shoulder lecture

  1. What does the shoulder complex consist of?
    scapula, clavicle, sternum, rib cage

    sternoclavicular jt, acromioclavicular jt, glenhohumeral jt, scapulothoracic articulation
  2. What does the shoulder girdle consist of?
    scapula, clavicle, sternum
  3. What does the shoulder jt consist of?
    scapula, humerus
  4. What does the scapula move over?
    rib cage
  5. What 2 joints allow the shoulder girdle mvmts of elevation/depression, upward/downward rotation, protraction/retraction?
    • sternoclavicular jt
    • acromioclavicular jt
  6. The SC, AC, GH, and ST articulation must work together to achieve what?
    synchronous rhythm to permit universal motion

    if something is wrong with one of them, something may be wrong with the others
  7. What is the humerus suspended from the scapula by?
    soft tissue, ligaments, muscles, joint capsule...only has minimal osseous support
  8. What is the GH joint supported by?
    tendons of the rotator cuff and GH and coracohumeral ligaments
  9. Which way is the slide for the humerus (convex-convace rule)?
    slides opposite of the direction of humerus
  10. If the humerus is moving into flexion, which way is the slide?
  11. If the humerus is moving into extension, which way is the slide?
  12. If the humerus is moving into abduction, which way is the slide?
  13. If the humerus is moving into adduction, which way is the slide?
  14. If the humerus is moving into internal rotation, which way is the slide?
  15. If the humerus is moving into external rotation, which way is the slide?
  16. If the humerus is moving into horizontal abduction, which way is the slide?
  17. If the humerus is moving into horizontal adduction, which way is the slide?
  18. What is the resting (loose packed) position of the GH jt?
    normal resting position, where it has the most give/joint play

    • abduction 55 degrees
    • horiz add 30 degrees
    • rotates so forearm is in the horizontal plane
  19. What is the closed packed position of the GH jt?
    least give/jt play

    maximum abduction with ER
  20. What is the capsular pattern of the GH jt?
  21. What type of jt is the acromioclavicular jt?
    plane, gliding, triaxial
  22. What reinforces the weak capsule of the AC jt?
    superior and inferior acromioclavicular ligaments
  23. Of the AC jt, what are the convex and concave bony partners?
    • convex- lateral end of clavicle
    • convace- acromion of scapula
  24. According to the convex-concave rule, which way does the acromial surface of the scapule move? what motions are available?
    moves in the same direction bc the surface is concave

    • upward/downward rotation
    • winging of vertebral border
    • tipping of inferior angle
  25. What type of jt is the sternoclavicular jt?
    incongruent, triaxial, saddle shaped
  26. What ligaments support the sternoclavicular jt?
    • ant/post stenoclavicular ligament
    • interclavicular and costoclavicular ligament
  27. Is the medial end of the clavicle convex/concave in the superior and inferior direction?
  28. Is the medial end of the clavicle convex/concave in the anterior and posterior direction?
  29. How does the clavicle at the SC jt slide?
    • ant/post- slides in same direction
    • sup/inf- slides opposite direction
  30. If the clavicle is moving into elevation, which way is the slide?
  31. If the clavicle is moving into depression, which way is the slide?
  32. If the clavicle is moving into protraction, which way is the slide?
  33. If the clavicle is moving into retraction, which way is the slide?
  34. If the clavicle is in rotation, which way is the slide?

    *rotation occurs as an accessory motion when the humerus is elevated above the horizontal position and the scapula upwardly rotates
  35. What are the characteristics of the scapulothoracic articulation?
    • motions of scapula require scapula sliding along the thorax
    • normally theres considerable soft tissue flexibility, allowing the scapula to participate in all upper extremity motions
  36. What scapular motions are seen with clavicular motions at the SC jt?
    elevation, protraction (abduction), retraction (adduction)
  37. What scapular motions are seen with clavicular motions at the SC jt and rotation at the AC jt?
    upward and downward rotation
  38. Upward rotation is necessary for full ROM for what mvmts?
    flexion and abduction of humerus
  39. In what portion of the shoulder jt do 9/10 people have their dysfunctions?
    suprahumeral portion
  40. The suprahumeral portion of the shoulder is also known as what?
    coracoacromial arch (composed of the acromion and coracoacromial ligament)
  41. What does the suprhumeral portion of the shoulder overlie?
    subacromial/subdeltoid bursa, supraspinatus tendon, portion of the muscles
  42. Inpingement syndromes of the suprahumeral portion of the shoulder occurs from what?
    compromise of the space from faulty m. action, faulty jt mechanics, or injury to soft tissue in the area

