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77 Cards in this Set
- Front
- Back
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What are 3 general ways that shoulder dysfunctions are classified?
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1) overuse/injury
2) decreased motion 3) increased motion |
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What things are included in an overuse/injury category to the shoulder?
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tendinitis, bursitis, impingement, RC tear
**accompanied by localized inflammation |
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What things are included in the decreased motion category?
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frozen shoulder (adhesive capsulitis), arthritis, tight muscles, scapular weakness (only active one)
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What is included in increased motion at the shoulder?
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instability and traumatic dislocation
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What do decreased motion and increased motion have in common (that differs from an overuse/injury)?
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they pertain to a CT dysfunction
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What is an overuse injury at the shoulder?
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a misuse or repetative strain injury (RSI)
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What is the general progression of an overuse injury?
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overuse --> impingement --> bursitis --> tendinitis --> partial RTC tear --> full RTC tear
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What is a pain pattern in the acute phase?
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pain occurs with motion and with most activities
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What is a pain pattern in the repair phase?
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pain during resistance
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What is a pain pattern in the maturation phase?
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pain with overpressure
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What happens when a person carries a briefcase?
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the coracohumeral ligament tightens and resists inferior translation and anterior translation
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Where does impingement generally occur?
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anterior lip of the acromion
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During scapular movement how do the SC joint and AC joint coordinate movement?
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SC joint elevates between 0-90 degrees and the AC joint upwardly rotates during 90-180 degrees
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How much do the SC/AC joints move together?
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30 degrees apiece for a total of 60 degrees
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During the motion of abdution what is the ratio of humerus to scapular motion?
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2:1 (humerus to scapula)
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How many degrees do the humerus and scapula move during abduction?
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120 degree of humerus and 60 degrees of scapula (half SC, half AC)
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What are some kinematics of elevation that are not normal in a person with impingment?
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-decrease in UR of scapula
-increase clavicular elevation (UT compensate for impinged shoulder) -increase IR of scapula -increase superior and anterior GH translation (goes into the acromion) |
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1) During shoulder abduction what does the clavicle do?
2) How much? 3) In what phase? |
1) posteriorly rotates
2) 40 degrees 3) in the late phase of abduction |
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Why does the clavicle rotate during the late phase of abduction?
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SA UR the scapula and coracoclavicular ligament is taut -- this rotates the clavicle between 30-50 degrees
**this is how the AC joint can get full UR |
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Name two force couples that if imbalanced may cause impingment?
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1) supraspinatus - deltoid
2) upper/lower traps and SA |
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Describe supraspinatus/deltoid muscle imbalance.
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weak supraspinatus, deltoid overpowers the supraspinatus and the head of the humerus collides with acromion (fails to inferiorly glide)
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Describe UT/LT and SA muscle imbalance.
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SA is weak, compensation by elevating the shoulder with UT to accomplish UR (SA normally does this)
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What causes supraspinatus weakness?
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tear, disuse, fatigue
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IR of scapula (as with bad posture) puts tension on what structure?
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suprascapular nerve (this causes weakness of the supraspinatus m)
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What muscles does the suprascapular nerve innervate?
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supraspinatus, infraspinatus
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Which muscles act to lower the medial side of the scapula back to the thorax? (ER of scapula)
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mid and lower traps (scapular stabilizers)
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What does SA do to the scapula?
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attaches to anterior side, holds medial side down (no winging), also a scapular rotator (UR)
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What happens when lower trap is weak?
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there is a decreased ability to UR scapula
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What is the ONLY trap muscle to rotate the scapula?
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lower traps
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How does tightness of the pec minor affect scapular movement?
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holds scapula down to the glenoid fossa due to its attachment to the coracoid process
**DR of the glenoid fossa |
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What happens at the beginning of shoulder abduction with regard to scapulohumeral rhythm?
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Beginning -- 30 degrees of humerus, no scapula
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What happens at the middle of shoulder abduction with regard to scapulohumeral rhythm?
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40 degrees of humerus and 20 degrees of scapula, clavicle elevates 15 degrees
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What happens at the end of shoulder abduction with regard to scapulohumeral rhythm?
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60 degrees of humerus (abduction accompanied by ER), 20 degrees of scapula, 30-50 degree of clavicular posterior rotation (some elevation)
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How does posture affect impingement?
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rounded shoulders DR of glenoid fossa, also the coracohumeral ligament is slack
**Reverses the scapulohumeral rhythm |
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What is the function of the supraspinatus?
