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182 Cards in this Set
- Front
- Back
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what are the four articulations of the shoulder? |
glenohumeral, acromioclavicular, sternoclavicular, scapulothoracic |
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what is the bony geometry of the GH joint? |
convex on concave |
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is the GH joint designed for mobility or stability? |
mobility |
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what is the most commonly dislocated joint on the human body? |
glenohumeral joint |
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is the glenoid fossa larger superiorly or inferiorly? |
inferiorly (20% larger) |
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how much is the glenoid fossa retroverted and inclined? |
7 degrees retroverted, 4 degrees inclined |
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what muscle attached superiorly on the glenoid labrum? |
long head of the biceps |
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where does the GH joint capsule provide some stability? |
at the end-range of motion |
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what makes up the medial aspect of the GH joint capsule? |
glenoid rim |
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what makes up the lateral aspect of the GH joint capsule? |
anatomical neck of the humerus |
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what makes up the inferior aspect of the GH joint capsule? |
loose axillary fold |
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which aspect of the GH joint capsule is the thickest/strongest? |
anterior and inferior |
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when does the superior GH ligament limit motion and what does it limit? |
limits ER at 0 degrees of abduction |
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when does the middle GH ligament limit motion and what does it limit? |
limits ER at 45 degrees of abduction |
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when does the inferior GH ligament complex limit motion and what does it limit? |
all in 90 degrees of abduction: limits IR posteriorly, ER anteriorly, and axillary pouch inferiorly |
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what are the two acromioclavicular ligaments? |
superior and inferior ligaments |
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what are the two coracoclavicular ligaments? |
conoid and trapezoid ligaments |
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what is the only true articulation between the axial and appendicular skeleton? |
sternoclavicular joint |
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which joint of the shoulder is more of a physiological than an anatomical joint? |
scapulothoracic joint |
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what is the angle of the joint plane of the scapula? |
30-40 degrees anterior to the frontal plane |
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what is the bony geometry of the scapulothoracic joint? |
concave anterior scap moves on convex thoracic wall |
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what muscles make up the sternoclavicular joint? |
subscapularis and serratus anterior |
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what is the overall ratio for humerus:scapula motion? |
2:1 |
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what are the biomechanics of the shoulder with elevation? |
upward rotation, external rotation, and posterior tilt |
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how much does the clavicle move in elevation? |
70 degrees |
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what are red flags during a shoulder exam? |
cancer, infection, prolonged corticosteroid use, bilateral/multijoint symptoms, trauma, heart issues, lung issues, C or T spine issues |
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what is the more common shoulder pathology from in younger people? |
instability |
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what is the more common shoulder pathology from in older people? |
degeneration |
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what is the minimum score on the Beighton index indicating generalized hypermobility? |
4/9 |
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what is the main purpose of the rotator cuff? |
to center the humeral head on the glenoid |
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what is the definition of external impingement? |
repetitive, mechanical contact of the supraspinatus, long head of the biceps tendon, and/or subacromial bursa beneath the anteroinferior portion of the acromion |
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what causes primary external impingement? |
acromion shape or AC joint osteophyte |
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what are possible causes of secondary external impingement? |
rotator cuff weakness, scapular weakness, posterior capsule contracture, poor posture, GH instability, neurologic |
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what are the characteristics of a stage I secondary external impingement? |
edema and hemorrhage |
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what are the characteristics of a stage II secondary external impingement? |
tendonosis and fibrosis |
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what are the characteristics of a stage III secondary external impingement? |
bone spurs and tendon rupture |
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what are the signs of a stage I impingement? |
painful arc, tenderness over the greater tubercle, tenderness at the anterior acromion, + impingement test, ROM may be decreased because of swelling |
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what are the signs of a stage II impingement? |
all of the signs from stage I PLUS, soft tissue crepitus, catching with eccentric abduction in the critical zone, limitation in AROM & PROM |
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what are the signs of a stage III impingement? |
stage I & II signs PLUS weak abduction, weak external rotation, infra and supraspin atrophy, AC joint tenderness, biceps tendon involvement |
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what is internal impingement? |
posterior glenoid impingement |
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which type of impingement do throwing athletes most often get? |
internal |
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where in the ROM does internal impingement occur? |
GH joint 90/90 |
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what are the causes of internal impingement? |
GH instability, scapular weakness, posterior capsular contracture/GH IR deficit |
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what is GIRD? |
GH IR deficit; arc of total motion is the same, less internal rotation |
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how do you treat GIRD? |
posterior GHJ mobilization, sleeper stretch |
