The Shoulder Complex

immediate care for acromioclavicular sprain

1. application of cold and presssure to control local hemorrhage 2. stabilization of the joint by a sling and swathe bandage 3. referral to a physician for definitive diagnosis and treatement

A patient receives a prescription that states: "Take 400 to 800 mg t.i.d to q.i.d. and p.c." What is the correct explanation of this notation?

400 to 800 milligrams three to four times a day and after meals

Which of the following exercises are MOST appropriate for the immediate post-operative phase of a Bankart repair?

Active assistive abduction to tolerance Active elbow/hand ROM Passive external rotation in scapular plane to 35-40 degrees at 90 degrees of abduction Passive flexion to tolerance Submaximal isometric in flexion and abduction

Which two ligaments combine to form the coracoclavicular ligament?

Conoid and trapezoid

The majority of rotator cuff injuries develop during which phase of overhead throwing?

Deceleration

A volleyball player is two weeks post-surgery for an arthroscopic SLAP lesion repair. The player has strict limitations on their ROM. Which type of rotator cuff strengthening exercises would be MOST appropriate to begin at this point in the rehabilitation process?

Isometric

A baseball pitcher comes to the athletic trainer complaining of pain and a clicking feeling in his shoulder in the cocking phase of his throwing motion. He also indicates that he feels like his arm is "dead." his pain seems to be posterior and lasts for several minutes, followed by extreme weakness of the entire arm. On examination he exhibits a positive apprehension sign. What is the most common cause of this problem?

It is most likely that the pitcher has some anterior instablitity that is allowing for excessive translation of the humeral head on the glenoid. During throwin this can create a repetitive compression of the rotator cuff, consequently causing impingement of soft tissues under the coracoacromial arch

innervation/ nerve root serratus anterior

Long Thoracic ( C5-C7)

A winging scapula may indicate an injury to which nerve?

Long thoracic

With the patient seated, which of the following is theOPTIMAL positioning of the glenohumeral joint to palpate the greater tuberosity of the humerus?

Passive external rotation

immediate care for sternocalvicular sprain

RICE, and reduction of dislocation from physician

superior aspect of the labrum that begins posteriorly and extends anteriorly and affects the attachement of the long head of the biceps to the superior labrum is called

SLAP Lesion

O'briens tests for what

SLAP lesion if pain is in glenohumeral joint, and AC joint pathology if pain in acromioclavicular joint

Which of the movements assess the C5 myotome?

Shoulder abduction and elbow flexion

innervation/ nerve root teres major

Subscapular (C5,C6)

At which point in the injury response will the application of ice be MOST beneficial in reducing secondary hypoxic injury?

Vascular and tissue damage

a softball player dislocated her left shoulder sliding into third base a year ago. Since this episode, she has sustaned repetitive subluxation episodes. What are the possible injuries that may be present within the glenohumeral joint

a dislocation can cause a bankart lesion, a hillsachs lesion, and a SLAP lesion. A bankart lesion is a defect of the anterior labrum while a hill sachs lesion is a defect on the posterior lateral aspect of the humeral head. A SLAP lesion involves a tear of the superior labrum that may also involve the biceps tendon

phase of throwing that lasts from maximum external roation until ball is released

acceleration phase

what four tests test for thoracic outlet syndrome

adson, allens, roos test, military brace position test

what specific tests should the athletic trainer do to determine whether thoracic outlet compression syndrome is present, and what do those tests indicate

adsons: tests for compression by the heads of the anterior and middle scalene muscles or between the cervical rib and the anterior scalene muscle roos test or military brace: tests for compression between the first rib and the clavicle. the hyperabduction syndrome test or allens test: tests for compression behind the pec and beneath the coracoid process

