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Biomechanics Test 3 > Shoulder Arthrology > Flashcards

Shoulder Arthrology Flashcards

1
Q

What is the articulation of the sternoclavicular (SC) joint?

A

Clavicle is like a strut holding the scapula

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2
Q

The acromioclavicular (AC) joint attaches the _____ to _____.

A

Scapula; Clavicle

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3
Q

What is considered to not be a true joint?

A

The scapulothoracic joint

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4
Q

What describes an interface between bones where movements are linked to the movements at the SC and AC joints?

A

The Scapulothoracic joint

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5
Q

In the scapulothoracic joint what provides the base for the GH joint?

A

The position of the scapula

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6
Q

What is the most distal and mobile portion of the whole shoulder complex?

A

The glenohumeral joint

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7
Q

What decreases the effectiveness of the entire UE?

A

Weakness, painful or unstable links

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8
Q

Elevation is what kind of movement?

A

Superior slide

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9
Q

Depression is what kind of movement?

A

Inferior slide

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10
Q

Protraction is what kind of movement?

A

Medial border slides anterior and lateral

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11
Q

Retraction is what kind of movement?

A

Posterior and Medial

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12
Q

Upward rotation is what kind of movement?

A
  • Inferior angle rotates superior and lateral direction
  • Glenoid fossa faces upwards (UE elevation)
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13
Q

What makes up the sternoclavicular joint?

A
  • Medial end of the clavicle
  • Clavicular facet on the sternum
  • Superior border of the cartilage of the first rib
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14
Q

What links the axial and appendicular skeleton?

A

The basilar joint of the UE

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15
Q

What joint has extensive periarticular tissue?

A

Sternoclavicular

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16
Q

What kind of joint is the SC joint?

A

Irregular saddle shape

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17
Q

What is the arthrokinematic movement of the SC joint?

A

Convex on Concave (with the sternal facet reciprocally shaped)

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18
Q

The longitudinal diameters of the SC joint extend roughly in the _____ plane between the superior and inferior points of the articular surfaces.

A

Frontal

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19
Q

The transverse diameters of the SC joint extend roughly in the _____ plane between the anterior and posterior points of the articular surfaces.

A

Transverse

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20
Q

What helps to reinforce the capsule at the SC joint?

A

The anterior and posterior SC ligaments

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21
Q

Where is the interclavicular ligament located?

A

Between the two clavicles

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22
Q

Where is the costoclavicular ligament located?

A

Between the clavicle and the costal cartilage of the rib below

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23
Q

What percentage of people have an articular disc at the SC joint?

A

50%

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24
Q

What muscles are associated with the SC joint?

A
  • SCM
  • Sternothyroid
  • Sternohyoid
  • Subclavius
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25
Q

How many degrees of freedom does the SC joint have and what are they?

A
  • 3 degrees of freedom
  • Sagittal
  • Frontal
  • Horizontal
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26
Q

What motions does the SC joint produce?

A
  • Elevation/ Depression
  • Protraction/ Retraction
  • Rotation
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27
Q

What is the goal of the SC joint?

A

To place the scapula in the optimal position for the head of the humerus

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28
Q

If you move the GH joint you will ultimately move what other joint in combination?

A

SC joint

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29
Q

The clavicle will rotate in how many degrees of freedom with UE elevation?

A

All 3

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30
Q

What plane is elevation and depression in at the SC joint?

A

Generally parallel to the frontal plane

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31
Q

What is the axis of elevation and depression at the SC joint?

A

Near anterior-posterior

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32
Q

How many degrees of elevation and depression does the SC joint get?

A
  • 35 to 45 degrees of elevation
  • 10 degrees of depression
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33
Q

What are the arthrokinematics of elevation of the clavicle at the SC joint?

A
  • Convex surface rolls superiorly and slides inferiorly
  • Costoclavicular ligament will stretch and limit motion
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34
Q

What are the arthrokinematics of depression of the clavicle at the SC joint?

A
  • Convex surface rolls inferiorly and slides superiorly
  • Interclavicular ligament and superior portion of the capsule will stretch
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35
Q

The arthrokinematics of elevation and depression at the SC joint occur along what diameter?

A

Longitudinal

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36
Q

What plane is protraction and retraction in at the SC joint?

A

Occurs nearly parallel to the horizontal plane

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37
Q

What is the axis of protraction and retraction at the SC joint?

