Shoulder Lecture

Question 1

What is the most mobile joint in the body?

Answer 1

Shoulder

Question 2

GH joint brings shoulder to what angle?

Answer 2

90 degrees

Question 3

Shoulder is comprised of what joints?

Answer 3

• GH (ball and socket synovial)
• Sternoclavicular (cartilaginous)
• AC (cartilaginous)

Question 4

Muscles of shoulder girdle

Answer 4

3 groups:

1. Rotator cuff (SITS)
2. Trap, serrat anterior, rhomboids, lev scapulae
3. Pec major and minor, lat dorsi

Question 5

Rotator cuff muscles

Answer 5

SITS

• Supraspinatus (superior most)
• Infraspinatus (posterior)
• Teres minor (posterior)
• Subscapularis (anteiror)

Question 6

Which muscles attach the scapula to the trunk and RAISE the scapula?

Answer 6

• Trap
• Serratus anterior
• Rhomboids
• Levator scapulae

Question 7

Which muscles internally rotate the shoulder?

Answer 7

• Pec major
• Pec minor
• Lat dorsi

Question 8

Inspection of the shoulder:

Answer 8

• Trauma or scars
• Muscular symmetry
• Clavicles for symmetry
• Lumps over AC joint (previous AC separation)
• Scapular winging (weakness in serrat anterior muscle)

Question 9

What causes scapular winging?

Answer 9

Weakness in serratus anterior muscle (long thoracic nerve)

Question 10

Bony palpation of shoulder:

Answer 10

• Suprasternal notch (immediately lateral to this is SC joint)
• Along the clavicle
• Outer third of clavicle but before AC joint, lower finger and may be able to palpate coracoid process
• Acromion
• Proximal humerus

Question 11

How to palpate proximal humerus?

Answer 11

• Bicipital groove is here (long head of biceps tendon)
• Pt ER arm to facilitate
• Palpate tendon gently (it is sensitive)

Question 12

How to palpate rotator cuff?

Answer 12

• Stand behind pt
• Passively extend shoulder (this moves supraspinatus out from under acromion for palpation)
• Cup hand over top of shoulder to palpate subacromial bursa

Question 13

The shoulder ROM includes:

Answer 13

• Abduction (180 degrees)
• Adduction (60 degrees)
• Extension (60 degrees)
• Flexion (160-180 degrees)
• ER (75-90 degrees)
• IR (60 degrees)

Question 14

Easiest way to assess AROM of the shoulder?

Answer 14

Apley Scratch test

Question 15

Describe Apley Scratch test

Answer 15

• Used to test AROM of shoulder

- Pt touches opposite shoulder (adduction/IR), behind head (adduction/IR), and behind back

Question 16

9 motions of the shoulder

Answer 16

1. Flex
2. Extension
3. Abduction
4. Adduction
5. ER
6. IR
7. Scapular elevation
8. Scapular retraction
9. Scapular protraction

Question 17

Which muscles help flex the shoulder?

Answer 17

Coracobrachialis
Pec major
Anterior deltoid
Biceps

Question 18

Which muscles help extend the shoulder?

Answer 18

Lat dorsi
Teres major/minor
Posterior deltoid
Triceps

Question 19

Which muscles help abduct the shoulder?

Answer 19

Deltoid
Supraspinatus
Serratus anterior

Question 20

Which muscles help adduct the shoulder?

Answer 20

Pec major
Lat dorsi
Teres major
Deltoid

Question 21

Which muscles help ER the shoulder?

Answer 21

TIP
Teres minor
Infraspinatus
Posterior deltoid

Question 22

Which muscles help IR the shoulder?

Answer 22

Subscapularis
Pec major
Lat dorsi
Teres major
Deltoid

Question 23

Which muscles help with scapular elevation?

Answer 23

Trap
Levator scapulae
Rhomboids

Question 24

Which muscles help with scapular retraction?

Answer 24

Rhomboids

Trapezius

Question 25

Which muscles help with scapular protraction?

Answer 25

Serratus anterior

Question 26

What is Speed's test?

Answer 26

- Test for bicipital tendinitis - Arm elevated to 90 degrees forward flex of shoulder w/elbow straight and arm supinated - Push down on pt palm - Positive: pain in anterior shoulder (bicipital groove)

Question 27

What is the empty can test?

Answer 27

- Tests supraspinatus tendinitis/tear | - Pt puts arms out in front and "empties cans"

Question 28

What is the impingement sign?

Answer 28

- Passively lift (forward flex) arm from 0 degrees up to 180 - Positive: pain between 90 and 150 degrees - Sign of impingement from bursitis or chronic impingement

Question 29

What is the apprehension sign of the shoulder?

Answer 29

- Bring pt's arm up into throwing position (abducted/ER) - Watch for apprehension - Indicates instability due to torn labrum, Bankart lesion, or anterior dislocation of shoulder

Question 30

What is the relocation sign of the shoulder?

Answer 30

- After establishing positive apprehension sign, lie pt prone on table - Reproduce apprehension sign - Reach underneath and push humeral head posteriorly - Bring back to apprehension position - If pt can tolerate this w/o apprehension, confirms anterior instability

Question 31

What is the point of the relocation sign of the shoulder?

Answer 31

Temporarily stabilize shoulder through manipulation (resolving apprehension)