Clinical Anatomy: Shimmy them shoulders

Multiple Choice

What is the lifetime prevalence of shoulder pain?

• 33%

• 87%

• 43%

• 67%

Multiple Choice

Evidence suggests that up to one year after experiencing shoulder pain, up to _____% of patients will still experience persistent symptoms?

• 40%

• 25%

• 30%

• 10%

Multiple Choice

What bones comprise the shoulder complex?

• Humerus, Radius, Ulna

• Clavicle, Scapula, Humerus

• Radius, Scapula, Clavicle

• Acromion, Humerus, Coracoid

Multiple Choice

What joints/articulations are associated with the shoulder complex?

• Scapulothoracic Articulation, Glenohumeral Joint, Radioulnar Joint, & Sternoclavicular Joint

• Radioulnar Joint, Acromioclavicular Joint, Atlantoaxial Articulation, & Glenohumeral Joint

• Glenohumeral Joint, Scapulothoracic Articulation, Acromioclavicular Joint, & Sternoclavicular Joint

• Acromiohumeral, Scapulothoracic Articulation, Sternoclavicular Joint, & Acromioclavicular Joint

Multiple Choice

Scapulohumeral rhythm describes the concerted contribution of which two articulations into reaching overhead?

• Glenohumeral & Sternoclavicular

• Scapulothoracic & Acromioclavicular

• Glenohumeral & Acromiocalvicular

• Glenohumeral & Scapulothoracic

Multiple Choice

What is considered the primary mover of the shoulder complex?

• Acromioclavicular Joint

• Glenohumeral Joint

• Scapulothoracic Articulation

• Sternoclavicular Joint

Multiple Choice

What connective tissue structure deepens the glenoid fossa by approximately 50%?

• Articular Disc

• Coracohumeral Ligament

• Labrum

• Subacromial Bursa

Multiple Choice

Which of the following describes the orientation of the glenoid fossa?

• 5* of retroversion

• 6* of anteversion

• 6* of posterior tilt

• 5* of superior tilt

Multiple Choice

What is one of the main causes of a rotator cuff tear?

• Subacromial Impingement Syndrome

• Tight Coracoacromial Ligament

• Grade 3 Acromioclavicular Separation

• Bankhart Lesion

Multiple Choice

The suprahumeral space needs to be how large in order to be able to accommodate the rotator cuff?

• 8-10 mm

• 11-13 mm

• 10-12 mm

• 3 mm

Multiple Choice

What is the distance between the coracoid process & the lesser tuberosity of the humerus?

• 8-10 mm

• 11-13 mm

• 10-12 mm

• 3 mm

Multiple Choice

What rotator cuff muscles insert on the greater tuberosity of the humerus?

• Supraspinatus, Subscapularis, Infraspinatus, & Teres Minor

• Subscapularis

• Supraspinatus, Infraspinatus, & Teres Minor

• Superaspinatus, Infraspinatus, & Teres Major

Multiple Choice

Pulling of what ligament can lead to the development of a type 3 acromion process?

• Trapezoid

• Coracohumeral

• Coracoacromial

• Acromioclavicular

Multiple Choice

What muscle inserts on the coracoid process?

• Short head Biceps Brachii

• Pectoralis Minor

• Coracobrachialis

• Pectoralis Major

​PECTORALIS MINOR

​Origin: anterior surface of ribs 3-5

​Insertion: coracoid process

​Action: Anteriorly tilts, internally rotates, & downwardly rotates scapula

​Innervation: Medial Pectoral

Multiple Choice

Most Bankhart lesion occur at which of the following?

• Between 3:00-6:00

• Between 2:00-10:00

• Between 6:00-7:00

• Between 1:00-2:00

Multiple Choice

Most SLAP lesions occur at which go the following?

• Between 3:00-6:00

• Between 2:00-10:00

• Between 6:00- 7:00

• Between 1:00-2:00

Multiple Choice

The negative intra-articular pressure within the shoulder joint could be compromised if:

• Some/all of the shoulder ligaments are torn.

• The posterior capsule is tight.

• The patient reaches overhead.

• The patient has a type 2 acromion.

