TA Session #2

Question 1

Upward rotation of the scapula is associated with what movement at the clavicle?

-Anterior rotation
-Protraction
-Posterior rotation
-Elevation

Answer 1

Posterior rotation

-Explanation: Anterior rotation of the clavicle is associated with downward rotation of the scapula. Protraction of the clavicle is associated with protraction of the scapula. Elevation of the clavicle is associated with elevation of the scapula.

Question 2

In order to elevate your arms in the frontal plane (abduction), what motion first has to occur at the scapulae?

-Retraction
-Protraction
-Depression
-Downward rotation

Answer 2

Retraction

-Explanation: Due to the curvature of the ribs + the plane that the scapulae sit in, the glenoid points 30-45 degrees away from the frontal plane. In order for us to elevate in the frontal plane we must retract our scapula first.

Question 3

As you abduct your humerus, what must occur at the glenohumeral joint to avoid impingement of the supraspinatus tendon?

-Internal rotation
-External rotation
-Flexion
-Extension

Answer 3

External rotation

-Explanation: ER of the humerus must occur to avoid impingement of the supraspinatus tendon between the acromion + greater tubercle.

Question 4

You have a patient with a rotator cuff tear. Which of the following correctly explains why the patient may shrug their shoulder when they are asked to raise their arm over their head?

-The deltoid is too tight, the patient needs manual therapy to loosen the muscle
-The rotator cuff causes superior sliding of the humeral head
-The rotator cuff pulls the humeral head inferiorly, if it is compromised the deltoid will cause shrugging of the shoulder
-The upper trap is likely overactive, constantly pulling the humeral head superiorly and overpowering the weakened rotator cuff

Answer 4

The rotator cuff pulls the humeral head inferiorly, if it is compromised the deltoid will cause shrugging of the shoulder

-Explanation: The deltoid + RC muscles work as a force couple. The deltoid pulls the humeral head superiorly, while the RC counteracts this to pull the humeral head inferiorly. If the RC is torn, this inferior pull is no longer happening, leading to shrugging of the affected shoulder.
-See diagram of force vectors of RC muscles on glenohumeral joint; RC muscles pull down + in while deltoid pulls up

Question 5

Which muscles form the primary force couple for upward rotation of the scapula during abduction?

-Upper trapezius, lower trapezius, serratus anterior
-Rhomboids, levator scapulae, deltoid
-Supraspinatus, infraspintaus, teres minor
-Deltoid, biceps brachii, latissimus dorsi

Answer 5

Upper trapezius, lower trapezius, serratus anterior

-Explanation: These 3 muscles work together to rotate the scapula upward so the glenoid cavity facces the humerus, allowing full overhead arm movement. The upper trapezius pulls the top of the scapula up, the lower trapezius pulls the bottom down, + the serratus anterior pushes the scapula outward along the rib cage.

Question 6

During the first 30 degrees of shoulder abduction, MOST of the motion comes from the:

-Scapula
-Clavicle
-Glenohumeral joint
-Sternoclavicular joint

Answer 6

Glenohumeral joint

-Explanation: During the first 30 degrees of shoulder abduction, the scapula moves very little if any at all. Most of the motion comes from the GH joint, which allows the humerus to lift away from the body before the scapula starts contributing significantly through scapulohumeral rhythm.

Question 7

Which of the following best describes the loose-packed position of the glenohumeral joint?

-Arm at the side in full adduction
-90 degree abduction with full external rotation
-55 degree abduction with 30 degree horizontal adduction
-Full abduction with internal rotation

Answer 7

55 degrees abduction with 30 degrees horizontal adduction

-Explanation: The loose-packed position of the GH joint is where the joint capsule + ligaments are most relaxed. This position allows maximum joint play + is commonly used for mobilizations or when assessing passive movement, because the humeral head is not tightly pressed into the glenoid fossa.

Question 8

T/F- The biceps brachii is maximally stretched when the shoulder is extended and the elbow is flexed.

Answer 8

False

-Explanation: The biceps brachii is maximally stretched when the shoulder is extended + the elbow is extended, because it crosses both the shoulder + elbow joints. Flexing the elbow shortens the biceps, so it is not stretched in that position.

Question 9

If there is significant scapular winging during shoulder abduction, what muscle is likely weak?

-Upper trap
-Posterior deltoid
-Serratus anterior
-Lower trap

Answer 9

Serratus anterior

-Explanation: The force couple helps to upwardly rotate the scapula during shoulder abduction past 90 degrees. If the serratus anterior is weak or impaired, the scapula will not stay up against the rib cage.

Question 10

What allows the shoulder complex to move the last couple degrees of motion?

-Thoracic spine
-Clavicle
-Lumbar spine
-Scapula

Answer 10

Thoracic spine

-Explanation: If you slump forward + then try to lift your arm overhead, you’ll notice it feels restricted. But if you sit up tall with good posture, it’s much easier to raise your arm fully + let the scapula complete its upward rotation.

Question 11

What is the closed-packed position of the acromioclavicular joint?

-Arm at side
-Arm externally rotated 30 degrees
-Arm abducted to 90 degrees
-Arm internally rotated 30 degrees

Answer 11

Arm abducted to 90 degrees

-Explanation: The AC joint surfaces are most congruent + the surrounding ligaments are maximally taut, providing the greatest stability.

Question 12

If an inferior translation were to occur to your glenohumeral joint with the arm in 45 degrees of abduction, what would be the stabilizer to resist inferior translation?

