Ch 13 Eval. Ortho

Description:	Ch 13- The Shoulder and Upper Arm
Category:	Sports Medicine
Created by:	gunrock on 2009-02-28

Question	Answer
Name the 3 pieces of the sternum.	Manubrium, Body of sternum, and Xiphoid process
What are the 3 real and the 1 false joint of the shoulder?	Sternoclavicular joint, acromioclavicular joint, and glenohumeral joint. The false joint is the scapulothoracic articulation
Define scapular tipping.	The inferior angle of the scapula moving away from the thorax while its superior border moves toward the thorax.
What 8 muscles act on the scapula?	Latissimus dorsi, levator scapulae, rhomboid major, rhomboid minor, serratus anterior, trapezius, pectoralis major, pectoralis major
Define force couple.	Coordination between dynamic and isometric contractions of opposing muscle groups to perform a movement of a joint.
What 11 muscles act on the humerus?	Biceps brachii, coracobrachialis, deltoid, infraspinatus, latissimus dorsi, pectoralis major, subscapularis, supraspinatus, teres major, teres minor, triceps brachii.
List 5 things that should be learned during a history.	Location of pain, Onset, Activity and injury mechanism, Symptoms, and Prior injury
What are the 5 phases of the pitching motion?	Wind-up, cocking, acceleration, deceleration, follow through.
What are 2 general things that should be observed when inspecting a shoulder injury?	Position of the head, position of the arm and willingness to move the involved limb.
What 4 anterior things should be inspected?	Level of the shoulders, contour of the clavicles, symmetry of the deltoid muscle groups, anterior humerus and biceps brachii muscle group
What 3 lateral things should be inspected?	deltoid muscle group, acromion process, position of the humerus
What 5 posterior things should be inspected?	Alignment of the vertebral column, position of the scapulae, sprengel's deformity (undescended scapula), muscle tone, position of the humerus
What 15 things should be palpated on the anterior shoulder?	Jugular notch, sc joint, clavicular shaft, acromion process and ac joint, coracoid process, humeral head, greater tuberosity, lesser tuberosity, bicipital groove, humeral shaft, pec major, pec minor, coracobrachialis, deltoid, biceps
What 12 things should be palpated on the posterior shoulder?	spine of the scaplua, superior angle, inferior angle, rotator cuff, teres major, rhomboid, levator scapulae, trapezius, latissimus dorsi, posterior deltoid, triceps brachii
What are the landmarks for goniometry when measuring shoulder flexion and extension?	Fulcrum- aligned lateral to the acromion process. Stationary arm- aligned parallel to the table top. Movement arm - centered over the midline of the lateral humerus
What are the landmarks for goniometry when measuring shoulder abduction and adduction?	Fulcrum- anterior to the acromion process. Stationary arm- parallel to the long axis of the torso. Movement arm- centered over the midline of the anterior humerus.
What are the landmarks for goniometry when measuring internal and external rotation?	Fulcrum- Centered lateral to the olecranon process. Stationary arm- perpendicular to the floor or parallel to the tabletop. Movement arm- centered over the long axis of the ulna
What motions are produced during the apley's scratch test to the opposite shoulder?	GH adduction, horizontal adduction, and internal rotation; scapular protraction
What motions are produced during the apley's scratch test behind the head to opposite shoulder?	GH abduction and external rotation; scapular protraction, elevation, and upward rotation
What motions are produced during the apley's scratch test behind the back?	GH adduction and internal rotation; scapular retraction and downward rotation
What constitutes a positive drop arm test?	The arm falls uncontrollably from a position of approximately 90 degrees abduction to the side.
What does a positive drop arm test implicate?	The inability to lower the arm in a controlled manner is indicative of lesions to the rotator cuff, especially supraspinatus
What constitutes a positive apprehension test for anterior glenohumeral laxity?	The patient displays apprehension that the shoulder may dislocate and resists further movement. Pain is centered in the anterior capsule of the GH joint.
What does a positive apprehension test implicate?	The anterior capsule, inferior GH ligament, or glenoid labrum have been compromised, allowing the humeral head to dislocate or subluxate anteriorly on the glenoid fossa
What constitutes a positive gerber lift-off test for subscapularis weakness?	The inability to lift the hand off the spine.
What does a positive lift-off test implicate?	Associated with tears and weakness of the subscapularis muscle.
What constitutes a positive glenohumeral glide test?	Pain or increased motion compared with the same direction on the opposite shoulder.