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what is the goal when treating GIRD? |
increase GHJ posterior capsulte extensibility |
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what are the symptoms of impingement? |
pain with overhead activity, shoulder pain at night (esp when laying on affected side), pain 2-5" below acromion on lateral aspect of arm, sudden onset with tearing sensation |
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what is the best test for impingement? |
Hawkins-Kennedy (SN 92%) |
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what are the three tests in the impingement test cluster? |
Painful arc, Infraspinatus, Hawkins-Kennedy |
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what are conservative treatments for impingement? |
cortisone injections/local modalities for inflammation, address posture, stretch posterior capsule, strengthen rotator cuff/scapular muscles |
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what is the surgical treatment for impingement? |
sub-acromial decompression (w/ or w/o distal clavicle resection) |
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which of the rotator cuff muscles is most commonly torn? |
supraspinatus |
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what are the four rotator cuff tear sizes? |
small (<1 cm), medium (1-3 cm), large (3-5 cm), and massive (>5 cm) |
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in which direction to rotator cuff tears tend to migrate? |
posteriorly |
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is surgery or conservative treatment better for acute rotator cuff tears? |
surgery |
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is surgery or conservative treatment better for chronic rotator cuff tears? |
conservative treatment because the tendon retracts |
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in addition to testing for a rotator cuff tear, what else can a shrug test diagnose? |
adhesive capsulitis |
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what does a positive ER lag sign indicate? |
full thickness tear |
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what are the three types of rotator cuff repair surgeries? |
open, micro-open, arthroscopic |
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how long post-op is the max protection phase of rotator cuff repair? |
0-6 weeks |
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how long post-op is the mod protection phase of rotator cuff repair? |
7-16 weeks |
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how long post-op is the min protection phase of rotator cuff repair? |
4 months + |
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what occurs during the max protection phase of rotator cuff repair? |
PROM, immobilized, NO active contraction of the shoulder |
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what occurs during the mod protection phase of rotator cuff repair? |
initiate strengthening exercises, restore full ROM |
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what occurs during the min protection phase of rotator cuff repair? |
advanced strengthening, prepare for return to activity |
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what does the Hawkins-Kennedy test look for? |
external impingement |
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what does the Neer's test look for? |
external impingement |
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what does the posterior internal test look for? |
internal impingement |
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how many degrees of abduction are required for the infraspinatus test? |
45 degrees |
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how many degrees of abduction are required for the teres minor test? |
90 degrees |
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what are the two tests for subscapularis tear? |
belly press and belly off |
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what does Yergason's test look for? |
long head of the biceps instability |
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what are the functions of the long head of the biceps? |
elbow flexor/decelerator, forearm supinator, shoulder flexor, humeral head depressor, humeral head stabilizer |
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what are two types of degenerative pathologies to the long head of the biceps? |
tendinosis (same as subacromial impingement syndrome) and rupture (tenodesis) |
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which direction does the biceps tendon typically sublux? |
medially |
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what is a SLAP lesion? |
superior labrum anterior posterior |
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what are the functions of the labrum? |
increase surface area and depth of the glenoid cavity, assist with restraining humeral head translation, serve as an attachment for LHB and GH ligs |
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what are symptoms of a SLAP lesion? |
pain, clicking/popping |
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what are common etiologies of SLAP lesions? |
compressive force, traction injury, peel-back (90-90 position), degeneration is more rare |
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where on the "clock" of the labrum do SLAP lesions occur? |
9-3 |
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what is a type I SLAP lesion? |
fraying and degeneration of labrum, but stable |
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what is a type II SLAP lesion? |
labrum and biceps anchor detached |
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what is a type III SLAP lesion? |
bucket handle tear |
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what is a type IV SLAP lesion? |
bucket handle tear extended into biceps |
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is conservative treatment or surgery better for a SLAP lesion? |
surgery |
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what are the four types of surgeries for a SLAP lesion? |
debridement, fixation of labrum, debridement and excision of bucket handle, labral repair |
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what two tests would be used to look for SLAP lesions in overhead athletes? |
pronated load, resisted supinated ER test |
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what is glenohumeral instability? |
motion of the humeral head which results in either subluxation or dislocation of the GHJ |
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at what age ranges are the peaks for GH instability? |
18-25 and 55-65 |
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what percentage of first time dislocations occur from a traumatic event? |
95% |
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the GHJ is typically unstable in which direction? |
anterior |
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what are the mechanisms of injury for GH instability? |
forced abduction/ER, FOOSH, direct blow posteriorly |
