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
