Quiz 2: Shoulder Complex, Dysfunctions, & Brachial Plexus

GH Flexion

Brady: biceps brachii

Pats: pectoralis major

CORAs: coracobrachialis

Ass: anterior deltoid

GH Extension

Pull: pec major

That: triceps brachii

LATtuce: LATtissimus dorsi

Tere: teres major

GH Abduction

Brady: biceps brachii

Drugs: deltoids

Suprina: supraspinatus

GH Adduction

Tere: teres major

Puts: pectoralis major

tere jr's: teres minor

LATtuce: latissimus dorsi

IN: infraspinatus

CORA's: coracobrachialis

Tummy: triceps brachii

GH internal rotation

Tere: teres major

Puts: pectoralis major

LATtuce: LATissimus dorsi

Around: anterior deltoid

SUBS: SUBScapularis

GH external rotation

TERE jr: teres minor

INvades: INfraspinatus

POland: posterior deltoids

Shoulder Complex Bones

-scapula

-humerus

-clavicle

-sternum

Articulation of shoulder complex

-scapulothoracic

-acromioclavicular

-sternoclavicular

-glenohumeral

Scapulothoracic joint

Articulation btwn. scapula and thorax (rib cage)

-not a TRUE joint

ST joint motions

elevation/depression

protraction/retraction

upward/downward rotation

Acromioclavicular Joint

Articulation btwn. acromion and clavicle

-plane joint

acromioclavicular joint motions

small amount of movement

-anterior/posterior translation

-superior/inferior translation

acromioclavicular important ligaments

coracoclavicular and acromioclavicular ligaments

-keep AC joint in place

sternoclavicular joint

Articulation between the clavicle and the sternum

-complex saddle joint

-3 degrees of freedom

sternoclavicular joint motions

elevation/depression, protraction/retraction, axial rotation

sternoclavicular stability

-sternoclavicular ligaments

-articular discs: fibrocartilage (shock absorptions, stability)

-costoclavicular and interclavicular ligament: keep bones from dislocating and distribute forces

Glenohumeral Joint

Articulation btwn. head of humerus and glenoid fossa

-ball and socket joint

-3 degrees of freedom

glenohumeral joint motions

flexion/extension, abduction/adduction, internal/external rotation, horizontal abduction/adduction, and scaption

scaption

30º anterior to frontal plane

other planar motions

horizontal abduction and adduction

scapulohumeral rhythm

when GH and scapula move at the same time

-ST contributes 60º upward rotation

-GH contributes 120º flexion

ST + GH motion = full ROM of shoulder

ratio: 2:1 for GH:ST motion

GH joint stability

GH sacrifices stability for mobility

static stability in GH joint

-capsular ligaments

-coracohumeral ligaments: resists inferior displacement of humeral head

-glenoid labrum: increases surface area

dynamic stability of GH joint

-rotator cuff muscles: SItS

-long head of biceps tendon: when contracts contributes to dynamic stability

coracoacromial arch

roof of GH joint formed by

-coracoacromial ligaments

-acromion

-coracoid process

subacromial space

underneath roof, includes:

-supraspinatus muscle and tendon

-infraspinatus tendon only

-subacromial bursae

-biceps long head

-superior capsule

structures giving dynamics stability

-compresses humeral head into glenoid fossa when carrying weight

-depress humeral head during elevation

-primary movers for shoulder motions (SItS, biceps, and triceps)

dysfunction results from

-structural deficits (congenital, injury)

-overuse/trauma

-nervous system damage

-physiological causes

rotator cuff tear

partial thickness or full thickness tear of SItS muscles

risk factors of RC tear

-repetitive OH activities

-trauma/FOOSH

-weak scapular muscles

-previous impingement

-age, sex, arm dominance

signs and symptoms of RC tear

-pain with active motion

-decreased AROM

-decrease strength, muscle atrophy

clincial evaluation for RC tear

AROM and PROM eval: lack of active abduction past 90º predicts RC tear

diagnostic eval for RC taer

-ultrasound

-MRI

special test for RC tear

jobe (empty can) test

adhesive capsulitis (frozen shoulder)

axillary pouch and posterior capsule gets tighter and cause decreased ROM

two types of adhesive capsulitis

primary: unknown

secondary: freq. associated w/ prev UE injuries, hemiplegia (CVA), or conditions where shoulder motion is limited

risk factors of adhesive capsulitis

-female

-thyroid disease

-diabetes

-other autoimmune disease

-CVA

signs and symptoms of adhesive capsulitis

-decrease AROM and PROM

-tight capsule

-pain

-functional challenges

three phases of adhesive capsulitis

phase 1: freezing (weeks to months)

phase 2: stiffness (4-12 months)

phase 3: thawing (5-26 months)