Load and shift tests for what

anterior and/or posterior instability and likely injury to the glenohumeral ligament

anterior and posterior drawer tests for what

anterior drawer: anterior glenohumeral instability posterior drawer: posterior glenohumeral instability

origin of the pectoralis minor

anterior surface of the third through the fifth ribs

immediate care for clavicular fracture

applying a sling and swathe bandage and treat patient for shock

peripheral nerve that affects the deltoid and teres minor

axillary

innervation/ nerve root of deltoid

axillary (C5,C6)

innervation/ nerve root teres minor

axillary (C5,C6)

teres minor origin

axillary border of the scapula

a tear or detachment of the glenoid labrum is called what

bankart lesion

phase of throwing that begins when the hands separate and ends when maximum external rotation of the humerus has occurred

cocking phase

insertion of the pectoralis minor

coracoid process of the scapula

origin of the coracobrachialis

coracoid process of the scapula

compression of the neurovascular bundle in the narrowed space between the first rib and clavicle is called

costoclavicular syndrome

phase of throwing that lasts from ball release until maximum shoulder internal rotation

deceleration phase

drop arm test tests for what

determine tears of the rotator cuff, primarily of the supraspinatous muscle

perpiheral nerve that affects the rhomboids and levator scapula

dorsal scapular

innervation/ nerve root levator scapulae

dorsal scapular (C5)

innervation/ nerve root of rhomboideus major

dorsal scapular (C5)

innervation/ nerve root rhomboideus minor

dorsal scapular (C5)

teres major origin

dorsal surface of the interior angle of the scapula

insertion of the serratus anterior

entire length of the ventral surface of the vertebral border of the scapula

A teenage girl trips and falls on the stairs. She lands on the tip of her left shoulder and in her chest. she has difficulty lifting her arm above her shoulder because of the pain. What injuries might result from this mechanism of injury?

falling on the tip of the shoulder is a typical mechanism of injury for a sprain of both the AC and sternoclavicular joints. It is also possible that a clavicular fracture has occurred.

lasts from maximum shoulder internal rotation until the end of the motion when the athlete is in a balanced position

follow through phase

deltoid insertion

greater tubercle of the humerus

infraspinatous insertion

greater tubercle of the humerus

pec major insertion

greater tubercle of the humerus

supraspinatus insertion

greater tubercle of the humerus

teres minor insertion

greater tubercle of the humerus

a volleyball player consistently experiences pain when serving the ball overhead. She also indicates that most of the time when she spikes the ball at the net she experiences pain. During an eval, the athletic trainer observes that when the humerus is flexed and internally rotated, the pain is worse. what is most likely causing this athletes pain when her shoulder is placed in the over head position?

her pain is probably due to mechanical impingement or compression of the supraspinatus tendon, the subacromial bursa, or the long head of the biceps under the coracromial arch as the arm moves into a fully abducted or flexed position. The space under the arch becomes even more compressed as the humerus is internally rotated, as would occur during the follow through

compression of the calcellous bone of the head of the humerus against the anterior glenoid rim that creates a divot in the humeral head is called

hill-sachs lesion

immediate care for scapular fracture

if injury is suspected patient should be given a supporting sling and sent for x rays immediatly

how are impingement and instabliity related to each other?

if the dynamic stablizers (rotator cuff) and the static stablizers ( joint capsule) of the GH joint cannot maintain the position of the humeral head relative to the glenoid, there will be excessive translation of the humeral head. Excessive translation of the huerus in the overhead position can result in mechanical impingement of those structures under the coracoacromial arch. If the scapular muscles do not maintain the position of the glenoid relative to the humerus, impingment can result.

immediate care for proximal humerus fracture

immediate support with a sling and swathe bandage and referral to a physician

peripheral nerve that affects the subscaularis and teres minor

inferior subscapular

infraspinatous origin

infraspinatus fossa of the scapula

Which exercise type is designed specifically to match the torque-generating capability of a concentric contracting muscle group throughout the full range of motion?

