Anatomy
What is the only joint in the upper body that articulates with the trunk?
sternoclavicular joint
What is little league shoulder?
humeral fracture at the epiphyseal plate
Is the posterior or anterior capsule stronger?
the posterior is stronger because it is 3x thicker
What is a test for a SLAP tear?
obrien, anterior slide, grind, larbral shear
What type of impingement is GIRD likely present in?
internal impingement
What is special (or useless) about the coracoacromial ligament?
it connects two parts of the same bone
Where do most clavicle fractures occur?
What deformity appears with an anterior glenohumeral dislocation?
flattened deltoid
Where does internal impingement take place?
under the rotator cuff muscles
What is a normal anterior shift of the humeral head? What is the normal posterior shift?
anterior = 1/4 of the humeral head
posterior = 1/2 of the humeral head
Where does the long head of the bicep insert into? Where does the short head insert into?
Long head --> labrum
Short head --> coracoid process
What is a bankart lesion and what type of dislocation does it usually accompany?
damage to the anterior lip of glenoid labrum between 3 and 6/7
labrum and capsule avulsed from the glenoid (inferior GH ligament)
anterior dislocation
What are the three degrees of AC sprain that we normally see?
1 - AC ligament sprained
2 - AC torn, CC sprained
3- AC torn, CC torn
Explain why you may need a bit of shoulder adduction along with shoulder flexion and internal rotation in order to get a posterior glenohumeral dislocation.
the tilt of the scapula and tilt of the glenoid provide a bony block -- adduction allows the humerus to slide past the glenoid
What three things are affected with external/outlet impingement?
supraspinatus, subacromial bursa, long head of the bicep tendon
What are the rotator cuff muscles and what movement are they each responsible for?
supraspinatus = initiates abduction
infraspinatus & teres minor = external rotaion
subscapularis = internal rotation
Explain dead arm syndrome.
this occurs with a person who continuously subluxes their glenohumeral joint anteriorly. when they sublux they nick the axillary nerve. the axillary nerve innervates the deltoid muscle which does abduction. hitting the nerve results in no longer being able to abduct, flex, or extend their arm.
How would you check to see if an anterior glenohumeral dislocation has been relocated? What about a posterior dislocation?
anterior = touch opposite shoulder and lower elbow to chest
posterior = supinate forearms
What is sign would you see with a biceps tendon rupture and what movment makes the sign more prominent?
popeyes sign during flexion
Your patient has hand stiffness and venous engorgement of the arm with cyanosis... what is your diagnosis and care?
thoracic outlet compression syndrome --> refer to doc immediately
Explain scapulohumeral rhythm.
coordinated movement of 1 degree of scapular rotation for every 2 degrees of humeral movement. at 180 degrees of movement there is 120 degrees of glenohumeral movement and 60 degrees of scapular movement
Explain the three grades of nerve injuries.
neuropraxia: temporary loss of sensation or motor function
axonotmesis: significant motor and mild sensory deficits
neurotmesis: motor and sensory deficits for up to a year
You have a basketball athlete who constantly hangs onto the rim when he dunks. Because of that has point tenderness on the anterior and lateral edges of the acromion process of their right shoulder, can't sleep on their right shoulder, and referred pain where their deltoid inserts.. what is likely the cause of this?
subacromial bursitis
Explain the three types of scapular dyskinesia
inferior dysfunction (type 1) - inferior angle is visualized, anteriorly tilted scapula
medial dysfunction (type 2) - medial border more prominent, scapula internally rotated
superior dysfunction (type 3) - early and/or excessive elevation of the scapula during active motion
What do you look for when trying to differentiate between suprascapular/brachial plexus injury and impingement?