1
Q
The shoulder complex is a coordinated function of:
A
- glenohumeral (scapulo-humeral)
- acromioclavicular
- sternoclavicular
- scapulothoracic
2
Q
3 Joints of the shoulder complex:
A
- sternoclavicular joint
- acromioclavicular joint
- glenohumeral (GH) joint
3
Q
Sternoclavicular joint is a direct connection between ____ and _____.
A
- UE
- trunk
4
Q
Sternoclavicular joint is what type of joint?
A
weak synovial plane joint
5
Q
Sternoclavicular joint is stabilized by…
A
strong ligaments and articular disc
6
Q
Sternoclavicular joint moves with….
A
- scapula
- actions of shoulder cause motion at this articulation
7
Q
Acromioclavicular joint is a connection between ____ and ____.
A
- scapula
- clavicle
8
Q
Acromioclavicular joint is what type of joint?
A
weak synovial gliding joint
9
Q
Acromioclavicular joint is stabilized by…
A
multiple strong ligaments
10
Q
Acromioclavicular joint moves with…
A
- UE
- actions of shoulder cause motion at this articulation
11
Q
Scapulothoracic pseudo-articulation is …
A
not a true joint
12
Q
Scapulothoracic pseudo-articulation movement pattern:
A
- between the scapula and across the thoracic cage (ribs)
- elevation, depression
- protraction, retraction
- rotation
13
Q
Scapulothoracic pseudo-articulation dysfunction often results in…
A
stress or injury to shoulder joint from repetition of movement
14
Q
With contraction of _____ stabilization muscles, a strong base for high level ___ ____ mobility of ____ is achieved.
A
- scapular
- GH joint
- UE
15
Q
GH joint:
A
- ball and socket joint
- multiaxial joint, mobile joint
- articulation of head of the humerus with glenoid fossa or cavity of scapula
16
Q
ROM of GH joint:
A
- flexion, extension
- abduction, adduction
- medial rotation, lateral rotation
17
Q
Labrum of the GH joint is called:
A
glenoid laburm
18
Q
Functions of the glenoid labrum:
A
- joint stability
- deepens and increases glenoid depth approximately 2x
- protects bone
- lubricate joint synovial fluid
19
Q
Glenoid labrum is continuous with …
A
tendon of long head of the biceps brachii
20
Q
Injury to glenoid labrum:
A
- labral stress
- load
- rotations with stress
- extreme ROMs (past end ROM)
21
Q
Capsule of the GH joint:
A
- assists in joint stability
- rotator cuff tendons blend in for a dynamic capsular tightening (restricts extreme ROM)
22
Q
Capsular injury of the GH joint can be…
A
acute or chronic injury
23
Q
Functions of bursa of the shoulder:
A
- aids mobility
- increases ROM
24
Q
4 bursae in the shoulder:
A
- subacromial bursa
- subdeltoid bursa
- subcoracoid bursa
- subscapular bursa
25
Bursae of the shoulder injury MOI:
- compression
| - contusion/contact
26
Most common bursae injuries:
- subacromial bursa
| - impingement
27
GH ligaments are the primary check against...
anterior and posterior dislocations
28
GH ligaments are critical structures for...
- joint stabilization
| - overhead activities
29
Ligamentous support of ...
- GH joint
| - AC joint, SC joint
30
If there is injury to the ligaments of the GH joint, there will be...
pain with ROM
31
3 components of neurovascular structures of shoulder joint and complex:
- arteries
- veins
- nerves
32
Important neuro structures of shoulder:
- brachial plexus
- auxillary nerve
- musculocutaneous n.
- radial n.
- scapula ulnar n.
- median n.
