1
Q
Surface Condition
A
-changes in texture, color, moisture, scars
2
Q
Surface contours
A
- circumferential and segmental bands of soft tissue may suggest instability
- flattened/tight areas suggest muscle imbalances
3
Q
Soft Tissue Proportions
A
-asymmetries between sides, over development vs atrophy may indicate structural and/or biomechanical differences
4
Q
Sternal-Rib Angle
A
Normal: 90*
>100=tight IO, weak EO
<75=tight EO
5
Q
Tight EO
A
- lead to post pelvic tilt and lumbar flexion
- fully flex arms and inhale: if no increase in Sternal-Rib angle=EO short
6
Q
Clavicular Angle
A
- 15-20* upward (medial to lateral)
- AC joint higher than SC joint
7
Q
Horizontal Clavicle
A
- depressed shoulder girdle
- long upper trap
8
Q
Excessive Upward angle of Clavicle
A
- elevated shoulder girdle
- tight upper trap
9
Q
SC Joint
A
-Even bilaterally
10
Q
SAM Test
A
- Spinal Activated Manubrium Test
- Pt: seated, hands in lap
- PT: facing pt, looking up at manubrium; hands on upper trap with thumbs midway between manubrial notch and manubriosternal junction
- Procedure: pt look down and up while PT monitors for asymetrical movement
- Flexion: if manubrium rotates right=T1/2 or T2/3 facet on right doesn’t flex properly
- Extension: same as above but facet doesn’t extend properly
11
Q
Finding T1
A
- C6 moves ant with extension
- C7 stable with extension
- T1 SP translates posterior with pressure on sternum
12
Q
Acromioclavicular Joint
A
- Find: pull humerus caudally
- high AC=severe sprain
13
Q
Increased pain with exhalation & decreased pain with inhalation
A
-consider thoracic disc lesion
14
Q
Increased pain with inhalation
A
-consider rib pathology
15
Q
Transverse Process “Finger Rule”–TS
A
- T1-2=one finger cranial to SP
- T3-4=two fingers cranial
- T5-8=three fingers cranial
- T9-10=two fingers cranial
- T11-12=one finger cranial
16
Q
Olecranon Position
A
- faces posteriorly in neutral
- faces forward with full shoulder flexion
17
Q
Scapular Downward Rotation
A
- inf angle of scap medial to upper portion
- Cause: rhomboids and levator scapulae are short and upper trap long
- serratus ant long
18
Q
Scapular Position
A
- Vertebral border is vertical & 3” from SP
- Superior angle: T1/2
- Scapular Spine: T3
- Inferior Angle: T7
19
Q
Scapular Upward Rotation
A
- spine of scap medial to inferior angle
- Cause: trap (any/all) short
20
Q
Scapular Elevation
A
- Sup border higher than T1/2
- Causes:
- If sup angle high but acromion not=short levator
- entire scap high and acromion high=short upper trap
21
Q
Scapular Depression
A
- sup border scap below T2 (long neck)
- Cause: upper trap long
- pec major and lat dorsi short
22
Q
Scapular Abduction
A
- vertebral border more than 3” from midline of thorax
- Cause: short serratus and/or pec major
23
Q
Scapular Adduction
A
- vert border less than 3” from SP
- Cause: rhomboids, trap short
- Long serratus ant
24
Q
Scapular Ant Tilt
A
- inferior angle of scap away from rib cage
- Cause: short pec minor and/or short biceps
- weak low trap
25
Scapular Winging
- vertebral border of scap away from thorax
| - Cause: short/weak serratus, scoliosis
26
Normal Humerus Alignment
- <1/3 hum head in front of acromion
- antecubital crease faces forward
- olecranon face posterior
- palm faces body
- humerus vertical (from front and side)
27
Anterior Humerus
- >1/3 head ant to acromion
- Causes:
- abd/tilted scapula
- tight post capsule
- lax ant capsule
28
Medially Rotated Humerus
- olecranon lateral/palm posterior
- causes
- Shortened IR Mm
29
Lat Rotated Humerus
- Rare: check if scap is Abducted
| - Causes: shortened ER Mm
30
Flexion/Extension of Humerus
- distal portion of humerus is ant or post to proximal
| - Causes: shortened Mm
31
If GH ROM is limited--Rule IN cervical involvement
- ROM in standing
- ROM in supine with cervical distraction
- Rule in Neck if supine ROM increases 10* or more
32
Lack of SC posterior rotation (with GH elevation)
-biomechanical problem with upward rotation of scap
33
Heavy Arms
- depressed/Abd/downwardly rotated scap
| - unstable scap/scap lag with elevation
34
Long Arms
- ant tilted/downwardly rotated scap
| - delayed/decreased upward rotation of scap
35
Long Trunk
-arm support of chair too low=depressed shoulder/SB trunk to reach
36
Large Breasts
- C-Spine: forward head
- Shoulders: anterior/med rotated
- T-Spine: increased thoracic kyphosis
- Scapulae: downward rotation/depression
- Sternum: depressed
- Clavicles: sloped
37
Scapula during first 30-60* GH flexion
-variable movement
38
Scapula at 140* GH flexion
-scap should stop moving
39
Scapular Movement
- 60* with max arm elevation
- inferior angle at midaxillary line
- only minimal elevation/no depression
- inf angle stays against thorax
- stable with ER/IR and H. add/abd (to 90*)
40
5 most common impairments of shoulder girdle
| Sahrmann
1. short/stiff ER Mm
2. Insufficient activity of ER Mm
3. Insufficient activity of Subscap
4. Dominance of deltoid Mm, causing superior glide of humerus
5. Shortness of capsule (post and inf)
41
Decreased GH ER
with arm abd to 45*=shor tsubscapularis
| with arm abd to 90*=tight capsule
42
At end range GH elevation there should be rotation of ________
T1, T2, T3
43
Humerus Movement
- rotates in glenoid fossa (constant PICR)
- olecranon ant (flexion) or lat (abd) at end range
- capsular end feel
- no ant translation during lowering
MSK 3
flashcards
Decks in class (18)
# Cards
-
Posture43
-
Shoulder/Intro23
-
Muscle Length & Scapula & GH Positioning10
-
Soft Tissue48
-
Scapular Exercises by Muscle7
-
Elbow18
-
Active Release5
-
Dry Needling8
-
Sahrmann Scapular Syndromes26
-
UQ Ther Ex Examples17
-
Ther Ex Guidelines11
-
Wrist and Hand21
-
Hip22
-
Knee42
-
Post Op Knee Rehab26
-
Ankle/Foot33
-
Running19
-
Gait Assessment26