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compresses the head of the humerus into the glenoid fossa, some superior glide, and ER
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What is the function of the deltoid?
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rotation and superior glide
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What is the function of subscapularis, infraspinatus, teres minor?
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compression of humeral head into the glenoid fossa and inferior glide (important to avoid impingment)
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What degrees through the abduction range is the SA most active?
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120-150
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What are 5 structural causes of impingment?
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1) anatomy of the cuff
2) shape of the acromion 3) encroachment of subacromial space 4) capsular stiffness 5) relationship between the coracohumeral ligament and the supraspinatus |
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What part of the capsule is usually stiff that causes impingment?
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posterior/inferior portion
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What structures are in the critical zone?
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supraspinatus, biceps tendon, greater tuberosity, subacromial bursa, and superior/GH ligaments
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How does the shape of the acromion affect impingment?
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it can decrease the already limited space -- type 3 is the worst (hooked)
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With capsular stiffness what glides are lacking?
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doesn't spin or glide inferior due to tightness in that part of the capsule so it hits acromion
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What is the anatomical relationship between the coracohumeral ligament and the supraspinatus?
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they share fascial connection, problems with one causes problems in other structures
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Localized pain indicates:
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not severe, superficial
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Diffuse pain location indicates:
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severe, deeper problem
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If pain patterns follow a dermatome:
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nerve root impingment
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Scleratome pain location:
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more diffuse
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Visceral pain is...
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more diffuse but segmental
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Sharp/localized pain indicates:
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superficial lesion
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Sharp/shooting pain:
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nerve root
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Tingling:
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if it's segmental -- nerve root
bilateral means spinal cord or something more serious (than the segmental tingling) |
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Dull or aching pain:
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deep somatic structures
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Excruciating, unrelenting, intolerable, deep, boring pain:
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severe lesion
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Changing quality of pain indicates:
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evidence for success in treatment
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What eases MS pain?
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rest (and activity aggrevates it)
**non-MS doesn't follow this pattern |
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What eases a disk problem?
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walking eases, sitting aggrevates
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When you see pain or stiffness in the morning, what do you suspect?
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Arthritis
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What kind of night pain is okay and what kind isn't?
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pain when you roll on the shoulder that you can fall back asleep is okay
generalized pain is more suspicious |
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What are characteristics of gall bladder problems?
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-R shoulder
-associated with meal intake -RUQ pain -not associated with movement |
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What might make you suspect a MI or coronary insufficiency?
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-pain in L shoulder, jaw, arm
-SOB -sweating |
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How does Herpes Zoster present?
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-unilateral along a dermatome
-burning pain -lesions |
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What are Sxs of an aortic aneurysm?
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-tearing pain
-pain between shoulder blades -smoker, HTN |
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Characteristics of a pancoast tumor (lung cancer)
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-pain sensory changes from shoulder down UE
-significant weight loss |
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What Sxs might make you suspect a herniated disc?
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-radiculopathy/paresthesia
-muscle weakeness -dermatome/myotome distribution |
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Tell me about pancreatitis.
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-L shoulder pain
-after alcohol intake -radiate to back -vomit |
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And FINALLY -- the liver. How do problems present?
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R shoulder pain with no (+) MS findings
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Differential Dx: What is associated with the L shoulder?
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1) MI/coronary insufficiency
2) pancreatitis |
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Differential Dx: What is associated with the R shoulder?
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1) Gall Blader
2) Liver |
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What might you suspect if a pt complains of pain between the shoulder blades?
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AA (aortic aneurysm)
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What might you suspect if you find lesions along a dermatomal pattern on one side of the body?
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herpes zoster
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What might you suspect if your pt recently had a weight loss and has pain and sensory changes beginning in the shoulder and going down the UE?
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pancoast tumor (lung cancer)
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If your patient is SOB and is experiencing pain the L shoulder, jaw or arm what might you suspect?
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MI
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If your patient has pain in the R shoulder after eating what might you suspect?
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gall bladder
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If your patient is experiencing muscle weakness and parasthesia along a dermatome or myotome distrubution what might you suspect?
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herniated disc
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If a pt complains of L shoulder pain, nausea and vomiting, specifically after alcohol intake (pain radiates to back) what might you suspect?
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pancreatitis
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If your pt has R shoulder pain but you can't reproduce any MS findings what could you suspect?
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liver
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