clinical evaluation

-physical exam

-AROM and PROM eval

-differential diagnosis to rule out other conditions

-assess functional limitations and pain

shoulder instability

shallow glenoid fossa- lack of bony stability

other impairment of structures can cause

-capsular laxity

-muscle weakness/imbalance

-nervous system damage

weakness of trapezius can cause

Loss or impairment of elevation, upward rotation, retraction, depression

weakness of serratus anterior can cause

-loss of protraction and upward rotation

-causes winging of scapula

shoulder subluxation

head of humerus comes PARTIALLY out of glenoid fossa; may reduce on its own

dislocation

head of humerus comes COMPLETELY out of glenoid fossa; needs to be reduced back

causes of subluxation

-trauma

-weakness or paralysis of muscles that help hold head of humerus in fossa due to CVA

signs and symptoms of subluxation

-instability at shoulder joint

-pain

-decrease AROM

-have >2cm of subacromiaol space

special test for subluxation

sulcus sign

impingement syndrome

irritation of structures in the subacromial space

risk factors of impingement

-structural causes that narrow space

-muscle imbalance/weakness/tightness

-overuse/excessive OH movements

-shoulder bursitis

-shoulder tendinitis

-posture

-variations in shape of acromion

signs and symptoms of impingement syndrome

-pain (esp. w/ OH activities, sleeping)

-weakness

-possible loss of AROM

evaluations for impingement syndrome

-PROM and AROM

-identify compensation patterns during ROM

-functional eval of occupations (posture/ergonomics)

special tests for impingement

-neer test: sensitive

-hawkins test: sensitive

-painful arc test: limited evidence to support use

brachial plexus formed from

ventral rami C5, C6, C7, C8, & T1

ventral rami nerve travel

C1-C8 travel ABOVE T1

T1 travels BELOW T2

bony contents located near brachial plexus

clavicle and 1st rib

muscular contents located near brachial plexus

-anterior and middle scalenes

-pectoralis minor

artery and veins located near brachial plexus

subclavian vein → axillary vein

subclavian artery → axillary artery

brachial plexus composed of

-5 rami (C5, C6, C7, C8, T1)

-3 trunks (upper, middle, lower)

-6 divisions coming from trunks (3 anterior and 3 posterior)

-3 cords (lateral, posterior, medial)

-branches (musculocutaneous (C5-C7), axillary (C5-C6), radial (C5-T1), median (C5-T1), ulnar (C7-T1)

brachial plexus supplies

motor and sensory information to UE

prefixed variaton

STRONG contribution from C4, WEAK contribution from T2

postfixed variation

WEAK contribution from C5, STRONG contribution from T12

upper plexus lesion

-Erb's palsy most common - shoulder is internally rotated, adducted, elbow extension, forward flex

-Happens during birth

muscles affected by erb's palsy

-proximal UE muscles (RC, scapular, triceps, supinator)

lower plexus lesion

Klumpke's Palsy (C8 -T1); less common

muscles affected by klumpke's palsy

distal UE muscles (loss of finger extension, thumb motions, wrist motions)

adult injury to brachial plexus

-trauma to head, neck, shoulder

-MVA

-GSW

-post anasthesia

thoracic outlet borders

Scalene muscles, first rib, and clavicle

thoracic outlet contains

-subclavian artery and vein

-brachial plexus

thoracic outlet syndrome

compression of brachial plexus/vascular structures within thoracic outlet

entrapment occurs

-scalene triangle

-costoclavicular interval

-axillary interval (under pec minor)

risk factors of TOS

-Anatomical Variations of the cervical rib

-Head or neck trauma

-large pectoral muscles

-tumors

-repetitive OH activity/trauma

-poor posture

-female

neurogenic TOS

-atrophy of UE muscles

-loss of discriminative touch/proprioception

-parasthesia

-dull pain/discomfort

Vascular TOS → compression of vein

-edema of UE

-blueness (cyanosis)

-stiffness

vascular TOS → compression of artery

-paleness

-coolness

-decreased pulse/BP

nonspecific TOS

mixed symptoms of both neurogenic and vascular TOS

motor symptoms

-weakness

-atrophy

-loss of AROM

sensory symptoms

-loss of proprioception

-parasthesia

-loss of discriminative touch

-pain

clinical evaluations for TOS

-physical exam

-sensory and motor testing

-BP or pulse

-ergonomice evals

special test for TOS

Roos test

ST retraction

Make: middle trap

Them: traps (upper and lower)

Retract: rhomboids

ST depression

LATs: latissimus dorsi

Party: pectoralis minor

Like: lower trapezius

Sarra: Serratus anterior

ST downward rotation

Please: pectoralis minor

Lower: levator scapulae

Rolls: rhomboids

ST elevation

Umbrella: upper trapezius

Likes: levator scapulae

Rain: rhomboids

ST upward rotation

Let: lower trapezius

Us: upper trapezius

Spin: serratus anterior

ST protraction

Protract: pectoralis minor

the

Scap: serratus anterior