Lecture 11 Flashcards by Emma Crawford

4 joints of the shoulder (pectoral) girdle

-glenohumeral joint
-acromioclavicular joint
-sternoclavicular joint
-scapulothoracic joint

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Glenoid labrum

-helps to deepen socket
-decrease incongruency in the joint
-allow for more stability

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What are the ligaments of the shoulder joint

-acromioclavicular ligament
-coracoacromial ligament
-coracohumeral ligament
-transverse humeral ligament
-coracoclavicular ligament

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Divisions of the coracoclavicular ligament

-conoid ligament
-trapezoid ligament

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Is there is a bursa in the shoulder joint

-yes

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What are the pectoral muscles

-pectoralis major
-pectoralis minor

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What else lies deep to the pectoral muscles

-brachial plexus
-subclavian artery and vein

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What pectoral muscle may cause neural or circulatory issues if tight

-pectoralis minor

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Muscles acting on the scapula

-levator scapulae muscle
-rhomboid minor muscle
-rhomboid major muscle
-trapezius muscle
-latissimus dorsi muscle

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How many insertion points does the latissimus dorsi have

-11

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What are the muscles of the rotator cuff

-supraspinatus
-infraspinatus
-teres minor
-subscapularis

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What is the rotator cuff

-major dynamic stabilizer of the shoulder

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Physiological ROM of GH joint

-abduction
-adduction
-flexion
-extension
-internal rotation
-external rotation
-horizontal adduction
-horizontal abduction
-accessory movements (roll, spin, glide)

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What is a dislocation

-head of humerus translates completely out of the glenoid

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What is a subluxation

-a partial or incomplete dislocation of the GH

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What type of shoulder dislocations are there

-anterior
-posterior
-inferior

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What type of shoulder dislocation is most common

-anterior

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What type of shoulder dislocation is rare

-inferior

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What does SLAP lesion/tear stand for

-superior labrum anterior and posterior

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What is a SLAP lesion/tear

-injury to superior aspect of labrum from anterior to posterior

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What can also be injured in a SLAP lesion/tear

-biceps tendon

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How many types of SLAP lesions/tears are there

-4

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MOI SLAP lesions

-repetitive overhead movements (throwing)
-FOOSH (fall on out stretched hand)
-sudden traction to the arm
-dislocation of GH

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Signs and symptoms of SLAP lesions

-clicking/catching/popping
-pain moving arm overhead
-pain lifting heavy objects
-pain deep in joint or in back of joint
-anterior shoulder pain if biceps involved

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What is a bankart lesion

-injury to the anterior-inferior glenoid labrum

What is a bankart lesion usually second to

-anterior dislocation

Signs and symptoms of a bankart lesion

-pain and limited ROM with most shoulder movements -clicking -catching -grinding -popping -subluxation

What is a 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

MOI anterior dislocation

-hit from the back -anything that drives head of humerus forward

Signs and symptoms of dislocations

-pain -pop -reduced ROM -reduced strength -swelling -numbness

MOI posterior dislocation

-hit from the front -anything that drives head of humerus backwards

MOI inferior dislocation

-anything that drives head of humerus downward -tumbling movements etc.

Acute management of dislocations

-PIER -treat for shock -refer

What are different types of rotator cuff injuries

-impingement -tendonitis/osis -rotator cuff tears

MOI rotator cuff impingement

-overuse -poor mechanics

MOI rotator cuff tendonitis

-overuse -poor mechanics

MOI rotator cuff tears

-acute -overuse

MOI AC separation/sprain

-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 -swatch -severe deformities need to be referred

What tape job can be used for AC separation to support healing

-AC tape

What are the different stages in the rockwood classification of AC injuries

-type I -type II -type III -type IV -type V -type VI

Treatment of acute shoulder injuries

-PIER -sling -Ac tape job to approximate joint -rehab to promote tissue healing and regain mobility and stability

When is surgery considered for shoulder injuries

-middle third clavicle fractures -type III Ac sprains in active people -type 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 should urgent surgical referral happen in shoulder injuries

-for posterior sternoclavicular dislocations

Why should surgical referral be urgent in posterior sternoclavicular dislocations

-because of important structures that sit behind (vasculature)

MOI subacromial (shoulder) impingement syndrome

-overuse -biomechanical imbalances -pinching and subsequent inflammation of structures under coracoacromial ligament

What may subacromial (shoulder impingement syndrome include

-supraspinatus tendon -long head of biceps tendon -subacromial bursa

Signs and symptoms of subacromial (shoulder) impingement syndrome

-pain and weakness in painful arc of abduction, and reaching -catching/clicking -pain with sleeping on affected side -pain putting jacket on

Special test for subacromial (shoulder) impingement syndrome

-painful arc

What is a positive test in the painful arc test

-pain furing GH abduction between 60 and 120 degrees

When would pain clear in a positive arc test

-beyond 120 degrees

Where is referred pain in subacromial (shoulder) impingement syndrome felt

-often reported in supraspinatus pattern down middle deltoid

What sport is subacromial (shoulder) impingement syndrome common in

-swimmers -overhead athletes

MOI 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 humerus

-surgical neck

What percent of humeral fractures are non-displaced (non-surgical)

-80%

Acute management of humerus fracture

-PIER -sling -treat for shock -send to emerge if stable or call EMS

Management of humerus fracture

-sling -pain management -start treatment early to avoid frozen shoulder

MOI scapula fractures

-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 of scapula fractures

-sling

When is surgery indicated for scapula fractures

-displaced fractures of glenoid -displaced fracture at neck of scapula -acromion fractures causing impingement

MOI clavicle fractures

-force to lateral shoulder -FOOSH -direct trauma

Signs and symptoms of clavicle fractures

-severe pain and swelling over site -deformity -unwillingness to move

Acute management of clavicle fractures

-tube sling -PIER

Treatment of clavicle fractures

-sling or figure 8 brace -PIER -pain management -alleviate spasm

Important considerations in treating the shoulder girdle

-thoracic spine mobility -scapular mobility -scapular stability -upper limb proprioception

What is a special test for GH dislocation

-apprehension test

How to perform the apprehension test

-put arm into cactus position -push arm backwards

What would a positive apprehension test look like

-they do not want to move into that position -grimace, pain etc.