Shoulder examination Flashcards
(34 cards)
Name the 4 joints in the shoulder complex
SC joint
ST joint
GH joint
AC joint
What % does the glenoid cover the humeral head?
25-30%
What position is the glenoid directed to ?
Anterior and lateral
Subacromial bursa
Size of bursa compared to others in body? Position? Vascularised? Innervation?
Largest in the body
Lies between deltoid + coracoacromial arch superiorly and Rotator cuff inferiorly
Well vascularised
Highly innervated with both proprioceptive and nociceptive endings
Kolk et al (2017) and Budoff et al (2005) findings related to bursectomy renders acromioplasty
Inneffectvie method
Rotator cuff description
Tendons of RC interweave and interdigitate as they attach to the humerus, forming a broad, confluent attachemnt, which involves the GHJ capsule and coracohumeral ligament.
Impossivle for tendons to be seperate entities, stress of any part of RC will involve all structures.
What is the primary purpose of the shoulder complex?
To place and control the hand in front of the body.
Scapular activity during elevation of the arm
Muscles involved? What movements do they allow?
Trapezius and serratus anterior
Upper trapezius - upward rot, retr + elev
Lower trapezius – upward rot, retr + dep
Serratus anterior – upward rot + pro
Scapular winging
When the muscle sof the scapula are weak or paralysed, resulting in limited ability to stabilise the scapula.
As a result the lateral borders of the scapula protrudes from back, like wings.
Muscle activity during elevation of the arm
Deltoid prime mover at the GHJ.
Infra/teres minor + subscapularis act as force couple to counteract upward pull of deltoid
RC exerts medial force on humeral head which approximates it to glenoid.
Long head of bicep exerts downard force, as long as humeral head centres on glenoid and not inf translated.
Shoulder instability
What does it depend on? What does it result from?
Depends upon fibrous tissue restraints and dynamic muscular action.
Instability results from inefficiency of the coraco and glenohumeral ligaments +/- rotator cuff.
Serratus anterior and traps contribute by way of scapular control
Not necessarily linked to a specific event but is often due to repeptive forces applied at rate that exceeds that of tissue repair.
GH ligament
Three ligaments on the anterior side of the shoulder joint.
They extend from the humerus to the glenoid fossa and reinforce the joint capsule.
Movements that tighten the anterior and posterior portions of the inferior glenohumeral ligament.
Abduction and external rotation - tighten anterior
Horizontal abduction and medial rotation tighten - postieror portion
Types of instability
Anterior
Posterior
Inferior
Clinical features of shoulder instability
History and exam.
History: dull ache; often do not c/o of instability, but more apprehension, a feeling something “not quite right”; fatigue; dead arm syndrome; family Hx; pain at night whether lying on either
side. If they do c/o shoulder “coming out” - does it come out all the way? how does it go back in? - disloc/sublux. Crucially, what posn is the shoulder when pt experiences Sx? → nature of any instability.
Clinical features of shoulder instability- exam
Atrophy; posn humeral head; ROM often full, but some pain end of flex/abd; weak cuff – possible tear; demonstrate instability?; generalized laxity?; +ve instability tests; possible +ve lag signs;
possible biceps tear/tendinopathy; possible labral tear
Clinical features of shoulder instability
Patterns of weakness and/or restriction
May be a degree of global cuff weakness
Often most painful shoulder conditions, is characterised by identifiable patterns of specific cuff weakness and resitriction/laxity of non-contractile tissues, primarily capsuloligamentous complexes.
Identifying, recognising and understanding these patterns of weakness and resticiton/laxity is important in diagnosis and crucial in delivering effective treatment.
Factors limiting anterior translation
**Dynamic resistance- **
Primary: Posterior cuff (infra + teres minor)
Secondary: long head of biceps; global cuff
**Non-contractile resistance- **
Primary: Anterior band inferior GHL
Secondary: coracohumeral lgt, superior GHL, middle GHL, anterior capsule.
Factors limiting posterior translation
Dynamic resistance
Primary: anterior cuff (subscapularis)
Secondary: global cuff
Non-contractile resistance
Primary: posterior band inferior GHL
Secondary: posterior capsule
Factors limiting inferior translation
Dynamic resistance
Primary: Superior cuff (Supraspinatus), global cuff
Non-contractile resistance
Primary: dependent posn- sup jt cap + superior GHL,
coracohumeral lgt + superior jt capsule
>45deg abduction - inferior GHL
Secondary:-ve intra-articular pressure
What is typical pattern for athletes with anterior instability and what does it indicate
Increased external rotation
Decreased internal rotation
Often indicates comparative restriction/laxity
of post/ant capsule
Impingement syndrome
Refers to symptoms of pain and dysfunction resulting from any pathologywhich either decreases the volume of the subacromial space or increases the size of its contents.
Primary impingement
acromial morphology;
osteophytes; thickened cuff; calcific
bursa/tendon; fracture; a-c dislocation; OA/RA;
bony kyphosis/scoliosis
Secondary impingment
Posture; weakness;
instability; ergonomics; neuropathy; muscle
imbalance
