Term
Which structure helps to deepen the articulation between the humerus and scpula and provides some measure of stability at the joint?
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Definition
| Labrum of the glenoid fossa |
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Term
| Which muscle is weak if the head of the humerus lacks stability in the glenoid fossa? Normal movement of the humerus, compression, and upward translation of the humerus during abduction will be miguided if this muscle is weak |
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Definition
Supraspinatus muscles
*upward translation of humerus during aBd*
*stabilize humeral head on glenoid fossa*
*guide N mvmt of humerus*
*promotes humeral compression* |
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Term
| What structure is dependent of scapular movement? |
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Definition
| motions of the clavicle occur as a result of scapular movement |
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Term
| Which ligament protects the humeral head? |
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Definition
coracoacromial ligament
> protects the humeral head
> provides volt |
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Term
| Which ligament strengthens the upper part of the capsule? |
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Definition
coracohumeral ligament
> strengthens the upper part of the capsule |
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Term
| Which ligament turns the bicipital groove into a canal? |
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Definition
Transverse humeral ligament
> turns the bicipital groove into a canal |
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Term
| Which ligament checks adduction of the humerus? |
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Definition
Superior glenohumeral ligament
> checks adduction |
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Term
| Which ligament checks external rotation of the humerus? |
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Definition
middle glenohumeral ligament
> checks external rotation |
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Term
| Which ligament checks abduction of the humerus? |
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Definition
inferior glenohumeral ligament
> checks abduction |
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Term
| Which motion of the scapula is necessary for full ROM and proper scapulothoracic articulation? |
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Definition
Upward rotation of the scapula
*applying a force medially on the lateral border of scapula while having partner abduct will cause scapula to push into your fingers after the first 20o of humeral abduction* |
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Term
| You apply a force medially onto the lateral border of your partner's scapula. Your partner then actively abducts his humerus. You note that you feel the lateral border of their scapula above 20o of abduction. What does this tell you? |
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Definition
| feel lateral border of scapula past 20o of abduction = there is weakness in upward rotator mm |
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Term
| Which muscle may contribute to disruption of ST rhythm if it is weak? |
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Definition
serratus anterior may contribute to disruption of ST rhythm if it is weak
> MOI: blow to the shoulder or neck, abnormal ousehold activities or may relate to disuse
> upwardly rotates scapula w/ arm flexion
> does NOT protect the scapula |
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Term
| If the entire medial border of the scapula lifts away from the rib cage, this will indicate weakness in which muscles? |
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Definition
entire medial border of the scapula lifts away from the rib cage = weak serratus anterior
*medial border moves away with weak serratus anterior*
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Term
| What is commonly seen with HFC or thoracic kyphosis? |
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Definition
HFC or thoracic kyphosis leads to tipping of scapula
*inferior angle of the scapula lifts off the rib cage*
*indicates weakness in anti-gravity muscles* |
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Term
| What does thoracic kyphosis indicate? |
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Definition
| thoracic kyphosis indicates weakness in anti-gravity muscles |
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Term
Which muscles are tight and weak in tipping of the scapula?
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Definition
tipping of the scapula
> tight muscle: pectoralis minor or levator scapula
> weak muscle: serratus anterior and trapezius muscle
*humerus is abducted and internally rotated with scapula* |
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Term
What position will the humerus assume with tipping of the scapula?
a) adducted and internally rotated
b) abducted and internally rotated
c) abducted and externally rotated |
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Definition
b) abducted and internally rotated
*this is an abnormal position of the humerus relative to the glenoid fossa* |
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Term
Complete the sentence
Anterior tipping of the scapula can cause an imbalance between the internal and external rotators. The internal rotators may become less 1)... and the external rotators may become 2)... |
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Definition
| The internal rotators may become less 1) flexible and the external rotators may become 2)weak |
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Term
| Which muscle may be impaired if you cannot elevate your arm into flexion or abduction? |
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Definition
pectoralis minor
> pec- needs to be extensible enough to lengthen with flexion/abduction as the scapula upwardly rotates, retracts and tips posteriorly |
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Term
True or false?
