Shoulder Flashcards
(81 cards)
1
Q
clavicle - acromial extremity
A
convex posteriorly
2
Q
clavicle - sternal extremity
A
convex anteriorly
3
Q
Sternoclavicular joint - capsule
A
strong - ant, post, sup
4
Q
Sternoclavicular joint - ligaments - sternoclavicular
A
ant, sup
5
Q
Sternoclavicular joint - ligaments - costoclavicular
A
limits scapula laterally
6
Q
Sternoclavicular joint - ligaments - interclavicular
A
depression/inf glide of head of clavicle
7
Q
Motion at sternoclavicular joint
A
45 elevation 15 depression 15 protraction 15 retraction 30-45 up/down rotation
8
Q
Acromioclavicular joint - movement
A
does not move freely
9
Q
Acromiocalvicular joint - type
A
gliding joint with flat articular surfaces
10
Q
Sternoclavicular joint - type
A
triaxial, ball and socket
saddle like
diarthritic
11
Q
Acromioclavicular joint - supporting structures
A
weak capsule
AC ligaments - horizontal stability
Coracoclavicular ligaments - horizontal stability
12
Q
Acromioclavicular joint - motion
A
20 elevation/tipping
25 up/down rot
35 protraction/winging
35 retraction
13
Q
Acromioclavicular joint - winging
A
Medial edge of scapula lifts off the ribcage
forward rotation is included
14
Q
Scapulothoracic joint
A
not a true joint
15
Q
Scapulothoracici joint - motion
A
60 elevation
10 depression
60 up rotation
10 down rot
16
Q
Motion - scapulothoracic - what occurs when
A
retraction before adduction
abduction before protraction
17
Q
Scapular elevation - mm
A
Upper trap
Levator scap
Rhomboid major and minor
18
Q
Scapular depression - mm
A
Lower trap Lower SA Pec minor Lat dorsi Lower pec major
19
Q
Scapular abduction - mm
A
pec major/minor
SA
20
Q
Scapular add - mm
A
rhomboids
trap
21
Q
Scapular up rotation
A
upper/lower trap
upper/lower SA
22
Q
Scapular downward rotation
A
levator scap
rhomboids
pec minor
23
Q
GH joint - type
A
ball and socket
3 DOF
24
Q
GH joint - capsule
A
large, loose capsule
tight superiorly
25
GH ligament
FILL IN
26
GH ligament - coracohumeral
FILL IN
27
GH ligament - coracoacromial
FILL IN
28
GH - motion
```
flex 120
ext 30
80 IR
90 ER
30 horizontal abd
140 horizontal add
60 abd with IR
120 abd with ER
```
29
Rotator cuff
Supraspinatus
Infraspinatus
Subscapularis
Teres Minor
30
Humeral retroversion
30-40 degrees is norm
Greater = more ER, less IR
Increased angle means more mobility at SC joint - injury to RTC will impact this angle
31
Coracoacromial arch - made up of
CA lig
CC lig
CH lig
Transverse humeral ligament
32
Coracoacromial arch - what passes through
Biceps tendon and supraspinatus
33
Coracoacromial arch - impingement
Can become impinged when head of humerus goes against the acromial part
If you dont glide down with roll up during abduction
34
Coracoacromial arch - load in abduction
HIGH! need teres minor and subscap and infraspinatus to help
35
Force couples means what
2 forces that are equal but opposite in direction - produce rotation
36
Force couples - Upper trap with
Low trap and SA
37
Force couple - humeral abd
deltoid and supraspinatus, infraspinatus, teres minor, subscap
38
Force couple - fownward rot
lat dorsi and teres major, pec major, rhomboids
39
Single joint mm
Needs other mm to supply stability on the scapula
40
2 joint mm
can act directly on the arm without needing other help to stabilize the scap
41
Scapulohumeral rhythm
GH joint moves 2 degrees for every 1 degree of scapular motion
42
Scapulohumeral rhythm - phases
phase 1 = setting - 30 degrees GH
phase 2 = setting to 90 degrees, 30-45 degrees GH and 30 degrees SC
phase 3 = 90 to 180 degrees, 50-60 GH, 30 AC, 10-20 spine
43
Arthrokinematics - superior rolling is directed by the
Supraspinatus
44
Bursae - largest
Subdeltoid - largest in body
45
Bursae - subscapularies
between subscap tendon and neck of scapula
46
Bursae - infraspinatus
between inrspintus tendon and joint capsule
47
To avoid subluxation due to gravity - need what
upward slope of glenoid cavity
48
