Term
| Quick note: The Shoulder exam cards start from pg 187 with Glenohumeral joint from Dr. Berg's notes. These cards may also be helpful for the POM MS exam, therefore I am putting in info that may not be tested thru the anatomy practical. |
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Definition
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Term
| The interface of the round head of the humerus and the flat glenoid fossa is formally called the... |
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Definition
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Term
| What kind of joint is the GH joint? |
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Definition
| Synovial joint --> Ball and Socket |
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Term
| The glenoid fossa is surrounded by... |
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Definition
| the glenoid LABRUM (fibrocartilagenous) |
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Term
| why is the Glenoid labrum important? |
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Definition
| 1) It deepens the connection b/w the glenoid fossa and the head of the humerus 2) provides stability to GH joint when shoulder moves |
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Term
| Name the 4 ligaments associated with the GH joint |
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Definition
1) Coracoacromial
2) Coracohumeral
3) Transverse humeral
4) Glenohumeral |
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Term
| Which ligament of the GH joint prevents UPWARD displacement of the shoulder joint? Why does this make sense? |
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Definition
| The coracoacromial ligament. Why? because it reinforces the SUPERIOR aspect of shoulder joint, thus helping to prevent upward dislocation |
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Term
| Which ligament helps resist excessive ABDUCTION? Why does that make sense? |
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Definition
| Coracohumeral. Why --> it's a ligament that attaches the scapula (anterior) to the humerus (which participates in ABDUCTION). |
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Term
| Which ligament hold the long head of the biceps in the bicipital groove? Why does that make sense? |
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Definition
Transverse humeral ligament.
Why --> the bicipital groove is only in the HUMERUS and the THL is in the humerus. The long head of the biceps is in that groove. |
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Term
| What ligaments support the ANTERIOR capsule of GH joint? |
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Definition
| The glenohumeral ligaments (superior, middle, and inferior). |
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Term
| What muscles stabilizes the CAPSULE of the shoulder joint? Describe where. |
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Definition
By rotator cuff muscles (SITS)
Anterior capsule --> Subscapularis
Posterior capsule --> Infraspinatus and Teres Minor
Superiorly --> Supraspinatus |
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Term
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Definition
Fluid filled sac that provides cushion between bones and tendons and/or muscles around a joint. This helps to reduce friction between the bones and allows free movement.
Can be infected --> bursitis |
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Term
| What provides the GH joint ACTIVE stability? |
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Definition
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Term
| Which of the SITS muscles keeps the head of the humerus in contact with the glenoid fossa? What is this process called? |
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Definition
The Subscapularis, Teres Minor and Infraspinatus m.m. actively ADDUCT the shoulder.
When the head of the humerus and the glenoid fossa are close --> ADDUCTION
Recall: Supraspinatus ABDUCTS (first ~15 deg) |
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Term
| Which of the 4 muscles (SITS) helps depress the head of the humerus? |
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Definition
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Term
| How can a shoulder dislocation occur? Give simple answer |
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Definition
| Tearing of the SITS muscles. |
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Term
| What are the 5 Components of the Shoulder Exam? Think POM |
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Definition
History
Inspection/Observation
Palpation
Range of Motion
Special Tests
Notice there's no Percussion and Auscultation! |
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Term
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Definition
| OLDCARTS (include MECHANISM of INJURY --> Trauma, Overuse, Metabolic, Idiopathic (unknown, spontaneous). |
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Term
| What is ONE major thing you would look for when Inspecting the patient's limbs |
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Definition
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Term
| What are the possible reasons for ASYMMETRY? |
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Definition
1) One shoulder drops => loss of passive stability => weak trapezius => Cr. XI damage?
2)Bone protruding => Shoulder separation (overriding clavicle over acromion) +/or visible acromion => deltoid m. damage
3) Step deformity => shoulder subluxation (~dislocation)
4) Bruising, redness => bursitis (infection) |
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Term
| What is the next step after Inspection? |
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Definition
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Term
| What is important to know for palpation? |
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Definition
Chart 1 - Palpable bony prominences and the structures that attach to it!