In arm flexion or abduction, the scapula upwardly rotates, protracts and tips posteriorly. |
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Definition
False
In arm flexion or abduction, the scapula upwardly rotates, retracts and tips posteriorly. |
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Term
| How many fingers width from the SP is the medial border, in normal scapular positioning on the rib cage? |
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Definition
medial border of scapula: 3-4 finger width
> sits on the rib cage
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Term
| In normal scapular positioning, where does the inferior angle of the scapula sit? |
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Definition
| Inferior angle of the scapula sits on the rib cage. |
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Term
Complete the sentence:
The spine of the scapula sits at 1)... and is at 2).... to ....o of inclination |
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Definition
The spine of the scapula sits at 1) T3 and is at
2) 10 to 15o of inclination.
*deviating numbers indicate imbalance*
*check with shoulder assessment* |
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Term
| Which muscles, if functioning properly, will counterbalance the downward rotation of the scapula? |
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Definition
trapezius and serratus anterior will counterbalance the downward rotation of the scapula (with the weight of the arm pulling the scapula).
*weight of arm pulls scapula into downward rotation, abduction and forward tipping* |
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Term
| Which muscles will counteract abduction and forward tipping of the scapula, if functioning properly? |
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Definition
rhomboids and middle trapezius will counteract abduction and forward tipping of the scapula, if functioning properly
*weight of arm pulls the scapula into downward rotation, abduction and forward tipping* |
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Term
| What is usually long and tight around the scapula? |
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Definition
Long and tight
> serratus anterior
> rhomboids
> upper, middle, lower trapezius
> external rotators: infraspinatus, teres minor |
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Term
| What is usually short and tight around the scapula? |
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Definition
short and tight
> pectoralis minor
> subscapularis
> levator scapula
> latissimus dorsi
> teres+
> deltoids if humerus is adducted in relation to scapula |
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Term
| Which muscle will be short and tight if the humerus is adducted in relation to the scapula? |
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Definition
| deltoid is short and tight if humerus is adducted in relation to scapula |
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Term
| What structures sit in the subacromial space? |
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Definition
subacromnial space
> subacromial bursa
> supraspinatus tendon
> portion of the supraspinatus muscle
*common tear location at MTJ* |
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Term
| Where is the common tear location in the subacromial space? |
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Definition
at MTJ
*if weight of arm is unopposed the greater tubercle of the humerus can run into the acromion; pinching the subacromial structures and causing pain* |
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Term
| Which head of the biceps tendon can be impinged? |
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Definition
| long head of biceps tendon can impinge |
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Term
| What structure will move between 0-20o of abduction? |
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Definition
0-20o abduction = only humerus moves
*ST rhythm allows for proper congruency of the head of the humerus in the glenoid fossa* |
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Term
| Which structure will move from 20-90o of abduction? |
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Definition
20-90o of abduction = 2:1 ratio
> 2o of humerus: 1o scapula
*up to 120o*
*ST rhythm allows for proper congruency of the head of the humerus in the glenoid fossa* |
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Term
| Which structure will move from 90-180o of abduction? |
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Definition
90-180o of abduction = 1:1 ratio
> 1o humerus : 1o scapula
*ST rhythm allows for proper congruency of the head of the humerus in the glenoid fossa* |
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Term
| Which structure moves during 20-50o of abduction? The SC joint or the AC joint? |
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Definition
20-50o of abduction = 1st abduction at SC joint
*first 30o of upward rotation of scapula occurs with elevation of the clavicle @ the SC joint followed by 30o @ the AC joint* |
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Term
| Which structure moves during 50-80o of abduction? The SC joint or the AC joint? |
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Definition
50-80o of abduction = AC joint
*first 30o of upward rotation of scapula occurs with elevation of the clavicle @ the SC joint followed by 30o @ the AC joint* |
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Term
| What impairements can lead from weak external rotators? |
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Definition
weak external rotators
> soft tissue impingement in subacromial space
> pain inflammation
> loss of function |
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Term
| What can happen if the force of the deltoids and supraspinatus is unopposed? |
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Definition
deltoids and supraspinatus force is unopposed = impingement on soft tissue of subacromial space (ie: teres minor, subscapularis)
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Term
| Which mm balance forces during abduction? |
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Definition
Muscles that balance force during abduction
> Supraspinatus
> Deltoids
> rotator cuff muscles |
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Term
| Which position and degrees will give the least amount of tension on the GH capsule? |
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Definition
30o of flexion in scaption (anterior to frontal plane)
*no rotation necessary to prevent impingement during abduction* |
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Term
True or false?
