Shoulder Complex - Review

A grade _ acromioclavicular sprain is presented with partial displacement and prominence of lateral clavicle. Pt. tenderness and inability to fully abduct. Indicates tearing or rupture of the acromioclavicular ligament and stretching of the coracoclavicular ligament

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With a proximal humerus fracture, the patient may be incapacitated for how long?

2-6 months

Only grades _ through _ acromioclavicular sprains require surgical intervention.

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A grade _ sprain results in complete rupture of the acromioclavicular and coracoclavicular ligaments, in addition to tearing of the trapezius and deltoid attachment to the clavicle and acromion. Gross deformity and prominent distal clavicle will be present, severe pain, loss of movement and general shoulder instability.

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A grade _ sprain is rare and involves an inferiorly displaced clavicle in relation to the coracoid, behind the coracobrachialis tendon.

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Acromioclavicular sprains may be classified in _ different ways

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Clavicular fractures management consists of

6-8 week immobilization followed by gentle isometrics and mobilization exercises

Crossover Test assesses for

Acromioclavicular injury

For full movement of the scapula during abduction, what bone must be able to move? Which motion and how many degrees?

Clavicle elevation 20 degrees posteriorly rotate 35 degrees

Defect on the posterior lateral aspect of the humeral head is called a

Hill-Sachs lesion

OIAN of Trapezius

O: Descending fibers: Occipital bone and C1-C7 Transverse fibers: T1-T4 Ascending fibers: T5-T12 I: Descending fibers: lateral 1/3 of clavicle Transverse fibers: medial acromion process Ascending fibers: spine of scapula A: scapular elevation, depression, rotation, adduction N: Spinal accessory

OIAN of Biceps Brachii

O: Long head - supraglenoid tubercle of scapula Short head - coracoid process I: radial tuberosity A: elbow and shoulder flexion, forearm supination N: musculocutaneous

OIAN of Rhomboid Minor

O: Lower Portion of Ligamentum Nuchae & SP's of C7-T1 I: Medial Border of the Scapula at the Root of the Spine A: scapular adduction and inferior rotation N: Dorsal Scapular

OIAN of Teres Major

O: Posterior aspect of Inferior Angle of the Scapula I: Lesser Tubercle of the Humerus A: Adduction, extension and internal rotation N: Subscapular Nerve

OIAN of Latissimus Dorsi

O: Spinous processes of T7-L5, iliac crest, sacrum, ribs 9-12 I: Medial aspect of bicipital groove A: Shoulder extension, adduction, internal rotation N: Thoracodorsal

OIAN of Subscapularis

O: Subscapular Fossa I: Lesser Tubercle of the Humerus A: Internal rotation N: Subscapular

OIAN of Teres Minor

O: Upper 1/3 of lateral border of Scaupla I: greater tubercle of the humerus A: External Rotation N: Axillary

OIAN of Coracobrachialis

O: coracoid process I: Middle 1/3 of medial humerus A: flexion and abduction of shoulder N: Musculocutaneous

OIAN of Deltoid

O: lateral 1/3 of the clavicle, acromion process and spine of the scapula I: deltoid tuberosity of the humerus A: anterior: flexes and internally rotates the arm middle: abducts arm posterior: extends and laterally rotates the arm N: axillary

OIAN of Pectoralis Major

O: medial half of clavicle, sternum, costal cartilages of upper 6 ribs I: Greater tubercle of humerus A: Shoulder flexion, adduction, internal rotation N: Medial and lateral pectoral nerve

OIAN of Serratus anterior

O: ribs 1-9 laterally I: medial aspect of the anterior surface of scapula A: scapular abduction, stabilization and external rotation N: long thoracic

OIAN of Pectoralis Minor

O: ribs 3-5 anteriorly I: coracoid process A: aids in respiration, pulls scapula anteriorly and inferiorly N: pectoral

OIAN of Supraspinatus

O: supraspinous fossa I: Greater tubercle of humerus A: shoulder abduction N: suprascapular

During a shoulder evaluation, why is it important to observe the athlete walking?

Observe asymmetrical arm swinging or leaning toward the injured shoulder

The five phases of throwing mechanism are

Windup Cocking Acceleration Deceleration Follow-through

The most common mechanism of a anterior or inferior shoulder dislocation is forced

abduction, external rotation and extension

The common mechanism of a posterior shoulder dislocation is usually forced

adduction and internal rotation

The most common direction of shoulder dislocation is

anterior

Apprehension Test assesses for

anterior or posterior glenohumeral instability

The bones that make up the shoulder complex and shoulder joint

clavicle, sternum, scapula, humerus

What is Sprengel's deformity?

congenital deformity in which scapula does not descend

Active movements in the glenohumeral joint relates to the _

deltoid and rotator cuff muscles

Muscles that originates on the scapula and attach to the humerus are:

deltoid, teres major, coracobrachialis

Movements at the glenohumeral joint are:

flexion, extension, abduction, adduction, internal rotation, external rotation, horizontal abduction, horizontal adduction, circumduction

Relocation Test assesses for

glenohumeral instability

Sulcus Test assesses for

glenohumeral instability

Load and Shift Test assesses for

glenohumeral instability and labrum injury

There is a _ incidence of recurrence of sternoclavicular sprains

high

Neer's Test assesses for

impingement

A SLAP lesion will affect the _

long head of the biceps attachment

What goes through the bicipital groove?