A

Vertical

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38
Q

How many degrees of protraction and retraction does the SC joint get?

A

15-30 degrees in each direction

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39
Q

The arthrokinematics of protraction and retraction at the SC joint occur along what diameter?

A

Transverse

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40
Q

What are the arthrokinematics of retraction of the clavicle at the SC joint?

A
  • Concave surface of clavicle rolls and slides posteriorly on convex surface of sternum
  • Stretches anterior costoclavicular ligament and anterior capsule
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41
Q

What are the arthrokinematics of protraction of the clavicle at the SC joint?

A
  • Occurs in an anterior direction
  • Stretches posterior costoclavicular ligament and posterior capsule
  • Involves reaching forward
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42
Q

Axial (longitudinal) rotation of the clavicle at the SC joint is done at the bones _____ axis?

A

Longitudinal

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43
Q

When someone elevates their UE how much does the clavicle posteriorly rotate?

A

20-35 degrees
(as the UE returns the clavicle returns)

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44
Q

When talking about axial rotation of the clavicle the spin of its sternal end is relative to what?

A

The lateral surface of the articular disc

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45
Q

Axial rotation of the clavicle can not be preformed when the arm is in what position?

A

Resting at the side

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46
Q

Axial rotation of the clavicle is linked with the overall kinematic motions of what?

A

Flexion and Abduction

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47
Q

What makes up the acromioclavicular joint?

A
  • The lateral end of the clavicle
  • The acromion of the scapula
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48
Q

The clavicular facet on the acromion faces what direction?

A

Medial and slightly superior

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49
Q

Are articular discs present in the AC joint?

A

Articular discs of varying forms present in most AC joints

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50
Q

What is the capsule at the AC joint reinforced by?

A

By the superior and inferior AC ligaments

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51
Q

What is the extrinsic stability for the AC joint?

A

Coracoclavicular ligament

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52
Q

The coracoclavicular ligament is made up of two parts that branch from the coracoid process to the clavicle, what are they?

A
  • Trapezoid ligament
  • Conoid ligament
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53
Q

How many degrees of freedom are found at the AC joint?

A

3 degrees of freedom

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54
Q

What is the primary motion of the AC joint?

A

Upward and downward rotation

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55
Q

What is the secondary motion of the AC joint?

A

Rotational adjustment motions - to fine tune the position of the scapula in the horizontal and sagittal planes

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56
Q

Upward rotation of the scapula at the AC swings _____ and _____ relative to the end of the clavicle.

A

Upward; Outward

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57
Q

How many degrees of upward rotation do we get at the AC joint?

A

Up to 30 degrees

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58
Q

Downward rotation of the scapula at the AC joint returns the scapula to what?

A

Anatomical position

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59
Q

What plane is downward rotation at the AC joint preformed in?

A

Frontal plane depicted - but really the scapular plane

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60
Q

Pivoting or twisting type motions of the scapula around the lateral end of the clavicle at the AC joint are considered what kind of motions?

A

Rotational adjustment

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61
Q

Rotational adjustment motions help to optimally align the scapula against what?

A

The thorax

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62
Q

The horizontal plane rotational adjustment motions of the AC joint sit on what axis and produce what movements?

A
  • A vertical axis
  • Medial border moves away and creates internal rotation of the glenoid fossa
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63
Q

The sagittal plane rotational adjustment motions of the AC joint sit on what axis and produce what movements?

A
  • Medial-lateral axis
  • Inferior angle pivots away and creates an anterior tilt or reverse a posterior tilt
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64
Q

What happens at the AC joint during protraction?

A

The AC joint internally rotates in the horizontal plane and helps align the anterior surface of the scapula with the thorax curved surface

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65
Q

Elevation or shrugging creates a _____ tilt.

A

Anterior

66
Q

What joint is considered not to be a true joint?

A

Scapulothoracic joint

67
Q

Why is the scapulothoracic joint not considered a true joint?

A

It does not have direct contact because it is separated by laters of muscles (the subscapularis, serratus anterior, and erector spinae)

68
Q

The scapula is seated in between what ribs?

A

The 2nd and 7th ribs

69
Q

Where is the medial border of the scapula located?

A

6 cm lateral to the spine

70
Q

What degree of anterior tilt, upward rotation, and internal rotation is found at the scapulothoracic joint?

A
  • 10 degrees of anterior tilt
  • 5-10 degrees of upward rotation
  • 30-40 degrees of internal rotation
71
Q

UE ROM is largely dependent on what?

