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Shoulder Complex
Notes from Musculoskeletal lecture on shoulder complex from 2/9/12
82
Anatomy
Graduate
03/17/2012

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Term
what is the most mobile, least stable joint in the body?
Definition
shoulder
Term
what tissues outside the shoulder can cause shoulder pain?
Definition
cervical spine; internal organs; chest tissues
Term
what internal organs can cause shoulder pain?
Definition
gall bladder, diaphragm
Term
what screen should you always do when someone has a shoulder problem?
Definition
cervical screen (unless you absolutely know that cervical spine is not involved)
Term
things to think about with shoulder pain
Definition
posture, function, aggravating and easing factors, which part of the shoulder complex is affected
Term
what to think about with function
Definition
when/where does pain occur; does pt often have arm in specific position; function they've lost helps set goals
Term
does the sternoclavicular joint have a disc?
Definition
yes
Term
what is the purpose of the intra-articular disc of the SC joint?
Definition
improves congruency, stability
Term
what are the 3 ligaments of the sternoclavicular joint?
Definition
sternoclavicular, interclavicular, costoclavicular
Term
what is the sternoclavicular ligament?
Definition
the lax capsular ligament of the sternoclavicular joint
Term
how much elevation/depression in the frontal plane occurs at the sternoclavicular joint?
Definition
45/15
Term
describe convex/concave of the sternoclavicular joint in the frontal plane
Definition
convex clavicle; concave manubrium
Term
how much protraction/retraction occurs in the transverse plane?
Definition
15/15
Term
describe convex/concave of the sternoclavicular joint in the transverse plane
Definition
concave clavicle; convex manubrium
Term
how much posterior rotation occurs in the sagittal plane?
Definition
30-45 degrees
Term
what are the 2 main ligaments of the AC joint
Definition
coracoclavicular, acromioclavicular (also the capsule is ligamentous)
Term
which of the 2 ligaments at the AC joint make up the coracoclavicular ligament?
Definition
trapezoid and conoid
Term
does the acromioclavicular joint have a disc?
Definition
yes
Term
does the acromioclavicular joint's disc play as important a role as the sternoclavicular joint's disc
Definition
no
Term
what joint is injured in a separated shoulder
Definition
AC joint
Term
what is the function of the trapezoid ligament
Definition
checks lateral and posterior movement of the clavicle as scapula moves medially
Term
what is the function of the conoid ligament?
Definition
checks superior movement of the clavicle
Term
what are the 4 muscles of the SC/AC joints?
Definition
pectoralis major, upper traps, SCM, subclavius
Term
what motion occurs at the AC joint with tipping of the inferior angle of the scapula in the sagittal plane?
Definition
flexion/extension
Term
what motion occurs at the AC joint with medial border winging of the scapula
Definition
internal/external rotation
Term
what motion of the AC joint occurs with spinning of the scapula
Definition
upward/downward rotation
Term
how much bigger is the humeral head surface area than glenoid surface area
Definition
3-4 times bigger
Term
what direction does the humeral head face
Definition
medially, slightly posteriorly, superiorly
Term
what direction does the glenoid cavity face?
Definition
superiorly, anteriorly, laterally
Term
describe the joint capusle of the glenohumeral ligament
Definition
large, loose, redundant
Term
where is the glenohumeral joint capsule the thickest?
Definition
anterior/inferior
Term
what is the pattern of capsular fibers in the glenohumeral joint capsule
Definition
cross-link pattern
Term
what does the cross-linked-fibered capsule do in GH rotation?
Definition
rotational force tightens the capsule, helping it to keep the ball in the center of the glenoid
Term
what are the 2 main ligaments of the glenohumeral joint?
Definition
transverse humeral ligament, glenohumeral ligaments
Term
what are the 3 glenohumeral ligaments
Definition
superior, middle, inferior
Term
what is the function of the superior glenohumeral ligament?
Definition
provides stability in inferior direction (keeps humerus from sliding down)from 0-50 degrees abduction
Term
what is the function of the middle glenohumeral ligament?
Definition
limits external rotation up to 90 deg abduction. Provides anterior stability between 45-60 degrees abduction
Term
what is the most important stabilizer against anterior/inferior dislocation of the glenohumeral ligament?
Definition
inferior glenohumeral ligament
Term
what is the most frequently injured component of the capsule?
Definition
inferior glenohumeral ligament
Term
what are the 3 bands of the inferior glenohumeral ligament?
Definition
anterior band, posterior band, axillary pouch
Term
function of the anterior band of the GHL
Definition
restrains anterior/inferior translation at 90 degrees abduction and external rotation
Term
function of the posterior band of the GHL
Definition
primary posterior stabilizer in flexion and internal rotation; inferior stabilizer at 90 degrees abduction
Term
what is the function of the axillary pouch
Definition
with external rotation: sling moves anterior to form a barrier to anterior dislocation. With internal rotation: sling moves posterior to form a barrier to posterior dislocation
Term
what is the function of the coracohumeral ligament?
