The glenohumeral joint trades joint stability for:
The glenohumeral joint trades joint stability for: increased range of motion
the sternum, thorax, clavicle, and the scapula for a _______________ that must fxn in unison to produces the desired glenohumeral motion.
the sternum, thorax, clavicle, and the scapula for a closed kinetic chain that must fxn in unison to produces the desired glenohumeral motion.
Dysfxn within this chain will produce dysfnx at the other segments, including the glenohumeral joint
during overhead motions, the scapula must provide:
during overhead motions, the scapula must provide: a stable base of motion
weakness of he scapular msucles leads to subtle, unwanted motions that alter the mechanics and increases:
weakness of he scapular msucles leads to subtle, unwanted motions that alter the mechanics and increases: the energy expenditure in overhead motions
why is there a vicious cycle that exists between rotator cuff tendinopathy, rotator cuff impingement, and rotator cuff tears?
one of these conditions inevitably leads to another
a differential diagnosis must be made between which 3 injuries:
insidious AC joint trauma
bicipital tendinopathy
and superior labral anterior to posterior lesions (SLPA)
which ligaments stabilized the sternoclavicular joint?
anterior and posterior sternoclavicular ligaments
costoclavicular ligament
interclavicular ligament
what movements does the acromioclavicular joint contribue to:
internal and external rotation around a verticle axis
upward and downard rotation around a axis perpendicular to the plane of the scapula
anterior and posterior scauplar tipping around a horizontal axis
list and describe the ligaments that support the AC joint:
AC ligament
divided into 2 seperate bands: superior and inferior
prevents calvicle from riding up over the acromion process
coracoclavicular ligamentsuspend the scaupla from the clavicle
most of the AC joints intrinsic stability arises from this ligament
divided into 2 portions: trapezoid ligament and conoid ligament
what is the cause for the common misconception that the "tip of the shoulder" is synonymous with the the AC joint?
the most lateral portion of the acromion hooks around medially to articulate with the clavicle
how can you palpate the coracoid process:
passively moving the pt's GH joint through 15 to 30 degrees off abduction-adduction
what ligaments and muscles attach on the coracoid process:
ligamentscoracohumeral ligament
coracoacromial ligament (posterior portion)
musclespectoralis minor
coracobrachialis
short head of the beceps brachii
what actions do the pectoralis major (5 actions) and minor perform?
pectoralis majorADD the humerus
Horizontal ADD the humerus
humeral flexion
internal humeral rotation
depress the shoulder gridle
pectoralis minorforward (anterior) titling
where do the heads of the biceps originate:
long head: supraglenoid tuberosity of the scapula
short head: coracoid process of the scapula
what are the actions performed by each of the 3 divisions of the deltoid:
anterior deltoidflexion
ABD
horizontal ADD
internal roation
middle deltoidABD
flexion
posterior deltoidextension
horizontal ABD
ABD
external rotation
what actions does the biceps perform at the shoulder:
flexion
ABD
where does the long head of the triceps brachii insert?
infraglenoid tubercle
what actions does the triceps perform at the shoulder?
extension (long head)
ADD
which rotator cuff muscle belly is not palpable?
subscapularis muscle
what motions does the latissimus dorsi perform at the GH joint?
extension
internal rotation
ADD
depression of shoulder girdle
the medial spine of the scapula is approximately located at teh level of the:
the medial spine of the scapula is approximately located at teh level of the: 3rd throacic vertebrae
what is the origin of the levator scapulae:
transverse processes of C1-C4
do the rhomboids rotate the scapula in an upward or a downward direction?