See pg 193 |
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Term
| Why would Palpation help the clinician? |
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Definition
Gives clues about:
1) fractures
2) bursitis
3) muscle strain
4) ligament sprain |
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Term
| Where would you palpate to get a clue for the pathology of the long head of the biceps? |
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Definition
| Bicipital groove (place thumb under anterior part of acromion) |
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Term
| If there is pain upon palpation of the AC joint, what may the patient have? |
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Definition
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Term
| If ligaments of the AC joint are torn, this may lead to... |
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Definition
| shoulder separation, possibly the clavicle can override the acromion. |
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Term
| What other test may indicate an AC joint shoulder separation? |
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Definition
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Term
| What is the Cross Body Maneuver? |
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Definition
| Injured arm is brought across the body anteriorly to touch opposite shoulder. If there's pain in the AC joint region, then test is + |
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Term
| What do you palpate for on the Coracoid process? |
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Definition
1) Pectoralis minor m.
2) Short head of Biceps brachii m.
3) Coracobrachialis m. |
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Term
| What do you palpate for on the Lesser Tubercle? |
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Definition
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Term
| What do you palpate for on the Greater Tubercle? |
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Definition
SIT (Supra-infra-spinatus m.m., Teres minor)
Note: NOT THE Subscapularis m., that's the Lesser Tubercle! |
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Term
| There are 3 spaces that are associated with the Intertubercular (Bicipital) groove. What are they? |
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Definition
| Lateral lip, Medial lip, and the Floor of the bicipital groove |
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Term
| What do you palpate for on the bicipital groove? |
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Definition
| Tendon of the Long head of the bicep |
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Term
| What do you palpate for on the Lateral lip of the bicipital groove? |
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Definition
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Term
| What do you palpate for on the Medial Lip? |
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Definition
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Term
| What do you palpate for on the Floor of the bicipital groove? |
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Definition
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Term
| What do you palpate for superior and inferior borders of the scapular spine? |
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Definition
| supraspinatus and infraspinatus, respectively |
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Term
| What muscles are not involved in the bicipital groove palpation? |
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Definition
The rotator cuff muscles!
SITS, recall they attach to the tubercles! |
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Term
| What comes after Palpation? |
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Definition
| Testing Range of Motion (ROM) - can patient make motions about the shoulder joint? Full/partial motion? etc |
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Term
| What is the first step of ROM? |
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Definition
Test for ACTIVE rom first!
Make sure to always compare each side! |
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Term
1) Define Active rom
2) What does a decrease in Active rom mean? |
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Definition
1) Use of OWN energy w/o assistance involving CONTRACTILE elements
2)Muscles and nerves are malfunctional |
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Term
| What ROM do you assess after Active rom? |
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Definition
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Term
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Definition
| Movement that occurs w/o muscle action (examiner moves a joint). |
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Term
| What elements are assessed in Passive rom? |
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Definition
| NON-CONTRACTILE elements! |
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Term
| What are Non-Contractile elements? |
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Definition
Capsule, Ligaments, Cartilage
(things that don't contract)
Notice that Muscle is not a non-contractile element! |
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Term
| Full STRENGTH can only be assessed with which ROM? |
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Definition
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Term
| How is resisted motion performed? |
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Definition
| Patient uses muscles to produce movement against resistance provided by examiner |
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Term
See page 190 of Dr. Berg's Notes for examples of Resisted and Passive ROM's
Part (B) will be discussed though |
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Definition
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Term
| Compressions to what nerve root(s)/trunk(s) often results in shoulder and neck pain? |
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Definition
| C5 and C6 roots and/or upper trunk of brachial plexus. |
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Term
| How do we "clear the neck"? (eliminate the neck as the source of a problem) |
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Definition
| Move neck (stand upright) in 4 ways: 1) Flexion (head forward) 2) Extension (head back) 3) Rotation (tilt head to look right and left) 4) Lateral flexion (side bending to each side) |
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Term
| What is the false joint of the shoulder girdle? |
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Definition
| The Scapulothoracic joint |
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Term
| What are the PRIME MOVERS of the ST joint? |
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Definition
STLRLP --> Serratus Anterior, Trapezius, Levator Scapula, Rhomboids, Latissimus Dorsi, Pectoralis Minor
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NOT PEC MAJOR b/c that attaches to the lateral groove of the bicipital groove of the HUMERUS |
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Term
| STLRP = Prime mover muscles of the ST joint. What's the mnemonic? |
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Definition
| Someone Tried Licking Rolaids Like Penis |
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Term
| For the upcoming Prime Mover muscles, name the type of (1) Movement, (2) nerve supply, and (3) Deficit (observation) |
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Definition
| Left intentionally blank. |
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Term
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Definition
1) Protraction of Scapula
2) Long Thoracic Nerve
3) Winging of Scapula (Medial border protrudes like a wing) |
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Term
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Definition
1) Retraction and Upward Rotation of Scapula
2) Cr. XI - Spinal Accessory Nerve (NOT Brachial Plexus!)
