shoulder Flashcards
(20 cards)
what are key bony landmarks?
Anterior:
Coracoid process
Greater tubercule
Lateral border of scapula
Posterior:
Acromion process
Spine of scapula
Superior angle of scapula
Medial border of scapula
Inferior angle of scapula
What makes up the shoulder complex?
Shoulder girdle: sternum, clavicle and scapula
- or pectoral girdle
- bony link between arm and trunk
- composes of sternoclavicular joint (sc joint) and acromioclavicular joint (ac joint)
Glenohumeral joint: scapula and head of humerus
What are the 4 major ligaments of the shoulder girdle?
Acromioclavicular (scapula - clavicle)
Coracoclavicular (scapula - clavicle)
Coracoacromial (scapula)
sternoclavicular (sternum - clavicle)
What are the glenohumeral ligaments?
Normally 4 ligaments:
Most important group in shoulder joint
superior
medial
inferior
spiral
not everyone has all four ligaments
connect glenohumeral joint to scapula
help improve anterior stability particularly for abduction, adduction and external rotation and reduce risk of anterior inferior dislocation
What are the main bursae of the shoulder?
Subacromial bursa
Subdeltoid bursa
Subcoracoid bursa
What is within the socket of the shoulder to enhance stability?
The labrum, due to the limited amount of the contact between the bones of the shoulder joint.
However, the shoulder is easily injured due to its great range of mobility.
What are components of the rotator cuff?
Includes:
- Supraspinatus
- Infraspinatus
- Teres minor
- Subscapularis (anterior)
Form collar around superior, anterior and posterior aspects to help protect
This is why most dislocations occur due to inferior movement of the humerus.
What is shoulder impingment?
Occurs due to structural narrowing of subacromial space
Leads to irritation and inflammation of the rotator cuff tendons as pass through space
- leads to pain, weakness and reduced ROM
often occurs when repeatedly connect to acromion in overhead positions
Considers swimmers or throwers shoulder
What are internal causes of shoulder impingment?
Inner aspect of the tendon compressed
Normally involves rotator cuff tendons and labrum
Can occur due to overhead activities
e.g. swimming, baseball, tennis, bowling
Repetitive overhead motions leading to wear and tear
What are external causes of shoulder impingement?
ALso known as subacromial impingement
more common
Outer aspect of tendon compressed in subacromial space
Often due to structural abnormalities such as hooked acromion, bone spurs and poor posture.
Also associated with repetitive overhead injuries
What are classifications of impingement?
Follows inflammation -> possibly osteophyte formation
Stage 1: inflammation
- painting and decorating jobs, reaching up for objects, athletes in throwing sports
- if managed and identified can be resolved with conservative treatment, e.g. rest, manual therapy
Stage 2: fibrosis / tendonitis
- if cont to subject to stress or doesn’t have rest
- scare tissue formed
- increases pain, stiffness and decreased flexibility
- conservative treatments can be effective
- soft tissue therapy to break down scare tissue
- exercise rehab
Stage 3: osteophyte
- continued repetitive stress
- leads to burn spurs / osteophytes which typically form along the inferior side of the acriomium
What is rotator cuff dysfunction?
Spectrum of conditions from acute inflammation of the rotator cuff tendons to partial and full-thickness rotator cuff tears
Rotator cuff disorders usually cause subacromial pain and this term is used to are often used to cover all causes of rotator cuff disorders e.g. overuse, acute injury, age related wear and tear and degenerative changes
Common causes
rotator cuff tears of one or more rotator cuff tendons - trauma or degeneration
tendonitis / impingment syndrome - rotator cuff tendons due to repetitive overuse
rotator cuff impingment - within subacromial space
rotator cuff muscle weakness / imbalance - less stability or control
What are AC joint injuries?
Occur between acromial process and clavicle
Can range from sprains to dislocation
Can be traumatic or overuse injuries
What are traumatic ac joint injuries?
type of injuyr that occurs when joint is disrupted from direct impact
often result in immediate pain, swelling, reduced mobility
range from mild sprain to complete dislocation
can be classified
What are overuse ac joint injuries?
repetitive strain injury
usually occur due to excessive repetitive overhead motions
heavy lifting overhead can cause this
can occur in handstand pressups before chest and shoulders are ready
usual gradual increase in pain, insiduous onset
discomfort with movement
sometimes swelling
How are AC joint injuries classified?
Type 1: sprain of ligaments, no significant disrumption or displacement
Type 2: partial tear which can lead to slight elevation or displacement of clavicle
Type 3: complete tear of ac ligament and partial of coraclavicular ligament, significant elevation / displacement = step deformity
Treatments can depend on severity - can require surgery
What occurs in anterior dislocation?
Humerus completley displaced from usual position
Normally some ligament and capsule strain - so don’t provide stability. Can have full tear.
often in traumatic event
Humeral head can become stuck at the front of the socket.
Can cause damage to surrounding tissue, e.g. blood vessels, labrum, nerves
why don’t put back in self
what occurs in posterior dislocation
moves backwards outside of glenohumeral fossa
falls, seizures or high energy sports injuries can cause
only occur in 3% of shoulder dislocations
can cause strain and tearing
characterised by pain and limited range, visible deformity
What is biceps tendinopathy?
Degenerative / inflammatory condition
Involves biceps tendon that connects biceps tendon to shoulder
Can be caused due to traumatic e.g. FOOSH or insidious
Pain is localised to LHB and muscle belly
Can have bony spurs
Instability of tendon
Poor scapular stability / posture
Result from rotator cuff tear
Can have greater tears, creating greater pain and disfuction
Pain expected when overhead and reaching
