Shoulder

Question 1

What are the shoulder movements?

Answer 1

Extension, flexion, abduction, adduction, medial rotation, lateral rotation, circumduction

Question 2

What is the characteristic of the acromion variation according to Bigliani?

Answer 2

Acromion has a hook shape

Question 3

How does the glenoid fossa affect mobility and instability?

Answer 3

It is highly unstable which creates high mobility

Question 4

What role does the labrum play in the glenoid fossa?

Answer 4

Increases stability

Question 5

What are the characteristics of the plane of the scapula?

Answer 5

Superior aspect is 30-45° anterior to frontal plane, slight anterior inclination, upward rotation in frontal plane

Question 6

Is arm elevation easier when the scapula is in its plane or out of plane?

Answer 6

Easier when scapula is in its plane

Question 7

Under which type of shoulder rotation is arm elevation easier?

Answer 7

Under external shoulder rotation

Question 8

Why is elevation easier with external shoulder rotation?

Answer 8

The greater tubercle can clear the acromion process and acromioclavicular ligaments

Question 9

What are the joints of the shoulder?

Answer 9

• Acromioclavicular joint
• Glenohumeral joint
• Scapulothoracic joint
• Sternoclavicular joint

Question 10

What are the characteristics of the acromioclavicular joint?

Answer 10

3 rotatory motions and 3 translatory motions

Question 11

What are the ligaments of the acromioclavicular joint?

Answer 11

• Coracoclavicular (trapezoid and conoid)
• Acromioclavicular

Question 12

What does the trapezoid ligament do?

Answer 12

Prevents medial movement of acromion process relative to clavicle

Question 13

What does the conoid ligament do?

Answer 13

Restricts upward rotation of scapula and pulls clavicle in upward rotation

Question 14

What are the grades of acromioclavicular joint injuries?

Answer 14

• Grade I: AC ligament stretched partially torn
• Grade II: AC ligament completely torn
• Grade III: AC joint separation

Question 15

What are the rotary motions of the sternoclavicular joint?

Answer 15

• Elevation/depression
• Protraction/retraction
• Upward/downward rotation

Question 16

What are the ligaments of the sternoclavicular joint?

Answer 16

• Anterior/posterior sternoclavicular
• Interclavicular
• Costoclavicular
• Intraarticular disc

Question 17

What is the scapulothoracic joint?

Answer 17

Not a real joint with no true articulations

Question 18

What are the functions of the scapulothoracic joint?

Answer 18

• Increase ROM of shoulder
• Enhance reach
• Maintain favourable length-tension relationship for deltoid
• Maintain G-H stability
• Shock absorption
• Permits elevation of body

Question 19

What is the glenohumeral joint type?

Answer 19

Ball and socket

Question 20

What is the scapulohumeral rhythm?

Answer 20

2:1 GH:ST; for every 2° of GH movement there is 1° of ST movement

Question 21

What are the contributions of shoulder joints to 180° of arm elevation?

Answer 21

• GH = 120° abduction
• ST = 60° upward rotation
• SC = 30° elevation and posterior rotation
• AC = 30° upward rotation

Question 22

What elements are responsible for static glenohumeral stability?

Answer 22

• Coracohumeral ligament
• Glenohumeral ligament
• Labrum
• Capsule
• Joint contact
• Scapular inclination
• Intraarticular pressure

Question 23

What elements are responsible for dynamic glenohumeral stability?

Answer 23

• Rotator cuff muscles
• Biceps
• Deltoid

Question 24

How is shoulder instability classified?

Answer 24

• Etiology: traumatic vs atraumatic
• Degree of instability: subluxation vs dislocation
• Unidirectional vs multidirectional
• Generalized ligamentous laxity

Question 25

What are the characteristics of the coracoacromial arch?

Answer 25

* Coracoacromial ligament * Sub-acromial space * Roof of glenohumeral joint

Question 26

What is impingement in the shoulder?

Answer 26

Irritation of structures in subacromial space leading to narrowing of subacromial space

Question 27

What are intrinsic and extrinsic mechanisms of impingement?

Answer 27

* Intrinsic: factors within tendon * Extrinsic: glenohumeral kinematics, anatomical factors

Question 28

What are the impingement tests?

Answer 28

* Neer’s test * Hawkin’s test

Question 29

How is glenohumeral instability compensated?

Answer 29

Scapulothoracic joint use

Question 30

What muscles stabilize the glenohumeral joint?

Answer 30

* Supraspinatus * Infraspinatus * Subscapularis * Teres minor * Biceps * Deltoid

Question 31

What effect does the deltoid have on the humerus?

Answer 31

Translates humeral head superiorly

Question 32

What does the supraspinatus do on the humerus?

Answer 32

Abduction of the humerus and compression of humeral head

Question 33

What do the infraspinatus, subscapularis, and teres minor do on the humerus?

Answer 33

Pull humeral head downwards and externally rotate humerus

Question 34

What happens if there is no rotator cuff function?

Answer 34

Excessive superior glide of humeral head

Question 35

What muscles stabilize the scapula?

Answer 35

* Serratus anterior * Trapezius * Rhomboids * Pectoralis minor * Levator scapulae

Question 36

What muscles perform upward scapular rotation?

Answer 36

* Upper trapezius * Lower trapezius * Serratus anterior

Question 37

What causes medial winging of the scapula?

Answer 37

Serratus anterior weakness, long thoracic nerve damage

Question 38

What causes lateral winging of the scapula?

Answer 38

Trapezial weakness, spinal accessory nerve damage

Question 39

What muscles perform downward scapular rotation?

Answer 39

* Pectoralis minor * Levator scapulae * Rhomboids

Question 40

What are the large muscle movers of the shoulder?

Answer 40

* Latissimus dorsi * Teres major * Pectoralis major * Coracobrachialis

Question 41

What muscles are involved in shoulder depression/weight bearing?

Answer 41

* Latissimus dorsi * Pectoralis major

Question 42

When is the moment arm of the upper extremity weight the highest?

Answer 42

When the shoulder is abducted at 90°

Question 43

When is the joint reaction force highest in shoulder abduction?

Answer 43

At 90° of abduction

Question 44

What does apprehension of the shoulder mean?

Answer 44

Anterior instability

Question 45

What does the sulcus sign indicate?

Answer 45

Inferior instability

Question 46

What does the load and shift test assess?

Answer 46

Anterior-posterior instability