What does a positive glenohumeral glide test implicate?	Laxity of the static stabilizers of the GH jt.;Anterior:coracohumeral lig.,superior and middle GH lig.,anterior jt. capsule,labral tear. Posterior:posterior jt. capsule,labral tear.Inferior-anterior:inferior jt. capsule,superior GH lig.,coracohumeral lig.
What are the pain characteristics of a sternoclavicular joint injury?	Limited to the SC joint area; pressure on the underlying neurovascular network can cause paresthesia in the upper extemity; pressure on the esophagus and trachea may impede swallowing and breathing.
What is the MOI of a sternoclavicular joint injury?	Force applied longitudinally to the clavicle, such as falling on an outstretched arm, or forceful distraction of the arm and distal shoulder complex.
What would you find on inspection of a sternoclavicular joint injury?	Dislocations are marked by displacement of the clavicular head anteriorly, superiorly, or posteriorly. Sprains may present with localized swelling over the joint; discoloration may be present. The patient's neck may be tilted toward the involved joint.
Define Dysphagia.	Difficulty with swallowing or the inability to swallow.
What structures are involved in a Type 1 AC joint sprain? What are the signs and symptoms?	Slight to partial damage of the AC ligament and capsule. Point tenderness over the AC joint; no laxity or deformity noted.
What structures are involved in a Type 2 AC joint sprain? What are the signs and symptoms?	Rupture of the AC ligament and partial damage to the coracoclavicular ligament. Slight laxity and deformity of the AC joint. Slight step deformity.
What structures are involved in a Type 3 AC joint sprain? What are the signs and symptoms?	Complete tearing of the AC and coracoclavicular ligaments; possible involvement of the deltoid and trapezius fascia. Obvious dislocation of the distal end of the clavicle from the acromion process.
What structures are involved in a Type 4 AC joint sprain? What are the signs and symptoms?	Complete tearing of the AC and coracoclavicular ligaments and tearing of the deltoid and trapezius fascia. Posterior clavicular displacement into the insertion of the upper fibers of the trapezius.
What structures are involved in a Type 5 AC joint sprain? What are the signs and symptoms?	Complete tearing of the AC and coracoclavicular lig. and tearing of deltoid and trapezius fascia. Displacement of the involved clavicle 100% to 300%, as compared w/ opposite limb;clavicle posteriorly displaced w/ stripping away of deltoid-trap aponeurosis
What structures are involved in a Type 6 AC joint sprain? What are the signs and symptoms?	Complete tearing of the AC and coracoclavicular ligaments and tearing of the deltoid and trapezius fascia. Displacement of the clavicle inferiorly under the coracoid (possible involvement of the brachial plexus).
What are the pain characteristics for an acromioclavicular joint sprain?	Primarily localized at the AC joint; also possibly including the upper trapezius, and upper scapula (secondary to trapezius spasm).
What is the MOI for an acromioclavicular joint sprain?	Falling on the point of the shoulder, landing on the AC joint. Force applied longitudinally to the clavicle, such as falling on an outstretched arm.
What would you find on inspection of a acromioclavicular joint sprain?	Displacement of the clavicle may be present. Step deformities indicate damage to the coracoclavicular ligament.
What constitutes a positive acromioclavicular traction test?	The humerus and scapula move inferior to the clavicle, causing a step deformity, pain, or both.
What does a positive acromioclavicular traction test implicate?	Sprain of the AC or costoclavicular ligaments.
What constitutes a positive acromioclavicular compression test?	Pain at the AC joint or excursion of the clavicle over the acromion process.
What does a positive acromioclavicular compression test implicate?	Damage of the AC ligament and possibly the coracoclavicular ligament.
What constitutes a positive relocation test for anterior glenohumeral laxity?	Decreased pain or increased ROM compared with the anterior apprehension test.
What does a postive relocation test for anterior glenohumeral laxity implicate?	Supports conclusion of increased laxity in the anterior capsule owing to capsular damage or labrum tears. Manual pressure applied by the examiner increases the stability of the anterior portion of the GH capsule,allowing more external rotation to occur.
What constitutes a positive posterior apprehension test for glenohumeral laxity?	The patient displays apprehension and produces muscle guarding to prevent shoulder from subluxating posteriorly.
What does a positive posterior apprehension test for glenohumeral laxity implicate?	Laxity in the posterior GH capsule, torn posterior labrum.
What constitutes a positive test for posterior instability in the plane of the scapula?	Pain or laxity in the posterior GH capsule or the patient displaying apprehension of a posterior subluxation.