downward rotation
the condition involves the clavicle riding above the acromion process, indicating an AC sprain is called:
step- off deformity
bobbing of the clavicle when downward pressure is applied is called:
piano key sign
the presences of the inferior angle lifting away from the thorax is called:
what is pathology caused by:
winging scapula
caused by: weakness of the serratus anterior or inhibition of the long thoriacic nerve
a congenitally undecended, or high riding, scapula is called:
sprengle's deformity
with overhead throwing athletes the arm position that produces pain and throwing deficits yeild information regarding the possible underlying pathology:
pain on the follow thru:
pain in cocked position:
pain in deceleration:
loss of control and/or velocity:
pain on the follow thru: possible rotator cuff patholgy
pain in cocked position: instability or impingement
pain in deceleration: SLAP lesion, biceps tendon pathology
loss of control and/or velocity: internal impingement, limitation in external roation
complete clavicular fx are indicated by:
where do these fxs usually occur:
how do patients tend to present with clavicular fxs:
complete clavicular fx are indicated by:gross defomity of the clavicular shaftwhere do these fxs usually occur: between the concave/convex (distal third of the shaft)how do patients tend to present with clavicular fxs: tend to suppor the involved arm next to the body and rotate the head to the opposite side
atrophy of the deltoid muscle group may indicate a lack of use in the involved are or may reflect pathology to which nerve roots:
C5 and C6 (axillary nerve involvement)
dislocations of the sternoclaicular joint tend to displace the clavicular head:
describe why a posterior SC joint dislocation are a medical emergency:
list the structures that are potentially threatened with a posterior dislocation:
dislocations of the sternoclaicular joint tend to displace the clavicular head: medial and superior to the clavicular notch
describe why a posterior SC joint dislocation are a medical emergency:may jeopardize the integrity of the neurovascular structures directly posterior to the joint
or
place pressure on the trachea, lung or both
potential threatssubclavian artery
subclavian vein
treachea
esophaugs
how would you position a pt. to make the inferior angle of the scapula more prominate:
ask the pt. to touch the inferior angle of the opposite scapula from below, causing the scapula undergoing examination to wing and making the inferior angle more easily palpable.
which muscle is a common trigger point in swimmers and in athletes who participate in sports with overhead movements:
teres major
pro baseball players do not display a significant difference in the amount of peak torque produced during internal rotation when compared bilaterally, so when does a signifiant difference arise?
high speed (greater than or equal to 300 degrees per second) during external rotation, with the dominate arm producing more torque
list the following ROMS:
GH flexion:
Elevation thru flexion:
GH extension:
how much is the shoulder complex capable of producing thru flexion- extension in the sagittal plane:
GH Flexion: 0-120 degrees
elevation thru flexion: 0- 180 degrees
GH extension: 0 - 60 degrees
how much is the shoulder complex capable of producing thru flexion- extension in the sagittal plane: 220 - 240 degrees
list the following ROMS...
GH Abduction:
Elevation thru Abduction:
GH Abduction: 0 - 120 degrees
elevation thru abduction: 0 - 180 degrees
adduction is blocked in the anatomical position and further movement requires that the GH joint flexed or extended so the humerus can pass the torso
list the following ROMS...
internal rotation:
external rotation:
internal rotation: 0 - 90 degrees
external rotation: 0 - 100 degrees
list the following ROMS...
horizontal ABD:
horizontal ADD:
horizontal ABD: 0 - 90 degrees
horizontal ADD: 0 - 50 degrees
drop arm test for rotator cuff tendinopathy..
patient position:
positive test:
implications:
the drop arm test determins the pt's ability to control humeral motion via eccentric contraction ad the arm is slowly lowered from a full ABD to ADD
patien position: humerus full ABD and externally rotated and the forearm supinated
positive test: the arm falls uncontrollably from a position of approximaltely 90 degrees ABD to the side
implication: indicative of lesions to the rotator cuff, especially the supraspinatus
gerber lift -off test for subscapularis pathology...
