Shoulder and Elbow Anatomy Quiz

Shoulder Anatomy

• The shoulder complex includes the anatomy, osteology, joints, musculature, innervation, assessment, and pathology.
• Three bones make up the shoulder: scapula, humerus, and clavicle.

Shoulder Anatomy - Osteology

• The scapula positions the glenoid fossa for humeral motion.
• It has a superior angle, medial (vertebral) border, inferior angle, and lateral (axillary) border.
• The scapula's position is vital for humeral movement.
• The clavicle positions the humerus laterally away from the upper body.
• It has an acromial end, anterior side, posterior side, sternal end.
• The clavicle's position is critical to preventing the humerus from moving away from the body too much and supports/positions the arm away from the body.
• The humerus has a greater tubercle, crest of greater tubercle, head of the humerus, neck, lesser tubercle, Intertubercular groove, surgical neck, deltoid tuberosity.
  • These features are important as they form articular surfaces for muscles and other bones.

Shoulder Complex - 4 Joints

• The scapulothoracic joint is the articulation between the scapula and the thorax.
• It facilitates movement across the ribcage.
• The sternoclavicular joint connects the clavicle to the sternum.
• It enables mobility of the arms/shoulder.
• The acromioclavicular joint joins the clavicle to the scapula.
• It assists in the full abduction of arm movement.
• The glenohumeral joint connects the humerus and the glenoid fossa of the scapula.
• It enables the wide range of shoulder movement.

Scapulothoracic Joint

• Articulates with the rib cage.
• Spans ribs 2-7
• It has six motions: elevation and depression, protraction, retraction, upward and downward rotation.
• Motions are critical to shoulder movement.

Sternoclavicular Joint

• The only bony connection between the upper limb and the axial skeleton.
• A disc is present between the articulating surfaces which provides stability.

Acromioclavicular Joint

• Augments the range of motion (ROM) of the humerus.
• It has a fibrous capsule surrounding the joint and contains an articular disc.
• It aids in full arm abduction up to 180°.

Glenohumeral Joint

• Depends on muscles (rather than bones/ligaments) for support.
• The labrum deepens the glenoid fossa.
• Its placement is critical for full abduction of the shoulder.

Shoulder Complex – Muscles

• Numerous muscles surround the shoulder.
• They are critical to shoulder and upper body movement.
• Examples: deltoid, pectoralis major, latissimus dorsi, serratus anterior, biceps brachii, triceps brachii, etc.

Shoulder Complex – Actions

• Tables detailing muscles and actions they perform.
• For example, the anterior deltoid performs flexion and abduction/horizontal adduction.

Shoulder Complex – Nerve Supply

• Tabular data on nerve supply to various muscles in the shoulder region.

Rotator Cuff

• Includes supraspinatus (abduction), infraspinatus (ER), teres minor (ER), and subscapularis (IR) muscles.
• Essential for glenohumeral joint function.

Scapulohumeral Rhythm

• 2:1 ratio of scapular and humeral movement during abduction.
• The clavicle plays a vital role in this movement.
• Without it, abduction might only be possible to 120°.

Reverse Scapulohumeral Rhythm

• In reverse rhythm, the scapula moves more than the humerus.
• This is a crucial part of initial shoulder movement.

Assessment

• Assessment involves observing the shoulder, active/passive movement, strength testing, functional assessment, and specific tests.

Observations

• Observations include natural alignment of body parts, spontaneous movement & function.
• Lack of movement, guarding, or bracing as well as skin condition and deformity.

Functional Assessment

• OTs use scales to assess function based on what clients need/want to do.
• Examples are self-care, productivity, and leisure.

Shoulder Pathology - Examples

• This section shows different examples of shoulder pathologies.
• Examples include bone fractures, capsule tears, ligament injuries, adhesive capsulitis, nerve damage, and more.

Fracture

• Clavicle fractures often require a figure of 8 brace.
• Humerus fractures can be impacted neck (stable) or shaft (may heal on its own).
• Gravity can affect fracture reduction.
• Surgery (ORIF) may be necessary.

Osteoarthritis

• Cartilage wears away, causing bone degeneration.
• Leads to bone remodelling.
• Pain and stiffness occur.
• Activity decreases.

Capsule Pathology/Ligament Tear

• Common after traumatic events and can range from mild stretching to complete tears resulting in instability to the shoulder(subluxation/dislocation).
• Dislocations can be in many directions, most commonly anterior/posterior.

Capsule/Ligament Tear - Treatment

• Treatment includes RICE (rest, ice, compression, elevation), movement within pain-free ranges, taping, and exercises.
  • Further treatment may be required if the injury is more serious..

Shoulder Separation

• A disruption of the acromioclavicular joint.
• Pain is a common symptom. Deformity also occurs.

Dislocation & Subluxation

• Displacement of the humeral head, often anterior.
• Treatment involves immobilization.
• Damage to the labrum and increased instability is possible.
• More common in persons over age 30

Special Tests: Anterior Instability

• Tests to assess for anterior instability of the shoulder include the apprehension, relocation, and load shift tests.

