Term
| 3 primary functions of the shoulder complex |
|
Definition
1) suspending the upper limb
2) providing sufficient fixation so movement at the upper limb can occur
3) serving as a fulcrum for arm elevation |
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Term
|
Definition
| medial, posterior, superior |
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|
Term
| position of glenoid fossa |
|
Definition
| anterior, lateral , superior |
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Term
| boundaries of subacromion space |
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Definition
| tuberosity of humeral head, coracoid process, coracoacromial arch |
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Term
| structures inside subacromian space |
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Definition
| humeral head, intraarticular portion of long head of the biceps, superior aspect of joint capsule, subdeltoid and subacromion bursa, inferior surface of coracoid acromion arch, suprispinatus and upper margin of subscapularis and infraspinatus |
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Term
| size of subacromion space |
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Definition
|
|
Term
| when is subacromion space the narrowest |
|
Definition
|
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Term
|
Definition
| verticle- convex clavicle on concave manubrium. horizontal- concave clavicle on convex manubrium |
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|
Term
| static restraint joint stability |
|
Definition
1) joint capsule and labrum
2) geometry of humeral head and glenoid articular surface
3) negative intraarticular pressure (joint cohesion)
4) GH ligaments
5) coracohumeral ligaments |
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Term
| Superior GH ligament- position and movements it limits? |
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Definition
| 12-1 oclock. limits external rotation and inferior translation (0 degrees of abduction) |
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Term
| Middle GH ligament- position and limitation |
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Definition
| 2-3 oclock. limits ER and anterior translation (0-45 degrees of ABD) |
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Term
| Inferior GH ligament (ant)- position and limitations |
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Definition
| 2-4 oclock/ below lesser tub. ER and inferior translation and anterior translation (abd 90 degrees) |
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Term
| Inferior GH (post)- position and limitation |
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Definition
| 7-9 oclock/ axillary pouch. limits IR. becomes taught in terminal degrees of ER with shoulder abducted 90 degrees. and anterior translation with abduction of 90 degrees |
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|
Term
| what percent of LH bicep terminates of superior glenoid tubercle? where does remainder insert |
|
Definition
| 40-60%. remainder terminates on labrum |
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|
Term
| where on labrum will LH bicep insert |
|
Definition
| posterior dominant. 17-37% equal distribution in anterior and posterior portion |
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|
Term
| dynamic restraints of shoulder stabilization |
|
Definition
1) Compression produced by synchronous 2) contraction of the RTC
3) Increased capsular tension produced by direct attachments of RTC to the capsule
4) Scapular stabilizers maintaining a stable glenoid platform (“ball on a seal’s nose)
5) Proprioception |
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Term
|
Definition
Elevation (flexion, scaption, abudction)
ER
IR
Extension
Horizontal Abduction
Horizontal Adduction |
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|
Term
|
Definition
1) Rotation in an a - p direction around a longitudinal axis
2) Rotation in a superoinferior direction
3) Pure spin/rotation
4) Glides (Anteroposterior, Superoinferior) |
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|
Term
| upward rotation- muscles used |
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Definition
| upper and lower trap and serratus anterior |
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|
Term
| downward rotation- muscles |
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Definition
| levator scap, rhomboids, lattsiumus dorsi, pec major and minor |
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|
Term
| scapular - inferior angle, superior angle, spine |
|
Definition
superior angle- T2
inferior angle- T8
spine- T4 |
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|
Term
| distance between scapula at restion position |
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Definition
|
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Term
| nondominants position compared to dominate scapulae in females on average |
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Definition
| dominant was .49 cm lower than nondominant |
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Term
| what % of patients with RC tears had scapular dyskinesia |
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Definition
|
|
Term
| % of of pts with labral tears with scapular dyskinesia |
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Definition
|
|
Term
| % of pts with GH instability with scapular dyskinesia |
|
Definition
|
|
Term
| types of shoulder instability |
|
Definition
|
|
Term
|
Definition
T- traumatic
U- unidirectional
B- bankart lsesion
(hill sachs lesion)
S- surgery |
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|
Term
|
Definition
| an injury of the anterior glenoid labrum due to repeated (anterior) shoulder dislocation.[1] It is an indication for surgery and often accompanied by a Hill-Sachs lesion, damage to the posterior humeral head. |
