shoulder

Question 1

what planes does the shoulder move in

Answer 1

3 planes

sagittal: flex, extend
frontal: ab/adduction
transverse: int/external rotation

Question 2

scapulohumeral rhythm

Answer 2

muscle moves the scapula and humerus, giving greater ROM than if the scapula were fixed

1:2 ratio…for every 1deg motion at scapulothoracic jt, 2deg of motion at GH joint

the greater the def of ROM, the greater the scapula tilts to add to ROM

Question 3

list the shoulder joints

Answer 3

sternoclavicular

coracoclavicular

acromioclavicular

scapulothoracic

glenohumeral

Question 4

sternoclavicular joint

Answer 4

plane synovial, gliding

connected via costoclavicular and anterior SC ligs

prevents medial displacement of clavicle, allows some clav rotation

Question 5

coracoclavicular joint

Answer 5

syndesmosis, connected via ligs
- minimal mvmnt

coracoclavicular lig has trapezoid and conoid branches

prevents upward mvmnt of clavicle and downward mvmnt of scapula

Question 6

acromioclavicular joint

Answer 6

superior and inferior acromioclavicular ligaments

main injury when fall and arm adducted

Question 7

scapulothoracic joint

Answer 7

connects scapula to thorax via muscle attachments

stablizes shoulder region and positions GH joint

Question 8

differential diagnoses

Answer 8

smth else that could be attributing to the injury that’s UNLIKELY but still plausible

can rule in/out in future

Question 9

rotator cuff muscles

Answer 9

SITS
- supraspinatus, infraspinatus, teres minor, subscapularis

role to stabilize GH joint and humerus

Question 10

shoulder mvmnts and muscles assoc

Answer 10

flexion: deltoid, pec major
extension: lat dorsi, pec major, teres major
abduction: deltoid, supraspinatus
adduction: lats, pec major, teres major
med rotation: subscapularis, teres major
lat rotation: infraspinatus, teres major

Question 11

sternoclavicular sprain

Answer 11

MOI = indirect force thru humerus, blow to clavicle

anterior and superior displacement: clav moves up and out, usually phys deformity
- 2nd deg = cannot horizontal adduct, holds arm close to body
- 3rd deg = most common, prominant deformity

posterior displacement: uncommon
- MEDICAL EMERGENCY
- diff swallowing, slow pulse, resp distress
- call EMS
- close to vessels

Question 12

acromioclavicular sprain

Answer 12

MOI = direct blow, fall on outstretched arm

main sign is STEP DEFORMITY

classifications:
- type 1 = lig is stretched
- type 2 = partial tear, slight step deformity
- type 3 = full tear AC and CC lig
- type 4 = full tear, clavicle displaced posterior over acromion
- type 5 = full tear of ligs, clavicle only held by skin
- type 6 = rare, clavicle under coracoid

Question 13

how to test for acromioclavicular sprain

Answer 13

distraction test: therapist’s hand stabilizes clavicle, and w other hand pulls arm down
- positive = pain and excess mvmnt

compression test: horizontal adduct arm, PRESSING BONES TGT
- can also squeeze joint

Question 14

glenohumeral sprain

Answer 14

MOI = forceful abduction, can be plus external rotation

joint capsule stretches or tears, humeral head moves in an anterior and inferior direction

1st deg = AROM, slight limitation
2nd deg = swelling, bruise, dec ROM

Question 15

SnNout and SpPin

Answer 15

SnNout = high sensitivity, a neg test rules out

SpPin = high specificity, post test rules in

Question 16

anterior GH dislocation

Answer 16

intense pain that dec w reoccurance
paresthesia, deformity

arm held in abduction and external rotation
- won’t allow passive horizontal adduction or internal rotation

check pulse and sensation

apprehension test: lay down, 90deg abduction

relocation test: lay down and abduct arm, hand moves the head of humerus POSTERIORLY to glenoid fossa
- feels more comfy bcs returning to proper place

Question 17

posterior GH dislocation

Answer 17

pain radiating to shoulder tip

arm held tight to chest and across trunk

side view: flat anterior shoulder, prominent coracoid process….posterior bulge

posterior load and shift test: stabilize shoulder tip, press humerus towards glenoid fossa

posterior apprehension test: lay down w arm in front of chest, try to push shoulder DOWN towards fossa