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what are the pathologies associated with traumatic anterior GH dislocations? |
TUUBS, "torn loose", anterior/inferior labrum torn from glenoid, Bankart lesion |
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what does TUUBS stand for? |
traumatic unilateral unidirectional bankart surgery |
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what percent of people with traumatic anterior GH instability/dislocation need surgery? |
70% |
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what injuries are associated with traumatic anterior GH dislocation? |
Hill-Sach's lesion, posterior capsular injury, rotator cuff tear, axillary nerve issues |
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what is a Hill-Sach's lesion? |
compression fracture to the posterior/lateral humeral head |
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how are patients with traumatic anterior GH dislocations immobilized? |
adduction and internal rotation |
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what occurs during phase I of conservative treatment for a traumatic anterior GH dislocation? |
acute motion: non-painful ROM, prevent muscular atrophy, decrease pain/inflammation |
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what occurs during phase II of conservative treatment for a traumatic anterior GH dislocation? |
intermediate phase: regain muscle strength, normalize arthrokinematics, improve neuromuscular control |
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what occurs during phase III of conservative treatment for a traumatic anterior GH dislocation? |
advanced strengthening phase: increased strength/endurance/power, improve neuromuscular control, prepare for return to activity |
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what occurs during phase IV of conservative treatment for a traumatic anterior GH dislocation? |
return to activity phase: maintain strength/power/endurance, return to sport/activity |
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what is a Bankart procedure? |
reattachment and tightening of the torn labrum |
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what are the pros of arthroscopy for traumatic GH dislocation? |
less dissection, less operating time, less blood loss, better cosmesis, less pain/pain meds, easier to regain ROM, earlier return to work |
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what are the cons of arthroscopy for traumatic GH dislocation? |
more technically demanding, higher recurrence rate |
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who are ideal candidates for Bankart surgery? |
well-defined and recent Bankart lesion, no signs of instability in other directions, overhead athlete, generally not recommended for return to contact sports |
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what occurs during the max protection phase of Bankart rehab? |
ice, work on elbow/wrist/hand, AAROM, submax isometrics |
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what occurs during the mod protection phase of Bankart rehab? |
gentle stretching, restore ROM by 12wks, progress to general strengthening |
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what occurs during the min protection phase of Bankart rehab? |
progressive strengthening, functional exercises |
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what are the pathologies associated with atraumatic GH instability? |
AMBRI, "born loose", most have not formally dislocated, instability in multiple directions |
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what does AMBRI stand for? |
atraumatic multidirectional bilateral rehab inferior capsular shift |
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is it better to treat atraumatic instability conservatively or with surgery? |
rehab! (70% response rate) |
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what are the symptoms of atraumatic GH instability? |
painful/sore shoulder, "slipping" of shoulder, pain with ADLs |
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what are etiologies of atraumatic instability? |
congenital or acquired (ex from swimming/throwing) |
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what anatomically causes atraumatic instability? |
oversized inferior pouch, large rotator interval opening |
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what is the rotator interval? |
inferior aspect of supraspinatus, superior aspect of subscapularis, coracoid and long head of biceps |
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what surgery can be used to treat atraumatic GH instability? |
capsular shift with or without rotator interval closure |
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what is a vulnerable position for someone with posterior GHJ instability? |
flexion, IR, horizontal adduction |
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what do posterior GHJ dislocations result from? |
seizures (most common), electrocution, FOOSH |
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what is the pathophysiology associated with posterior GHJ instability? |
pushing weight posteriorly |
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what are the two tests used for identifying posterior GHJ instability? |
jerk test and posterior apprehension |
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what are the symptoms of adhesive capsulitis? |
pain, decreased ROM |
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what are the three stages of adhesive capsulitis in order? |
freezing, frozen, thawing |
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does adhesive capsulitis usually occur in one shoulder or both? |
one |
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what is the etiology of adhesive capsulitis? |
unknown |
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what is the capsular pattern of the shoulder? |
ER > abduction > IR |
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what are the conservative treatments for the freezing stage of adhesive capsulitis? |
corticosteroid injection/oral steroids, gentle physical therapy |
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what are the conservative treatments for the thawing stage of adhesive capsulitis? |
vigorous mobilization/stretching, scapular mechanics |
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what are the surgical treatments for adhesive capsulitis? |
manipulation under anesthesia, arthroscopic release |
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what are post-op requirements for adhesive capsulitis? |
ice, meds, immediate motion, in-clinic treatment 5x/week |
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what shoulder joint injury is referred to as "shoulder separation?" |
AC joint |
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what causes an AC joint injury? |
downward fall with arm in adducted position |
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what are two symptoms of AC joint injury? |
pain local to the joint, C4 dermatome issues |
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what percentage of shoulder dislocations occur in the AC joint? |
