MSK II Unit 1 and 2: Shoulder complex

how is the glenoid fossa positioned

it faces laterally, superiorly, and anteriorly

how is the head of the humerus positioned in the humerus

medially, posteriorly, and superiorly

what are the arthrokinematics of GH flexion

lower ROM: posterior roll with inferior glide

Higher ROM: superior roll/inferior glide (spin)

what are the arthrokinematics of GH extension and horizontal abduction

posterior roll anterior glide (spin)

what are the arthrokinematics of GH abduction and scaption

superior roll, inferior glide

what are the arthrokinematics of GH ER

posterior roll anterior glide

what are the arthrokinematics of GH IR

anterior roll posterior glide

what are the arthrokinematics of GH horizontal adduction

anterior roll, posterior glide

what is the open pack position for the GH joint

30 degrees flexion, 30 degrees abduction

what is the closed pack position for the GH joint

90 degrees abduction and full ER

what is the function of scapulohumeral rhythm

positions the glenoid for optimal UE function and length tension relationships for the RC and humeral movers

what occurs at the scapula with abduction (3)

upward rotation

posterior tilting

protraction

what is calcific tendinitis

an acute flare up of tendinitis that limits motion and is considered to be a mobility deficit

what is the movement ratio in the scapulohumeral rhythm

2:1 between GH joint and scapula

120 degrees GH, 60 degrees scapula

what pathologies are included in mobility deficits for the shoulder (6)

Adhesive capsulitis

muscle tightness

osteoarthritis

articular cartilage injury

calcific tendinitis

bursitis

what pathologies are included in muscle performance deficits of the shoulder (6)

muscle pain/strain

rotator cuff tear

Biceps LH tear

strength power endurance deficits

tendinopathy (RTC syndrome)

subacromial pain/impingement

what are the pathologies in movement coordination/stability deficits of the shoulder (5)

altered movement patterns (scapular dyskinesia)

GHJ instability

Labral tears

ligament laxity (AC sprain)

Postural deficits

What are the pathologies for pain/radiation pain in the shoulder (6)

neuropathic pain

radiculopathy

axillary N

Suprascapular N

long thoracic N

Accessory N

what should be asked in the subjective exam of shoulder pathologies

R or L dominant

pop/click/snap/grind

feeling like it will pop out?

Pain with sleeping positions

stiffness/loss of motion

past history of neck injury/pain

what outcome measures are commonly used for shoulders (4)

UE functional score/index

Disabilities of the arm shoulder hand

Shoulder pain and disability

American shoulder/ elbow surgeons score

what is found in an extracapsular humeral fracture

edema

what is found in an intracapsular humeral fracture

effusion

what is bleeding in the joint called

hemarthrosis

what are the predisposing factors to humerus fractures (3)

elderly women

FOOSH

may also sustain humeral head trauma from compressive forces

what are the predisposing factors for a humeral shaft fracture

direct trauma to the arm

what is the prognosis for humeral shaft fractures

good due to blood supply

what is seen in inspection for humerus fractures

atrophy

swelling

bruising

surgical scar

what is seen in ROM with humerus fractures

limited ROM in elbow, shoulder, AC and SC joint

what may be seen in strength with humerus fractures

weakness in shoulder, elbow,

what may be seen in a neurological assessment for humerus fractures

may have diminished sensation/motor due to potential radial, axillary nerve involvement

what are Codman's exercises

pendulum exercises to create less pain and minimal muscle effort to allow joint separation and movement to gate pain

what is the most common childhood fracture

greenstick clavicle fracture

how do clavicle fractures present

in the middle third of the clavicle with the lateral clavicle pulled inferomedial

what is the treatment for greenstick clavicle fractures

figure 8 brace 3-6 weeks

what is the treatment for a complete clavicle fracture

splint/brace 3-6 weeks or ORIF

what is initiated to the clavicle immediately following mobilization

joint mobs

what interventions are used for altered movement patterns/coordinated deficits

NM and movement retrianing

what interventions are used for joint hypermobility and ligament laxity (3)

cyclic loading

dynamic stabilization

strength around joint

what interventions are used for postural deficits in the shoulder(3)

correct imbalances

strength, endurance

movement training

what is the MOI for AC joint sprains

fall on tip of shoulder with arm adducted

FOOSH

what is a grade 1 AC sprain (2)

clavicle is not elevated

AC ligament sprain

what is a grade II AC sprain

clavicle elevated but not above superior border of acromion

what structures are involved in a grade II AC sprain (5)