long head tendon of the biceps brachii

Three parts of the sternum:

manubrium, body, xiphoid process

The shoulder has a great degree of _ and lacks _

mobility stability

The main danger of an epiphyseal fracture of the humerus is

possibility of damaging the epiphyseal growth centers

Jerk Test assesses for

posteroinferior labrum injury

Kim Test assesses for

posteroinferior labrum injury

Scapulohumeral rhythm describes the movement of the _

scapula relative to the movement of the humerus throughout a full range of abduction

Exercises that should be incorporated into the treatment plan of scapular dyskinesis

stretching of the posterior shoulder capsule strengthening of scapular stabilizers stretch the pec minor, coracobrachialis, short head of biceps

The subacromial bursa is easily subjected to trauma when:

the humerus is in the overhead position because it becomes compressed under the coracoacromial arch

Most proximal humerus fractures occur at

the surgical neck

What does thoracic kyphosis indicate when observing a shoulder injury?

weakness of the spinal erector muscles and tightness of the pectoral muscles

A grade _ acromioclavicular sprain is presented with pt. tenderness and discomfort during movement. Mild stretching of the acromioclavicular and coracoclavicular ligaments

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After the setting phase, there is a _ ratio of glenohumeral to scapulothoracic movement

2:1

A grade _ sprain involves rupture of both the acromioclavicular and coracoclavicular ligaments.

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The patient with a fracture to the humeral shaft will be out of competition for

3-4 months

Immobilization following a sternoclavicular sprain is usually maintained for _

3-5 weeks

There is no scapular movement in the first _ degrees of abduction. This is also known as the _ phase

30 setting

A grade _ sprain is presented with posterior separation of the clavicle with complete disruption of the acromioclavicular ligament. Occasionally, the coracoclavicular ligament remains intact.

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Permanent anterior defect on the labrum is called a

Bankart lesion

Speed's Test assesses for

Bicep tendon irritation and superior labrum tear

What lies between the greater tubercle and lesser tubercle?

Bicipital groove

Dorsal scapular nerve stems from which nerve root?

C5

Axillary nerve stems from which nerve roots?

C5 C6

Subscapular nerve stems from which nerve roots?

C5 C6

Musculocutaneous nerve stems from which nerve roots?

C5-C7

Pectoral nerve stems from which nerve roots?

C5-T1

Radial nerve stems from which nerve roots?

C5-T1

The brachial plexus is comprised of which spinal nerve roots?

C5-T1

What does a winged scapula on one side indicate?

Long thoracic nerve injury

OIAN of Levator scapulae

O: C1-C4 I: superior angle of medial border of scapula A: scapular elevation, lateral neck flexion N: dorsal scapular

OIAN of Rhomboid Major

O: C7-T1 I: medial border of scapula A: scapular adduction and inferior rotation N: Dorsal Scapular

OIAN of Infraspinatus

O: Infraspinous fossa I: Greater tubercle of humerus A: external rotation N: suprascapular

Defect that occurs on the anteromedial portion of the humeral head following a posterior shoulder dislocation

Reverse Hill-Sachs lesion

Dynamic Labral Shear (DLS) Test assesses for

SLAP tear

O'Brien's Test assesses for

SLAP tear

Abnormal movement of the scapula is called

Scapular dyskinesis

What does a winged scapula on both sides indicate?

Serratus anterior weakness

Exercises that should be incorporated into the treatment plan of thoracic outlet syndrome

Strengthening of the trapezius, rhomboids, serratus anterior and erector muscles of the spine stretching of pec minor and scalenes

Bear Hug & Belly Press Test assesses for

Subscapularis injury

Gerber's Lift Off Test assesses for

Subscapularis injury and impingement

Drop Arm Test assesses for

Supraspinatus injury

Empty Can Test assesses for

Supraspinatus injury

A complication of humeral shaft fractures is

severed radial nerve causing paralysis and wrist drop

What type of injury would be shown with a prominent lateral aspect of the clavicle?

step-off deformity as a result of AC sprain or dislocation

What are the four articulations of the shoulder complex?

sternoclavicular joint, acromioclavicular, glenohumeral joint, scapulothoracic joint

The most important bursa in the shoulder joint is the _

subacromial bursa

A brief, short occurrence in which the humeral head quickly returns to its normal position relative to the glenoid is a

subluxation

Shoulder impingement involves a mechanical compression of the _ all of which are located under the coracoacromial arch

supraspinatus tendon, subacromial bursa, and long head of the biceps tendon

Muscles that make up the rotator cuff are:

supraspinatus, infraspinatus, subscapularis, teres minor

The 3 immediate care steps of acromioclavicular sprains are

application of ice and pressure, stabilization, and referral

How long is the immobilization period for an epiphyseal fracture of the humerus?

approximately 3 weeks

Thoracic outlet syndrome involve compression of what three structures?

brachial plexus subclavian artery subclavian vein

The mechanism of an acromioclavicular sprain is most often a

direct impact to the tip of the shoulder

The scapular muscles are important to the shoulder complex because they provide _

dynamic stability

The glenohumeral joint is a _ joint, also known as a ball-and-socket joint

enarthrodial

Hawkins-Kennedy Test assesses for

impingement

Passive movement in the glenohumeral joint relates to the _

labrum and capsular ligaments

Clunk Test assesses for

labrum injury

Muscles that originate on the axial skeleton and attach to the humerus are:

latissimus dorsi and pectoralis major

Muscles that attach the axial skeleton to the scapula are:

levator scapulae, trapezius, rhomboids, serratus anterior, serratus posterior

The biggest concern with a sternoclavicular dislocation is when the joint dislocates in a _ direction. Why?

posterior because it could strike the trachea, esophagus and blood vessels