A

Scapular motion

72
Q

Elevation and depression as a whole are combinations of what joints?

A

Composite SC and AC

73
Q

Protraction and retraction is a summation of what motions?

A

Horizontal motions at both the SC and AC

74
Q

For protraction and retraction movements what does each joint involved focus on?

A
  • SC joint focuses on the protraction aspect
  • AC joint focuses on the internal rotation
75
Q

What supports/ stabilizes the head of the humerus during upward and downward rotation?

A

The glenoid fossa

76
Q

Upward rotation is the summation of _____ elevation and SC/ scapular upward rotation.

A

Clavicular

77
Q

What degrees of upward rotation do we get at the scapula?

A

60 degrees

78
Q

What makes up the glenohumeral joint?

A
  • Large convex head
  • Shallow concavity (glenoid fossa)
79
Q

The head of the humerus is positioned how?

A

Medially, superiorly, and posteriorly (normal retroversion)

80
Q

How would you describe the fibrous capsule?

A
  • Capsule that branches from the rim of the glenoid fossa to the anatomical neck of the humerus
  • It is loose fitting, thin and expandable
  • It allows for mobility, and is reinforced by external ligaments
81
Q

In the anatomical position, is the inferior portion of the capsule slackened or taught?

A

Slackened - called the axillary pouch

82
Q

What lines the inner wall of the GH joint?

A

Synovial membrane

83
Q

There is an extension of the synovial membrane that lines the intracapsular portion of the tendon of the long head of the biceps and exits into the _____ _____.

A

Intertubercule groove

84
Q

The head of the humerus and the glenoid fossa is line with what?

A

Articular cartilage

85
Q

What amount of space is present in the GH joint?

A

A volume 2 times the size of the humeral head

86
Q

What are the 3 primary stabilizers of the GH joint?

A
  • A passive tension that is in the embedded ligaments
  • Active forces that are produced by the local muscles (specifically the rotator cuff)
  • Long head of the biceps tendon crosses superior over the head of the humerus to help stabilize too
87
Q

The GH capsular ligaments are fibrous connective tissues made up of interlacing collagen fibers that limit what motion?

A

Extremes of rotation and translation

87
Q

The superior ligament of the GH capsule resists what motions?

A

Exterior rotation and inferior and anterior translations of the humeral head

88
Q

The middle ligament of the GH capsule does what?

A
  • Stabilizes most motions
  • Resists anterior translation of the humeral head, especially in 45 to 90 degrees of abduction and extremes of external rotation
89
Q

Where is the middle ligament of the GH capsule slackened?

A

In internal rotation (blends with the subscapularis)

90
Q

The inferior GH ligament has 3 portions (bands), in what position are they taught in?

A
  • All: Taught in 90 degrees of abduction
  • Axillary: combined with anterior-posterior and inferior translations
  • Anterior: and full external rotation; anterior translation of humeral head
  • Posterior: and full internal rotation
91
Q

What do the inferior bands of the GH capsule support?

A
  • Hammock like so it supports the suspended humeral head
92
Q

What do the inferior bands of the GH capsule resist?

A

Inferior and anterior-posterior translation

93
Q

What is the strongest and thickest part of the GH capsule?

A

Anterior

94
Q

Where does the coracohumeral ligament run?

A

From the coracoid process to the greater tubercle

95
Q

What does the coracohumeral ligament blend with?

A

The superior capsule and supraspinatus tendon

96
Q

Where is the coracohumeral ligament taught?

A

In anatomical position

97
Q

What does the coracohumeral ligament resist?

A

Inferior translation of the humeral head and external rotation

98
Q

What is being described when someone says: its is a significant structural support to the capsule, it blends with the capsule, the belly of the muscles are close to the joint, and it protects and is an active stabilizer.

A

The rotator cuff

99
Q

Where does the subscapularis sit in reference to the capsule?

A

Anterior

100
Q

Where do the supraspinatus, infraspinatus, and teres minor sit in reference to the capsule?

A

Superior and posterior

101
Q

What is the thickest muscle in the rotator cuff?

A

Subscapularis

102
Q

Where is the most common site for a dislocation?

A

Rotator cuff interval - inferior and supraspinatus/ subscapularis

103
Q

What is the rotator cuff interval reinforced by?