Just like abduction in the frontal plane, abduction of the humerus in plane of scaption will require rotation to prevent impingement. |
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Definition
False
No rotation required to prevent impingement during abduction in plane of scaption.
*30o anterior to frontal plane = least amount of tension on capsule* |
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Term
| What will inflammation in the shoulder girdle indicate? |
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Definition
inflammation = degree of tissue damage from either:
> sprain
> strain |
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Term
| Where is dermatome of C5 located? |
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Definition
| dermatome C5 : over shoulder and lateral arm |
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Term
Complete the sentence
TOS causing nn pain radiating down the arm is a type of 1).... 2).... disorder |
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Definition
| TOS causing nn pain radiating down the arm is a type of 1) neural 2)tension disorder |
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Term
| Where is dermatome of C4 nerve root located? |
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Definition
| dermatome C4 n root: over trapezius and tip of shoulder (over shoulder) |
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Term
| Frozen shoulder is a common known name for... |
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Definition
frozen shoulder aka adhesive capsulitis
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Term
Complete the sentence
Adhesive capsulitis is a common condition which includes 1).... of the joint capsule with dense adhesions and therefore restricts 2).... |
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Definition
Adhesive capsulitis is a common condition which includes 1)thickening of the joint capsule with dense adhesions and therefore restricts 2)ROM
*capsular folds in axillary recess = loss of ability to stretch*
*insidious onset (40-60 yrs)*
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Term
| How old are clients usually affected with adhesive capsulitis? |
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Definition
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Term
| In frozen shoulder, which structure will have adhesions/scarring? |
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Definition
| adhesion/scarring in joint capsule |
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Term
True or false?
In 1o frozen shoulder, the cause is unknown. |
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Definition
True
> could be d/t chronic inflammation in contractile/synovial tissues ie: biceps tendon, rotator cuff, jt capsule |
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Term
| What may be predisposed from adhesive capsulitis? |
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Definition
| 1o frozen shoulder may predispose the subacromial space to impingement syndromes |
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Term
| What do you qualify a frozen shoulder that is developped d/t another condition (ie: OA, RA, trauma followed by a period of inflammation)? |
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Definition
2o frozen shoulder
* can be associated with conditions such as diabetes or with individuals with hyperkyphosis* |
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Term
True or false?
2o frozen shoulder can be associatd with conditions such as diabetes or with individuals with hyperkyphosis. |
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Definition
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Term
| Which stage of frozen shoulder will be marked by intense pain and limitation of motion? |
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Definition
Freezing stage
> 10-36 weeks |
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Term
| Which stage of frozen shoulder will be marked by pain only with movement? |
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Definition
Frozen stage
> 4-12 months
> substitute motions of the scapula possible atrophy of rotator cuff, biceps, triceps |
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Term
| Which muscles may be atrophied during the frozen stage of adhesive capsulitis? |
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Definition
> rotator cuff
> biceps
> triceps
*frozen stage aka sub-acute stage* |
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Term
| Which stage of frozen shoulder will be marked by no pain with significant capsular restrictions? |
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Definition
Thawing stage
> aka chronic stage |
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Term
| During which stage of frozen shoulder will you aim to control pain and progressively increase ROM? |
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Definition
| Frozen stage/ sub-acute stage |
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Term
During which stage of frozen shoulder will you use deeper neuromuscular and CT techniques, to engage the tissue more?
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Definition
Frozen stage/ sub-acute stage
*myofascial techniques not CI'd* |
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Term
During the sub-acute stage of frozen shoulder, is joing mobilization and stretching CI'd?
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Definition
NO
sub-acute/frozen stage: whenever possible and with clinical reasoning, use jt mobs and stretch to progress and regain ROM
*can use pendulum exercise*
*don't overdo to ↑ ROM; it might relapse* |
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Term
True or false?
