Anatomy Block III- Shoulder and Hip Joints

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1

what is an articulation

a joint; where two or more bones connect, surrounded by CT typically

2

what do joints allow in general

MOVEMENT

3

what is mobility

amount of movement allowed

4

what does movement occur due to

muscle contractions

5

what do joints need

stability

6

what is the correlation of joint stability to how prone it is to injury

more stable, less prone to injury

7

what can contribute to stability of a joint in general

amount of articulation, CT (ligaments and cartilage and joint capsules), muscle that cross joint

8

what is the relationship between stability and mobility

inverse

9

what is Hilton's law

nerves supplying a joint also supply the muscles moving the joint and the skin covering the insertion of those muscles (usually they are the nerves supplying proprioceptors and nociceptors of the joint

10

what is O'Laughlin's law

if a muscle crosses over (spans) a joint, it must move that joint

11

what is the mobility of synovial joints

freely moveable

12

what covers synovial joints

articular capsule

13

what is an articular capsule

CT surrounding joint, providing stability

14

what do synovial joints have besides an articular capsule

synovial membrane

15

what do synovial membranes make

synovial fluid

16

what is the role of the synovial fluid

provides lubrication of the joint to reduce friction in a given joint and nourishes the articular cartilage (hyaline cartilage) which surounds the end of the bone

17

what helps to maintain the hyaline cartilage of a joint

synovial fluid

18
card image

a. sternoclavicular ligament
b. articular disc
c. costoclavicular ligament

19
card image

a. transverse humeral ligament
b. coracohumeral ligament
c. acromioclavicular ligament
d. parts of coracoclavicular ligament
e. glenohumeral ligaments

20

what articulatinos make up the shoulder joint

sternoclavicular joint
acromioclavicular joint
glenohumeral joint

21

what is the stability of the SC joint

high

22

what is the mobility of the SC joint

very low

23

what does the SC joint connect

physical attachment point of pectoral girdle to axial skeleton

24

what makes up the rest of the pectoral girdle besides the clavicle

scapula

25

what is the motion of the scapula in general

glides over thoracic cage

26

what ligaments does the SC joint have

sternoclavicular and costoclavicular

27

what is the role of the sternoclavicular ligaments

help hold down clavicular head in place

28

where does the costoclavicular ligament run

comes off first rib and attaches to clavicle

29

what is the roel of the costoclavicular ligament

restricts elevation

30

besides the costoclavicular ligament what is a notable structure of the determination of the stability of the sternoclavicular joint

articular disc

31

what movement does the sternoclavicular joint allow

movement of pectoral girdle: elevates and depresses as you shrug shoulders and put them back down, clavicle rises and lowers with these

there is also some anterior/posterior movmeent that helps in protraction and retraction of shoulders, but that is more limited than elevation and depression

32

what innervates the sternoclavicular joint

supraclavicular nerve and nerve to subclavius

33

are injuries to the sternoclavicular joint rare

yes

34

what is dislocation of the sternoclavicular joint usually also accompanied by

tearing of sternoclavicular ligaments

35

what do tearing of sternoclavicular ligaments usually look like

superior swelling over sternal head, sternal head pops upward

36

what directions do sternoclavicular injuries usually go

anteriorly or superiorly

37

what usually happens before you have disruption of sternoclavicular joint due to the strength of the joint

fracture of clavicle

38

what types of fractures are fractures of the clavicle usually

greenstick fracture where branch splinters and does not tear completely

39

what does the AC joint connect

clavicle to acromion process of scapula

40

what are the stability and mobility of the AC joint

some stability and not much movement

41

what does the AC joint attach

scapula and clavicle (upper limb to axial skelton)

42

does the AC joint use a lot of movement

no

43

are the ligaments that hold the AC joint together strong

no

44

what are the ligaments involved in the AC joint

acromioclavicular ligament
coracoclavicular ligament

45

what does the acromioclavicular ligament cover

synovial membarne between clavicle and acromion process

46

what does the coracoclavicular ligament connect

coracoid process to clavicle

47

what is the role of the coracoclavicular ligament

holds clavicle down, maintains articulation between the coracoid process and clavicle

48

what type of injuries are common with the AC joint

sprain of acromioclavicular ligament and coracoclavicular ligament

49

what is a sprain

some kind of rupture of fibers of ligament/CT whether partial or complete

50

are sprains and dislocations different

yes

51

what is a type 1 AC separation

some fibers tearing but other fibers keep connections; minimal damage;