33
Important vascular structures of shoulder:
- subclavian artery
- axillary artery
- brachial artery
34
DOI questions for shoulder:
- acute
| - chronic (repetitive movements of arm)
35
MOI questions for shoulder:
- understand tissues under stress (fall on point, or repetitive motion)
- not position of arm relative to joint (ie. FOOSH, at side, forcefully abducted and extended)
36
Pain questions for shoulder:
- region, referred or radiates (if yes, quadrant scan)
- establish relationship with function and the pain
- ADL, sleep (affected, positions of pain)
37
Unusual sounds and sensations questions for shoulder:
- crepitus
- catching or clicking
- give way
- pop out
38
Function questions for shoulder:
- notable weakness
| - affect function of the wrist and hand
39
Previous injury questions for shoulder:
- dislocations
- MVA
- whiplash
- injury to neck or spine
40
Changes in sensations (unusual sensations) questions for shoulder:
- numbness
- tingling
- stabbing
- any circulation changes (cold)
41
Activity/sport history questions for shoulder:
- any OH activities in sport, ADL, occupation (positions of pain)
- changes to activity, training, strength training
42
Key observations to consider for the GH joint:
- all view points
- scapular posture
- position of shape of clavicle
- muscle asymmetry
- spinal alignment
- scapulo-humeral rhythm
43
All view points includes:
- anterior
- posterior
- lateral
- landmarks
44
What to look for with scapular posture:
- resting position of the scapula
- bilateral position
- scapular elevation
- protraction position
- winging
- scapular deviations
45
Position and shape of clavicle:
- acromion process (height of, deformity of)
- observe notable or remarkable postures
- bony prominences
46
What to look for with muscle asymmetry:
- shape
- girth
- atrophy
47
What to look for with spinal alignment:
- position of head
- t-spine
- position of UE
48
Scapular dyskinesis:
- noting border prominences that are remarkable
- protracted, retracted
- rotated, tilted
- winging
49
Acromion process deformity:
- AC joint
| - piano key (sign for a sprain of AC ligaments)
50
Impact of spinal alignment with shoulder pain:
- CC: pain in ant. aspect of shoulder
- observe thoracic spine (kyphotic posture)
- impact on shoulder pain
51
Scapulo-humeral rhythm:
observation of a pattern or rhythm of the movement of the humerus (UE) in relation to the scapula
52
Full ROM at the shoulder is a combination of...
- complex
- GH joint
- SC joint
- AC joint
- scapulothoracic movement along with the spine
53
Full ROM movement can be compromised by...
- anything that changes the position of the scapula
| - such as muscle imbalances
54
Purpose for effective movement pattern:
- to achieve full and functional ROM in a pain free ROM
| - for efficient and effective strength and power in movement
55
Movement pattern for first ___ degrees abduction or first ____ degrees flexion:
- 30
- 45
- humerus moves
- scapula is fixed to a position of stability on thorax
56
Movement pattern for beyond the initial range:
- the ratio of humerus to scapular movements is a 2:1 ratio
| - scapular rotation facilitates GH movement
57
Degree of ROM is an assessment relative to...
positioning of the UE
58
How to assess degree of ROM:
- direct rotation of UE or observe for it
- evaluate with elbow straight or bent elbow
- can assess internal/external GH ROM in any degree of abduction or of flexion (ie rotation at 90/90)
- transverse or horizontal abduction
59
When assessing ROM, we should assess _____ for ...
- bilaterally
- pain
- strength
- degree of range
60
Notable or remarkable observations in ROM:
- painful arc pattern
- starting positions for initiating movement
- observation of the scapulo-humeral rhythm
61
Painful arc pattern describes a syndrome where there is...
- a common painful range of 60-120 degrees for flexion and abduction
- painful at end of the ROM
62
Painful arc pattern IOS:
- subacromial dysfunction
| - inflamed tendon presses against acromium
63
Structure of painful arc pattern:
- compressed, pinching
| - AC joint, RTC tendon, subacromial bursa
64
Glenohumeral painful arc:
60-120 degrees
65
Acromioclavicular painful arc:
170+ degrees
66
MMT using UE positioning: deltoid:
- anterior, lateral, posterior
| - flexion, abduction, extension
67
MMT using UE positioning: supraspinatus:
- abduction
| - deltoid
68
MMT using UE positioning: biceps long head:
- flexion
- 2 joint muscle (TJM)
- anterior deltoid
69
Impingement positions are...
unwanted compression of soft tissue between 2 or more harder unyielding structures
70
Impingement positions leads to...
- pressure
- inflammation
- pain
- loss of function
71
MOI for impingement positions:
typically repetitive OH actions
72
Impingement positions are evaluated in ....