What does a positive test for posterior instability in the plane of the scapula implicate?	Laxity in the posterior GH capsule, coracohumeral ligament
What constitutes a positive sulcus sign for inferior glenohumeral laxity?	An indentation appears beneath the acromion process.
What does a positive sulcus sign for inferior glenohumeral laxity implicate?	The humeral head slides inferiorly on the glenoid fossa, indicating laxity in the superior GH ligament.
Define scapular dyskinesis?	An improperly moving scapula.
What are the 2 compression forces that cause rotator cuff impingement and their sources?	Primary compression (irregularly shaped acromion, coracoacromial ligament, enlarged bursa, thickened rotator cuff tendons), Secondary compression (loss of humeral head depression/stabilization, poor posture, repetitive overhead movement).
What are the 2 tensile forces that cause rotator cuff impingement and their sources?	Primary tensile (Repetitive overload, eccentric forces). Secondary tensile (Scapular dyskinesis, rotator cuff muscle weakness, GH instability).
What are the pain characteristics of rotator cuff impingement?	Beneath the acromion process and radiating to the lateral arm.
What is the MOI for rotator cuff impingement?	Repetitive overhead motion impinging the rotator cuff muscles (especially the supraspinatus) and long head of the biceps tendon between the humeral head and coracoacromial arch.
What would you find on inspection of rotator cuff impingement?	The shoulder may be postured for comfort by holding the arm close to the body and avoiding overhead arm movements.
What constitutes a positive Neer shoulder impingement test?	Pain with motion, especially near the end of ROM.
What does a positive Neer shoulder impingement test implicate?	Pathology is present in the rotator cuff group or the long head of the biceps brachii tendon. The motion of the test impinges these structures between the greater tuberosity and the inferior side of the acromion process and the AC joint.
What constitutes a positive Hawkins shoulder impingement test?	Pain with motion, especially near the end of ROM.
What does a positive Hawkins shoulder impingement test implicate?	Pathology is present in the rotator cuff group or the long head of the biceps brachii tendon. The motion of the test impinges these structures between the greater tuberosity and the inferior side of the acromion process.
What are the 4 classifications of acromion shapes?	Type1 acromion is flat Type2 acromion process gently curved w/ potential to compress tissues Type3 acromion process sharply beaked higher potential to cause RC path Type4 acromion process has spurs projecting off its inferior surface highest RC path rate
What are the pain characteristics for rotator cuff tears?	Deep within the shoulder beneath the acromion process. Pain usually radiating into the lateral arm.
What is the MOI for rotator cuff tears?	Insidious: Chronic impingement or weakening of the rotator cuff tendons over time due to aging; a single traumatic episode may cause the final rupture of a weakened tendon. Acute: Dynamic overloading of the tendon.
What would you find on inspection of rotator cuff tears?	In chronic cases, inspection of the scapula possibly revealing atrophy of the infraspinatus and/or supraspinatus.
What constitutes a positive empty can test for supraspinatus pathology?	Weakness or pain accompanying the movement.
What does a positive empty can test for supraspinatus pathology indicate?	The supraspinatous tendon is being impinged between the humeral head and the coracoacromial arch, it is inflamed, or contains a lesion
What constitutes a positive yergason's test for subluxation of the biceps tendon?	Pain or snapping int the biciptal groove.
What does a positive yergason's test for subluxation of the biceps tendon implicate?	Primary:snapping or popping in biciptial groove indicates a tear or laxity of transverse humeral lig.Pathology prevents ligament from securing long head of tendon in groove.Secondary:pain w/ no popping in biciptial groove may indicate biciptial tendinitis
What constitutes a positive speed's test for long head of the biceps brachii tendinitis?	Pain along the long head of the biceps brachii tendon, especially in the biciptial groove.
What does a positive speed's test for long head of the biceps brachii tendinitis indicate?	Inflammation of the long head of the biceps tendon as it passes through the biciptial groove. Possible tear of the transverse humeral ligament with concurrent instability of the long head of the biceps tendon as it passes through the biciptial groove.
What constitutes a positive ludington's test for biceps brachii pathology?	Decreased or no tension is felt under the involved tendon; the tendon should be felt developing tension in the uninvolved muscle. Pain is increased.
What does a positive ludington's test for biceps brachii pathology implicate?	Rupture of the long head of the biceps brachii tendon.