52

what is the treatment for a type 1 AC separation

shoulder sling

53

what is a type 2 AC separation

AC ligament torn, but articular surfaces are still close to one another

54

what is the treatment for type 2 AC separation

shoulder sling treatment

55

what is a type 3 AC separatino

AC and CC ligaments are torn, so you get actual separation

56

what is the treatment for type 3 AC separation

repaired surgically

57

what is considered the true shoulder joint

glenohumeral joint

58

what type of joint is the glenohumeral joint

ball and socket joint

59

what forms the glenohumeral joint

humerus and glenoid cavity of scapula

60

how many degrees of motion does the glenohumeral joint have

3

61

what are teh degrees of motion of the glenohumeral joint

flexion/extension
abduction/adduction
internal/external rotation

62

where does the rotation of the glenohumeral joint take place

glenoid cavity

63

what are teh stats of glenohumeral joint mobility and stability

very mobile, not very stable

64

what ligaments help the glenohumeral jiont

glenohumeral
coracohumeral
transverse humeral
coracoacromial*

65

how many ligamtnes are within the glenohumeral group? what are they like

3

thickened bands of CT

66

whattype of support do the glenohumeral ligaments provide

anterior support

67

what do the glenohumeral ligaments prevent

limit external rotation and hyperextension of shoulder

68

where do coracohumeral ligaments run

coracoid process to top of joint

69

what type of support do coracohumeral ligaments provide

superior support

70

where are the transverse humeral ligaments

between greater and lesser tubercle of humerus

71

what goes through the transverse humeral ligament

long head of biceps brachii

72

what forms a canal to hold the long head of the biceps brachii in place

transvese humeral ligament

73

where does the coracoacromial ligament run

coracoid process to acromion

74

what type of support does the coracoacromial liagment provide

superior support

75

what cavity does the humerus go into and what bone is that cavity part of

glenoid cavity, part of scapula

76

is the glenoid cavity small or large compared with the head of the humerus

small

77

how much stability does the glenoid cavity provide to the shoulder joint

limited stability

78
card image

a. glenoid cavity
b. glenoid labrum

79

what is the role of the glenoid labrum

helps deepen pocket of the glenoid cavity, which increase stability due to the deeper socket

80

what is the glenoid labrum made of

fibrocartilage

81

what does a SLAP lesion stand for

superior labrum, anterior to posterior

82

what happens in a SLAP lesion

long head of biceps brahii attaches to glenoid labrum, so in SLAP you have pulling of the long head of the biceps tendon that tears away labrum from glenoid

83

what makes SLAP lesions so painful

cartilage disrutpion, which reduces stability of joint and ruins smooth, frictionless surface of joint moveemnt

84

what are the two concerns in a SLAP lesion

pain and a catching feelng due to a piece of cartilage flapping down between the glenoid and humerus, causing a loss of that smooth surface

85
card image

a. subscapularis muscle
b. infraspinatus muscle
c. teres major muscle
d. supraspinatus muscle

86

what structure provides the msot stability to the shuolder

rotator cuff

87

how does the rotator cuff provide the msot stability to the shoulder joint

active contractions, cover anterior superior and posterior surfaces, when they tonically contract they pull humerus into glenoid to maintain glenohumeral articulation and subsequently help stability

88

what is a secondary role of the rotator cuff

slows down rotational motion of humerus after throwing motions

89

what muscle is protected by subsacromial bursa

supraspinatus

90

what is the initiator of shoulder abductino

supraspinatus

91

what happens to the subacromial space as shoulder abductino increases

narrows

92

what typically tears in rotator cuff tears

SS tendon

93

what will happen if SS tendon is torn

limits abduction

94

as scapula rotates what does the glenoid cavity move to do

maximize articular surface

95

how many degrees of scapular rotation do you get for every 2-3 degrees of humeral movement

1 degree

96
card image

subacromial bursa

97

what is the glenoid labrum important for

maintaining glenohumeral articulation surface, critical especially when arm is overhead

98

what is a bursa

folding of synovial membranes

99

what is the function of bursas

help cushoin and protect tendon of supraspinatus

100

what happens in shoulder impingement

bursitis or inflammation of supraspinatus from narrowing of subacromial space

101

what type of motins can irritate bursa or supraspinatus

overhead

102

what can happen in extreme cases of the narrowing of that subacromial space

due to increased bony growth (bone spurs) to fill spaces like taht subacromial space