-Anterior band of the inferior GH ligament complex
-Superior glenohumeral ligament
-Posterior band of the inferior GH ligament complex
-Middle glenohumeral ligament

Answer 12

Anterior band of the inferior GH ligament complex

-Explanation: With the arm in 45 degrees of abduction, if there were to be an inferior translation, the anterior band would have the most amount of resistance because of the force being applied in that position goes directly to that band. This causes the ligament to get pulled, thus getting taut.

Question 13

What is the dynamic stabilizer of the glenohumeral joint?

-Supraspinatus
-Teres minor
-Long head of biceps
-All of the above

Answer 13

All of the above

-Explanation: The supraspinatus + teres minor are both part of the rotator cuff muscles, which assist in stabilizing the GH joint by holding the humeral head against the glenoid. The long head of the bicep is also a dynamic stabilizer. It crosses the anterior portion of the shoulder + then the superior aspect of the GH joint attaching onto the labrum. When the biceps contract, it compresses the humeral head + glenoid + also resists traction of the joint.

Question 14

In the elbow, the carrying angle of the elbow is greater in ____, and it naturally has a little ____?

-Men, varus
-Women, valgus
-Men, valgus
-Women, varus

Answer 14

Women, valgus

-Explanation: Women tend to have naturally bigger carrying angles at around 10-15 degrees, while men are at about 5 degrees. We have a little bit of valgus because it improves arm swings when walking so that your arms do not hit your side when walking + it also makes it easier to carry loads beside the body.

Question 15

Which of the following best describes the close-packed position of the sternoclavicular joint?

-Arm 55-70 degrees of abduction, 30 degrees of horizontal adduction, neutral rotation
-Arm at side
-Arm maximally elevated
-Arm abducted to 90 degrees

Answer 15

Arm maximally elevated

-Explanation: For the sternoclavicular (SC) joint, the close-packed position is when the arm is maximally elevated, such as during full shoulder abduction or flexion (raising the arm overhead). As the arm elevates, the clavicle rotates posteriorly + moves upward + backward at the SC joint. This brings the sternal end of the clavicle into the most congruence with the manubrium (upper broad segment of the sternum).

Question 16

Which term refers to muscles + their tendons that actively contract to stabilize a joint during movement?

-Loose-packed stabilizers
-Passive stabilizers
-Close-packed stabilizers
-Dynamic stabilizers

Answer 16

Dynamic stabilizers

-Explanation: This is the definition of dynamic stabilizers. Passive stabilizers are structures that provide stability without active contraction.

Question 17

Your patient’s scapula fails to upwardly rotate during shoulder abduction. Approximately how many degrees of active arm abduction can they achieve?

-120 degrees
-90 degrees
-45 degrees
-30 degrees

Answer 17

90 degrees

-Explanation: Full arm abduction is approximately 180 degrees. If the scapula fails to upwardly rotate + clear the acromion, this causes a mechanical block + impingement around 90 degrees of abduction.

Question 18

You go to Southwest after class and decide to work on your pullups. During the lowering phase (eccentric portion), what is the primary motion occurring, and in which plane does it occur?

-Adduction of the arm, frontal plane
-Adduction of the arm, sagittal plane
-Abduction of the arm, frontal plane
-Abduction of the arm, sagittal plane

Answer 18

Abduction of the arm, frontal plane

-Explanation: During the lowering portion (eccentric phase), you slowly lower your body down, which involves shoulder abduction as your arms move away from the midline. Adduction + abduction always occur in the frontal plane.

Question 19

Which of the following exercises would be more difficult for an individual with a larger carrying angle?

-Bent over rows
-Barbell biceps curls
-Pull ups
-Seated chest press

Answer 19

Barbell biceps curls

-Explanation: Carrying angle is the natural valgus in the elbow in anatomical position. If someone had a larger carrying angle, lifting a fixed barbell in the sagittal plane may result in excessive strain to the structures in the elbow. Using dumbbells would be more appropriate for a more natural movement.

Question 20

During a biceps curl which of the following muscles is primarily working isometrically?

-Biceps brachii
-Coracobrachialis
-Flexor carpi radialis
-Extensor carpi raidalis

Answer 20

Flexor carpi radialis

-Explanation: The wrist flexors work isometrically during a biceps curl to prevent the weight from pulling the wrist into extension, leading to excessive strain on the wrist.

Question 21

It’s international bench press day and you decide it’s finally time to hit 315lbs. You load up the bar after properly warming up and attempt your new 1RM with a trained spotter. However, it’s too much weight and your shoulder dislocates anteriorly. You go see Dr. Bishop to assess your shoulder. Which structure is he most likely going to tell you is compromised?

-Middle glenohumeral ligament
-Posterior capsule
-Superior glenohumeral ligament
-Anterior band of the inferior glenohumeral ligament

Answer 21

Middle glenohumeral ligament

-Explanation: The middle glenohumeral ligament stabilizes the GH joint at 45 degrees of abduction. During a bench press, your shoulder should be between 45-60 degrees of abduction, making this ligament the most likely structure to be compromised due to an anterior dislocation.

Question 22

You’re at Swamphead celebrating the Gators win over Miami thtis weekend. They start playing this new underground DJ John Summit. Naturally, you start to frat flick as your get into this new music. Describe the arthrokinematics of the final position of the radiocarpal joint during the frat flick (wrist extension).

-Roll dorsal, glide palmar
-Roll palmar, glide dorsal
-Roll dorsal, glide dorsal
-Roll palmar, glide palmar

Answer 22

Roll dorsal, glide palmar

-Explanation: Because the convex proximal carpal row is moving on the concave radioulnar surface, the roll + glide will be in opposite directions. The final position of your general frat flick is at the end of wrist extension, meaning the roll will be dorsal + the glide will be palmar.