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|
Term
|
Definition
| a cortical depression in the head of the humerus bone. It results from forceful impaction of the humeral head against the anteroinferior glenoid rim when the shoulder is dislocated anteriorly. |
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Term
|
Definition
A- atraumatic
M- multidirectional
B- bilateral
R- rehab
I- inferior capsule |
|
|
Term
| bankhard lesion vs Hill Sachs lesion |
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Definition
| glenoid fossa avulsion/ humeral head avulsion |
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|
Term
| most common GH dislocation |
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Definition
| anterior GH dislocation accounts for 95% of all dislocations |
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|
Term
| Position of arm likely in anterior dislocation |
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Definition
|
|
Term
| how often does bankhart lesion occur |
|
Definition
| 97% of initial dislocation |
|
|
Term
| how often does hill sachs lesion occur |
|
Definition
| 77%-90% of all traumatic dislocations |
|
|
Term
| which nerve is often damaged in anterior dislocation? |
|
Definition
| 42% of dislocations accompanied by axillary n damage |
|
|
Term
| what position should anterior dislocated shoulder be immobilized |
|
Definition
| 10 degrees of ER reduces risk of recurrence of first time traumatic anterior dislocation when compared with conventional immobilization |
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|
Term
| what is "gold standard" for surgical repair of recurrent shoulder dislocation |
|
Definition
| bankhart procedure- In the procedure, the torn ligaments are re-attached to the proper place in the shoulder joint, with the goal of restoring normal function. |
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|
Term
| How common is posterior instability |
|
Definition
| relatively rare- 2-12% of shoulder dislocations |
|
|
Term
| 2 mechanisms of posterior instability |
|
Definition
|
|
Term
| posterior instability- trauma examples |
|
Definition
| acute posterior force to GH joint, seizures, electric shock, MVA |
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|
Term
| example of repetitive trauma that causes posterior instability |
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Definition
|
|
Term
| provocation position of posterior instability |
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Definition
|
|
Term
| classic sign of posterior shoulder isntability |
|
Definition
| loud clunk noise when moved from FF to abd and ER |
|
|
Term
| how can posterior should stability be tested? |
|
Definition
|
|
Term
| possible lesion of posterior instability |
|
Definition
|
|
Term
|
Definition
| 75% of posterior instability have reveresed hill sachs lesion |
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|
Term
| sign of multidirectional instability |
|
Definition
| usually have significant inferior laxity that can be tested by the sulcus sign combine with increased A-P translation |
|
|
Term
|
Definition
| . With the arm straight and relaxed to the side of the patient, the elbow is grasped and traction is applied in an inferior direction. With excessive inferior translation, a depression occurs just below the acromion. |
|
|
Term
| what is a positive sulcus sign |
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Definition
|
|
Term
| with MDI one will experience? |
|
Definition
| difficult with overhead sports |
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|
Term
| Surgical treatment for MDI |
|
Definition
| thermal capsular shrinkage and inferior capsular shift |
|
|
Term
| thermal capsular shrinkage |
|
Definition
| Abundant basic science research has revealed that RF energy applied to collagen tissues results in shortening proportional to temperature and duration of contact. |
|
|
Term
| MDI causes excessive mobility of joint especially in these positions |
|
Definition
| anterioinferior and posteriorinferior |
|
|
Term
| degrees of thermal shrinkage |
|
Definition
|
|
Term
|
Definition
| Traumatic dislocation in an inferior direction that causes the arm(s) to be stuck in an overhead position |
|
|
Term
| mechanism of injury of luxatio erecta |
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Definition
|
|
Term
| how common is luxatio erecta |
|
Definition
| .5% of all shoulder dislocations |
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|
Term
| RC disease/ impingement syndrome |
|
Definition
| continuum beginning with mild impingement and progressing to full thickness tear |
|
|
Term
| RC disease tears associated with chronic impingement |
|
Definition
| usually begin on bursa surface or within the tendon substance |
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|
Term
| RC tears in younger, overhead athletes |
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Definition
| occur on articular surfaces because of tension failure |
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|
Term
| types of subacromion impingement syndrome |
|
Definition
primary (hypomobile)
secondary (hypermobile) |
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|
Term
| impingement assocated with primary subacromial impingement |
|
Definition
| impingement of RTC against acromion, coracoid acromion (CA) ligament, and often the AC joint |
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|
Term
| Signs of primary (hypomobile) subacromial impingement |
|
Definition
1) frequently abnormal structure of acromion
2) poor posture
3) poor capsular control
4) RTC weakness |
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|
Term
| Population usually effected by primary (hypomobile) subacromial impingement |
