Flashcards in The Shoulder Deck (95):
What is the primary function of the shoulder complex?
To position the hand in space, allowing interaction with the environment
What are the 3 secondary functions of the shoulder complex?
- Suspend the upper limb
- Provide sufficient fixation so that motion of the UE or trunk can occur
- Serve as a fulcrum for arm elevation
What 3 things are shoulder mobility dependent upon?
- A healthy articular surface
- Intact muscle-tendon units
- Supple capsuloligamentous restraints
What 3 things are shoulder stability dependent upon?
- Intact capsuloligamentous structures
- Proper function of the muscles
- Integrity of the osseous articular structures
What type of joint is the GH joint?
a true synovial-lined diarthrodial joint
In what position does the humerus face?
Medially, Posteriorly, and Superiorly
In what position does the glenoid fossa face?
Laterally, Anteriorly, and Superiorly
What makes the glenoid fossa deeper?
The labrum, but 50%
What does the labrum attach to?
The glenoid cavity, joint capsule, and lateral potion of the biceps
What percentage of long head of the biceps fibers originate from the superior labrum?
At any given point during elevation, what percentage of the humeral head is in contact with the glenoid?
What 3 positions most significantly reduce humeral head contact with the glenoid?
- Adduction, flexion and IR
- Abduction and elevation
- Adducted at the side with downwardly rotated scapula
What are the GH dynamic stabilizers?
RC muscles among other force couples
What are the GH static stabilizers?
- Joint capsule
- Joint cohesion
- Ligamentous support
Scaption is considered arm elevation with the arm held __-__ degrees anterior to the frontal plane
How many muscles attach to the scapula? How many of those are involved in support and scapular movement and how many are involved in GH motion?
- Six of these support and move the scapula
- Ten of these are concerned with GH motion
Describe the lateral, medial, inferior, and superior attachments of the GH joint capsule
- Laterally attaches to the neck of the humerus
- Medially attaches to the periphery of the glenoid and its labrum
- Inferiorly attaches to the inferior portion of the glenoid
- Anteriorly is reinforced by the Z ligaments and the RC tendons
Why is the inferior aspect of the GH joint capsule loose?
To allow for gliding during elevation
When is the anterior GH ligament under tension?
when the shoulder is in extension, ABD and/or ER
When is the posterior GH ligament under tension?
when the shoulder is in flexion and ER
When is the inferior GH ligament under tension?
when the shoulder is ABD, extended and/or ER
When is the posterior GH ligament under tension?
when the shoulder is flexed and ER
Which GH ligament is the primary restraint against anterior and posterior humeral head dislocation?
Inferior GH ligament
What structures are found within the coracoacromial arch?
- Head of the humerus
- Long head of the biceps tendon
- Superior aspect of the joint capsule
- Supraspinatus and upper margins of the subscapularis - and infraspinatus
- Subdeltoid bursa
- Subacromial bursa
What is the normal size of the GH joint in height?
What nerves are found in the anterior should joint?
axillary, subscapular and lateral pectoral
What nerves are found in the posterior should joint?
suprascapular nerve, small branches of the axillary nerve
What artery supplies the shoulder complex for the most part?
What is the open-packed position of the GH joint?
55 degrees of abduction and 30 degrees of horizontal adduction
What is the closed-packed position of the GH joint?
Abduction and full ER
What is the capsular pattern of the GH joint?
ER > ABD > IR
What is the open-packed position of the AC joint?
arm by the side
What is the closed-packed position of the AC joint?
90 degrees of abduction
What is the capsular pattern of the AC joint?
extremes of ROM cause pain
What joint serves as the main articulation that suspends the UE from the trunk?
What ligament is the primary support of the AC joint?
What is the open-packed position of the SC joint?
Arm at the side
What is the closed-packed position of the SC joint?
Maximum arm elevation and protraction
What is the capsular pattern of the SC joint?
Pain occurs at the extremes of ROM, esp. full arm elevation and horizontal adduction
If held vertically, the proximal end of the clavicle is con___.
If held A/P, the proximal end of the clavicle is con___.
What are the 3 DOF at the SC joint?
At the ST Joint:
__ degrees of upward rotation of the scapula
__-__ degrees of IR/ER
__-__ degrees of anterior/posterior tipping
What is the capsular pattern of the scapulothoracic joint?
What is the closed packed position of the scapulothoracic joint?
What is the open packed position of the scapulothoracic joint?
30-45 degrees of IR, slight upward rotation and 5-20 degrees of anterior tipping
What is the main function of the serratus anterior?
- Protract and upwardly rotate the scapula
- Provide a strong, mobile BOS to position the glenoid for maximum efficiency
What muscle provides eccentric control of the scapula during flexion and abduction?
What muscle helps control scapular position, especially with horizontal flexion and extension?
Describe the movements that occur during the first 90 degrees of abduction
60 degrees of GH abduction
30 degrees of ST upward rotation
The 30 degrees of ST upward rotation that occurs during the first part of abduction can be broken down into __-__ degrees of clavicular elevation and __-__ degrees of AC upward rotation
Describe the movements that occur during the second 90 (90-180) degrees of abduction
60 deg of GH abduction
30 deg of ST upward rotation
The 30 degrees of ST upward rotation that occurs during the late phase of abduction can be broken down into __-__ degrees of clavicular elevation and __-__ degrees of AC upward rotation
Pain during __-__ degrees of abduction is deemed a “painful arc”. What may this indicate?
