Marys notes on the shoulder
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| 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
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| Bony Anatomy | Manubrium-jugular&clavicular notches, clavicle,scapula-subscapular fossa,vertebral border,inf &sup angle,scapular spine, supraspinous fossa,acromion&coracoid process-
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| humerus | humeral head, anatomical neck, surgical neck, bicipital groove, greater and lesser trochanter, deltoid tuberosity
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| joints of the shoulder | glenhumeral(GH), acromioclavicular(AC), Sternoclavicular (SC), scapulothoracic
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| 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,
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| Ligaments of the Sternoclavicular joint | anterior and posterior sternoclavicular ligaments, interclavicular ligament, costoclavicular ligament
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| Acromioclavicular joint | gliding, allows motion b/w scapula&clavicle during early and late stages of GH ROM, Ligaments-acromioclavicular, corococlavicular, coracoacromial
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| Acromioclavicular ligament | prevents clavicle from riding up over acromion
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| 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),
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| 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
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| Glenhumeral Joint | glenoid fossa/humeral head, ball and socket, unstable b/cof size of glenoid in relationship to humeral head,
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| 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
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| Muscles acting on Scapula | rhomboid major, rhomboid minor, levator scapulae, serratus anterior, trapezius, latissimus dorsi, pec major
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| 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
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| Scapular ROM | elevation, depression, protraction/retraction, upward and downward rotation
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| Glenhumeral ROM | flex180/ext60, ABD180/ADD, IR90/ER100, HABD90/HADD50, circumduction
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| 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
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| Muscles acting on Scapular depression | lat dorsi, trapezius(lower fibers), serratus ant(lower fibers)
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| Muscles acting on scapular elevation | levator scapulae, rhomboid major, rhomboid minor, trapezius(upper fibers), serratus anterior Upper fibers
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| Muscles actin on scapular upward rotation | serratus anterior, trapezius(upper fibers)
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| Muscles acting on scapular downward rotation | levator scapulae, rhomboid major
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| Muscles acting on scapular protraction | serratus anterior
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| Muscles acting on scapular retraction | rhomboid major, rhomboid minor, trapezius (middle and lower fibers)
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| Muslces acting on scapular anterior tilt | Pec Minor
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| Muscles acting on scapular stabalization | pec minor, serratus anterior
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| muscles acting on GH flexion | biceps brachii, coracobrachialis, anterior deltoid, pec major-clavicular fibers
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| Muscles acting on GH extention | posterior deltoid, lat dorsi, teres major, triceps
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| Muscles acting on GH Abduction | deltoid, supraspinatus, biceps brachii
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| Muscles acting on GH adduction | corocobrachialis, lat doris, pec major, teres major, triceps
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| Muscles acting on GH Internal Rotation | lat dorsi, anterior deltoid, pec major, subscapularis, teres major
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| muscles acting on GH External Rotation | posterior deltoid, supraspinatus, infraspinatus, teres minor
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| Muscles acting on GH Horizontal Abduction | posterior deltoid, intraspinatius
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| Muslces acting on GH horizontal adduction | anterior deltoid, pec major
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| 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)
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| Humeral head stabalizers | supraspinatus, infraspinatus, teres minor, subscapularis,
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| 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
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| Subacromial bursa | above supraspinatus tendon, buffers tendon contact w/ acromion process, and the coracoclavicular ligamnet, inflammed bursa can lead to RTC impingement
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| 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
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| inspection of lateral shoulder | deltoid muscles group, acromion process, position of the humerus, forward head posture
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| inspection of posterior shoulder | alignment of vertebral column, position of scapula, position of the humerus, muscle development
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| Resting Scapular postures | scapular elevation/depression, scapular retraction/protraction, scapular rotation, scapular winging
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| Scapular elevation/depression | height of scapulae compared using the inferior angle as a landmark, normal height correlates w/ 7-9 thoracic vertebrae
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| 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
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| Scapular rotation | distance from the T7 vertebra, to inferior angle is measured, increased disance indicates upwardly rotated scapula
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| Scapular winging | protrusion of medial border of scapula, "psuedowinging"-when inferior angle (not entire medial border)is prominent, associated w/ anterior tipping of scapula
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| Pain in cocked position | anterior instability or impingement
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| pain with deceleration | SLAP lesion, biceps tendon pathology,
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| pain in follow thru | possible RC pathology
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| loss of control and or velocity | possible impingement or decreased IR ROM
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| Circulation | carotid pulse, radial pusle, brachial pulse, capillary refill, skin color and temperature
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| 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)
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| Sternoclavicular joint ligament testin | inferior-interclavicular ligament, superior-costoclavicular ligament, anterior-SC ligament, posterior-SC ligament
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| Acromioclavicular joint ligament testing | inferior-AC ligament, Superior-trapezoid, conoid, Ac ligament, Anterior-AC and CC ligaments, Posterior-AC ligament, posterior bony block*(acromion)
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| 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
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| 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
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| 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
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