Special Tests: Inferior Instability

• Tests involve assessment.
• This section describes specific tests to evaluate for inferior shoulder instability, such as the sulcus sign.

Adhesive Capsulitis

• Also known as frozen shoulder.
• Characterized by a thickening of the shoulder capsule.
• Common in women age 40-60.
• May occur after prolonged immobilization.
• Often self-limiting but hydrodilatation is an option in prolonged cases.
• The disease includes four stages: Painful, Freezing, Frozen, and Thawing.
  • Stages 1-3 involves increasingly severe symptoms, stiffness or pain in the freezing or frozen stages.
  • Stage 4 has gradual improvement in movement and decreased pain.

Rotator Cuff Injury

• Can be acute or chronic.
• More prevalent in persons > 60 but happens to younger people.
• Repetitive overhead activities and forceful loading can cause issues, commonly impacting the supraspinatus or other rotator cuff muscles.

Rotator Cuff Painful Arc

• Presents with pain, weakness, decreased ROM, clicking, catching, and stiffness.

Impingement

• Impingement involves soft tissue (e.g., rotator cuff, bursa, tendon) pinched or impinged under the acromion during overhead activities.
• Often presents with pain in the shoulder, arm, and/or possible into the forearm
• Impingement can be caused by many factors, including structural abnormalities, inflammation, or shoulder instability.

Special Tests: Impingement

• Tests for impingement such as the Neer test assess for pain with the test.

Special Tests: Muscle or Tendon

• Specific tests for evaluating supraspinatus, empty can test, or drop test are critical to the testing procedure.

Bursa Pathologies

• Bursas are shock absorbers.
• Inflammation, rupture, or deterioration can occur, often due to overuse or impingement

Winging Scapula

• Weakness in rhomboids, long thoracic nerve (serratus), or the nerve to the trapezius.
• A scapula that protrudes when testing for winging.

Elbow Anatomy

• Elbow anatomy includes osteology, joints, musculature, innervation, assessment, and pathology.

Elbow - Muscles

• Flexors include biceps brachii, brachialis, and brachioradialis.
• Extensors include triceps brachii, and anconeus.

Elbow & Forearm - Actions

• Tabular of the various actions performed by these muscles.

Elbow & Forearm - Nerves

• Provides a table of nerves supplying the elbow and forearm.

Assessment - Observations

• Evaluation includes observation of the carrying angle.
• Men typically have 5-10 degree carrying angle, women typically have 10-15.
• Cubitus Valgus is above 15 degrees and can be observed on extension of the elbow.
• Cubitus varus is less than 5-10 degrees.

Fracture

• Supracondylar humeral fractures, aka gunstock deformity, result in varus angulation.
• Common injuries include radial head fractures with MOI (mechanism of injury) often due to FOOSH (fall on outstretched hand).
• Pain, tenderness, and limited movement of arm or elbow often accompanies this injury.
• Treatment may include immobilization and potentially surgery (ORIF).

Dislocation/Subluxation

• Radial head subluxation, also known as nursemaid's elbow.
• Can occur in toddlers due to a sudden traction force on the forearm.
• Adults injuries might have a wider radial head, potentially causing issues with the ligaments.

Lateral Epicondylitis

• Also called tennis elbow.
• It affects the common extensor tendon origin at the lateral epicondyle of the humerus.
• It typically occurs from repetitive wrist extension/activities
• Can present as dull ache at rest or sharp pain with activity

Medial Epicondylitis

• Also known as golfer's elbow.
• It affects the wrist flexor tendon origin at the medial epicondyle of the humerus.
• It typically occurs from repetitive wrist flexion/activities
• Can present with elbow pain or weakness with twisting, grabbing things, or lifting.

Pronator Teres Syndrome

• Median nerve compression by pronator teres.
• Can cause paresthesia (numbness) in the thumb, index, and/or middle finger
• Typically aggravated by activity causing possible pain on the volar surface of the forearm.

Cubital Tunnel Syndrome

• Ulnar nerve compression at the elbow called cubital tunnel.
• Causes are many and can include the position of the arm during movement/activity, repeated pressure on the forearm leading to pain and numbness in the ring and small finger.

Ulnar Collateral Ligament Pathology

• Inflammation, stretching, or tearing of the ulnar collateral ligament.
• Common in activities such as baseball pitching.
• Pain/Instability are common.

Special Tests – Neuro Dysfunction

• Section describing various neurological tests (e.g., Tinel's sign, pronator teres tests, etc.).

Special Tests – Epicondylitis

• Section describing specific tests for various epicondylitis conditions (e.g., Lateral/medial).

OT Interventions

• Includes education, donning and doffing assistance, exercises (e.g., pendular).
• Can also include ADLS which addresses daily living tasks.

Test your knowledge on shoulder dislocations, rotator cuff injuries, and elbow joint anatomy. This quiz covers common symptoms, diagnostic tests, and treatment methods associated with these conditions. Perfect for students and professionals in the medical field.