- end range of AROM and PROM
| - sign and a symptom
73
How to conduct a impingement test:
- position the UE to stress structures of the GH joint
| - pinch, impinge, compress
74
Coracoacromial arch is made up of:
- acromion
- coracoacromial ligament
- coracoid process
75
Common impingement structures at the GH joint:
under coracoacromial arch
76
Apprehension test assesses...
- the integrity of stabilizing structures of the joint
| - the client's feeling of instability in ROMs
77
Anterior apprehension test:
- positive test illicit apprehension in putting the humeral head into a position to stress the joint
- leads to an IOS of GH joint instability (subluxation, dislocation)
78
Movements of function:
- in OH activities; as a weight-bearing joint
| - load, compress, stress the joint and the shoulder complex (stress to structures; symptoms)
79
Movement of shoulder complex in combination of
- SC joint
- AC joint
- scapula: movement to positions of stability
- GH joint
- spine
80
Maintaining ____ while allowing for a high degree of _____ is critical for effective and full shoulder function.
- stability
| - mobility
81
___ joint instability is often the cause of many specific shoulder injuries like...
- GH
| - tendinitis, dislocation, subluxation
82
GH joint injuries result from...
- structural vulnerability
- extensive freedom of movement
- poor correlation between articular surfaces
- great strength of surrounding musculature
83
While the GH joint is inherently _____, the coordinated and synchronous actions of the ____ and _____ structures provide joint stability.
- unstable
- static
- dynamic
84
GH joint has integrated function of ____ structures and _____ (____) structures such as....
- inert
- contractile (dynamic)
- joint
- scapular stabilizing muscles
- RTC muscles
- joint capsule labrum and ligaments
85
What originates on axial skeleton to humerus?
- latissimus dorsi
| - pec major
86
What originates from the scapula to humerus?
- deltoid, teres major, corochobrachialis
| - subscapularis, teres minor, supraspinatus, infraspinatus
87
RTC in conjunction with biceps provide dynamic stability through...
- minimizing excessive humeral head displacement
| - creates force couples to compress humeral head into glenoid fossa
88
_____ imbalances cause _____ mechanics.
- dynamic
| - abnormal
89
Stability: which muscles go from axial skeleton/spine to scapula?
- pecs
- lats
- levator scap
- rhomboids
- serratus anterior
- trapezius
90
____ stability aids _____ mobility of GH joint.
- scapular
| - functional
91
Scapular muscles produce ....
- scapular motion
| - dynamically position the glenoid for humeral motion
92
Collectively, scapular muscles work to ....
maintain consistent length-tension relationships with the glenohumeral musculature
93
Scapular muscles sustain _____ _____ through a larger portion of the ROM.
force production
94
Scapular muscles prevents _____ between the _____ and the _____ (____).
- impingement
- humerus
- acromion (scapula)
- movement between the humerus and scapula is limited
95
Key scapular stabilizers:
- spinal posture
| - scapular posture
96
What provides strength for the shoulder?
- scapular stabilizers
| - RTC
97
At the shoulder, we are palpating for ...
- pain
- TICS
- integrity of the joint (AC, SC joints)
- instability of the bones (clavicle, acromian, humerus)
- soft tissue structures (muscles, tendons, ligaments, bursa)
- pain (specific site = location of structure)
98
Structures in the shoulder:
- bone
- joint
- ligament
- muscular
- nerve
- meniscus
- bursa
- capsule
99
Types of potential injuries:
- sprain
- strain, tendonitis
- bursitis
- fracture
- dislocation, subluxation
- labral injury
- brachial plexus/nerve injury
- thoracic outlet syndrome
100
Severity is ranked by....
grade
101
Rehab considerations: ____ response to _____ controlled.
- tissues
| - trauma
102
Rehab considerations: injured part should be ____/____.
rested/supported
103
Rehab considerations: restore...
- scapulothoracic control
- ROM
- rotator cuff function and endurance
104
Rehab considerations: assess...
- scapulohumeral rhythm
| - posture
105
Rehab considerations: _____ control.
proprioceptive
106
Rehab considerations: how to have progressive return to function:
- activity modification
| - equipment modification
KIN 440
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