103

what innervates the rotator cuff muscles

suprascapular nerve

104

what innervates the deltoid

axillary nerve

105

what innervates the pec major

lateral pectoral nerve

medial pectoral nerve

106

what nerves innervate the shoulder region

suprascapular
axillary
lateral pectoral

107

what is a shoulder subluxation

partial dislocation that spontaneously reduces

108

do shoudler subluxations hurt

yes

109

what is a shoulder dislocation

bone slips out of position and stays out of position, resulting in a large functiona decrease

110

why cant most dislocations just go back into position

body spasms muscle around joint and locks it out of place

111

what directions are most shoulder dislocations

anterior and inferior

112

what is the technique for reducing a glenohumeral dislocation

tractino-countertraction: wait for muscles to relax and then muscles will pull it back int position

113

what is usually used in shoulder reductions to hel pout

muscle relaxants;

114

what should you be careful about reducing shoulders

arteries and nerves and bony areas against one another (damage)

115

what is the minimal articulating surface of the shoulder

abducted and externally rotated

116

what is the apprehension test

abduct and externally rotate arm to see if

117

why are joints more apt to be dislocated after they have been dislocated once

articular capsule has negative pressure sticking joints together and once disrupted that is lost for good

118

what type of joint is the hip joint

ball and socket

119

what is the articulation in the hip joint

head of femur with acetabulum of os coxae

120

how many degrees of movement are present in the hip joint

3

121

what are teh degrees of movement in the hip joint

flex/ex
ab/ad
int/ext rotation

122

is the hip joint mroe or less stable and mobile than the shoulder

more stable, less mobile

123
card image

a. iliofemoral ligament
b. pubofemoral ligament

124
card image

ischiofemoral ligament

125

what ligaments help the hip joint maintain stability

iliofemoral
pubofemoral
ischiofemoral
ligament of the head of the femur

126

what does the iliofemoral ligament prvent

hyperextension

127

what does the pubofemoral ligament prevent

hyperabduction

128

what does the ischiofemoral ligament prevent

weak, but prevents excessive internal rotation

129

what does the ligament of the head of the femur help support

nothing

130

wht does the ligament of the head of the femur do

conducts of small artery

131

what is close pack of the hip

extension

132

what is close pack

position of limb where ligaments are tight and have greatest stability

133

what is loose pack for the hip

flexion

134

what is loose pack

position of limb where ligaemnts are loose and have limited stability

135

what is the articular surface of the hip like

acetabulum surrounds head of the femur

136

why is the articular surface of the hip more stable than the glenoid cavity

deeper socket

137
card image

a. medial circumflex femoral artery
b. acetabular ligament
c. ligament of head of femur
d. acetabular branch

138

what labrum helps the hip joint's articular surface

acetabular labrum

139

what nerves run through the hip joint

femoral
obturator
superior gluteal
nerve to QF
sciatic

140

what does the femoral nerve innervate

anterior muscles

141

what does the obturator nerve innervate

adductors and knee

142

are injuries to the hip joint common or rare

rare due to stability

143

is a fracture of the femoral neck common or rare

fairly common

144

what is the type of fracture of the femoral neck called

garden fracture

145

what can result from femoral neck fractures

avascular necrosis, may maintain artery to femoral head but usually insurfficienct to provide blood to fractured segment which can die off and necrose

146

what is osteoarthritis

wearing away of smooth articular surfaces of hyaline cartilage, lose that smooth surface

147

what results from osteoarthritist

lot of pain, inflammatino, some grinding

148

what usually helps osteoarthritis

walking around
joint replacement surgery usually needed

149

what types of hip dislocations are tehre

congenital and acquired

150

what happens in a congenital dislocation

head of femur doesnt develop in acetabulum in a good position

151

what is difficult in congenital hip dislocaitnos

abduction

152

what does the leg look like in congenital hip dislocatino

medially rotated and apparent leg length discrepancy because femur has moved upward

153

what are acquired hip dislocations from in general

large traumatic forces

154

what is someone with an acquired hip dislocatin usually unable to do

abduct hip

155

what does the acquired hip dislocation look like

medially rotated and usually a posterior dislocation

156

what part of the acetabulum is waekest

posteiror side

157

how are hips usually dislocated

car crash where leg pushed backward as it crashes into something