Definition
Stabilizes the long head of the biceps tendon; provides stability in inferior direction from 0-50 degrees abduction along with superior glenohumeral ligament
Term
what is the rotator interval
Definition
anterosuperior space between the subscapularis and supraspinatus tendons
Term
what things are in the rotator interval
Definition
coracohumeral ligament; superior glenohumeral ligament; biceps tendon; anterior joint capsule
Term
what happens when you have contracture of the rotator interval
Definition
adhesive capsulitis
Term
what happens when you have laxity of the rotator interval?
Definition
glenohumeral instability
Term
what are the functions of the rotator interval
Definition
contributes to glenohumeral stability; increases stability to biceps tendon; limits excessive glenohumeral motion
Term
what things make up the coracoacromial arch
Definition
coracoacromial ligament + acromion + coracoid
Term
what is the function of the coracoacromial arch
Definition
provides superior stability to glenohumeral joint
Term
what happens in impingement syndrome
Definition
compression of structures pressing up against coracoacromial arch
Term
how much space is there between the head of the humerus and the coracoacromial arch at rest?
Definition
10mm
Term
how much space is there between the head of the humerus and the coracoacromial arch in abduction?
Definition
5mm
Term
describe the glenoid labrum
Definition
dense, fibrous rim. Few elastic fibers
Term
functions of the glenoid labrum
Definition
Deepens fossa; increases surface area contact with humeral head; allows for glenohumeral ligament attachment to glenoid; acts as a stopper to limit humeral head translation; provides blood supply to the periphery
Term
compare the attachments of the superior and inferior glenoid labrum
Definition
looser superior attachment; firm inferior attachment
Term
where does the long head of the biceps tendon insert?
Definition
onto superior portion of labrum
Term
what is a bursa
Definition
small pouch lined by synovium that contains synovial fluid
Term
function of bursa
Definition
alleviate friction by creating space between 2 tightly opposed structures
Term
how many bursae are there in the shoulder?
Definition
8 to 9
Term
what type of tissue is bursa?
Definition
non-contractile tissue
Term
why is bursitis difficult to treat
Definition
non-contractile; can't strengthen or stretch it
Term
what type of treatment to use for bursitis
Definition
ultrasound
Term
how much flexion occurs at the glenohumeral joint?
Definition
180 degrees
Term
how much extension occurs at the glenohumeral ligament?
Definition
30 degrees
Term
how much abduction occurs at the glenohumeral ligament?
Definition
180 degrees
Term
how much adduction occurs at the glenohumeral ligament?
Definition
45 degrees
Term
how much internal rotation occurs at the glenohumeral joint?
Definition
90 degrees
Term
how much external rotation occurs at the glenohumeral joint?
Definition
60 degrees
Term
what is the close packed position of the glenohumeral ligament?
Definition
full abduction with full external rotation
Term
what is the resting position of the glenohumeral joint?
Definition
55 degrees abduction with 30 degrees horizontal adduction
Term
is the scapulothoracic joint a true anatomic joint?
Definition
no
Term
at what thoracic levels does the scapula res?
Definition
T2-T7
Term
what is the angle of the medial border of the scapula from top to bottom?
Definition
3 degrees
Term
function of the scapula
Definition
provide a stable base for normal shoulder motion
Term
what is the position of the scapula compared to the sagittal plane
Definition
scapula lies 20-30 deg forward of sagittal plane (that's what the ppt says. i think he means frontal plane?)
Term
what are the movements of the scapulothoracic joint?
Definition
elevation/depression, protraction/retraction, upward/downward rotation, tipping, winging
Term
what are some pathologic conditions of the shoulder complex?
Definition
AC & SC joint injury, rotator cuff impingement/tear, subacromial bursitis, adhesive capsulitis, glenohumeral instability, glenoid labrum lesions, thoracic outlet syndrome, fracture
Term
overview of assessment of the shoulder complex (steps)
Definition
history, observation, UQ screen, active/passive/resisted movement, special tests, palpation
Term
why should you expalin to the patient when you do an UQ screen for a shoulder problem?
Definition
so they'll know you know the difference between shoulder and neck
Term
What are some general age-related changes to the shoulder that may be normal at some ages but abnormal at younger ages?
Definition
sarcopenia, joint laxity, brittle cartilage, meniscal degeneration, diminished circulation, osteoporosis, worsening cardiovascular status, reduced activity, depression, loss of proprioception and balance, reduced mobility, postural changes, history of surgery and/or comorbidities
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