A
  • Long head of the biceps
  • Coracohumeral ligament
  • Superior and middle capsular ligaments
104
Q

The long head of the biceps originates where?

A
  • The supraglenoid tubercle and the labrum
  • The intracapsular tendon crosses the humeral head
  • Runs through the inter tubercle groove on the anterior humerus
105
Q

What does the long head of the biceps resist?

A

Anterior translation of the humeral head

106
Q

The glenoid labrum is a _____ ring.

A

fibrocartilaginous

107
Q

The glenoid labrum gets _____ percent of its depth from its structures and is a stabilizer.

A

50%

108
Q

What are the 5 tissues that reinforce or deepen the glenohumeral joint?

A
  • Joint capsule/ GH capsular ligaments
  • Coracohumeral ligaments
  • Rotator cuff muscles (SITS)
  • Long head of the biceps
  • Glenoid labrum
109
Q

The GH joint is like a …

A

Ball on an inclined surface

110
Q

What provides ligamentous support for scapulothroacic posture?

A

Superior capsular structures: superior capsular ligament, coracohumeral ligament, and the tendon of the supraspinatus

111
Q

When looking at a free body diagram, the force from the humerus into the GH joint labeled CF is what?

A

The compressive force

112
Q

The coracoacromial arch is formed by what two structures?

A
  • Coracoaromial ligament
  • Acromion process
113
Q

What is considered the “roof” of the GH joint?

A

The coracoacromial arch

114
Q

The coracoacromial arch is _____ cm in adults at rest with their arms by their sides.

A

1 cm

115
Q

The subacromial space is the space between the _____ and the _____ _____.

A

Arch; humeral head

116
Q

What is within the subacromial space?

A
  • Supraspinatus muscle
  • Supraspinatus tendon
  • Subacromial bursa
  • Long head of the biceps
  • Superior capsule
117
Q

Where are bursa sacs typically placed around the GH joint?

A

Situated where significant frictional forces develop such as between tendons, capsules and bone, muscles and ligaments, and 2 adjacent muscles
- there are 2 superior to the humeral head

118
Q

The subacromial bursa protects what muscle from what bone?

A

Protects the supraspinatus from the acromial bone

119
Q

The subdeltoid bursa limits friction forces between what muscle and what bone?

A

Limits friction between the deltoid and the supraspinatus tendon and the humeral head

120
Q

The shoulder has how many degrees of freedom?

A

3 degrees (flexion/extension, abduction/adduction, internal/ external rotation)

121
Q

The shoulder also has a 4th motion, what is it?

A

Horizontal abduction/ adduction that starts at 90 degrees of abduction

122
Q

Horizontal abductions sits on what axis?

A

Vertical axis

123
Q

What is the anatomical position of the shoulder?

A

0 degrees

124
Q

Rotation (abduction/adduction) of the humerus is done in what plane and on what axis?

A
  • The frontal plane
  • The anterior - posterior axis
125
Q

During shoulder abduction when does the scapula start to upwardly rotate as well?

A

At 60 degrees

126
Q

What is the arthrokinematic movement of humerus abduction?

A

The convex head of the humerus rolls superior and slides inferiorly along the longitudinal diameter of the glenoid fossa
* adduction is reverse

127
Q

What tendon blends with the superior capsule?

A

Supraspinatus

128
Q

Active contractions pull the capsule tight and prevent it from being punched between what two surfaces?

A

The humeral head and the undersurface of the acromion

129
Q

At 90 degrees of abduction the humeral head stretches out the inferior capsular ligament (axillary pouch) which acts like a hammock and supports what?

A

The head of the humerus

130
Q

Where will you find the most (7.5 mm) acromiohumeral distance? (chart in words)

A

When shoulder abduction is at 20 degrees

131
Q

Where will you find the least (2.6 mm) acromiohumeral distance? (chart in words)

A

When shoulder abduction is at 85 degrees

132
Q

Where will you find the middle amount (5 mm) of acromiohumeral distance? (chart in words)

A

When shoulder abduction is at 150 degrees

133
Q

At a low degree (about 20-35 degrees) of abduction what is closest to the undersurface of the acromion?

A

The humeral head

134
Q

At a medium degree (about 35-70 degrees) of abduction what is closest to the undersurface of the acromion?

A

Distal attachment of the supraspinatus

135
Q

At a high degree (about 70-160 degrees) of abduction what is closest to the undersurface of the acromion?