12% |
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which grade of AC joint injury is the most common? |
grade I |
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which grade of AC joint injury is a slight dislocation of the joint with the AC ligament stretched or partially torn? |
grade I |
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which grade of AC joint injury is a complete tear of the AC ligament? |
grade II |
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which grade of AC joint injury is a complete tear of the AC ligament, coracoclavicular ligaments, and the joint capsule? |
grade III |
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which grade of AC joint injury is an elevated clavicle apparent on observation |
grade III |
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which grade of AC joint injury is an avulsion fracture of the coracoclavicular ligament from the distal clavicle? |
grade IV |
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which grade of AC joint injury is a grade III with greater displacement of the clavicle from the scapula? |
grade V |
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which grade of AC joint injury is a grade III in which the distal clavicle ends up inferior to either the coracoid or acromion process? |
grade VI |
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which grades of AC joint injury require surgical intervention? |
grades IV, V, and VI |
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in what population is osteolysis common? |
weight lifters |
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what is osteolysis? |
repetitive microtrauma where osteoclasts resorb bone |
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what are the three surgical procedures that can be done on an AC joint? |
Mumford DCR or DCE, Weaver-Dunn, or Anatomic reconstruction |
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how do you test the AC joint? |
passive horizontal adduction and resisted horizontal abduction |
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what percentage of proximal humeral fractures are minimally or non-displaced? |
80-85% |
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how does one get a proximal humeral fracture? |
FOOSH from standing |
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what population is at greater risk for proximal humeral fractures? |
older, osteoporotic patients |
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what nerve may get damaged from a proximal humeral fracture? |
axillary nerve |
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what is the overall goal when treating a proximal humeral fracture? |
restore rotator cuff function |
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how do you treat a non-displaced proximal humeral fracture? |
sling, early ROM |
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how do you treat a displaced proximal humeral fracture? |
2 & 3 part - ORIF, 4 part - hemiarthroplasty |
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how does one get a mid-shaft humeral fracture? |
blunt trauma |
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if the patient is ambulatory, how do you treat a mid-shaft humeral fracture? |
conservatively |
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if the patient is not ambulatory, how do you treat a mid-shaft humeral fracture? |
with surgery |
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what type of brace is used for patients with mid-shaft humeral fractures? |
Sarmiento brace |
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what are two complications associated with mid-shaft humeral fractures? |
radial nerve palsy, non-union |
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what can be damaged with a clavicle fracture? |
major blood vessels, brachial plexus, lungs |
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what location of clavicular fracture is most common? |
mid-clavicular |
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where do type I clavicular fractures occur? |
between the coracoclavicular ligament and the coracoid |
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where do type IIA clavicular fractures occur? |
proximal to the coracoclavicular ligaments |
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where do type IIB clavicular fractures occur? |
between the ligaments, involved conoid ligament tear |
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where do type III clavicular fractures occur? |
small chip distally |
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which gender typically fractures their clavicle more often? |
males |
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how does one acquire a clavicular fracture? |
FOOSH, direct clavicular trauma |
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how are clavicular fractures treated? |
sling immobilization for 6-8 weeks |
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what are indications for a total shoulder arthroplasty? |
OA, RA, humeral head fracture, osteonecrosis, infection, tumor |
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what are the goals of a total shoulder replacement? |
decrease pain, increase function |
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what are the contraindications for a total shoulder replacement? |
sepsis/local (active) infection, loss of deltoid and rotator cuff, bony deficiency (osteoporosis) |
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what is the surgical approach for a total shoulder replacement? |
anterior |
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which of the rotator cuff muscles are not left intact in a total shoulder arthroplasty? |
subscapularis |
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how long do patients stay in the hospital after a total shoulder replacement? |
1-3 days |
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how long are patients non-weight bearing following a total shoulder replacement? |
6 weeks |
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what shoulder motion is restricted following total shoulder arthroplasty? |
ER |
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what are possible complications of a total shoulder replacement? |
stiffness, instability, infection, loosening, subscapularis rupture, fracture, component wear |
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how long does a total shoulder replacement last? |
about 15 years |
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what elevates the arm following a reverse total shoulder replacement? |
deltoid |
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why would a reverse total shoulder arthroplasty be performed? |
severe DJD or no rotator cuff function |
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what is a main complication from reverse total shoulder replacement? |
scapular notching |
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do regular or reverse total shoulder replacements have a higher complication rate? |
reverse total shoulder replacements |
