what other conditions can result in subacromial bursitis

Answer 66

impingement and degenerative changes in RC m.

Question 67

subacromial bursitis is common in what types of athletes and what other inj is it commonly mistaken w

Answer 67

common in OH athletes | RC pathology

Question 68

s/s or subacromial bursitis

Answer 68

- point tenderness on ant and lateral edges of acromion process - painful arc btw 70-120° of passive abd - inability to sleep (affected side, active pain if inflamed even if not sleeping on it) - pain referred to distal deltoid attachment - pain on initiation and acceleration of throw (pain at beginning here and at the end for RCT)

Question 69

what is the most common moi for a bicep tendinopathy

Answer 69

- repetitive overuse during rapid OH mvt (involving elbow flexion and supination activities) - direct blow (transverse humeral ligament damage); inflammation of tendon bc of friction on bicipital groove) - ant impingement may damage tendon

Question 70

what sports are commonly associated w bicep tendinopathy

Answer 70

racquet sports, shot putters/javelin, baseball/softball, QB, swimmers

Question 71

what is a bicep tendinopathy

Answer 71

irritation of the tendon as it slides within the bicipital groove

Question 72

s/s bicep tendinopathy

Answer 72

- pain w flexion of sh and elbow - pain w OH mvt - pain in ant aspect of sh in the groove for bicep tendon (flipping in and out with ext and int rot) - pain w palpation of the biceps tendon, coracoid process

Question 73

what are the moi for a bicep strain/rupture

Answer 73

macro vs micro trauma foosh excessive resistance (gymnasts, swimmers, weight lifters) prolongued tendinopathy

Question 74

s/s of biceps tendon rupture

Answer 74

- snapping sensation - intense pain - ecchymosis - palpable defect - weakness in flexion of elbow and shoulder and supination of forearm

Question 75

what moi causes a pec major strain

Answer 75

forceful eccentric contraction (tackle or weight lifting)

Question 76

muscle contusions are caused by what moi, are common in what m. and what are the common s/s

Answer 76

direct trauma to m. belly common in biceps, delts and triceps presents w ecchymosis, swelling, limited ROM, weakness in MMT

Question 77

what is thoracic outlet compression syndrome and what are the two types one can have

Answer 77

n. and/or vessels become compressed in proximal neck or axilla (bc of bad posture or not using the diaphragm properly) neurological (90% of cases); lower trunk of brachial plexus vascular ; subclavian a. and v. (refer right away)

Question 78

s/s of thoracic outlet syndrome if vessels are compressed and if nerves are

Answer 78

vessels: subclavian v. (edema, stiffness in hand, cyanosis), subclavian a. (rapid onset of coolness, numbness in whole arm, fatigue after exertional OH activity, radial pulse maybe weak/absent w arm hyper extension) nerves: aching; pins/needles sensation; numbness; weakness in gripping and atrophy of hand m.

Question 79

long thoracic n. palsy (C5-7) are most common w which athletes, what kind of moi

Answer 79

spontaneous or traumatic OH athletes more at risk innervates the serratus anterior (keeps scap in rib cage; scap won't be where its supposed to ability to grab w hand the inf and medial borders)

Question 80

what joints will be affected following scapular dyskinesis

Answer 80

AC, GH and SC joints

Question 81

what is scapular dyskinesis

Answer 81

abnormal scapular positioning and kinematics Scapular malposition Inferiomedial border prominence Coracoid pain and malposition (felt during palpation) dysKinesis of scapular motion (arms above heads, flex, abd, etc will hurt)

Question 82

what is the normal static alignment of the scapula

Answer 82

- vertebral border of scap is // to spine and 3" from midline - located btw 2nd and 7th rib - scap is flat against thorax - rotated 30° ant to the frontal plane

Question 83

s/s of scapular dyskinesis

Answer 83

- pain in ant or posterior sup aspect of the shoulder - pain in upper part of lat arm below acromion - pain in upper fiber traps - SICK acronym - improper posture (flat back or round shoulders) - fatigue w activity (m. aren't working properly)

Question 84

can you tape a misplaced scap

Answer 84

yes you can tape to bring the tilt backwards so the scap isn't too much elevated