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42 Cards in this Set
- Front
- Back
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Describe the joints of the shoulder girdle:
- sternum - clavicle - scapula - humerus |
- sternum - pivot/anchor
- clavicle - strut - scapula - lever & pulley - humerus - lever |
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What are the motions of the scapula?
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elevation/depression
protraction/retraction up/downward rotation |
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What is necessary to keep the GH joint in position of maximum stability?
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scapular rotation
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Describe the glenohumeral joint & its motions
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- ball & socket (head 3x larger than glenoid fossa)
- 3 planes of movements - flexion/extension - abduction/adduction -internal/external rotaiton |
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Lits the rotator cuff muscles & areas of attachment
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- supraspinatous
- infraspinatous - teres minor (all attach in order on greater tuberosity) - subscapularis - lesser tuberosity |
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This muscle is the primary mover of the shoulder in flexion & abduction
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deltoid
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These help position scapula & orient glenohumeral joint. Also contribute to compressive force across joint
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peri-scapular muscles
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This is a secondary stabilizer as it forms part of the coracoacromial arch
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coracoacromial ligament
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What is the origin/insertion/function of the coracohumeral ligament. Becomes taut with ...?
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O - anterolateral coracoid process
I- g/l tuberosities - stability, restraining inferior subluxation with arm at side, - - external rotation |
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T/F
The anterior glenohumeral capsule is thicker than the posterior capsule |
true
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The superior glenohumeral ligament resists _____ & contribute to stability in ________. Origin & insertion?
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- inferior subluxation
- posterior & inferior directions O- tubercle on glenoid just posterior to long head of biceps I - humeral head near upper end of lesser tubercle |
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The middle glenohumeral ligament resists _____ . Origin & insertion?
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anterior excursion instability & external rotation
O- superior glenoid & labrum I- blends with subscapularis tendon |
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The inferior glenohumeral ligament acts like ________. It's primary restraint is ... Origin & insertion?
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- a sling
- 45-90 degree abduction O- anterior glenoid rim & labrum I- inferior aspect of humeral articular surface & anatomic neck |
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____ contributes to instability in the anterior/superior direction
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rotation interval b/t SGHL & MGHL
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Which glenohumeral ligamnet is considered the most important stabilizer?
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The inferior glenohumeral ligament
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The glenoid labrum is poor for ______ & great for ______
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- stability
- function - contributes 20% to GH stability by deepening the glenoid by 50% - purposes are to i/c surface contact area, act as a buttress & an attachment site for GH ligaments |
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What does the term stability include?
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laxity, subluxation & dislocation
- GH instability is the inability to maintain the humeral head in the glenoid fossa |
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What is the most common form of glenohumeral instability?
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anterior instability
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Are the roatator cuff muscles, deltoid & biceps dynamic or static restraints of the GH joint?
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dynamic
static are - intra-articular pressure, ligaments & capsule, labrum (i/c convexity) & articular surfaces/osseous anatomy help the humeral head stay centered in the glenoid fossa |
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The GH joint will not dislocate as long as the ____ is directed within the ______
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- net humeral joint reaction force
- effective glenoid arc |
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What is the stability ratio?
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the maximal displacing force in a given direction (perpendicular to the glenoid center line) that can be stabilized by compressive load
if balanced force exceeds balanced stability angle the joint will be unstable |
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What are the two kinds of recurrent instability?
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TUBS - traumatic, unidirectional, bankart lesion & surgery
AMBRII - atramatic, multidirectinal, bilateral, rehab, inferior capsular shift, rotator interval |
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Who is more likely to get traumatic instability?
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people in their 20s
atraumatic usually happens in ages 10-30 |
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How would you describe an anterior dislocation?
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- 97% of dislocations!
forced abduction, extension & external roation |
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What are some causes of posterior dislocations?
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seizures, shock, fall on flexed & adducted arm
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Which nerve is most likely to be injured in an anterior dislocation?
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axillary nerve
remember in an anterior location the pt presents with arm in abduction & internal rotation |
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If a person is susceptible to posterior location, will the apprehension & relocation tests be + or - ?
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negative
remember, in posterior location pt presents with arm EXternally rotated |
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A positive sulcus test is pathognomonic of ...
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multidirectional instability
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In patients with acute injury the best test to subjectively quantify instability is the ...
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load-and-shift maneuver
pt supine- Dr. places both hands around pts upper arm, then loads against GH & humeral head is pushed anteriorly & posteriorly |
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Describe the relocation test
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done with pt supine & edge of table as a fulcrum. Arm is abducted & externally rotated. + if pt experiences apprehension that is relieved by posterior stress on shoulder
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Describe the drawer test
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pt sitting, Dr. pushes humeral head against GF & moves anterior & posterior. + is anterior displacement on joint
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What is this test called ...
Pt sits while Dr. applies caudal traction on humerus in an attempt to dislocate humerus inferiorly. + is dislocation |
sulcus test
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Describe the anterior apprehension test (crank test)
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pt sitting, Dr. applies ABduction & external rotation stress on joint. + if pt is apprehensive
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What is a Bankart lesion?
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a tear in the anterior glenoid labrum in association with detachment of the inferior GH ligament - usually due to repeated anterior dislocation
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What is a stryker notch view important for?
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can delineate a Hills-Sachs defect - posterolateral humeral head indentation fracture is created occuring from anterior shoulder dislocation, as soft base of humeral head impacts against relatively hard anterior glenoid
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What can you see radiographically with a posterior dislocation?
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an anteromedial osteochondral lesion - trough sign
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The "West Point Axillary View" is good for ...
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assessing anterior stability & determining if there is a Bankart lesion
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use this for labral tears & degree of capsular laxity ...
for rotator cuff pathology ... for bony defects ... |
MRI & CT
MRI CT |
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How do you treat recurrent traumatic anterior dislocation?
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surgical stabilization
- poor response to non-operative tx |
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What is the treatment for recurrent posterior instability?
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- strengthening (non-operative)
- 12-50% fail with surgical stabilization |
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80% of _______ respond to physical therapy
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atraumatic instability - can use surgical capsulorraphy if non-op fails
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What is included in the following phases of rehabilitation ..
I II III IV |
I- rest/immobile/pain control (RICE)
II- isometric/isotonic strengthening, exercise in adduction/flex forward --> abduction III- endurance building, strengthening, get to 90% IV- I/C activity of joint |
