Chapter 15: Shoulder and Upper Arm Pathologies

The ___________ ligament provides anterior/posterior stability of the joint

acromioclavicular

The acromioclavicular ligament tunctions to main continuity between the articulating surfaces of the _______ and _________

acromion and clavicle

Chronic AC joint degeneration may present as _______ ______ ______ injury but with no MOI

acute AC joint

_________ _______ is associated with loss of ROM in all planes

adhesive capsulitis

Patients who present with equal limitations in active and passive motion may have ______ ______

adhesive capsulitis ***frozen shoulder

________ of ___________ is the relationship between the shaft of the humerus and and humeral head in the frontal plane

angle of inclination

______ of _______ is 130 to 150 degrees

angle of inclination*

In the transverse plane, relationship between the shaft of the humerus and the humeral head is ________ of ________

angle of torsion

What is also a complaint of an anterior GH dislocation?

axillary nerve being stretched

Clavicular fractures usually happen at the _______ and ________ _______ of the clavicle

concave and convex bend

If the clavicle starts to elevate and depress, what ligament is torn?

coracoclavicular(c and T)

Generally athletes that have overhead sports for long periods of time have __________

degeneration

____________ shoulder should appear lower

dominant

classic GH impingement:

forward flexion and abduction

what happens if a partial-thickness tear goes untreated?

full-thickness tear

The _____ ____-_____ test is a sensitive method of isolating the subscapularis

gerber lift-off

The ______________ joint is made up of the humeral head and glenoid fossa

glenohumeral joint

Only end feel of the shoulder that is not always firm is.....

horizontal adduction

During a Traumatic Anterior Dislocation, what could happen to the labrum?

inferior GH ligament may avulse from labrum/may avuls with part of the labrum

An impingement generally starts with....

inflammation of the rotator cup tendons

GIRD is generally associated with.... -

internal impingement

Throwers/overhead athletes generally lack __________ rotation and have more __________ rotation

internal/external

Example of Primary subacromial impingement:

irregularly shaped acromion spur formation on acromion

the _______ _________ is above the manubrium

jugular notch

The _______ _________ _________ is the last growth plate in the body to ossify

medial clavicular epiphysis

Complaints made in early stages of rotator cuff tendonapothy is...

pain deep within the shoulder in the subacromial area after activity

___________-_________ ______ are short longitudinal lesions in the tendon

partial-thickness tear

Internal impingement patients usually complain of....

posterior shoulder pain that worsens with activity

Drop arm test is for _______ _______ _______

rotator cuff tendinopathy

___________ ________ is an improperly moving scapula

scapular dyskinesis

An AC joint sprain is known as.....

separated shoulder

Weakness of the _________ __________ or injury to the long thoracic nerve innervating it results with scapular winging

serratus anterior

Disruption of the glenoid labrum is often done by __________ ___________

shoulder instability

Type II AC sprains generally have...

some type of deformity

______________ _____________ is a congenital undescended scapula

sprengels deformity

__________ _________ is the clavicle riding above the acromion process indicating an AC sprain

step deformity

_________ ________ functions as a shock absorber

sternoclavicular disc

Grade IV AC joint sprain structures involved: signs and symptoms:

structures involved: Complete tearing of the AC and coracoclavicular ligaments and tearing of the deltoid and trapezius fascia signs and symptoms: posterior clavicular displacement into the insertion of the upper fibers of the trapezius

Grade III AC joint sprain structures involved: signs and symptoms:

structures involved: complete tearing of the AC and coracoclavicular ligaments; possible involvement of the deltoid and trapezius fascia signs and symptoms: obvious dislocation of the distal end of the clavicle from the acromion process

Grade II AC joint sprain structures involved: signs and symptoms:

structures involved: rupture of the AC ligament and partial damage to the coracoclavicular ligament signs and symptoms: slight laxity and deformity of the AC joint/slight step deformity

Grade VI AC joint sprain structures involved: signs and symptoms:

structures involved: same as type IV signs and symptoms: displacement of the clavicle inferior

Grade V AC joint sprain structures involved: signs and symptoms:

structures involved: same type as type IV signs and symptoms: displacement of the involved clavicle from the acromion 1 to 3 times the height of the clavicle as compared with the opposite limb; clavicle posteriorly displaced with stripping away of the deltoid-trapezius aponeurosis