Multiple Choice

Primary disorders of the glenohumeral joint include all of the following EXCEPT:

• Shoulder dislocation

• Post-traumatic arthritis

• Rotator cuff tear

Multiple Choice

Impingement of the rotator cuff commonly occurs when reaching overhead and part of the rotator cuff gets pinched between the humerus and the:

• Coracoid process

• Spine of the scapula

• Glenoid fossa

• Acromion process

Multiple Choice

Which muscle originates off the supraglenoid tubercle?

• Long head triceps

• Long head biceps

• Coracobrachialis

• Subscapularis

​BICEPS BRACHII

​Origin: LH- Supraglenoid tubercle

​ SH- Coracoid process of the scapula

​Insertion: Radial tuberosity & bicipital aponeurosis

​Action: Supination. Elbow & Shoulder Flexion.

​Innervation: Musculocutaneous

Multiple Choice

Which muscle originates off the infraglenoid tubercle?

• Long head triceps

• Long head biceps

• Coracobrachialis

• Subscapularis

​TRICEPS BRACHII

​Origin: Long Head- Infraglenoid tubercle

​Lateral Head- posterior humerus (superior to radial groove)

​Medial Head- posterior humerus (inferior to radial groove)

​Insertion: Olecranon process

​Action: Shoulder & Elbow Extension

​Innervation: Long Head- Axillary

​ Lateral & Medial Heads- Radial

Multiple Choice

The shape of a type 3 acromion process could be described as being

• Flat

• Square

• Hook-like

• Convex

​

Multiple Choice

Changes in the morphology of the acromion process could be due to:

• Decreased subacromial space

• SLAP tear

• Thickening of the acromioclavicular ligaments

• Pull from coracoacromial ligament

Multiple Choice

A type 3 acromion is always a congenital defect.

• True

• False

Multiple Choice

The glenoid labrum is an attachment site for the majority of the:

• Rotator Cuff

• Glenohumeral Ligaments

• Coracoclavicular Ligaments

• Glenohumeral Bursae

Multiple Choice

Which glenoid labrum tear occurs between 10:00-2:00?

• SLAP Lesion

• Bankhart Lesion

• Biceps Tendon Rupture

• Triceps Tendon Rupture

Multiple Choice

Which glenoid labrum tear occurs between 3:00-6:00?

• SLAP Lesion

• Bankhart Lesion

• Biceps Tendon Rupture

• Triceps Tendon Rupture

Multiple Choice

Labral tears will decrease which of the following?

• Mobility

• Subacromial Space

• Stability

• Blood supply to the glenohumeral joint

Multiple Choice

Which ligament can be compressed by the humerus when reaching overhead?

• Glenohumeral Ligaments

• Coracoacromial Ligament

• Coracohumeral Ligament

• Trapezoid Ligament

Multiple Choice

The coracohumeral ligament does all of the following EXCEPT:

• Inserts onto the lesser tubercle of the humerus

• Interdigitates with the subscapularis tendon

• Inserts onto the greater tubercle of the humerus

• Blends with the supraspinatus tendon

Multiple Choice

All anterior shoulder ligaments will be taut with all of the following movements EXCEPT:

• External rotation at end range

• Abduction (overhead & horizontal)

• Extension

• Adduction (overhead & horizontal)

Multiple Choice

The foramen of whitebrecht, located ______, is thought to make the shoulder more susceptible to dislocation.

• In the posterior capsule

• between the humerus and the acromion

• between the superior and middle glenohumeral ligaments

• anterior to the rotator interval

Multiple Choice

Which portion of the inferior glenohumeral ligament is taut in combined internal rotation and horizontal adduction?

• Anterior Inferior Glenohumeral Band

• Posterior Inferior Glenohumeral Band

• Both portions of the Inferior Glenohumeral Ligament

• Neither portion of the Inferior Glenohumeral Ligament

Multiple Choice

The loose nature of the posterior inferior shoulder capsule allows for what motion?

• Extension

• Internal Rotation

• External Rotation

• Overhead

Multiple Choice

Which of the following is NOT true regarding the rotator interval?

• originates from the anterior capsule and inserts on the anterior humerus towards the bicipital groove

• fibers run from proximal lateral to distal medial

• receives fibers from coracohumeral ligament and superior glenohumeral ligament

• a tear can lead to anterior instability and subluxation of the biceps tendon

• can thicken with conditions like adhesive capsulitits

Multiple Choice

What is the potential volume of the glenohumeral joint capsule?