AC ligament rupture

CC ligament sprain

joint capsule rupture

deltoid min detached

trapezius min detached

what is a grade III AC sprain

clavicle elevated above superior border of acromion

AC lig rupture

CC lig rupture

Capsule rupture

Deltoid detatched

Upper trap detached

what may be seen in the postural inspection of AC joint

stair step deformity/piano key deformity

what is the test cluster for an AC joint sprain

Obrien/active compression

Cross over

AC resisted extension

what are the interventions used for grade I and II AC sprains

immobilization for 1-2 weeks

good prognosis

what are the interventions used for grade III AC sprains

conservative first then surgery if needed

what is the expected full sport/occupation participation timeline for grade I-II

12 weeks

what direction are most SC joint dislocations

anterior is more common

why are posterior SC joint sprains dangerous

vital structures such as carotid or subclavian artery behind clavicle

what is the MOI of SC joint sprains (2)

MVA

FOOSH with arm flexed or adducted

what symptoms may be felt with a SC joint injury

meniscus type symptoms such as clicking, popping, and/or locking

what is a type I SC sprain

sprain of SC lig

what is a type II SC sprain

subluxation

partial teat of capsule lig, disk, or CC ligaments

what is a type IIA SC sprain

anterior subluxation (most common)

what is a type IIB SC sprain

posterior subluxation (potential safety issue)

what is a type IIIA SC sprain

anterior dislocation

what is a type IIIB SC sprain

posterior dislocation

what is a type IV SC sprain

habitual dislocation (rare)

when does the coracohumeral ligament become taut

with extension and horizontal abduction

what does the coracohumeral ligament resist

inferior translation and ER of the humeral head with the arm in neutral to 30 degrees of flexion/extension

what makes up the GH ligaments

thickenings of the anterior capsule

what are the GH ligaments

superior

middle

inferior

what makes up the Z ligament

Superior, middle, and inferior GH lig

what makes the superior GH ligament taut (3)

adduction

ER with arm at side

inferior and anterior-posterior translations of humerus head

what does a torn superior GH ligament allow

inferior subluxation of humerus

what does a contracture of the superior GH lig limit

ER and flexon

what makes the middle GH ligament taut

anterior translation of humerus (in 45-60 abduction)

ER at 45 degrees elevation

what does the middle GH lig blend with

the subscapularis tendon

what does the middle GH lig limit

anterior translation of the humerus with the arm abducted 45 degrees and ER

what are the two portions of the inferior GH lig

anterior and posterior band with an axillary pouch between them

what does the axillary pouch do

supports the humerus during abduction and ER

what does the inferior GH ligament provide

primary static stabilized when the arm is abducted from 45-90 degrees

when is the anterior band of the inferior GH lig taut (2)

90 degrees of abduction and full ER

anterior translation of humerus

when is the posterior band of the inferior GH ligament taut

90 degrees of abduction and full IR

when is the axillary pouch taut

90 degrees of abduction with anterior-posterior and inferior translation

what is GH joint instability

abnormal symptomatic motion of the GHJ that affects normal joint kinematics and results in pain, subluxation, or dislocations of the shoulder

what is the impact of GH joint instability (3)

excessive translation leads to tissue injury

excessive translation of the humerus head can lead to secondary issues like impingmenet

loss of function and performance

what are the risk factors of GH joint instability (2)

prior history of sublux/dislocation

athletic adolescents with repetitive overhead activities

what leads to atraumatic GH joint instability

congenital laxity becomes symptomatic leading to poor stabilizing control especially in overhead motions

what occurs to the humerus in GH joint instability

the head translated anterior and inferior stretching capsuloligamentous structures

what is the most common direction of instability in atraumatic GH joint instability

anterior/inferior

what is the MOI of traumatic GH joint instability

FOOSH injury with forced abduction, extension, and ER

what is the most common traumatic shoulder dislocation

anterior

what is TUBS instability

torn loose

usually involves labral tear

what is AMBRII instability

born loose

capsular laxity

repeated microtrauma from positional stresses

what is AMBRII

Atraumatic

Multidirectional

Bilateral

Rehabilitation

Inferior capsular shift

rotator Interval

what is often reported in the subjective exam for AMBRII instability (3)

deep vague pain with mechanical symptoms

reports of shoulder slipping or popping out

history of OH athlete or occupation that stresses GHJ

what is often seen in inspection of AMBRII instability

sulcus sign

what is often seen in joint mobility of AMBRII instability

laxity

what is often seen in ROM of AMBRII instability

scapular dyskinesia

what is often seen in muscle performance of AMBRII instability

RC and scapula weakness

core/trunk weakness

what is often seen in special tests of AMBRII instability (6)

apprehension/relocation/surprise

load shift

sulcus crank

clunk

posterior apprehension

what is the beighton scale

a scale that predicts symptomatic shoulder laxity and risk of recurrent instability to understand laxity

what is the impact of a labrum tear

there is compromised structural stability in the joint

what is the MOI of labrum injuries (3)

traumatic from glenoid

fraying

chronic

where are the post common locations of labral tears (3)

anterior

posterior

Superior labrum anterior to posterior (SLAP)

how are labral teras documented

in relation to a clock for position

what does TUBS instability stand for

Traumatic

Unidirectional (anterior)

Bankart lesion

Surgery