Grade I AC joint sprain structures involved: signs and symptoms:

structures involved: slight to partial damage of the AC ligament and capsule signs and symptoms: point tenderness over the AC joint; no laxity or deformity

Inflammation of the rotator cuff tendons will usually lead to....

subacromial impingement(external)

________ ________ is used to identify the presence of multidirectional instability

sulcus sign

Internal rotation occurs when the ___________ and __________ tendons twist and are compressed against the glenoid during abduction and external rotation

supraspinatus and infraspinatus

Trapezoid ligament= Conoid ligament=

t= lateral movement of clavicle c= superior movement of clavicle

A hill-sachs lesion occurs due to....

the humeral head shearing over the glenoid rim

The GH joint is _________

unstable

What could lead to subacromial bursitis? - -

untreated: -rotator cuff impingement -rotator cuff tears

Trauma to the AC joint is described where?

upper shoulder

What ligaments are sprained in the AC joint? - -

-AC ligament -Coracoclavicular ligament= conoid/trapezoid

Bankhart can be diagnosed(generally) with... - - -

-GH joint play assessment -load and shift -external rotation of humerus

Internal Impingement: - -GH instability - -occupation requiring repetitive overhead activity

-Glenohumeral internal rotation deficit (GIRD) -High volume of throwing or other repetitive overhead activities

When you are inspecting someones shoulder, what should you look at? - - -

-Height of AC -clavicle -SC joint

Wind up; decelerating muscle activity: - -subscapularis - -latissimus dorsi

-anterior deltoid -pectoralis major

Acceleration; accelerating muscle activity: - -subscapularis - -latissimus dorsi - -serratus anterior (stabilizes the scap) -

-anterior deltoid -pectoralis major -triceps brachii -trapezius (stabilizes scapula)

Positive sign for drop arm test is:

-arm falls uncontrollably from about 90 degrees of abduction -severe pain

What athletes are predisposed to posterior GH instability? - -

-blockers in football -throwers

What makes up the SC joint?

-clavicle and sternum

The GH ligaments are: - -

-coracohumeral ligament -glenohumeral ligament

Pain occurring with passive shoulder extension could mean: - -damage to coracohumeral ligament

-damage to the anterior portion of the GH capsule

Chronic AC joint pain -people over the age of 50 - -aging

-degeneration of the articulation

Sternoclavicular(SC) joint has 3 degrees of freedom: - -anterior and posterior rotation -

-elevation and depression -protraction and retraction

What are the shoulder capsular patterns?** - - -

-external rotation -abduction -internal rotation

What is the MOI of a SC joint sprain: - -

-falling on an outstretched arm -anterior/posterior force placed on the lateral portion of the arm

The cause of acute posterior instability is... -

-flexed and with internal rotation with a longitudinal force

Acute pain may be a result of: - -GH joint dislocation/subluxation -tendon rupture -

-fracture -AC sprain

What bony anatomy makes up the shoulder? - -clavicle -scapula -

-humerus -sternum

Pain experienced during both passive abduction and adduction could be do to: -

-inflammation of the subacromial structures

Anterior instability is laxity of what anterior structures? - -

-middle GH ligament -anterior band of the inferior GH ligament

What are factors that contribute to rotator cuff pathology? - -capsular laxity - -subacromial/internal impingement

-muscle imbalance between internal and external rotators -poor scapular control

Secondary Subacromial impingement: -loss of humeral head depression/stabilization - -repetitve overhead movement - -GH stability -

-poor posture -scapular dyskinesis -supraspinatous hypertrophy

Deceleration; decelerating muscle activity: - -supraspinatus - -brachialis - -trapezius -

-posterior deltoid -biceps -serratus anterior (scapula) -rhomboids

Instability of the GH joint can occur from: - -

-repetitive overloads -acute subluxations/dislocations

Biceps tendinopathy occurs because.. - - -

-rotator cuff dysfunction -overuse of biceps brachii -subacromial impingement

Repetitive throwing creates an anterior shear force across the GH joint that may lead to... -

-stretching of static structures ^^this then leads to demand on dynamic stabilization

The space between the superior GH joint and coracoacromial ligament is taken up by... - -

-supraspinatus -infraspinatus

Wind up; accelerating muscle activity: -deltoid - -inspinatus/teres minor - -trapezius

-supraspinatus -serratus anterior(rotates scapula)

What structures are between the acromion process and humeral head? - -infraspinatus tendon - -subacromial bursa - -head of humerus