3) Drooping ipsilateral shoulder |
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Term
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Definition
1) Retraction and elevation (shoulder shrugs)
2) Cr XI and Dorsal Scapular Nerve
3) Not in chart (darn) - I'm guessing droopy shoulders (can't shrug shoulders?) |
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Term
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Definition
1) Elevate Scapula
2) C3, C4 (NOT BRACHIAL PLEXUS!)
3) Not in chart (guess - can't lift scapula on affected side) |
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Term
| Serratus Anterior + Upper Trapezius |
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Definition
1) Phase 3 Shoulder Abduction --> Upward Rotation of Scapula, abduct arm ABOVE shoulder level
2) Long Thoracic n. + Cr. XI
3) Cannot abduct arm over shoulder level |
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Term
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Definition
1) Downward Rotation
2) Medial Pectoral Nerve
3) ? |
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Term
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Definition
1) Downward Rotation of Scapula (think Lat pulls)
2) Thoracodorsal nerve (Lat is in thorax region and on the back!)
3) Upward displacement of shoulder if weak |
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Term
| What is Scapulohumeral rhythm? |
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Definition
| describes interaction of S & H upon COMPLETE Abduction of shoulder |
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Term
| How can you tell if the scapula is not being upwardly rotated as humerus is abducted? |
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Definition
| Humerus can't go above shoulder level (acromion stops it) |
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Term
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Definition
Acromion moves UPWARD
Inferior angle moves LATERALLY
Palpate inferior angle and have humerus abducted. |
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Term
| How many phases are there in shoulder abduction? |
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Definition
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Term
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Definition
Note the r/s b'w each ligament and associated bone.
(Shoulder abduction phases continued on next flashcard!) |
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Term
| Phase 1 (initial) of ABDUCTION |
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Definition
| SUPRASPINATUS moves the HUMERUS about 15 degrees. Scapula moves very little |
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Term
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Definition
| DELTOID MUSCLE moves Humerus to Shoulder level. |
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Term
| In Phase 2, the Scapula is upwardly rotated. How? |
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Definition
| The Serratus anterior and upper trapezius muscles! |
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Term
| Phase 3 (Terminal phase) of Abduction |
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Definition
| Still the DELTOID m. (humerus to head) |
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Term
| In Phase 3, upward rotation is completed of the Scapula. How? |
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Definition
| Again, the Serratus anterior and upper trapezius muscles! Phase 3 abduction cannot occur w/o scapula upward rotation b/c acromion would prevent humerus from going further. |
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Term
| How would you test for a "Painful Arc"? |
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Definition
| Upon full ABDUCTION, patient feels PAIN MIDWAY through (during Phase 2 of Abduction). Not Phase 1 or 3! |
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Term
| What does a painful arc indicate? |
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Definition
| Shoulder impingement (pain) |
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Term
| What are the rotator cuff muscles again? |
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Definition
| SITS - Supraspinatus, Infraspinatus, Teres Minor, and Subscapularis |
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Term
| What muscles are tested in the Appley Scratch test? |
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Definition
| Tests for function of the Subscapularis, Teres Minor, and Infraspinatus muscles |
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Term
| What ROM is (are) tested by the Appley Scratch Test? |
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Definition
1) External (Lateral) Rotation of shoulder)
2) Internal (Medial) Rotation of shoulder |
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Term
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Definition
Appley Scratch Test (I-T-S muscles only!)
Left side = External Rotation (Infraspinatus and Teres Minor m.m.)
