shoulder pre class Flashcards
(92 cards)
1
Q
glenohumeral joint - joint type
A
multaxial ball and socket synovial joint
labrum deepens glenoid fossa by 50%
2
Q
GHJ resting position
A
55 abduction, 30 horizontal adduction
3
Q
GHJ close pack
A
full abduction, ER
4
Q
GHJ capsular pattern
A
ER, Abd, IR
5
Q
GHJ ROM - flexion
A
0-180
6
Q
GHJ ROM - extension
A
0-60
7
Q
GHJ ROM - abduction
A
0-180
8
Q
GHJ ROM - IR
A
0-70
9
Q
GHJ ROM - ER
A
0-90
10
Q
GHJ inferior capsule
A
extends down humerus
does not add much stability
least supported
11
Q
GHJ capsule attaches
A
to circumference of glendoid fossa and spans to anatomical neck of humerus
12
Q
GH ligaments
A
superior, middle, inferior
13
Q
superior GH lig
A
blends w/ labrum along head of biceps
suspends humerus
14
Q
superior GH lig resists
A
inferior glide and ER during first 60 deg abduction
15
Q
middle GH lig
A
variable present
restrains ER between 0-90 deg abduction
16
Q
inferior GH lig
A
anterior, posterior, axillary pouch
-ant is primary restraint to anterior translation at 90 degrees abduction
17
Q
coracohumeral ligament limits
A
inferior glide and ER below 60 deg abduction
18
Q
coracohumeral ligament found in
A
rotation interval (ant border of supraspinatus tendon and superior border of subscap tendon)
19
Q
coracoacromial ligament
A
limits superior glide
forms arch over humeral head
20
Q
what ligament forms roof over bicipital groove?
A
transverse humeral lig
21
Q
scapulohumeral muscles
A
deltoid
teres major
coracobrachialis
rotator cuff (SSIT)
22
Q
scapulothoracic muscles
A
Serratus ant traps rhomboids levator scapulae pec minor
23
Q
thoracohumeral
A
latts
pec major
24
Q
what joint has more fractures than dislocations
A
sternoclavicular
25
sternoclavicular movements
```
elevation (around AP axis)
depression
protraction(around vertical axis)
retraction
rotation (around long axis)
```
26
moments at SC corresponding to scap movements
post glide - retraction - concave
ant glide - protraction - concave
inf glide - elevation - convex
sup glide - depression - convex
27
sc resting
arm at side
28
sc close pack
full elevation
29
sc capsular pattern
pain at extremes of ROM, esp horizontal adduction and full elevation
30
AC joint type
plane synovial w/ 3 deg freedom
| acromion slides on clavicle in same direction as scapular movement
31
first ligaments to be injured when AC joint is stressed
acromioclavicular lig
32
primary support of AC joint
coracoclavicular lig
33
AC joint resting
arm by side
34
AC close pack
90 deg abduction
35
AC capsular pattern
pain at extremes of ROM, esp horizontal Add and full elevation
36
AC sprain type I
AC ligt stretched but stable
37
AC sprain type II
AC lig torn, coracoclavicular stretched
38
AC sprain type III
AV and coracoclavicular torn and eventually tears deltoids and traps
39
GHJ as humerus elevates
context rule
as humerus elevates from 30-60 deg, glides sup
then center of rotation remains fixed and spinning occurs
40
greatest force on inf GH ligament
abd, ER
41
what contributes the most to GH stability?
rotator cuff group
42
scapulothoracic joint
upward rotation is most important (serratus and traps)
43
resting position of scap
30 deg ant tilt, upward rotation 3 deg
44
scapulohumeral rhythm
first 30 deg "setting phase" variable
last 60 about 1:1
average is 2:1 GH:scap
45
scapulohumeral rhythm stage 1
humerus 30 deg ab
scapula minimal motion
clavicle 0-5 deg elvation
46
scapulohumeral rhythm stage 2
humerus 40 deg ab
scapula 20 deg upward rotation, min protraction or elevation
clavicle 15 deg elevation
47
scapulohumeral rhythm stage 3
humerus 60 deg ab, 90 deg ER
scapula 30 deg upward rotation
clavicle 30-50 post rotation 15 deg elevation
48
instantaneous center or rotation
moves from root of spine to acromion
49
early elevation
upper trap and serratus ant responsible for upward rotation and protraction
-as U trap loses MA, L trap kicks in, SA active throughout
ICR now at acromion
50
Bankart Lesion
Labrum avulses from
anterior inferior part of fossa, stripping the
capsule
51
Comparable sign
```
A combination
of pain, stiffness and/or spasm that
the therapist finds on examination
and considers to be comparable to
the patient’s symptoms
```
52
Hills-Sachs Lesion
```
A radiological
finding thought to be a
compression fracture of the
posterior humeral head as it
translates anteriorly over the sharp
anterior lip of the glenoid rim
```
53
Hypermobility
Excessive ROM
with muscular control to provide
stability
54
Primary impingement-
Rotator cuff being
mechanically impinged underneath the
coracoacromial arch.