-supraspinatus tendon -long head of the biceps brachii tendon -GH joint capsule **subacromial impingement

Pain occurring with passive shoulder flexion means impingement: - -biceps brachii -

-supraspinatus tendon -subacromial bursa between the inferior portion of the acromion process

Inflammatory conditions usually are insidious and are: - -bursitis

-tendinopathies -osteoarthritis

Pain in the phases of pitching 1. Pain on the follow through- 2. Pain in cocked position- 3. Pain in deceleration- 4. Loss of control and/or velocity-

1. Pain on the follow through- possible rotator cuff pathology 2. Pain in cocked position- instability or impingement 3. Pain in deceleration- SLAP lesion/ biceps tendonopathy 4. Loss of control and/or velocity- early ball release: internal impingement/ loss of velocity: limitation of IR

1. superior angle of the scapula sits at: 2. inferior angle of the scapula sits at:

1. T3 and T4 2. T7 and T8

Phases of Pitching 1. 2. 3. 4. 5.

1. Wind-up 2. Cocking 3. acceleration 4. deceleration 5.follow through

SLAP lesions are tears of the ______ aspect of the glenoid labrum that extend ________ to _______

1. superior 2. anterior to posterior

What are the 2 coracoclavicular ligaments? - -

1. trapezoid (most lateral) 2. conoid (most medial)

What are the 4 stages of adhesive capsulitis pain pattern? 1. 2. severe night pain and stiffness 3. 4.profound stiffness with minimal pain

1.pain at night; pain referred to deltoid insertion 3. profound stiffness; pain at end-range

Total ROM for internal and external rotation of shoulder:

170 to 190 degrees

GH ROM for flexion:

170-180

GH ROM for abduction:

170-180 AB

Total ROM for extension/flexion:

220-240

The clavicle's middle epiphysis does not fully close until age _____

25

Posterior dislocations only account for....

3% of dislocations

GH ROM for extension:

50 to 60

Shoulder ROM of internal Rotation:

80 to 90 degrees

Shoulder ROM of external rotation:

90 to 100 degrees

A hill-sachs lesion occurs with a...

Bankhart lesion

Hypertrophy of the deltoid may be a result of the ____ and _____ nerve roots

C5 and C6

AC sprain Direct: Indirect:

D: person falls onto acromion with arm at side I: occurs when person falls on oustretched arm, driving the humeral head into the acromion

The _______ of _______ is a weak site in the capsule often torn during anterior GH dislocations

Foramen of Weitbrecht

__________-__________ __________ is a bony defect on the posterior aspect of the humeral head

Hill-Sachs lesion

Sternoclavicular Joint Injury History/MOI: Symptoms: Inspection: Palpation: Joint loss/gain: special tests:

History/MOI: -acute -falling on outstretched arm -posterior direct force Symptoms: -pain generally in SC joint -pain with any shoulder movement that moves the SC joint -may have paresthesia in upper extremity Inspection: -localized swelling -discoloration Palpation: -palpable difference in SC joint Joint loss/gain: AROM: pain with flexion and abduction PROM: flexion/ abduction/horizontal adduction pain special tests: -none

Acromioclavicular Joint Sprain History/MOI: Symptoms: Inspection: Palpation: Joint loss/gain: special tests:

History/MOI: -acute -falling on the point of the shoulder -landing on AC joint -falling on outstretched arm Symptoms: -superior anterior shoulder at AC joint -anterolateral neck -anterolateral deltoid Inspection: -displacement of clavicle may be obvious -step deformities with coracoclavicular ligament Palpation: -superior placement of clavicle Joint loss/gain: AROM: pain with elevation/ protraction and retraction of scapula MMT: decreased strength to muscles that insert on acromion or clavicle PROM: pain with horizontal abduction special tests: -AC traction test -AC compression

Scapular Dyskinesis History/MOI: Symptoms: Inspection: Palpation: Joint loss/gain: special tests:

History/MOI: -gradual -may be due to increase in overhead activity Symptoms: -pain localized over coracoid process/pec minor/superior and medial border of scap/ AC joint Inspection: -thoracic kyphosis/cervical lordosis/ Palpation: Joint loss/gain: special tests:

Internal impingement: external impingement:

I: between humeral head and glenoid E: subacromial space

The ________________ joint has the poorest bony stability of any major joints

Sternoclavicular joint

Depressed shoulders can predispose someone to _________

TOS