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Theshoulder

Marys notes on the shoulder

QuestionAnswer
Joint characteristica provides loarge ROM at expense of stability, unstable joint=lacks bone and ligamentous static stabalizers, relies on dynamic support thru muscularture, motion arises from 4 bones, sternum, clavicle, humerus and scapula
Bony Anatomy Manubrium-jugular&clavicular notches, clavicle,scapula-subscapular fossa,vertebral border,inf &sup angle,scapular spine, supraspinous fossa,acromion&coracoid process-
humerus humeral head, anatomical neck, surgical neck, bicipital groove, greater and lesser trochanter, deltoid tuberosity
joints of the shoulder glenhumeral(GH), acromioclavicular(AC), Sternoclavicular (SC), scapulothoracic
Sternoclaviculaar joint gliding joint, UE only attachment to the upper extremity, func in all movements up UE, poor bony stability, fibrocartilaginous disk-sternoclavicular disk-stability and shock absorption, strong ligamentous strcture nto often dx,
Ligaments of the Sternoclavicular joint anterior and posterior sternoclavicular ligaments, interclavicular ligament, costoclavicular ligament
Acromioclavicular joint gliding, allows motion b/w scapula&clavicle during early and late stages of GH ROM, Ligaments-acromioclavicular, corococlavicular, coracoacromial
Acromioclavicular ligament prevents clavicle from riding up over acromion
Coracoclavicular ligament strong intrinsic support, Trapezoid ligament-limits lateral movemtn of clavicle over acromion(sits laterally), conoid-restricts superior movement of clavicle(sits medially to trapeziod),
scapulothoracis articulation not tru anatomical joint, lacks typical characteristics-fibrous, cartilaginous, synovial tissues, moves in response to SC, AC, GH, shoulder ABD=ST rotates upward, changes in mobility in SC or AH affects scapulothoracic movement
Glenhumeral Joint glenoid fossa/humeral head, ball and socket, unstable b/cof size of glenoid in relationship to humeral head,
What aides in GH stability Glenoid labrum-deepens socket, increases articular surface-Joint capsule-lax to allow ROM 2 cm-arises from glenoid fossa and labrum, blends with RC muscles-coracohumeral ligament, glenhumeral ligament-superior anterior and inferior
Muscles acting on Scapula rhomboid major, rhomboid minor, levator scapulae, serratus anterior, trapezius, latissimus dorsi, pec major
Muscles acting on humerus rotator cuff muscle group-subscapularis, supraspinatus, infraspinatus, teres minor, deltoid muscles-anterior, middle, posterior fibers, pec major, latissimus group, long head of triceps brachii, corocobrachialis, biceps brachii
Scapular ROM elevation, depression, protraction/retraction, upward and downward rotation
Glenhumeral ROM flex180/ext60, ABD180/ADD, IR90/ER100, HABD90/HADD50, circumduction
Muscles acting on scapula have two purposes 1.control position of Glenoid fossa to allow increased ROM(180instead of 120), 2. fixate scapula to thorax to provide a base of support for RC muscles
Muscles acting on Scapular depression lat dorsi, trapezius(lower fibers), serratus ant(lower fibers)
Muscles acting on scapular elevation levator scapulae, rhomboid major, rhomboid minor, trapezius(upper fibers), serratus anterior Upper fibers
Muscles actin on scapular upward rotation serratus anterior, trapezius(upper fibers)
Muscles acting on scapular downward rotation levator scapulae, rhomboid major
Muscles acting on scapular protraction serratus anterior
Muscles acting on scapular retraction rhomboid major, rhomboid minor, trapezius (middle and lower fibers)
Muslces acting on scapular anterior tilt Pec Minor
Muscles acting on scapular stabalization pec minor, serratus anterior
muscles acting on GH flexion biceps brachii, coracobrachialis, anterior deltoid, pec major-clavicular fibers
Muscles acting on GH extention posterior deltoid, lat dorsi, teres major, triceps
Muscles acting on GH Abduction deltoid, supraspinatus, biceps brachii
Muscles acting on GH adduction corocobrachialis, lat doris, pec major, teres major, triceps