Right Side = Internal Rotation (Subscapularis m) |
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Term
| There are different ways to describe the rotations of the shoulder. What are they? |
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Definition
Lateral = External = Outward Rotation
AND
Medial = Internal = Inward Rotation |
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Term
| *RANDOM Q* Prime Movers of the Glenohumeral joint are... |
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Definition
Pectoralis major, Biceps, Supraspinatus, Serratus anterior Deltoid, Latissimus Dorsi, Teres Major, Triceps (long head), upper Trapezius
Mnemonic
P-B-S Showed Dr. Lee and T T T
Can't be Pec minor (attaches to Coracoid)
should be Upper Trapezius b/c GH joint is superior |
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Term
| For the following cards, describe (1) movement and (2) nerve innervation |
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Definition
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Term
| Pectoralis Major - Clavicular Head |
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Definition
1) Flex shoulder
2) Lateral Pectoral N. (C5,6,7) |
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Term
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Definition
1) Flex shoulder 2) Musculocutaneous N. (C5,C6, C7)
Recall Mnemonic for brachial plexus Branches:
My Aunt Raped My Uncle
MC, Ax, Rad, Median, Ulnar |
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Term
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Definition
1) Flex Shoulder
2) Axillary n (C5, C6) |
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Term
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Definition
1) Extend shoulder
2) Axillary n. (C5, C6) |
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Term
| Long head of Triceps brachii |
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Definition
1) Extend shoulder
2) Radial n. (C5,6,7,8, sometimes T1) |
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Term
| Pectoralis Major (sternocostal head) |
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Definition
1) Adduction (fly exercise) medially rotates the humerus Actively.
It also Passively protracts Scapula anteriorly and inferiorly (push-ups).
2) Medial Pectoral n (C8, T1) |
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Term
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Definition
1) Adduction (lat pulldown)
2) Thoracodorsal n (C7, C8) |
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Term
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Definition
1) Adduction
2) Lower Subscapular n. (C5, C6) |
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Term
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Definition
| 1) Starts Abduction 2) Suprascapular n. (C5, C6) 3) If lesioned --> inability to move arm AWAY from SIDE. |
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Term
Serratus Anterior m.
(with trapezius m.) |
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Definition
| 1) Lateral Thoracic n. (C5, C6, C7) 2) Abduction of humerus |
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Term
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Definition
1) Upper and Lower Subscapular nerves (Both are C5, C6)
2) Internal Rotation
3) Test: Appley Scratch, resisted internal rotation, Lift test (hand behind back, inwardly rotate against resistance) |
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Term
| Test for Supraspinatus m. |
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Definition
1) Resist initial abduction
2) Drop Arm Test for tears (Start at 90 deg abduction, and lower arm smoothly, if difficult and feels pain, then + test for tear in supraspinatus) |
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Term
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Definition
1) Action: Outward (External) rotation 2) Tests: i) Appley Scratch ii) Resist External Rotation
3) Suprascapular nerve (C5,C6) |
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Term
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Definition
1) Outward (external) rotation 2) Appley Scratch and resist external rotation
3) Axillary n. (C5,C6)
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Term
| Last Part: Neurovascular Testing |
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Definition
| Dermatomes, Myotomes, Common Nerve Lesions |
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Term
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Definition
Top --> C3, C4
Lateral: C5
Medial -> T1 |
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Term
| If pain from a test is NOT reproduceble, what may be going on? |
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Definition
| If pain is reproduced after resistance, for example, then the pain is likely a DIRECT PAIN. If NOT reproduced, then it may be REFERRED PAIN. Why --> Referred pain is not affected by joint/muscle movement. True joint pain can be reproduced through palpation or resisted muscle testing. |
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Term
| What nerve is derived from C3,C4? |
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Definition
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Term
| Phrenic nerve Referred pain |
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Definition
1)Pleura (mediastinal and diaphragmatic)
2)Peritoneum under diaphragm (right -gall bladder, left - spleen)
3) Pericardium |
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Term
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Definition
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Term
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Definition
Deltoid Muscle (Axillary n => C5,C6)
If C6 is damaged, deltoid m. still weak, but not as weak if C5 was damaged. No other myotome affects the deltoid |
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Term
| What nerve may be lesioned from an ANTERIOR shoulder dislocation? |
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Definition
| Axillary nerve (C5 and C6) |
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Term
| Result of Axillary nerve lesion? |
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Definition
Flaccid Paralysis Deltoid and teres minor
Visible acromion |
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Term
| Too much Abduction and Lateral (External) Rotation may lead to lesion of... |
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Definition
| Suprascapular nerve (C5, C6) |
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Term
| Result of too much javelin throwing can damage the....nerve and affect which muscles? |
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Definition
Suprascapular nerve (C5, C6).
Supraspinatus and infraspinatus muscles |
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Term
| Signs of damages suprascapular nerve are? |
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Definition
1) hard to START abduction (supraspinatus)
2) + Empty Can test (arms internally rotated and resist downward force; supraspinatus)
3) Weak external rotation of humerus (infraspinatus m)
4) hollow impression above and below scapular spine |
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Term
| Check vascular integrity how? |
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Definition
| Axillary and brachial pulses |
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