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65 Cards in this Set

  • Front
  • Back
-connects upper limb to axial skeleton and trunk
-acts as a strut holding upper limb free from trunk
-provedes attachments for muscles
-transmits forces from upper limb to axial skeleton
-provides attachements for muscles
-foundation for proper shoulder stability and fuction
-acromion coracoid process
-spine of scapula
-extends from shoulder to elbow
-greater and lesser tubercles
-medial and lateral eicondyle
Sternoclavicular joint
-sternum and clavicle
-only ligamentous attachment of should girdle to axial skeleton
Acromioclavicular joint
-acromion process and distal clavicle
-coracoacromial ligament (ligament arch)
Glenohumeral joint
-scapula and head of humerus
-joint mobility greater than joint stability
-slenoid labrum
-glenohumeral ligaments
GH joint - Sagittal plane
GH joint - Frontal plane
GH joint - Transverse plane
-horizontal abduction/adduction
-internal(medial) rotation
external (lateral) rotation
Scapulothoracic joint
-scapula motion w/ respect to trunk
-stabilizes shoulder region
-facilitates movement of uppper extremity
Scapulothoracic movements
-superior/inferior rotation
-scapulohumeral rhythm
Scapulothoracic Muscles
-peck minor
-levator scapulae
-serratus anterior
-upper, middle, lower
superior - elevate
middle - retract
inferior - depress
superior and lower - rotation
insertion - medial scapula border
actioin - retract and rotate sca
Peck Minor
-origion at ribs 3 + 5
-insertion at coracoid process
-action to stabilize and rotate scaupla
Levator Scapula
insertion -scapula
action - elevate and rotate scapula
Serratus Anterior
origion - ribs 1 to 8
insertion - medial scaula border
action - protract and rotate scapula
origin - scapula
insertion - greater tubercule of humerus
action - assist deltoid with abduction
innervator - subscapular nerve
origin - scapula
insertion - greater tubercle of humerus
action - externally rotate humerus
innervator - suprascapular nerve
Teres Minor
origin - scapula
insertion - greater tubercle of humerus
action - externally rotate humerus
innervator - axillary nerve
origin - scapula
insertion - lesser tubercle of humerus
actioin - internally rotate humerus
innervator - upper and lower sub scap nerve
anterior middle posterior
origin - clavicle + scapula
insertion - humerus
action - anterior = flex
middle = abduct humerus
posterior = extend
innervator - axillary nerve
Lattissimus Dorsi
origin - thoracic spine
insertion - humerus
actioin - extend, adduct, and IR humerus
innervator - thoracodorsal nerve
Peck Major
origin - clavicle and sternum
insertion - humerus
action - adduct and IR humerus
innervator - lateral and medial pectoral
Cocking Phase
Rhomboid concentrically pulls scapula and g-h joint posteriorly, assisted by serratus anterior for increased scapular stability
Horizontal adductors (pec major/lat dorsi) and internal rotators (subscap) are eccentrically loaded
injuries of cocking phase
-glenohumeral instability
-labral tears
-internal rotator strains
Acceleration phase
-forwars arm movement
-rapid forcefull extension of elbow
-humeral horizontal adduction/internal rotatioin and elbow extension by pec major, lat dorsi, subscap and triceps
injuries of acceleration phase
-glenohumeral subluxation
-labral tears
-rotator cuff tendonitis/tear
-bicipital tendonitis
Deceleration phase
-Following ball release, maximum shoulder internal rotation occurs - eccentric activation of posterior rotator cuff to control humerus
-Eccentric contraction of middle trapezius and rhomboid to control scapula
injuries of deceleration phase
-glenohumeral subluxation
-labral tears
-rotator cuff tendonities/tears
Shoulder injuries
sprains - AC joint, GH joint
strain - rotator cuff tendonitis/rupture, rotator cuff impingement, bicep tendonitis/rupture
-brachil plexus injury
AC joint sprain
mechanism of injury - foosh
seperated shoulder
AC signs and symptoms
-palable tenderness and joint
-step off deformity
-pain with elevation and horizontal adduction
AC grade 1 seperation
-No deformity
-Mild swelling, tenderness, ROM/strength limitation
-Ice/NSAIDs, return (1-2 weeks) as tolerated with protection
AC grade 2 seperation
-Slight deformity