• 8-10 mL

• 10-15 mL

• 15-20 mL

• 22-26 mL

Multiple Choice

The posterior glenohumeral joint capsule tends to become thickened and taut in overhead athletes. This can lead to all of the following EXCEPT:

• decreased extension

• decreased internal rotation

• decreased flexion

• decreased horizontal adduction

Multiple Choice

Which of the following are injuries/disorders associated with the glenohumeral joint capsule?

• SLAP Lesion

• Biceps Tendonopathy

• AC Separation

• Frozen Shoulder

Multiple Choice

Which joint is the connection between the clavicle and the scapula?

• Glenohumeral

• Acromioclavicular

• Scapulothoracic

• Sternoclavicular

Multiple Choice

The acromioclavicular joint receives overcoverage from the deltoid and which other muscle(s)?

• Trapezius

• Scalenes

• Supraspinatus

• Latissimus Dorsi

Multiple Choice

How much space should there be between the clavicle and the coracoid process?

• 8-10 mm

• 11-13 mm

• 10-12 mm

• 3 mm

Multiple Choice

How much space should there be between the the acromion process and the clavicle?

• 8-10 mm

• 11-13 mm

• 10-12 mm

• 3 mm

Multiple Choice

The acromioclavicular joint has which of the following?

• Superior & Inferior AC Ligaments

• Anterior & Posterior AC Ligaments

Multiple Choice

Which of the following is the most medial coracoclavicular ligament?

• Coracoacromial

• Conoid

• Transverse Humeral

• Trapezoid

​LEFT SHOULDER

A: Conoid Ligament

B: Superior AC Ligament

C: Trapezoid Ligament​

Multiple Choice

What AC joint condition is common amongst young weightlifters and hockey players?

• Biceps Tendon Rupture

• Bankhart Lesion

• Degenerative Joint Disease

• Adhesive Capsulitis

Multiple Choice

A grade 3 AC separation would result in superior displacement of which of the following?

• Clavicle

• Acromion

• Humerus

• Sternum

Multiple Choice

A grade 3 AC separation involves a sprain/tear to all of the following structures EXCEPT

• Trapezoid Ligament

• AC Joint Capsule & Superior/Inferior AC Ligaments

• Coracoacromial Ligament

Multiple Choice

What structure associated with the SC joint resists medial displacement and divides the joint to allow for more motion?

• Synovial Fluid

• Interclavicular Ligament

• Articular Disc

• Costoclavicular Ligament

Multiple Choice

Which describes the correct orientation of the SC articular disc?

• Originates at the first rib and travels superiorly between the medial aspect of the clavicle and the manubrium.

• Originates at the manubrium and travels posteriorly to the medial aspect of the clavicle and inserts on the first rib.

Multiple Choice

What is the function of the interclavicular ligament?

• prevent anterior dislocation

• prevent posterior dislocation

• prevent medial displacement

• prevent inferior displacement

Multiple Choice

Describe the motion of the clavicle when reaching overhead.

• 30-55* anterior translation

• 30-55* posterior rotation

• 30-55* superior translation

• 30-55* medial rotation

Multiple Choice

The sternoclavicular joint has which of the following?

• anterior & posterior ligaments

• superior & inferior ligaments

• annular ligaments

• transverse ligaments

Multiple Choice

Where does the costoclavicular ligament attach on the clavicle?

• Anterior Inferior Clavicle

• Anterior Medial Clavicle

• Posterior Inferior Clavicle

• Posterior Medial Clavicle

Multiple Choice

Movements at the sternoclavicular articulation are concurrent with movements at which other articulation?

• Scapulothoracic

• Glenohumeral

• Acromioclavicluar

• Costoclavicular

Multiple Choice

The lateral aspect of the clavicle moving anteriorly describes what SC joint movement?

• Rotation

• Rectraction

• Elevation

• Protraction

• Depression

Multiple Choice

Can you move the humerus without moving the scapula?

• Yes

• No

Multiple Choice

At what spinous process level can the spine of the scapula typically be palpated?

• C6-T1

• T2-T4

• T5-T7

• T8-T9

Multiple Choice

At what spinous process level can the inferior angle of the scapula typically be palpated?

• C6-T1

• T2-T4

• T5-T7

• T8-T9

Multiple Choice

The medial border of the scapula can typically be palpated at what distance from the spinous processes?

• 8-10 mm

• 2-3 in

• 11-13 mm

• 2-3 cm

Multiple Choice

The scapula is positioned in which plane?