To avoid upward subuxation of humerus - what do you need
RTC mm contraction and coracoacromial lig
49
Impingement syndrome
Compresion of subacromial contents due to encroachment of the humerus nto the coracoacromial arch
50
Impingement syndrome - space should be
9-10 mm
| pathologic if less than 6
51
Impingememnt syndrome - 1st degree
```
due to non mechanical reasons
FOOSH
tight post capsule
bone spur
rubbing along supraspinatus with elevation
```
52
Impingment syndrome - 2nd degree
due to instability, poor force couple balance, posture, poor motor control, training rrors
53
Impingement - stage 1
```
edema and hemorrhage
less than 25
due to overuse
painful arc 60-120
anterior lateral shoulder pain
sharp with elevation
no functional limtiations
```
54
Impingement - stage 2
fibrosis and tendonitis
25-40 yo
dec ROM ER and Abd
55
Impinge - stage 3
```
derangement of tendon (RTC)
over 40
Weak in abd/ER
significant functional limitations
bone spurs
less than 1cm RTC tear
```
56
Impingem - stage 4
complete thickness RTC tear
over 40
weakness, mm atrophy
cannot initiiate abd without substitutions
57
Special tests for impingement
Hawkins Kennedy
Neers
Cross over
Yokum
58
Special tests - hawkins kennedy
for impingement
passively flex GH to 90
Passively IR
Supraspinatus, biceps tendon, bursa
59
ST - Neers
for impingement
Stabilize scapular, passively elevate arm with thumb down
Supraspinatus, LH of biceps, burs
60
ST - cross over test
for impingement
stabilize scap, horiz add shoulder
Ant pain - subscap, supraspin, biceps tendon
Post pain - infraspinatus, teres minor, post capsule
61
Tendonitis
supraspinatus, LH of biceps are most common
| Pain with ecc contraction, tender with palpation, strong but painful mm testing
62
Special tests for tendonitis
Empty can
Speeds
Yergason
63
ST - empty can
tendonitis
Active scaption to 90, thumbs down, resist downward force
Supraspinatus
64
ST - speeds test
tendonitis
Active flex to 90, elbow ext, forearm supinated, palpate bicipital groove, apply downward force
Biceps
65
ST - Yergason
tendonitis
90 elbow flex, full forearm pronation, resist against ER and supination
Biceps
66
ST for RTC tear
Drop arm test
Empty can test
Hornblowers
IR lag
67
Drop arm test
for RTC tear
Passively abd to 90
pt tries to slowly lower arm
supra and infra
68
Empty can test
for RTC tear
weak and painful
active scaption to 90, thumb down
supraspinatus
69
Hornblower sign
for RTC tear
passively 90 scap
resist ER
Teres minor
70
Adhesive capsulitis - who more common
F more than M
40-60 yo
non dominant arm more than dominant
71
Adhesive capsulitis - clinical presentation
Dec scapulohumeral rhythm
less than 90-135 elevation
50-60% of normal ER
72
Adhesive capsulitis - stages
Preadhesive - often misdiagnosed with impingement
Freezing - 10-36 wks
Frozen - 4 to 12 months
Thawing - 5 to 42 mo
73
AC joint sprain - types
```
1 = AC spran, joint intact
2 = AC and CCL sprain, unstable but intact joint
3 = AC and CCL torn, unstable joint, delt/trap disrupted, distal calvicle migration
4 = "..." post dislocated clavicle
5 = inf dislocated clavicle
```
74
Labral ST
Compression rotation test
Crank test
Obriens
75
Compression rotation test
Labral
90 abd
90 elbow flex
axial force to humerus with rotation and curcumduction
76
Crank test
```
Labral
pt supine
160 scaption
axial load through humerus
IR/ER shoulder
```
77
Obrien
```
Labral
pt seated
90 flex with elbow ext
10 horizontal add
full IR/ER
apply downward force
IR pain greater than ER pain
```
78
Adsons test
Palpate radial pulse
ER, extend shoulder, turn head to test arm, extend head, hold breath
(+) if pulse goes away within 10 sec
79
Costoclavicular test
Palpate radial pulse
Retract/depress scapula
(+) if pulse goes away
80
Hyperabduction test
palpate radial pulse
passively hyperabd arm
(+) f pulse goes away
pec minor
81
Roos test
90 abd, full ER, open and close hands for 3 min
| (+) asymmetrical swelling, pallor, pain, numbness