patient position:
positive test:
implications:
gerber lift-off is a modificiation of a subscapularis manal muscle test
patien position: standing with the humerus internally rotated, the dorsal surface of the hand placed against the midlumbar spine
positive test: inability to lift the hand off the back
implications: tears or weakness of the subscapularis muscle, possible C5, C6, C7 nerve root pathology
patients who present with equal limitations in active and passive ROM may have "frozen shoulder", known as:
adhesive capsulitis
describe the following gelnohumeral joint capsular patterns and end-feels:
apprehension test for anterior glenohumeral laxity:
patient position:
positive test:
implications:
the apprehension test, passive external rotation of the glenohumeral joint, places the joint in the closed pack position and replicates the mechansim of injury for anterior GH dislocations
pt position: the GH joint is ABD to 90 degrees and the elbow is flexed to 90 degrees
positive test: the pt. displays apprehension that the shoulder may dislocate, resist further movement. pain is centered in the anterior capusle of the GH joint
implications: anterior capsule, inferior GH ligament, or glenoid labrum have been compromised, allowing the humeral head to disolocate or subluxate anteriorly on the glenoid fossa
the GH joint is palpated during passive internal/external rotation to determin the presence of:
crepitus: may indicate rotator cuff or bicipital tendinitis and subacromial bursitis
clicks: labral tear
Pain at the end-range of horizontal ADD is assoicated with which pathology:
restriction in passive horizontal ADD may be indicitative of:
Pain at the end-range of horizontal ADD is assoicated with which pathology: AC joint pathology
restriction in passive horizontal ADD may be indicitative of: glenohumeral impingement
applying a gliding pressure that forces the medial clavicle downward, upward, anteriorly, and posteriorly relative to the sternum... describe the structures stressed with each motion:
inferior: interclavicular ligament
superior: costoclavciular ligament (anterior and posterior fibers)
anterior: SC ligament (posterior)
posterior: SC ligament (anterior)
apply a gliding pressure that forces the distal clavicle downward, upward, anteriorly, and posteriorly relative to the scapula for AC joint play.... describe the structures stressed with each motion:
inferior: AC ligament (superior fibers)
superiorconoid ligament (portion of the coracoclavicluar)
trapezoid ligament (portion of the coracoclavicular)
AC ligament (inferior fibers)
anteriorAC ligament
coracoclavciluar ligament (in the absence of the AC ligament)
explain why laxity and instablity are not synonymous:
a lax shoulder can still be fxnally stable.
an unstable shoulder may not demonstrate laxity.
describe the implications of GH joint play if hyper or hypomobility is found in each of the following...
inferior:
anterior:
posterior:
inferiorinferior joint capusle
superior GH ligament
coracohumeral ligament
anteriorcoracohumeral ligament
superior and middle GH ligaments
anterior joint capsule
posterior
posterior joint capusle
labrum tear
list to MOI for a sternoclavicular joint dislocation:
force applied longitudinally to the clavicle, such as falling on an outstretched arm, or forceful distraction of the arm and distal shoulder complex
indirect mechanisms include anterior or posterior forces exerted on the anterolateral or posterolateral shoulder
the similarities in the signs and symptoms of an SC joint sprain or dislocation and those associated with an epiphyseal injury are simliar, known as:
pseudo-dislocation
injuries to the growth plate must be ruled out in patiens younger than 25 y/o
list 3 MOI for an AC joint patholgoy:
landing on a foward-flexed outstretched arm or the point of the elbow, which drives the scapula posterior to the clavicle
a blow the the superior acromion process, which drives the scapula inferior to the clavicle
a force that drives the clavicle away from the scapula when the scapula is fixated
describe the structures involved in the following grades of AC joint sprain:
Type I:
Type II:
Type III:
Type IV:
type Islight to partial damage of the AC ligament and capusle
signs: point tenderness, no laxity or deformity
type IIrupture of the AC ligament and partial damage to the coracoclavicular ligament
signs: slight laxity and deformity, slight step deformity
Type IIIcomplete tear of AC and coracoclavicular ligaments; possible involvement of deltoid and trapezius fascia
signs: obvious dislocation at distal end of the clavicle from acromion process
type Iv:complete tear of the AC and coracoclavicular ligaments and tearing of the deltoid and trapezius muscles
signs: posterior clavicular displacement into the insertion of the upper fibers of the trapezius
acromionclavicular traction test...
patient position:
positive test:
implications:
patient position: the arm hanging naturally to the side
positive test: humerus/scapula move inferior to the clavicle, causing a step deformity, pain or both
implications: sprain of the AC or coracoclavicular ligament
acromionclavicular compression test..
patient position:
positive test:
implications:
attempts to displace the clavicle over the acromion process, stressing the coracoclavicular ligament
patient position: arm hanging naturally at the side
positive test: pain at the AC joint or excursion fo the clavicle over the arcomion process
implications: damage to AC or coracoclavicular ligaments
what is known as the indented superior region of the manubrium?
