Lecture 8 - Shoulder Complex

Question 1

bones and joints of the shoulder

Answer 1

• clavicle
• coracoid process
• acromion
• gleaned cavity
• scapula
• humerus

Question 2

what joint is affected during a “shoulder separation” and best test for it

Answer 2

AC (Acromioclavicular) joint
- horizontal abduction

Question 3

what joint is affected during a shoulder subluxation

Answer 3

GH (glenohumeral) joint
- doesn’t actually separate, the gap gets bigger and you sprain all your ligaments

Question 4

characteristics about shoulder dislocations/subluxation

Answer 4

• women are more prone to sub/dislocation
• anterior dislocation is more common

Question 5

explain the 2 most common ways to posteriorly dislocate shoulder

Answer 5

• seizures
• electric shock
  both caused by violent muscle contractions following seizure or electrocution

Question 6

ligaments of the shoulder (that I need to know)

Answer 6

• coracoacomial joint
• acromioclavicular joint (AC)
• coracoclavicular (2 parts)

Question 7

muscles that make up the shoulder

Answer 7

• deltoid (abbductors)
• trapizius
• rotator cuff muscles
• rhomboids
• long head of the biceps
• pec major/minor
• lattisimus dorsi

Question 8

rotator cuff muscles

Answer 8

SITS
- Subscapularis.
- Infraspinatus.
- Teres minor.
- Supraspinatus.

Question 9

possible movements at the shoulder joint

Answer 9

• Flexion/Extension
• internal/external rotation
• abduction (vertical and horizontal)
• adduction (vertical and horizontal)

Question 10

epidemiology of shoulder injuries in rugby players

Answer 10

• AC joint is the most commonly affected
• MOI: player to player and player to ground contact
• on average they miss 37 days of play

Question 11

steps of a shoulder exam

Answer 11

1. History
   - pervious injury, MOI
2. Observation
   - deformity, swelling, discolouration
3. ROM
   - active, passive, resisted
4. Manual muscle testing
5. Palpation
   - point tenderness of ligaments may be a good indicator of which strcutures are injured
6. Special tests
7. functional Ax

Question 12

soft tissue injuries (involving the shoulder)

Answer 12

• bone contusion
• fractures
• muscle contusion
• muscular injury
• tendinopathy
• ligamentous injury
  sprains and labral tears

Question 13

bone contusion

Answer 13

bone bruise, less severe than a bone fracture
MOI: contact to area
Observations:
- pain locally
- swelling
- pain with ROM, minimal to no decresae
- if repeated, may have increase bone formation present

Question 14

muscle contusion

Answer 14

MOI: contact to area
Observtions
- pain locally
- hematoma
- swelling
- pain with ROM with decrease in ROM
- myositis ossificans

Question 15

muscular injury

Answer 15

MOI: tissue contracting or stretching pas capacity
Observation
- swelling
- redness/bruising
- pain with active and resisted testing
common muscular injuries are rotator cuff, pectoralis, biceps

Question 16

shoulder muscles commonly affected by teninopathy

Answer 16

• rotator cuff muscles
• both bicep tendons

Question 17

types of ligamentous injuries

Answer 17

sprains and labral tears

Question 18

Sprains

Answer 18

MOI: ligament/joint capsule is forced beyond normal ROM
Observation: point tenderness, decreased ROM and strength, pain with active and passive ROM

Question 19

SLAP tear

Answer 19

SLAP tear (Superior labrum anterior and posterior)
- top part of labrum is injured, this top area is also where the bicep tendon attaches to the labrum (isn’t always involved with a SLAP tear but can be)
MOI: FOOSH, repetitive overhead actions (throwing), and/or lifting heavy objects
Observation: catching sensations and deep pain

Question 20

types of labral tears

Answer 20

• SLAP (10-2 on a clock)
• Bankart (bony vs labral) (3-6 on a clock; anterior)

Question 21

Bankart tear

Answer 21

Bony
- labrum tears and a part of the bony glenoid fractures or breaks off. May lead to notable bone loss in the glenoid, a cause chronic instability
Labral
- an anteroinferior labral tear
- labrum tears from the glenoid, and the injury involves only the soft tissue. Most common

Question 22

management of shoulder injuries

Answer 22

• RICE
• taping and bracing (helpful in reducing reoccurrence of injury
• ROM
• strengthening
• balance
• functional/sport specific exercises
• RTP

Question 23

fractures

Answer 23

MOI: external or internal force (fall, muscle force, external blow)
Observation
- deformity
- swelling
- pain

Question 24

most commonly fractured bone(s) in the shoulder girdle

Answer 24

1. clavicle
2. humerus (surgical neck)
3. scapula (uncommon)

Question 25

why do ppl on anabolic steroids tear their bicept and pecs more frequently than gen pop

Answer 25

- muscle grows very fast but the tendon doens't grow as fast - they then overload the tendon