-Moderate swelling and tenderness
-Moderate ROM/ strength limitation 2% pain
-Sling, NSAIDs, pain-relief modalities, exercise, return (2-4 weeks)with protection
AC grade 3 seperation
-Step-off deformity (permanent)
-Severe swelling and tenderness
-Severe ROM/strength limitation 2o pain
-Joint instability
-Ice, immobilize, rehabilitation, return (6-8 weeks) with protection
GH joint sprain
glenoid labram
-slap lesion
GH joint
-inherently unstable
-gold ball on a tee
-temendous motion and little stability
GH joint passive stabilizers
-bone structure
-Glenoid labrum
-Negative intra-articular pressure
-Adhesion/cohesion forces
-Joint proprioceptors
GH joint active stabilizers
-Rotator cuff
Supraspinatus muscle
Infraspinatus muscle
Teres minor muscle
Subscapularis muscle
humeral head movement on glenoid
clinical condition in which unwanted movement of humeral head on glenoid compromises the comfort and function of the shoulder
complete seperation of joint suufaces with spontaneous reduction
complete seperation of joint surfaces without spontaneous reduction
Inferior capsular shift
Bankart lesion (hill- sachs lesion)
Surgery (Bankart repair)
Anterior dislocation
-Abduction and external rotation
-Horizontal abduction
Posterior dislocation
Subtle episodes of instability depending upon activities, dynamic stability and fatigue
Complications of Dislocation
-Ligamentous/capsular changes
-Rotator cuff tears
-Neurovascular injuries
-Recurrent dislocations
<20 y.o. = >85% incidence
>40 y.o. = <10% incidence
Majority within 2 years of initial injury (M > F)
Glenoid labrum tears
bankart lesion
-instablity and mechanical symptoms present
-fraying and stripping of superios labrum and biceps tendon
-bucket handle tear superior labrum and biceps involvement
Clinical presentation of dislocation
-prominent acromion and humeral head
-flattened shoulder
-interternally rotated and slightly abducted shoulder
-flexed elbow
-pronated forearm, supported by other hand
Management of shoulder instability
-immobilize, but encourage immediate motion
-immediate strengthening of rotator cuff and scapula in safe ROM to patients tolerance
-dynamic stability, resistive endurance exercises
-proprioceptive and neromuscular training
-gradual work for patient to be in a position which they can work
Supraspinatus outlet
-Subacromial space
Long head of biceps
Subacromial bursa
shoulder impingement
mechanical compression of structures within subacromial space between humeral head and acromion
shoulder impingement 2
swimmers shoulder
repetative external rotations
Management of rotator cuff tendonitis
-restore ROM/flex
-restore rotator cuff/scapula stabilizer muscles
-regain shoulder stability/proprioception
-modify skill technique
-return to full activity
Bicipital tendonitis
-rapid overhead movements
-excessive elbow flexion and wrist supination
-forceful, repetitive eccentric loading during rapid elbow extension
Brachial plexus injury
-“Burner” or “stinger”
-Tension force along nerve 2o shoulder depression & neck lateral flexion
-Immediate, severe, burning pain with paresthesia down arm, usually subsiding within 10 minutes
-Muscle weakness in shoulder abduction and external rotation
-Diminished/absent reflexes possible with transient paresthesia/sensory loss
nerve injury grade 1
signs and symptoms
-temporary loss of sensation and loss of motor function
-recovery w/in days to weeks
nerve injury grade 2
signs and symptoms
-significant motor and mild sensory defecits
-last 2 weeks, usually restored to normal
nerve injury grade 3
signs and symptoms
-motor and sensory deficits persist for 12 months
-poor prognosis with surgical intervention often necessary
Clacicular fracture
-Direct blow/compressive force to clavicle, FOOSH, fall on point of shoulder
-Contact sports/activities
-Deformity often 2o pull of pec major and SCM
-Immobilize 4-6 weeks (figure-8 clavicular straps?)
-Restore ROM/flexibility, strength/endurance and proprioception as necessary
Proximal Humeral fracture
-closed reduction if impacted
-ORIF with any displacement of fragments
Midshaft Humeral fracture
-spiral fracture
-fracture along radial nerve groove at posterior humerus
-often results in wrist drop (radial nerve palsy)