Question 18

bankart lesion

Answer 18

damaged anterior lip of glenoid labrum

assoc w anterior dislocation and aging

Question 19

SLAP lesion

Answer 19

superior labrum, anterior to posterior

tear of superior labrum with disrupted attachment of long head biceps tendon

Question 20

hill-sachs

Answer 20

not labrum

posterior humeral head injury, often occurs alongside bankart lesion

Question 21

reverse hill-sachs

Answer 21

lesion to anteromedial humeral head

Question 22

how to test for glenoid labrum tears

Answer 22

clunk test: patient lies down and puts arm into abduction + ext rotation
- other hand pulls humerus forwards
- positive = clunk from instability

compression rotation test: apply compression upwards, positive if catching by humeral head

Question 23

atraumatic osteolysis of distal clavicle

Answer 23

clavicle fracture from repetitive trauma or post-traumatic injury to distal clav or AC joint

bone resorption and erosion leads to continuous stress

S&S = prox fragment upwards, interferes w ADLs, pt tender, pain w hori adduction

Question 24

traumatic clavicular fractures

Answer 24

MOI = in/direct force

S&S = upwards prox fragment, flat distal shoulder, deformity

manage w figure 8 brace

Question 25

epiphyseal fracture

Answer 25

little league shoulder - proximal humerus bcs of rep internal rotation and adduction S&S = acute pain when throwing manage w sling and doctor referral

Question 26

humeral fractures

Answer 26

MOI = FOOSH, direct blow S&S = inability to supinate, paralysis

Question 27

impingement syndrome

Answer 27

microtear of rotator cuff and subacromial bursa against CA lig and greater tubercle overuse injury of rotator cuff, MAINLY SUPRASPINATUS S&S = deep pain, night pain (if bursa) - PAINFUL ARC b/w 70-120deg (beginning and end of motion is fine) painful bcs changing shape of subacromial space contributing factors: - rep overhead mvmnts i.e. carpentry - thickened tendons i.e. high muscle - limited subacromial space - imbalanced strength/endurance - tight muscles

Question 28

subacromial space

Answer 28

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

Question 29

tests for impingement syndrome

Answer 29

neer test: patient flexes arm thru full ROM w therapist applying resistance - changes subacromial space hawkins-kennedy test: arm 90deg flex w bent inwards....tilt at angle so shoulder up - squeezes supraspinatus - pos = lean away, pain empty can test: arms out w thumbs down, try to resist downwards motion - weakness, pain drop arm test: indicates supraspinatus tear...lift and drop arm, see if struggle to keep up

Question 30

bicipital tendinitis

Answer 30

MOI = rep overhead w elbow flexion and supination - tendon passes b/w groove - can also be acute/direct blow bcs inflammation S&S = pain w in/external rotation, painfdul passive stretch in shoulder extension yergason's test: neutral wrist, support joint and have try to flex arm plus supinate w ext rotation speed's test: tries to bring palm to shoulder, allow full ROM while resisting therapist

Question 31

biceps tendon rupture

Answer 31

MOI = prolonged tendonitis, forceful flexion against resistance - linesman pushing others - load PLUS stretch S&S = snap, intense pain, popeye defect in muscle belly ludington's test = put hands on head and apply load...see deformity or compensation transverse humeral ligament test

Question 32

thoracic outlet compression syndrome

Answer 32

can be a neurological or vascular syndrome neurological: stretch or compression of lower trunk of brachial plexus - S&S = aching pain, paresthesia, numb in side or back neck extending across shoulder to ulnar hand - weak grasp and hand atrophy vascular: compression of subclavian artery or vein - S&S = if vein --> edema, stiff hand, cyanosis and large veins - artery --> rapid onset of coolness, arm numb, fatigue w overhead activity, dec radial pulse

Question 33

tests for thoracic outlet compression syndrome

Answer 33

allen test = palpate radial pulse, abduct shoulder w 90deg flexion, look to other shoulder adson's test = palpate rad pulse and have patient look up/extend head...lat rotate humerus - pos if dec/no radial pulse military brace test = palpate pulse, retract shoulder and hyperextend neck and abduct arm 30deg