|
Definition
|
|
Term
| Secondary (hypermobile) subacromial impingement |
|
Definition
| GH instability and/or tensile overload of the RTC results in poor control of humeral head with overhead activities |
|
|
Term
| Common age of those with secondary (hypermobile) subacromial impingement |
|
Definition
|
|
Term
| Px associated with secondary subacromial impingement |
|
Definition
| anterior or later pain associated with activity |
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|
Term
| movement often associated with secondary (hypermobile) subacromial impingement |
|
Definition
| limited IR, excessive ER and anterior superior humeral head migration |
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|
Term
| things that may have occured in secondary subacromial impingement |
|
Definition
| May have had traumatic anterior instability, Hill-Sach’s lesion, damage to posterior glenoi |
|
|
Term
| physical findings accompaines with secondary hypermobile subacromial impingement |
|
Definition
Usually painful on palpation of SST/LH biceps
Positive impingement tests
Negative apprehension/relocation tests
RTC & scapular stabilizer weakness
Scapular malposition
Altered SH rhythm
Atrophy |
|
|
Term
|
Definition
Type I- flat
Type II- curvature
Type III – more curve |
|
|
Term
| PT for different types of acromion in treatment for secondary subacromial impingement |
|
Definition
| 91% successful for type II. 66% sucessful for type III |
|
|
Term
| possible treatments for subacromial impingement |
|
Definition
meds injection
PT
SAD and possible CA ligament release
Debridement
Mumford (distal clavicular resection) |
|
|
Term
| Neer Classification of SIS- Stage I |
|
Definition
Edema, inflammation, hemorrhage
Usually reversible, modify biomechanics |
|
|
Term
| Neer Classification of SIS- Stage II |
|
Definition
Thickening of bursa
Fibrosis of tendons
Difficult to reverse
Rest, NSAIDS, TE program |
|
|
Term
| Neer Classification of SIS- Stage III |
|
Definition
Partial or complete RTC tears
Bony changes: deltoid, humeral head |
|
|
Term
| treatment for Stage III Neer Classification of SIS |
|
Definition
| usually surgical (SAD, CA ligament resection, Mumford, RTC debridement |
|
|
Term
| treatment for Stage III Neer Classification of SIS |
|
Definition
| usually surgical (SAD, CA ligament resection, Mumford, RTC debridement |
|
|
Term
| according to studies what is the different between dominant and non dominant arm in SIS |
|
Definition
| no difference/ dominant arm involved 2/3 of the time |
|
|
Term
| When is posterior internal impingement seen |
|
Definition
| dominant arm of overhead athletes |
|
|
Term
| lesions associated with posterior internalimpingement |
|
Definition
Impingement on the undersurface of articular side RCT tendon ag posterosuperior glenoid
Posterior labral fraying (10:00 – 12:00 o’clock position R shoulder)
Osteochondral lesions |
|
|
Term
| Physical findings of posterior internal impingement |
|
Definition
Px in the cocking position
GIRD
Frequently have tight posterior capsule
Positive relocation test (Paley et al, 2000 found 62% had positive test)
May have +ve apprehension & impingement tests |
|
|
Term
| what age does anterior internal impingement occur? |
|
Definition
|
|
Term
| anterior internal impingement may have signs of? |
|
Definition
|
|
Term
| Anterior internal impingement |
|
Definition
| Arthroscopically found to have undersurface RTC tear caused by impingement of RTC between superior labrum, just anterior to biceps anchor |
|
|
Term
| how do u test betwen anterior internal impingement and SA impingement |
|
Definition
| no clinical tests to differentiate |
|
|
Term
| treatment for anterior internal impingmeent |
|
Definition
Debridement of RC, possibly repair
Possibly posterior capsule release in presence of GIRD
Arthroscopic debridement &/or repair of tendon |
|
|
Term
| Conservative treatment of anterior internal impingement |
|
Definition
Strengthening
Address throwing mechanics, if needed
Posterior capsular stretching |
|
|
Term
|
Definition
| the subscapularis tendon is impinged between the lesser tuberosity and coracoid process. RARE |
|
|
Term
| subcoracoid impingement is characterized by? |
|
Definition
| anterior should pain made worse by flexion (120-130 degrees), IR with abduction and HABD- pain is reffered to upper arm and forearm. painful clicking may also accompany above position |
|
|
Term
| subcoracoid impingement may occur with? |
|
Definition
| May occur with long, or excessively laterally placed coracoid process |
|
|
Term
| normal placement of coracoid |
|
Definition
| < 7 mm between humerus and coracoid with arms crossed is considered “normal |
|
|
Term
| treatment subcoracoid impingement (conservative) |
|
Definition
| conservative successful in all cases with out surgery- steroid injections most frequently successful |
|
|
Term
| What age is RTC tears common? |
|
Definition
|
|
Term
| majority of RTC result from? |
|
Definition
| long term degenerative process |
|
|
Term
|
Definition
| articular side (tension), bursal side (compression, intertendinous |
|
|
Term
| classifications of RTC tears |
|
Definition
small- medium- > 1 to 3 cm
large- > 3 to 5 cm
Massive >5cm |
|
|
Term
|
Definition
Insidious onset of px
Night px, difficulty lying on involved side
Pain in the deltoid region
Weakness
Difference between AROM & PROM
LOM
scapular dyskensia
superior migration of humeral head
palpable tenderness of cuff insertion |
|
|
Term
| what muscles show atrophy with RTC tears |
|
Definition
| esp supraspinatous and infraspinatous |
|
|
Term
| RTC tear will show a painful arc where? |
|
Definition
|
|
Term
| What test will show positive with RTC tears? |
|
Definition
| px with impingement test, positive lag sign, positive hornblowers, positive lift off test, |
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|