A. jugular notch
which ligament is responsible for restricting superior movement of the clavicle at the AC joint:
B. conoid ligament
injury to what nerve woould be indicated by scapular winging?
A. long thoracic nerve
a weakness of which muscle in the shoulder complex can result in scapular winging?
B. serratus anterior
for which muscle does the coracoid process serve as the point of insertion?
A. pectoralis minor
what is GH instablity caused by:
D. all of the above
tears most commonly occur in which rotator cuff msucle:
A. supraspinatus
list the ligament that limits humeral motion in the following position...
external roation in 0 degrees abduction:
superior GH ligament
coracohumeral ligament
list the ligament that limits humeral motion in the following position...
external rotation in 45 degrees of ABD:
middle GH ligament
anterior band of the inferior GH ligament
list the ligament that limits humeral motion in the following position...
external rotation in 90 degrees in ABD:
inferior GH ligament
list the ligament that limits humeral motion in the following position...
internal rotation in 90 degrees ABD
posterior band of the inferior GH ligament
list the ligament that limits humeral motion in the following position...
inferior displacement in 0 degrees ABD:
superior GH ligament
corachohumeral ligament
list the ligament that limits humeral motion in the following position...
inferior displacement in 90 degrees of ABD:
inferior GH ligament
the inferior GH ligament may be avulsed from the labrum or may be avulsed along with a portion of the labrum forming a:
bankart lesion
a defect in the posterior humeral head's articular cartilage caused by the impact of the humeral head on the glenoid fossa as the humerus attempts to relocate is called:
hill sachs lesion
a common MRI finding assoicated with anterior GH dislocations
lesions found on the anterior portion of the humeral head after a posterior dislocation are called:
reverse hill-sachs lesions
posterior aprehension test for glenohumeral laxity:
patient position:
positive test:
implication:
the humeral head is moved posterioly on the glenoid fossa.
patient position: sitting or supine; shoulder flexed to 90, and elbow flexed to 90
positive test: pt displays apprehension and produces muscle guarding to prevent the shoulder from subluxating posteriorly
implication: lax posterior GH capsule, torn posterior labrum
sulcus sign for inferior glenohumeral laxity...
patient position:
positive test:
implications:
determins the amount of inferior glide of the humeral head when traction is applied to the humerus.
patient position: arm hanging at side
positive test: indentation (sulcus) appears beneath acromion process
implications: laxity in the superior GH ligament
grade I: 1cm or less
grade II: 1-2 cm
grade III: greater than 2 cm
list the 5 muscles that contribute to scapular elevation:
levator scapulae
rhomboid major
rhomboid minor
serratus anterior (upper portion)
trapzeius (upper portion)
list the 1 muscle that contributes to scapular protraction:
serratus anterior
list the 2 muscles that contribute to scapular upward rotation:
serratus anterior
trapeizus (upper and lower portion)
list the 3 muscles that contribute to scapular depression:
serratus anterior (lower portion)
trapezius (lower portion)
pectoralis major ( claviclar portion)
list the 4 muscles that contribute to scapular retraction:
rhomboid major
rhomboid minor
trapezius (middle fibers)
trapezius (lower fibers)
list the 4 muscles that contribute to scapular downward rotation:
rhomboid major
rhomboid minor
levator scapulae
trapezius (lower portion)
list the 5 muscles that contribute to humeral flexion:
biceps brachii
coracobrachialis
deltoid (anterior 1/3rd)
deltoid (middle 1/3rd)
pectoralis major (clavicular fibers)
list the 4 muscles that contribute to humeral extension:
deltoid ( posterior 1/3rd)
latissimus dorsi
teres major
triceps brachii (long head)
list the 5 muscles that contribute to humeral ADD:
coracobrachialis
latissimus dorsi
pectoralis major
teres major
triceps brachii
list the 5 muscles that contribute to humeral ABD:
biceps brachii
deltoid (anterior)
deltoid ( middle)
deltoid (posterior)
supraspinatus
list the 2 muscles that contribute to humeral horizontal ADD:
deltoid (anterior)
pectoralis major
list the 3 muscles that contribute to humeral horziontal ABD: