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MS II Flashcards

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1
Q 
anatomy of sternoclavicular jt
 classification
 mechanical/ functional 
 resting position
 closed pack position
 capsular pattern
A
  1. anatomically complex (b/c disc)
  2. mechanically: bi-axial sadldle / functionally: ball and socket

resting position = arm at side
closed pack= abduction 90 degrees
capsular pattern= pain with extremes of motion

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2
Q

osteokinematics of SC joint (2)

A
  1. protraction/retraction = concave on convex

2. elevation/ depression = convex on concave

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3
Q

biomechanics of SC jt: ROM and axis
elevation/ depression
protraction/ retraction
rotation

A

elevation = 45-60 degrees
depression = 5 degrees
around sagittal axis (z)

protraction & retraction = 15 degrees
around vertical axis (y)

rotation = 30-50 degrees
around longitudinal axis of clavicle (x)

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4
Q

ligaments (3) and capsule of sternoclavicular jt

A
  1. capsule is reinforced by SCM fibers

3 ligaments:

  1. anterior/ posterior sternoclavicular ligament
  2. **costoclavicular ligament - anterior and posterior bands
  3. interclavicular ligament
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5
Q

directionality of sternoclavicular ligaments

directionality of costoclavicular ligaments (2)

A

sternoclavicular lig: a/p- both run inferior and oblique (very short)

costoclavicular lig:
anterior runs upward and laterally
posterior runs upwards and medially
these two criss-cross to increase stability

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6
Q

attachments of costoclavicular ligaments

A

upper surface of first rib and cartilage -> inferior surface of clavicle

anterior runs laterally, posterior runs medially

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7
Q 
anatomy of acromioclavicular jt
 classification
 mechanical/ functional 
 resting position
 closed pack position
 capsular pattern
A

classification: anatomically simple
mechanically = compound plane gliding joint/ functionally = ball and socket joint

resting position = arms at side
closed pack position = upward rotation of scap with arm at abduction
capsular pattern = pain with elevating arm or horizontal adduction, ltd full extension

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8
Q

ligaments of AC joint (3)

general purpose/ attachements

A
  1. acromioclavicular ligament** -covers superior part of joint * most likely to rupture
  2. coracoacromial ligament
  3. coracoclavicular ligament
    a. trapezoid
    b. conoid (triangular)
    both attach to bottom of clavicle and serve to hold down clavicle
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9
Q

biomechanics of AC and ROM (3)

A
  1. saggital axis: ab/adduction = upward and downward rotation (of inferior angle of scapula)
    ROM 20-30 degrees
  2. vertical axis: winging - vertebral border pulling away from thorax during protraction/ retraction
    ROM 30-50 degrees
  3. long axis: tipping = sagittal plane, flexion/extension
    ROM 30 degrees
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10
Q

scapulothoracic joint

ligaments (2)

A

not a true joint, just an articulation

ligaments:

  1. coraco-humeral
  2. superior transverse; converts scapular notch into foramen
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11
Q

articular surfaces of GH joint

A

head of humerus is covered with hyaline cartilage; faces
superior, medially, and posterior

glenoid faces superior, lateral and anterior and is smaller than head of humerus… this is why we have a labrum

glenoid is < 1/3 as wide of head of humerus

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12
Q

inferior capsule of GH joint

A

redundant fold that allows for movements. the head of humerus needs to drop inferior into capsule for any movement to occur.

adhesive capsulitis affects inferior capsule of GH joint

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13
Q

what arm position puts most stress on SITS?

A

IR and flexion or aBduction to 90 degrees

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14
Q

4 ligaments of GH joint

A
  1. capsule
  2. superior, middle, inferior lGH ligaments
  3. coracohumeral ligament
  4. transverse humeral ligament
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15
Q

capsule of GH joint
encompasses…
least supported…
5 tendons that reinforce capsule

A

encompasses long head of bicep and goest to mid shaft

weakest inferior

tendons that reinforce capsule:

anterior: subscap tendon
posterior: infraspinatus and teres minor
superior: supraspinatus
inferior: long head of tricep

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16
Q

GH ligament attachments
superior band
middle band
inferior band

A

blend with labrum; origin at medial margin of glenoid cavity =>

superior band: passes along medial edge of bicep tendon and attaches above lesser tubercle

middle band: lower part of lesser tubercle

lower band: lower part of anatomical neck

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17
Q

coracohumeral ligament attachments

A

lateral border of root of coracoid => greater tubercle , blends with supraspinatus tendon

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18
Q

transverse humeral ligament attachements/ purpose

A

canal for bicep tendon

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19
Q

ROM of GH joint

A

flexion/ abduction = 120
extension = 55

adduction = return to neutral

ER= 90 degrees
IR = 60-70 degrees
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20
Q

2 spaces of upper limb girdle and muscles that create them

A

spaces are for nerves and vessels to pass thru

  1. triangular space - long head of tricep lateral, teres minor &, teres major
  2. quadrangular space- tricep (long and short heads) teres major & minor
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21
Q

GH joint
resting position
closed pack
capsular pattern of GH joint (3)

Study These Flashcards
A

resting position = 55 degrees abduction, 30 degrees horizontal abduction

closed pack = max abduction & ER

capsular pattern: ER
aBduction
IR

22
Q

8 bursae

Study These Flashcards
A
  1. btwn subscap and joint capsule
  2. btwn infraspinatous & joint capsule
  3. summit of acromion
    4 btwn coracoid and capsule
  4. behind coracobrachialis
  5. btwn teres major & long head of tricep
  6. ant & post to lats
  7. subdeltiod (subacromial)
23
Q

scapulothoracic group
aka
muscles (4)
movements

Study These Flashcards
A

a.k.a. axioscapular

muscles:
pec minor
levator scapulae
rhomboids
serratus anterior

movements:
elevation/depression of scapula
upward/downward rotation
protraction/ retraction

24
Q

scapulohumeral group
muscles (7)
movements

Study These Flashcards
A

flexion/extension of humerus
ab/adduction of humerus
IR/ER

muscles:
subscap
teres major/ minor
supraspinatus
infraspinatus
coracobrachialis
deltoids
25
thoracohumeral group a.k.a. muscles (2) and each of their movements
a.k.a. axiohumeral pec major: IR, flexion, horizontal adduction lats: IR & extension of humerus
26
referred pain to the shoulder region from: (4)
1. c-spine 2. t-spine 3. viscera 4. myocardium
27
where is protraction/ retraction taking place?
occurs as SC joint and brings scap along, small amount of AC
28
where is aBduction taking place?
elevation of clavicle at SC joint, upward rotation at AC joint
29
movement occurring during flexion by degree (3)
1. 1st 30 deg = GH joint 2. 30- 120 deg = GH joint & ST 3. 120-180 deg = ST
30
``` degrees of movement during aBduction (and what movement) ST jt AC jt SC jt GH jt ``` *pic on pg 59 of packet
``` ST jt upward rotation = 60 degrees AC jt upward rotation = 30 degrees SC jt elevation = 30 degrees and posterior rotation GH jt abduction = 120 degrees total = 180 degrees ``` **look at pg 59 of packet
31
biomechanics of ELEVATION at the SC jt during elevation which direction is the clavicle rolling and sliding? which ligaments are being shortened? which ligaments are being lengthened? p. 60 of packet
during elevation which direction is the clavicle rolling and sliding? the clavicle rolls superomedial and slides inferior *convex on concave so osteokinematics are opposite of arthrokinematics** which ligaments are being shortened during elevation? sternoclavicular and intraclavicular ligaments which ligaments are being lengthened? costoclavicular
32
biomechanics of DEPRESSION at the SC jt during depression which direction is the clavicle rolling and sliding? which ligaments are being shortened? which ligaments are being lengthened? p. 60 of packet
during depression which direction is the clavicle rolling and sliding? clavicle rolls inferior/ medial and slides superior * convex on concave so osteokinematics and opposite of arthrokinematics** which ligaments are being shortened? costoclavicular which ligaments are being lengthened? sternoclavicular and intraclaviular
33
biomechanics of retraction during retraction which direction is the clavicle rolling and sliding? which ligaments are being shortened? which ligaments are being lengthened? p. 60 of packet
during retraction which direction is the clavicle rolling and sliding? clavicle is rolling and sliding posterior *concave on convex so arthrokinematics = osteokinematics** which ligaments are being shortened? posterior sc ligament which ligaments are being lengthened? costoclavicular ligament & anterior sc ligament
34
synergistic muscle activity of arm elevation (abduction) at GH joint with delts and RC 3 things that occur during arm elevation and the muscles that do it
rotator cuff + deltioids 1. compression of humeral head supraspinatus 2. depression (/inferior glide) of humeral head subscap, inraspinatus, teres minor 3. centering of humeral head all rotator cuff muscles
35
during IR and ER of the humerus, what directions is it rolling and sliding? what muscles are working/ being stretched?
IR: rolls anterior and slides posterior teres major is contracting? ER: rolls posterior and slides anterior infraspinatus contracts while subscap is being stretched and preventing excessive ant glide
36
what muscles work in synergy for arm elevation besides RC + delts?
upper and lower traps + serratus anterior
37
3 grades of AC separation | severity and ligaments affected
grade 1*: minor separation of AC joint w/ either stretch or tear of AC lig grade 2*: AC joint more separated, AC lig completely torn grade 3: AC joint completely separated, AC & coracoclavicular lig torn ** grade 1 & 2 may not be visible on x-ray and may be lax on joint play assesment
38
GH painful arcs (by degree) (2) for diagnostic purposes
GH painful arc = 45 (-60)- 120 degrees | AC painful arc = 170-80
39
sensitivity vs. specifity
sensitivity => true positive (false negative) % of positives which are correctly identified specificity => true negative (false positive) % of negatives which are correctly identified
40
positive predictive value | negative predictive value
positive predictive value = proportion of people who truly have the condition relative to all pts who test (+) negative predictive value= proportion of people who truly do not have the condition relative to all pts who test (-)
41
anterior instability tests (3)
1. anterior apprehension 2. anterior drawer 3. jobe relocation test
42
posterior instability tests (3)
1. posterior apprehension 2. posterior drawer 3. rockwood test
43
inferior instability special tests (2)
1. sulcus sign (2 variations) | 2. faegin test
44
multidirectional instability special test
1. rowe test | anterior, inferior (stand behind pt); posterior (stand in front of pt)
45
bicipital tendon tests (3)
1. yergason test | 2. speed's tests (2) - isometric
46
RC tears special tests (2)
1. drop arm test (eccentric) | 2. empty/ full can test (isometric)
47
supraspinatus special tests
1 test, pt in scaption/abduction ~80 + IR => isometric resistance to downward pressure
48
``` impingement tests (3) and what a positive sign is ```
1. hawkins kennedy test 2. yocum test 3. neer (to ear) test (+) on all 3 = pain secondary to compression under coracoacromion lig & acromion
49
labral tear specific tests (and specifics of what part of labrum) (4)
1. cranks test - labral pathology 2. o'briens test - superior labrum vs. AC jt 3. Mimori new pain provocation- superior labrum 4. bicep load test
50
During PROTRACTION What direction is the clavicle rolling and sliding? what ligaments are being lengthened? What ligaments are being shortened?
During PROTRACTION the clavicle is rolling and sliding anterior *concsve on convex so osteokinematics = arthrokinematics** what ligaments are being lengthened? posterior sternoclavicular what ligaments are being shortened? anterior clavicular
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