• Frontal

• Median

• Scapular

• Humeral

Multiple Choice

Which muscle does NOT contribute to scapular elevation?

• Rhomboids

• Levator Scapulae

• Trapezius

Multiple Choice

Which muscle does NOT contribute to scapular depression?

• Pectoralis Minor

• Serratus Anterior

• Trapezius

Multiple Choice

Which muscle contributes to scapular abduction/protraction?

• Trapezius

• Deltoid

• Levator Scapulae

• Serratus Anterior

Multiple Choice

Which muscle does NOT contribute to scapular retraction?

• Rhomboids

• Trapezius

• Latissimus Dorsi

Multiple Choice

A patient is diagnosed with supraspinatus tendinopathy from impingement. What space is impingement likely to originate from?

• Subscapular

• Subacromial

• Suprascapular

• Supracromial

Multiple Choice

What ligament that attaches to the coracoid process is usually resected with surgery?

• Conjoin Ligament

• Acromioclavicular

• Coracoacromial

• Anterior AC Ligament

Multiple Choice

A patient with adhesive capsulitits would be expected to have ________ shoulder capsule volume.

• increased

• decreased

• normal

Multiple Choice

A tight posterior capsule would restrict which of the following movements?

• Horizontal abduction, ER, & Flexion

• Overhead reaching & Abduction

• Horizontal adduction, IR, & Flexion

• Horizontal adduction, IR, & Extension

Multiple Choice

What neurovascular structure passes through the suprascapular notch underneath the transverse suprascapular ligament?

• Supraspinous Artery

• Supraspinous Nerve

• Suprascapular Artery

• Suprascapular Nerve

Multiple Choice

The superior articular branch of the suprascapular nerve provides

• sensory innervation to the bursa, ligaments, & anterior capsule

• motor innervation of supraspinatus

• Sensory innervation of the posterior capsule

• motor innervation of infraspinatus

Multiple Choice

A posterior labral tear resulting in the formation of a cyst in the spinoglenoid notch can cause:

• Inability to abduct or externally rotate the shoulder

• abnormalities in sensation along the C5-C6 dermatomes

• posterior shoulder dislocation

• abnormalities in sensation along the posterior GH capsule

Multiple Choice

What is the function of the bursae in the shoulder?

• increase range of motion

• decrease friction

• increase stability

• decrease joint space

Multiple Choice

Which nerve is responsible for sensory innervation of the deltoid region?

• Lateral Brachial Cutaneous Nerve

• C3 Dermatome

• Axillary Nerve

• C8 Dermatome

Multiple Choice

The axillary nerve provides motor innervation to all of the following muscles EXCEPT:

• long head triceps

• deltoid

• rhomboid minor

• teres minor

Multiple Choice

Patient with neuropraxia of the long thoracic nerve can present with all of the following EXCEPT:

• winging of the medial border of the scapula at rest

• excessive anterior tipping of the scapula

• limited protraction of the scapula

• limited upward rotation of the scapula

Multiple Choice

Neuropraxia of the axillary nerve would result in all of the following EXCEPT:

• abnormal sensation over deltoid region

• weakness in abduction

• weakness in adduction

• weakness in flexion

• weakness in extension

Multiple Choice

Which of the following correctly lists the functions of the pectoralis minor?

• Elevation, upward rotation, anterior tilt, & internal rotation

• Elevation, downward rotation, posterior tilt, & internal rotation

• Depression, upward rotation, anterior tilt, & external rotation

• Depression, downward rotation, anterior tilt, & internal rotation

Multiple Choice

Blood supply to the rotator cuff musculature comes from an anastomosis of which 3 arteries?

• suprascapular, subscapular, anterior humeral circumflex

• suprascapular, subscapular, posterior humeral circumflex

• supraspinous, subscapular, anterior humeral circumflex

• supraspinous, circumflex scapular, posterior humeral circumflex

Multiple Choice

Occlusion of the blood supply to the rotator cuff occurs with which positions?

• external rotation and extension

• internal rotation and extension

• arm at side and arm overhead

• side-sleeping and horizontal adduction

Multiple Choice

All of the following muscles contribute to the conjoined tendon of the rotator cuff EXCEPT:

• Supraspinatus

• Subscapularis

• Infraspinatus

• Teres Minor