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Functional Anatomy > Shoulder > Flashcards

Shoulder Flashcards

1
Q

Why are non-unions/mal-unions common in clavicles?

A

Weight and load from UE

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2
Q

Angle of glenoid

A

Lateral
Anterior
Superior

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3
Q

Glenoid Inclination

A

5 degrees of upward inclination –> lends passive stability

–Downward rotation of scapula reduces joint stability

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4
Q

Humerus Inclination

A

130-150 degrees toward body

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5
Q

Humerus Retroversion

A

20-30 degrees

  • Diminishes IR
  • This and humerus inclination facilitate articulation with the superiorly oriented glenoid
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6
Q

Sternoclavicular Joint

A

Sellar
Contains a meniscus, which absorbs shock and can become painful or stiff
Anterior and posterior sternoclavicular ligaments

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7
Q

How does clavicle rotate with arm elevation?

A

Posteriorly

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8
Q

AC Joint

A

Resists inferior translation of arm
Diarthrodial joint with meniscus (but meniscus doesn’t do much shock absorption)
Frequent site of DJD

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9
Q

AC Joint Ligaments

A 
Acromioclavicular Ligament
Coracoacromial Ligament
Coracoclavicular Ligaments
- Trapezoid
- Conoid (more medial)
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10
Q

Muscles that reinforce the AC joint

A

Deltoid, Trapezius

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11
Q

Classification of AC Joint Injury

A 
Rockwood Classification
Type I-III: Same as tissue sprain classification
Type IV: Surgery considered
Type V: 100-300% increase in CC space
Type VI: Less than normal CC space
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12
Q

Scapulothoracic Joint Functions

A
  1. Increase GH stability/ Congruency
  2. Increase arm elevation ROM (2:1 GH to ST ratio)
  3. Muscle attachments
    - Optimizes length-tension relation of deltoid, e.g.
  4. Absorb force from arm/ allow reaching
  5. Maintain subacromial space
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13
Q

Scaption

A

30-40 degrees anterior to the frontal plane
Plane of maximal GH elevation
Allows humeral head to remain centered on the glenoid
- Equal sharing of tension in GH ligaments
Functional position of arm

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14
Q

What nerve innervates Serratus Anterior?

A

Long thoracic

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15
Q

Anterior Scapular Stabilizers

A 
Serratus Anterior
Pec Minor (--> Downward tilt of scapula)
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16
Q

Rhomboid

A

Scapular retraction AND elevation

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17
Q

Upward Rotators of Scapula

A

Upper trap, lower trap, serratus

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18
Q

Downward Rotators of Scapula

A

Levator, rhomboids, pec minor

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19
Q

Phases of scapulohumeral rhythm

A

I (Setting), II (Critical) and III

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20
Q

Setting phase of scapulohumeral rhythm

A

Scapular Stabilization

  • Clavicular Elevation
  • AC Rotation
  • GH Spin/Roll/Glide
    3. 3GH: 1 ST
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21
Q

Critical phase of scapulohumeral rhythm

A

0-90 degrees
Clavicular Rhotation
GH Roll and Glide (Inferior translation)
0.7GH: 1 ST

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22
Q

Phase III of scapulohumeral rhythm

A 
90 degrees and higher
AC Rotation
GH Roll and Glide
Thoracic and lumbar spine
**Where compensations begin (e.g. arching back)
3.5GH: 1 ST
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23
Q

Describe Neumann’s Principle re: SC and AC movement during scapular rotation

A

Elevation of SC

Rotation of AC

24
Q

Describe Neumann’s Principle re: clavicle movement during shoulder horizontal ABD

A

Clavicle retracts and posteriorly rotates around it’s own axis

25
Q

Describe Neumann’s Principle re: scapular tilt and rotation during horizontal ABD

A

Posterior tilt

External rotation

26
Q

Describe Neumann’s Principle re: humerus movement during horizontal ABD

A

Humerus externally rotates to get greater tuberosity out of the way from acromion

27
Q

Panjabi’s Joint Stability Model - Neural control system

A

Involuntary loops
GTO, muscle spindle, spasm, resting tension, muscle balance and firing pattern
Allows “functional instability”

28
Q

Panjabi’s Joint Stability Model - Passive system factors

A
  1. Joint geometry
  2. Static stabilizers (capsule, ligaments, deltoid muscle bulk)
  3. Joint compressive forces (gravity, capsule suction, glenoid upward inclination)
29
Q