55
Neer’s stages 1
Impingement
| Edema and hemorrhage
56
Neer’s stage 2
Impingement
| Fibrosis and tendinitis
57
Neer’s stage 3
Tear of rotator cuff, biceps rupture, bone changes
58
Secondary impingement
Impingement as a result of GH or functional scapular instability
59
Secondary impingement causes
- decrease in SAS due to instability
- high demand of overhead sport —> GHJ lax —> superior migration of HH
- kyphosis TSpine and protracted scap
- poor force coupling at small -> decreased upward rotation
60
Instability leads to
Excessive displacement anterior or posterior of humeral head in relationship to glenoid fossa
61
TUBS
Traumatic Unidirectional anterior
instability with Bankart lesion requiring
Surgery
62
AMBRII
Atraumatic Multidirectional
Bilateral laxity Rehabilitation Inferior
capsule and rotator Interval
63
GHJ instability grade 0
No translation
64
GHJ instability grade 1
Mild
Humeral head moves slightly up face of glenoid
0-1cm translation
65
GHJ instability grade 2
Moderate
Humeral head rides up glenoid face but not over the rim
1-2 cm translation
66
GHJ instability grade 3
Severe
Humeral head rides up and over the glenoid rim
Usually reduces when stress removed
Main remain dislocated when stress removed
>2cm translation
67
Painful arc
Range of 60-120 deg shoulder elevation
68
SLAP lesion
Superior Labrum Anterior
Posterior (superior labrum avulsion at the
biceps insertion)
69
Subluxation
partial loss of joint
congruency, but can be normally controlled
with dynamic stabilizers
70
Joints of shoulder and shoulder girdle
Glenohumeral joint • Acromioclavicular joint • Sternoclavicular joint • Scapulothoracic joint
71
Key functional movement limitations if shoulder not working properly
Reaching above head – Reaching behind back – Lifting (flexion or extension) – Pushing forward or backward – Throwing/over head hitting
72
Arthro of SC protraction
Concave rule
Role ant
Slide ant
73
Arthro of SC retraction
Concave rule
Post roll
Post slide
74
Arthro of SC elevation
Convex rule
Sup roll
Inf slide
75
Arthro of SC depression
Convex rule
Inf roll
Sup slide
76
Weight of dependent arm
Causes scap downward rotate, ab, forward tipping
Balanced by U trap, SA (forward tip by rhomb, M trap)
77
Dynamic scapular stability
| Flexion or ab
U and L trap w/ SA caused upward rotation
78
Dynamic pushing activities
Scapular protraction by SA
79
Dynamic pulling activities
Retraction and D rotation by: rhomb, lats, T major, rotator cuff
80
Faulty scapular postures forward tilt
tight pec minor, weak SA (ab/IR humerus)
81
Clavicular elevation and rotation
As scap rotates upward
- clavicle first elevates 30 deg
- coracoclavicular tights and rotation takes place, 38-50 deg
- allowing xtra 30 deg of scap upward rotation
82
Humeral ER
Must occur for full AB
| Allows greater tubercle to clear coracoacromial arch
83
Humeral IR and passive shoulder flexion
Starts at 50 deg of passive shoulder flexion
Ant capsule and lig tighten and pull humerus into IR
Countered by infraspinatus and teres minor
84
Scaption
30 deg anterior to frontal place
Less tension on capsule
No humeral rotation necessary for clearing greater tubercle
Many functional activities occur here
85
Telford and short rotator cuff
Delt alone - Upward translation of humerus
Combined short rotator cuff muscles compress head of humerus into glenoid fossa and prevent excess superior migration
Supraspinatus compress head into glenoid w/ slight upward translation
86
What is suggestive of recent or recurrent subluxations?
Bankart lesion
87
Adhesive capsulitis stage 1
0-3 months
Sig night pain
Pain w/ active and passive ROM
Limitation: forward flex, ab, IR, ER
88
Adhesive capusilitis stage 2
Freezing stage
3-9 months
Chronic pain w/ active and passive ROM
Sig limits of forward flex, ab, IR, ER,
89
Adhesive capsulitis stage 3
Frozen stage 9-15 mo
Minimal pain except at end ROM
Sig limitation of ROM w/ rigid end feel
90
Adhesive capsulitis stage 4
Thawing phase
15-24 mo
Minimal pain
Progressive improvement in ROM
91
Downward rotated
poor coordination of SA and U trap
92
Adducted
hypertrophied rhomboids