RC impingement/tearing or subacromial bursitis
What does pain during 120-180 may indicate?
involvement of the AC joint
Describe Humeral Superior Glide Syndrome
The humeral head glides superiorly during elevation, because the downward pull of the RC muscles is insufficient to counterbalance the upward pull of the deltoid
ROM with unilateral elevation should be ____ than bilateral elevation
What test tests for IR AROM?
Apley’s Scratch Test
Where should the thumb reach during Apley’s Scratch Test?
During elevation, when does the scapula stop its rotation?
when the arm has been elevated to approximately 140 degrees
What do resistive tests test?
Inert tissues for involvement before coming to the conclusion that only the M/T structure is at fault
Pain with isometric muscle testing is generally considered a sign of what?
1st or 2nd degree musculotendinous lesion
Pain that occurs during a muscle contraction is more likely to indicate what?
a lesion within a muscle belly
Pain that occurs on release of the contraction is more likely to indicate what?
a lesion within the tendon
What motions are required in order to eat?
70-100 of horizontal adduction
45-65 of abduction
What motions are required in order to comb your hair?
30-70 of horizontal adduction
105-120 of abduction
90 of ER
What motions are required in order to reach your perineum?
75-90 of horizontal abduction
30-45 of abduction
90 of IR
What motions are required in order to tuck in your shirt?
50-60 of horizontal abduction
55-65 of abduction
90 of ER
What motions are required in order to put your hand behind your head?
1-15 of horizontal adduction
110-125 of flexion
90 of ER
What motions are required in order to put on item on a shelf?
70-80 horizontal adduction
70-80 of flexion
45 of ER
What motions are required in order to wash your opposite shoulder?
60-90 of flexion
60-120 of horizontal adduction
What are 5 of the most commonly used shoulder outcome scales?
- UCLA Shoulder Rating Scale
- Simple Shoulder Test
- Shoulder Pain and Disability Index
- Disabilities of the Arm, Shoulder and Hand (DASH)
- Penn Shoulder Score
It is an outcome measure that reflects the impact on function of a variety of musculoskeletal diseases and injuries in the UE
What are grade I and II oscillations used for?
What are grade III and IV mobilizations used for?
to increased ROM
In what direction does GH distraction occur?
Lateral, anterior and inferior direction
What are the 3 passive accessory motion GH tests?
- Anterior glide
- posterior glide
- inferior glide
What are the 4 passive accessory motion ST tests?
- Superior Glide
- Inferior Glide
- Medial Glide
- Lateral Glide
Describe movement of the clavicle during GH abduction or shoulder elevation
- Lateral end of the clavicle moves superiorly
- Medial end slides and rolls inferiorly
- Clavicle rotates anteriorly
Describe movement of the clavicle during GH adduction or shoulder depression
- Lateral end of the clavicle moves inferiorly
- Medial end rolls and slides superiorly
- Clavicle rotates posteriorly
What are the 4 tests for shoulder impingement?
- Neer Impingement Test
- Hawkins-Kennedy Impingement Test
- Yocum Test
- Painful Arc Test
What are the 7 tests that test RC integrity?
- Drop Arm Test
- Empty Can Test
- External Rotation Lag Sign
- Lift Off Test
- Internal Rotation Lag Sign
- Posterior Impingement Sign
- Hornblower’s Sign
What are the 2 tests for a biceps tear?
- Speed's Test
- Yergason’s Test
What are the 6 tests for a superior labral tear?
- Clunk Test
- Crank Test
- Jerk Test
- O’Brien’s Test (aka Active Compression Test)
- Anterior Slide Test
- Compression Rotation Test
What are the 3 tests that test for AC pathology?
- O’Brien’s Test
- Crossover Impingement/Horizontal Adduction Test
- Acromioclavicular Resisted Extension Test
What are the 4 tests that test for anterior instability?
- Load and Shift
- Apprehension Test
- Jobe Subluxation/Relocation Test
- Rockwood Test
What are the 2 tests that test for inferior/multidirectional instability?
- Sulcus Sign
- Feagin Test
How is Sulcus Sign graded?
Graded by measuring the inferior margin or acromion to the humeral head
+1 sulcus implies distance of less than 1cm
+2 sulcus implies distance of 1-2cm
+3 sulcus implies distance of more than 2cm
What are the 3 tests that test for posterior instability?
- Load and Shift Test
- Posterior Apprehension or Stress Test
Describe the 3 grades of shift (anterior or posterior)
- Grade I: up to 50% of humeral head translation with head riding up onto glenoid rim and spontaneous reduction
- Grade II: greater than 50% of humeral head translation with head riding over glenoid rim and spontaneous reduction
- Grade III: humeral head rides over glenoid rim and does not reduce spontaneously
Is greater laxity expected more anteriorly or posteriorly, why?
Posterior, because we already sit in a slouched position
What are the 3 Upper Limb Tension Tests?
- ULTT 1: Median Nerve
- ULTT 2: Radial Nerve
- ULTT 3: Ulnar Nerve
In what plane should you rehab the shoulder? Why?
In the scapular plane as it is more functional
What type of mobilization with movement should be performed for patient's with decreased elevation?
1) Clinician places one hand over the scapula and one hand over the anterior aspect of the head of the humerus
2) The patient is asked to elevate the arm while the clinician applies a posterior glide to the humeral head