    need to be able to maintain this space
  43. What is the scapulohumeral rhythm?
    motion of scapula synchronous with motions of humerus allow for 150-180 degress of ROM of the shoulder into flexion or abduction with elevation
  44. What is the glenohumeral/scapular motion ratio?
    • 2:1
    • 2 gleno, 1 scapular
  45. How much elevation of the clavicle occurs at the SC joint with upward scapular rotation?
    30 degrees
  46. What must happen while abducting the arm for the humerus to clear the coroacromial arch?
  47. What are the 2 main things you need to focus on with a shoulder pt?
    • posture
    • retrain rotator cuff
  48. What can happen to soft tissues if the deltoid moved the humerus upward unopposed?
    impingement of the soft tissues within the suprahumeral space (between the humeral head and corocoacromial arch
  49. What does the combined effect of the rotator cuff muscles do for the shoulder?
    causes a stabilizing compression and downward translation of the humerus and the glenoid
  50. Together, the rotator cuff and deltoid couple together to perform what action?
    abduction of the humerus
  51. What GH disorder causes the development of adhesions and capsular patterns?
    idiopathic frozen shoulder (adhesive capsulitis)

    • could be caused from a provoking chronic inflammation in a mechanism such as the rotator cuff, biceps tendon, or joint capsule
    • no normal scapulohumeral rhythm
  52. What type of conditions in the AC/SC joints normally arise from overuse syndroms?
    arthritic or post traumatic
  53. Whats the difference between a subluxation and a dislocation?
    subluxation- shoulder sits low in the joint, like a mini dislocation

    dislocations- completely out of socket
  54. What are subluxations/dislocations normally caused by?
    falling against the shoulder or outstretched arm

    clavicular fractures may also result from the same sort of fall (AC joint separation)
  55. What disorder results in a painful arc with overhead reaching, when the rotator mm. start to kick in?
    supraspinatus tendonitis (75-120 ish degrees)
  56. What is infraspinatus tendonitis?
    painful arc with overhead or forward motions
  57. What is bicipital tendonitis?
    involves long head tendon and the bicipital groove beneath or just distal to the transverse humeral ligament

    pain occurs with exertion of the forearm in a supinated position while the shoulder is flexing and on palpation of the bicipital groove

    complain of pain in shoulder, not muscle belly
  58. What disorder has symptoms the same as supraspinatus tendonitis?
    bursitis (subdeltoid or subacromial)

    once inflammation is under control, there are no symptoms with resistance
  59. What may be the cause of shoulder instability/subluxation?
    result of joint laxity, but usually related to rotator cuff fatigue and inadequate dynamic stabilizing mechanisms of rotator cuff and long head of biceps

    strengthen muscles
  60. With aging, what rotator cuff tendon is vulnerable to impingement or stress from overuse strain?
    distal portion of supraspinatus tendon
  61. What do pts with rotator cuff tears normally experience?
    with degenerative changes, calcification and eventual tendon rupture may occur

    pain, and most commonly weakness of shoulder abduction and external rotation
  62. What are the characteristics of traumatic anterior shoulder dislocation?
    • complete separation of articular surfaces caused by indirect/direct force
    • normally occurs while arm is in abduction and ER

    • humeral head normally rests in the subcorocoid region
    • usually associated with complete rupture of the rotator cuff
  63. With recurrent shoulder dislocations, if a patient has had surgery, what should you not do?
    aggressively stretch
  64. What are some symptoms of thoracic outlet syndrome?
    pain, parasthesia, numbness, weakness, discoloration, swelling, ulceration, gangrene in the related upper extremity
  65. What are some causes of thoracic outlet syndrome?
    • cervical nerve roots may be compressed in foramina of vertebra
    • proximal portion of brachial plexus of the subclavian artery may be compressed as they course thru scalene mm.
    • brachial plexus and subclavian artery and vein may be compressed against first rib or cervical rib as they course under the clavicle

    adsons test helps detect
  66. What are the characteristics of complex regional pain syndrome (reflex sympathetic dystrophy/shoulder hand syndrom)?
    • sympathetic and parasympathetic systems go haywire
    • nerves are not getting stimulated properly as it heals
    • persistent painful lesion, such as painful shoulder after a traumatic event (CVA, MI, fracture etc)
    • *make them use their limb
  67. What test determines whether the biceps tendon (long head) is stable in the bicipital groove?
    yergason test

    • ER pts arm and supinate and provide resistance
    • palpate the biceps tendon, if it pops out it is a positive test
  68. What test is used to determine if there are tears in the rotator cuff?
    drop test

    • fully abduct arm, ask pt to slowly lower it to their side (or give a little resistance)
    • if there are tears, the arm will frop from a position about 90 will not be able to slowly and smoothly lower their arm

    most common tear is the supraspinatus
  69. What is the test used to check for chronic shoulder dislocation?
    apprehension test for shoulder dislocation

    • abduct and ER arm
    • if shoulder is ready to dislocate the pt will have a look of apprehension or alarm and resist further motion
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shoulder lecture