What are the classifications of SLAP lesions?	Type1 Fraying of labrum near insertion of LHB tendon. Type2 Avulsion of glenoid labrum w/ an associated tear of LHB Type3 bucket-handle tear of the labrum with displacement of fragment Type4 Bucket-handle tear of labrum w/ associated tearing of LHB tendon
Define Pallor.	Lack of color in the skin.
What are the signs and symptoms of neurological onset of thoracic outlet syndrome?	Numbness, pain, paresthesia
What are the signs and symptoms of arterial onset of thoracic outlet syndrome?	Coldness of skin, pallor, cyanosis in the fingers, muscular weakness
What are the signs and symptoms of venous onset of thoracic outlet syndrome?	muscular and joint stiffness, edema, venous engorgement, thrombophlebitis
What constitutes a positive O'brein test?	Pain that is experienced with the arm internally rotated but is decreased during external rotation: 1. pain or clicking within the GH joint may indicate a labral tear. 2. Pain at the AC joint may indicate AC joint pathology
What does a positive O'brein test implicate?	SLAP lesion
What constitutes a positive adson's test for thoracic outlet syndrome?	The radial pulse disappears or makedly diminishes.
What does a positive adson's test for thoracic outlet syndrome implicate?	The subclavian artery is being occluded between the anterior and middle scalene muscles and the pectoralis minor.
What constitutes a positive Allen test for thoracic outlet syndrome?	The radial pulse disappears.
What does a positive Allen test for thoracic outlet syndrome implicate?	The pectoralis minor muscle is compressing the neurovascular bundle.
What constitutes a positive military brace position for thoracic outlet syndrome test?	The radial pulse disappears.
What does a positive positive military brace position for thoracic outlet syndrome test implicate?	The subclavian artery is being blocked by the costoclavicular structures of the shoulder.
Define nerve gliding.	Movement of the nerve through surronding tissues by placing the limb in various positions. The ability of the nerve to move freely during functional activity is assessed.
What constitutes a positive Roos test?	Inability to maintain the test position, diminished motor function of the hands, and/or loss of sensation in the upper extremities
What does a positive Roos test implicate?	Thoracic outlet syndrome secondary to neurovascular compromise.
What constitutes a positive cross-over impingement test and what are the implications of each type of positive?	Superior shoulder pain is indicative of AC jt pathology Anterior shoulder pain is indicative of subscapularis, supraspinatus, or biceps long head pathology Posterior shoulder pain is indicative of infraspinatus, teres minor, or posterior capsule pathology
What constitutes a positive piano key sign?	The examiner is able to use inferior pressure to depress the clavicle into its normal resting position and subsequently watch the clavicle elevate again once the pressure is removed.
What does a positive piano key sign implicate?	Instability of the AC joint on the involved side.
What constitutes a positive anterior drawer test?	Increased anterior translation of the humeral head relative to the scapula/glenoid fossa.
What does a positive anterior drawer test implicate?	Anterior instability.
What constitutes a positive posterior drawer test?	Increased posterior instability of the humeral head relative to the scapula/ glenoid fossa.
What does a positive posterior drawer test implicate?	Posterior instability.
What constitutes a positive Feagin test?	Excessive gliding of the humerus.
What does a positive Feagin test implicate?	Anterior and/or inferior glenohumeral instability.
What constitutes a positive grind test?	Grinding or clunking sensation.
What does a positive grind test implicate?	Glenoid labrum tear to the specific location that is being compressed.
What constitutes a positive clunk test?	Grinding or clunking sensation.
What does a positive clunk test implicate?	Possible tear of glenoid labrum.
What constitutes a positive crank test?	Pain and/or clicking.
What does a positive crank test implicate?	Glenoid labral pathology.
What constitutes a positive Hawkins-Kennedy impingement test?	Shoulder pain and apprehension.
What does a positive Hawkins-Kennedy impingement test implicate?	Shoulder impingement, particularly of the supraspinatus tendon.
What constitutes a positive Posterior impingement test?	Reproduction of the subject's pain in the posterior aspect of the shoulder.
What does a positive Posterior impingement test implicate?	Rotator cuff and/or posterior labral pathology.
What constitutes a positive Lateral scapular slide test?	A side to side difference of >1.5 cm.
What does a positive Lateral scapular slide test implicate?	Scapular asymmetry secondary to weakness of the scapular stabilizers.
What constitutes a positive Pectoralis major contracture test?	Patient is unable to passively have his elbow reach the table.
What does a positive Pectoralis major contracture test implicate?	The pectoralis major has an unnatural contracture.