Lecture 7 - Shoulder ax Flashcards by Marilou Gélinas

Type of joint at shoulder

Multiaxial ball and socket synovial joint

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At the shoulder, you sacrifice __ to gain __ compared to the hip which is a deeper joint

Stability for mobility

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GH joint - resting position + close packed position + capsular pattern

rest. pos = 40-55d ABD, 30d horiz ADD (scapular plane)
close packed = full ABD + lat rot
capsular pattern = ext rot, ABD, int rot

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Shoulder is a shallow socket, what increases it?

Labrum by 50%

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Type of joint for AC joint

Plane synovial joint

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Purpose of AC joint

Augments the ROM of the humerus in the glenoid

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AC joint - resting position, close packed position, capsular pattern

rest pos = arm resting by side
close packed = 90 ABD
capsular patt = pain at extremes of ROM (hor add + full elevation)

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Role of SC joint

along with AC joint, enables the humerus in the glenoid to move through a full 180d of ABD

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Mvt of SC - horizontal ABD

Moves forward

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Mvt of SC - shoulder depression

Moves superior

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Mvt of SC - Horizontal ADD

Moves posterior

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SC joint - resting position, close packed position, capsular pattern

rest pos = arm resting by side
close packed = full elevation + protraction
capsular pattern = pain at extremes of ROM (horiz ADD + full elevation)

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No capsular pattern
Is a stable base for the RC
20-30d forward of sagittal plane

Scapulothoracic

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Scapulothoracic rhythm
at 0-30d
at 30-90d
at more than 90d

should have no scapular mvt
2:1
1:1

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Special thing to check in posture anterior view at shoulder

Head and neck are in the midline of the body and observe their relation to the shoulders

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In most people, dominant shoulder is __ than the nondominant side

lower

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Injured shoulder, when protecting/guarding, will be __ than the other side

Higher

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What to note in posterior view of shoulder (4)

Scapular dyskinesia
Primary scapular winging
Secondary scapular winging
Dynamic scapular winging

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Scapular dysfunction - type 1

Inferior medial border being prominent at rest
Inferior angle tilts dorsally with movement (scapular tilt)
Acromion tilts anteriorly over the top of the thorax

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Type 1 scap dysk. indicates what

Presence of weak muscles or tight pecs pulling or tilting the scapula forward

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Scapular dysfunction - Type 2

Classic winging, whole medial border
Prominent, lifting from the posterior chest wall
Statically and dynamically

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Type 2 scap dysk. indicates what

Presence of SLAP lesion
Weakness of SA, Rhomb, UFT/MFT/LFT, long thoracic n. problem, or tight RC

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Scapular dysfunction - Type 3

Superior border elevated at rest and during movement
Minimal winging

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Type 3 scap dysk. indicates what?

Study These Flashcards

Over activity of letavor scapulae and UFT
Imbalances in UFT/LFT force couple
Impingement and RC lesions

Scapular dysfunction - Type 4

- Symmetrical scapulae - Rotatory winging (inferior angles rotating laterally)

Type 4 scap dysk. indicates what?

during movement and may indicate the scapular control muscles are not stabilizing the scapula (WHAT YOU WANT- but could be both not normal even though they both move symmetrically)

Primary scapular winging

Due to muscle weakness of one of the scapular muscle stabilizers

Secondary scapular winging

Normal movement of scapula is altered because of pathology in glenohumeral joint

Dynamic scapular winging

may be due to lesion of the long thoracic nerve affecting serratus anterior, trapezius palsy (spinal accessory nerve), rhomboid weakness, multidirectional instability, voluntary action, or a painful shoulder resulting in splinting of the glenohumeral joint, which in turn causes reverse scapulohumeral rhythm

4 causes of scapular dyskinesia

- Bony - Joint - Soft tissue - Neurological

Scapular dyskinesia - bony

thoracic kyphosis clavicular fracture or malunion

Scapular dyskinesia - Joint

AC instability/arthrosis GH internal derangement

Scapular dyskinesia - Neurological

Cervical radiculopathy Long thoracic n. palsy Spinal accessory n. palsy

Scapular dyskinesia - soft tissue

- intrinsic m. pathology - hypomobility - GH int. rot deficit - altered m. activation patterns

What is the popeye sign

Bicep long head tendon rupture

What is the lennie test

Measure the distance between scapula and compare dominant vs nondominant side

See slide 47 for abnormal active ROM

4 causes

What is GERG and GIRD

Glenohumeral external rotation gain Glenohumeral internal rotation deficit

If GIRD/GERG ratio is >1

Patient will probably develop shoulder problems

What is snapping scapula

Comes from the scapular retraction/protraction cycle Caused by the scapular rubbing over the underlying ribs

Explain apley's scratch test

Med rot + adduction Lat rot + abduction

Functional ADLs at shoulder

Brush teeth Brush hair Tuck in shirt Reach to shelf Sport-specific movts

Define characteristics of laxity

Nonpathological "looseness" Greater ROM in one or more directions SHD complex functions normally Found bilaterally

Define characteristics of instability

Inability to control or stabilize a joint Dynamic or static Static restraints have been injured Weak muscles or unbalanced force couples

Anatomical instability

Static restraints have been injured

Translational instability

Weak muscles or unbalanced force couples

2 types of sh instabilities

TUBS or AMBRI

TUBS

Traumatic, unidirectional, Bankart, SLAP Surgery required

AMBRI

Autraumatic, multidirectional, bilateral, rehabilitation/inferior capsular shift

Jobe classification - Grade 1

Pure impingement with no instability (often seen in older patients)

Jobe classification - Grade 2

Secondary impingement and instability caused by chronic capsular and labral microtrauma

Jobe classification - Grade 3

Secondary impingement and instability caused by generalized hypermobility or laxity

Jobe classification - Grade 4

Primary instability with no impingement

Types of SLAP tears - Type I

Degenerative fraying with no detachment of biceps insertion

Types of SLAP tears - Type II

Most common type and represents a detachment of the superior labrum and biceps from the glenoid rim

Types of SLAP tears - Type III

Bucket-handle tear of the labrum with an intect biceps tendon insertion to the bone

Types of SLAP tears - Type IV

Least common type represents intra-substance tear of the biceps tendon with a bucket-handle tear of the superior aspect of the labrum

See chart document for special tests

+ practice charting slide 130

Lecture 7 - Shoulder ax Flashcards

(58 cards)