Muscles acting on GH Internal Rotation lat dorsi, anterior deltoid, pec major, subscapularis, teres major
muscles acting on GH External Rotation posterior deltoid, supraspinatus, infraspinatus, teres minor
Muscles acting on GH Horizontal Abduction posterior deltoid, intraspinatius
Muslces acting on GH horizontal adduction anterior deltoid, pec major
As a group Rotator cuff muscles 1. internal and exteralrotation, 2. compress humeral head into glenoid fossa,3. downward pull on humeral head during late stages of abduction(couple forcce)
Humeral head stabalizers supraspinatus, infraspinatus, teres minor, subscapularis,
Scapulothroacic rythm GH and ST jointmust combine avaliable ROM to get full shoulder ROM, 2:1 ratio b/w GH elevation:upward scapular rotation, 120 from GH, 60 from St, ratio varies thru ROM, subacromial bursa
Subacromial bursa above supraspinatus tendon, buffers tendon contact w/ acromion process, and the coracoclavicular ligamnet, inflammed bursa can lead to RTC impingement
Inspection of Anterior shoulder level of shoulders, postion of head, arm position, contour of clavicles, symmetry of deltoids, anterior humerus and biceps brachii muscles group
inspection of lateral shoulder deltoid muscles group, acromion process, position of the humerus, forward head posture
inspection of posterior shoulder alignment of vertebral column, position of scapula, position of the humerus, muscle development
Resting Scapular postures scapular elevation/depression, scapular retraction/protraction, scapular rotation, scapular winging
Scapular elevation/depression height of scapulae compared using the inferior angle as a landmark, normal height correlates w/ 7-9 thoracic vertebrae
Scapular retraction/protraction distance from T3 spinous process to the medial border of scapula is measured w/ patient standing, normal value 5-7cm, increased distance means protracted scapula , decreased distance retracted scapula
Scapular rotation distance from the T7 vertebra, to inferior angle is measured, increased disance indicates upwardly rotated scapula
Scapular winging protrusion of medial border of scapula, "psuedowinging"-when inferior angle (not entire medial border)is prominent, associated w/ anterior tipping of scapula
Pain in cocked position anterior instability or impingement
pain with deceleration SLAP lesion, biceps tendon pathology,
pain in follow thru possible RC pathology
loss of control and or velocity possible impingement or decreased IR ROM
Circulation carotid pulse, radial pusle, brachial pulse, capillary refill, skin color and temperature
Joint Stability Tests testsintegrity of joints ligaments&capsule-manip of clavicle is hard, can result in(-) test unless there is gross laxity, contraindicated when fx/dx suspected-pt positon-supine, + test-p!, hypomobility(joint adheasions),hypermobility(laxity/sprains)
Sternoclavicular joint ligament testin inferior-interclavicular ligament, superior-costoclavicular ligament, anterior-SC ligament, posterior-SC ligament
Acromioclavicular joint ligament testing inferior-AC ligament, Superior-trapezoid, conoid, Ac ligament, Anterior-AC and CC ligaments, Posterior-AC ligament, posterior bony block*(acromion)
Glenohumeral joint ligament tessting inferior-inferior joint capsule, superior GH&corocohumeral ligaments, Anterior-corocohumeral, superior and middle GH ligaments, anterior joint capsule, labrum, Posterior-posterior joint capsule, labrum
Sternoclavicular joint sprain MOI-longitudinal force on clavicle, FOOSH, hit on lat portion shoulder, traction-S/S- p! w/ protraction, retraction&joint play, P! w/motions above 90*, post dx-MEDICAL EMERGENCY, threat to subclavian artery, vein, trachea, esophogus, Special tests-SCglide
Acromioclavicular joint pathology "seperated shoulder"-MOI-FOOSH,blow to sup acromion process,fall on tip of shoulder, presens w/-step deformity, p! w/ humeral elevation(esp HABD), decreased strength, classified b structure involved, degree of instability,&direction of displaced clavicle
Created by: jwebst1