isokinetic

peripheral nerve that affects the pectoralis major

lateral pectoral

deltoid origin

lateral third of the clavicle, the acromion process, and the spine of the scapula

insertion of the trapezius

lateral third of the clavicle, the acromion process, and the spine of the scapula

teres major insertion

lesser tubercle

subscapularus insertion

lesser tubercle of the humerus

peripheral nerve that affects the serratus anterior

long thoracic

innervation/ nerve root of pec major

medial and lateral pectoral (C5-C8, T1)

pec major origin

medial half of the clavicle, the sternum, the costal cartilages of the upper six ribs, and the aponeurosis of the external oblique muscle

latissimus dorsi insertion

medial margin of the intertubercular groove of the humerus

peripheral nerve that affects the pectoralis major and minor

medial pectoral

innervation/ nerve root pectoralis minor

medial pectoral (eight cervical and first thoracic)

insertion of the coracobrachilais

middle of the humerus, medial surface

innervation/ nerve root coracobrachialis

musculocutaneous (C5,C6)

what is a normal scapulohumeral rhythm

no movement of the scap as the humerus elevates to 30 degrees. As the humerus elevates from 30 degrees to 90 degrees, the scapula should abduct and upwardly rotate 1 degree for every 2 degrees of humeral elevation. From 90 degrees to full abduction of the humerus, the scapula should abduct and rotate upward 1 degree for each 1 degree of humeral elevation

origin of the trapezius

occipital bone, the ligamentum nuchae, and the spinous processes of the seventh cervical and all of the thoracic vertebrae

origin of the serratus anterior

outer surface of the first nine ribs

apprehension test tests for what

posterior instability

clunk test tests for what

presence of a tear in the glenoid labrum

immediate care for humeral fracture

requires immediate application of splint, treatment for shock, and referral to physician

peripheral nerve that affects the trapezius

spinal accessory

innervation/ nerve root trapezius

spinal accessory (accessory cranial nerve)

latissimus dorsi origin

spinous processes of the lower six thoracic and the lumbar vertebrae, the sacrum, the posterior iliac

immediate care for epiphyseal fracture

splinting and immediate referral to physician (most common in younger population)

When performing palpation of the shoulder, what joint is located immediately lateral to the suprasternal notch?

sternoclavicular

Adsons test is to indicate if what artery is being compressed

subclavian artery

allens test is to indicate if what is being compressed

subclavian, axillary, and the brachial plexus

innervation/ nerve root of subscapularis

subscapular (C5,C6)

subscapularus origin

subscapular fossa of the scapula

perpiheral nerve that affects the subscapularis

superior subscapular

Peripheral nerve that affects the supraspinatus and infraspinatus

suprascapular

innervation/ nerve root infraspinatus

suprascpular (C5,C6)

innervation/ nerve root of supraspinatus

suprascpular (C5,C6)

supraspinatus origin

supraspinatus fossa of the scapula

empty can test tests for what

supraspinatus muscle strength

what muscles function to actively internally rotate the glenohumeral joint during the acceleration phase, and what muscles decelerate internal rotation during follow through

the subscapularis, pec major, latissimus dorsi, teres major, and anterior deltoid must all contract concentrically to produce internal rotation during the acceleration phase. The infraspinatus, teres minor, and posterior deltoid must contract eccentrically during the follow through to decelerate internal roation

a firefighter has a multidirectional instability of the glenohumeral joint resulting from a series of two anterior dislocations he wants to know what he can do to strengthen his should so that is does not dislocate again what muscles are important in providing dynamic stability specifically to the glenohumeral joint, and will strengthening these muscles prevent a subsequent dislocations?

there is a high likelyhood that a recurrent dislocation will occur. The dynamic stablizers of the GH joint include the subscapularis, infraspinatus, teres minor, and supraspinatus... also just as important to strengthen scapular muscles

innervation/ nerve root of latissimus dorsi

thoracododorsal (C6-C8)

peripheral nerve that affects the latissimus dorsi

thoracodorsal

origin of the levator scapulae

transverse processes of the upper four cervical vertebrae

insertion of the levator scapulae

vertebral border of the scapula, above the spine of the scapula

phase of throwing that lasts from first movement until the ball leaves the gloved opposite hand

windup phase

what three tests test for bicep tendon irritation

yergasons, speeds, and ludingtons