After the thawing stage, all suffering of frozen shoulder regain complete ROM |
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Definition
False
Some never regain complete ROM
>attempt to normalize ROM and make ROM as functional as possible |
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Term
| Which stage of frozen shoulder will you aim to resolve TrPS, mobilize joints and stretch to normalize ROM? |
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Definition
| Thawing stage/ Chronic stage |
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Term
| Which stage of frozen shoulder will you aim to strengthen scapular mm and the rotator cuff? |
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Definition
| Thawing stage/ chronic stage |
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Term
| What position will the humerus need to be for an anterior dislocation to occur? |
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Definition
anterior dislocation: blow to humerus in a position of abduction and external rotation
*weakness & instability can contribute to dislocation ie: RSI (overhead activities) eg: tennies, swimming, volley ball, painters, combing hair, getting dressed* |
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Term
| If there is a rotator cuff tear accompanied by an anterior dislocation of the GH joint, what action will the humerus not be able to do? |
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Definition
rotator cuff tear with anterior dislocation = humerus cannot abduct against gravity
*dislocation impairments: pain, inflammation, muscle guarding* |
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Term
| During the acute/sub-acute stage of an anterior dislocation, how many weeks will activity be resctrited? |
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Definition
| activity is restricted for 6-8 weeks |
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Term
True or false?
During the acute/sub-acute stage of an anterior dislocation, the MOI should be avoided. |
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Definition
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Term
Complete the sentence
During the acute/sub-acute stage of an anterior dislocation, external rotation is avoided at 1)...o of abduction and 2).... is also avoided |
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Definition
During the acute/sub-acute stage of an anterior dislocation, external rotation is avoided at 1)90o of abduction and 2)extension is also avoided.
* ext. rot. and abd. stress the anterior capsule*
*mx techs are to manage pain and maintain tissue mobility* |
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Term
| During what stage of healing of an anterior dislocated shoulder should progressive strengthening of the shoulder to regain stability be made? |
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Definition
during the acute/sub-acute stage
*progressive strengthening of the shoulder as soon as possible to regain stability* |
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Term
| How long will full rehab of an anterior dislocation of the GH joint take? |
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Definition
full rehab = 2.5-4 months
*in thawing stage/chronic stage*
*restore full strength, ROM and coordination of the shoulder -> prioritize stability before ROM* |
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Term
| With a dislocation of the shoulder, what will you prioritize before ROM? |
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Definition
| Prioritize stability before ROM |
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Term
Acromioclavicular painful arc is felt at from
...o - ...o |
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Definition
Acromioclavicular painful arc is felt at from 170o-180o
> mechanical compression and irritation of soft tissues in the subacromial space |
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Term
| Glenohumeral painful arc is felt at what degrees of abduction? |
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Definition
45-120o
> mechanical compression and irritation of soft tissues in the subacromial space |
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Term
| Wear of soft tissues in primary impigement syndromes typicall happen where on the acromion? |
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Definition
| antero-inferior aspect of the acromion |
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Term
| Where does lesion in supraspinatus tendinitis usually occur? |
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Definition
on musculotendinous junction/MTJ
> pain on palpation of tendon, inferior to anterior aspect of the acromion when cl's hand is placed behind his back
*painful arch with overhead reaching*
*extrinsic 1o impigement* |
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Term
Complete the sentence, true to bicipital tendinitis
Lesion involves the ... tendon of the bicipital groove. |
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Definition
Lesion involves the long tendon of the bicipital groove.
> pain with resisted forearm supination & shoulder flexion
> pain on palpation to the bicipital groove |
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Term
Complete the sentence:
A scapula that is ... rotated will cause the acromion to drop. |
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Definition
| A scapula that is downwardly rotated will cause the acromion to drop. |
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Term
| With a downwardly rotated scapula, which muscles will you expect to be weak? |
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Definition
Weak: serratus anterior
> downwardly rotated scapula drops the acromion |
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Term
| With a downwardly rotated scapula, which muscles will you expect to be short and tight? |
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Definition
Short and tight: pectoralis minor, levator scapula, lower trapezius, rhomboids, middle trapezius
> downwardly rotated scapula drops the acromion |
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Term
| With an anteriorly tipped scapula, which muscles will you expect to be short and tight? |
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Definition
short and tight: pectoralis minor, infraspinatus
> anteriorly tipped scapula drops the acromion |
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Term
| With an anteriorly tipped scapula, which muscles will you expect to be weak and with poor control? |
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Definition
| Weak and poor control: lower trapezius, rhomboids, serratus anterior |
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