A

Proximal shaft of the humerus

136
Q

At what degree is the supraspinatus usually compressed?

A

35-70 degrees

137
Q

What is adhesive capsulitis?

A

Excessive thickening or stiffness in the inferior capsular ligament

138
Q

What does adhesive capsulitis limit?

A

Limits inferior slide of the humeral head

139
Q

The superior roll in adhesive capsulitis leads to what?

A
  • Jamming of the humeral head against the coracoacromial arch
  • There is only 22 degrees before this without any slide
140
Q

What is impingement syndrome?

A

An unnatural and repeated compression or abrasion that may damage the suprasinatus tendon, subacromial bursa, long head of the biceps tendon, or the superior parts of the capsule

141
Q

Over time repeated compression may lead to what?

A

Impingement syndrome

142
Q

Flexion is rotation of the humerus in what plane and on what axis?

A
  • The sagittal plane
  • The medial-lateral axis
143
Q

What are the arthrokinematics of shoulder flexion?

A

Spinning motion of the humeral head in the fossa

144
Q

During shoulder flexion are most of the surrounding capsular structures taut or slackened?

A

Taut

145
Q

In extremes of flexion tension in the posterior capsule may cause a slight _____ translation of the humerus.

A

Anterior

146
Q

How many degrees of GH flexion do we get and then how much do we get when we add the scapula in?

A
  • 120 degrees of GH flexion
  • 180 degrees includes the scapula
147
Q

How much active and passive extension do we get at the shoulder?

A
  • 65 degrees of active extension
  • 80 degrees of passive extension
148
Q

Extension causes a slight _____ tilt of the scapula and stretch of capsular ligaments

A

Anterior

149
Q

Axial rotation of the humerus (IR and ER) is done in what plane and along what axis?

A
  • The horizontal plane
  • The longitudinal axis
150
Q

In neutral where do we sit when it comes to IR and ER?

A
  • 75-85 degrees of internal rotation
  • 60-70 degrees of external rotation
151
Q

What are the arthrokinematics of internal and external rotation?

A
  • Occurs over a transverse diameter
  • Roll posterior, slide anterior for external rotation
  • Roll anterior and slide posterior for internal rotation
152
Q

At what degree of abduction is external rotation primarily spinning?

A

90 degrees

153
Q

How many kinematic principles are there for shoulder abduction?

A

Six - motion is not at a specific joint but at the whole complex

154
Q

The first kinematic principle is scapulohumeral rhythm, what does this mean?

A
  • There is a generalized 2:1 ratio of scapulohumeral rhythm so for every 3 degrees of abduction you get 2 degrees of GH joint and 1 degree of ST upward rotation
  • You have active shoulder abduction of about 180 degrees that occurs as a result of simultaneous 120 degrees of GH joint and 60 degrees of scapulothoracic upward rotation
155
Q

The second kinematic principle is SC and AC joint movement during full abduction, what does this mean?

A

The 60 degrees of upward rotation of the scapula during full shoulder abduction is the result of a simultaneous elevation at the sternoclavicular (SC) joint combined with upward rotation at the acromioclavicular (AC) joint

156
Q

The third kinematic principle is also SC and AC joint movement during full abduction, what does this mean?

A
  • The clavicle retracts at the SC joint during shoulder abduction
  • The clavicle is horizontal about 20 degrees posterior to the frontal plane to start
  • During abduction the clavicle retracts another 15-20 degrees
  • The clavicle does more in the frontal plane than the scapula or flexion
157
Q

What is the fourth kinematic principle?

A
  • The upwardly rotating scapula posteriorly tilts and less consistently externally rotates slightly during full shoulder abduction
  • At rest it is anteriorly tilted 10 degrees and internally rotated 30-40 degrees
  • With abduction it posteriorly tilts 20 degrees
158
Q

What is the fifth kinematic principle?

A
  • The clavicle posteriorly rotates around its own axis during shoulder abduction
  • 20-35 degrees during full abduction
  • This is the most predominant motion of the clavicle with abduction
  • Those with subacromial impingement showed reduced rotation
159
Q

What is the sixth kinematic motion?

A
  • The GH joint externally rotates during shoulder abduction
  • Allows the greater tubercle on the humerus to pass posterior to the acromion
  • Strict frontal plane has more than scaption
  • 25-50 degree range; majority occurring before 70-80 degrees of abduction

Biomechanics Test 3 (2 decks)

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