Panjabi’s Joint Stability Model - Active system factors

A
  1. Weight of arm and load (variable)
  2. Compression by rotator cuff
  3. Upward elevation of scapula be parascapular muscles
30
Q

Glenoid Labrum Characteristics

A
  • Narrow at top, wide at bottom
  • Hyaline cartilage lining is thinnest at the center where OA may develop
  • Attachment for ligaments
31
Q

Bankart Labral Tear

A

Ant/Inf dislocation

Tear in ant/inf corner of labrum

32
Q

SLAP lesion

A

Superior Labrum A–>P
Biceps l.h. pulls labrum away from glenoid
“Peel back” mechanism from position of ABD,ER (pitcher)

33
Q

Kim Labral Tear

A

Posterior Inferior labrum

34
Q

GH Joint capsule

A
  • Blends with ligaments
  • Redundancy (Capsule is 2x volume of humeral head) allows mobility, but also allows adhesions to form after injury
  • Highly “reactive” to insults…Fibrosis of capsule
35
Q

Adhesive capsulitis

A

Inflammation of the capsule’s subsynovial layer with fibrosis, contracture, and adhesion between the capsule and the humeral neck, and in pockets of the capsule

  • Self-limiting
  • Treatment: Inferior GH glide
36
Q

GH Ligaments

A

Superior, Middle, and Inferior

Fibers angled upward (from humeral head up toward scapula) to allow for ER

37
Q

Superior GH Ligament

A

Limits inferior glide from anatomical position

38
Q

Middle GH Ligament

A

Limits anterior glide from partial abduction

39
Q

Inferior GH Ligament

A

3 Parts
1. Anterior Band
2. Posterior Band
3. Axillary pouch between the two (like a sling)
Acts as a sling to protect against anterior and inferior instability

40
Q

Coraco-humeral Ligament

A

Strongest supportive ligament
Reinforces rotator cuff interval
Limits inferior GH glide and extremes of GH ER

41
Q

Rotator Cuff Interval

A

Recess between Supra and subscap
-Allows translation of coracoid
-Reinforced by coracohumeral ligament
Scar tissue can form here

42
Q

Scapular Dumping

A

Inferior orientation of glenoid
Humeral head vs. capsule and ligaments
E.g. “mousing shoulder” (using a computer mouse)

43
Q

Glenohumeral instability pattern: TUBS

A

Traumatic Unilateral Bankart Surgery

44
Q

Glenohumeral instability pattern: AMBRI

A

Atraumatic Multidirectional Bilateral Rehabilitation Inferior Cap Shift
- Often can be treated with strengthening dynamic stabilizers

45
Q

Functions of the rotator cuff

A
  1. Humeral rotation and elevation
  2. Stabilizes/ Compresses GH Joint
  3. Positions the GH joint by counterbalancing upward pull of the deltoid (mechanical)
  4. Centers humeral head on glenoid (neuromuscular control)
46
Q

Subscapularis

A
  • Torn with anterior dislocation
  • Glides humerus inferiorly
  • Upper subscapular nerve
47
Q

Supraspinatus

A
  • Most commonly torn, can be asymptomatic
  • Avascular insertion
  • Suprascapular nerve
48
Q

Infraspinatus

A
  • Involved in most large RC tears
  • Glides humerus inferiorly
  • Suprascapular nerve
49
Q

Teres Minor

A
  • Least commonly torn
  • Glides humerus inferiorly
  • Axillary nerve
50
Q

Acetabularization

A

Deltoid overcomes RC strength –> Humerus pulled superiorly –> humeral head + acromion begins to resemble acetabulum

51
Q

Where do the greatest shear forces of the deltoid occur?

A

60 degrees of elevation

These forces are countered by the RC

52
Q

Long head of biceps

A

Limits anterior translation when the arm is positioned in ABD and ER

53
Q

Transverse Ligament

A

Spans from tubercle to tubercle over biceps l.h.

54
Q

Where are the acromial undersurface and the RC most approximated?

A

Between 60 and 120 degrees of elevation

- “painful arc”

55
Q

“Wringing Out” of Supraspinatus

A

Abduction decreases compression on supra tendon and increases blood flow to it.

56
Q

Load and Shift manual translation exam

A

0-3+ grading level of glenumeral anterior translation

57
Q

Anterior Apprehension test

A

Pt in supine, ABD, ER

+ if compression of anterior aspect of GH joint decreases symptoms

Functional Anatomy (14 decks)

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