E3 - Shoulder Complex 1 & 2 Flashcards
Why are dominant side asymmetries common?
more stress on muscle causes more contraction with leads to increased muscles tone
movement of the humerus is accompanied by what other structures
primarily scapula
other smaller joints
what is the importance of actin/myosin overlap to prevent active insufficiency
too much overlap will not allow for the muscle to further contract
what position of the scapula exerts max tension on the brachial plexus
150 degrees
what is the motion of the humerus during 0-150 degrees of overhead reaching
flexion, abduction, external rotation
what is the motion of the scapula during 0-150 degrees of overhead reaching
elevation, upward rotation, and protraction around the AC joint
what is the motion of the humerus during 0-150 degrees of overhead reaching
flexion, abduction, external rotation
what is the motion of the scapula during 0-150 degrees of overhead reaching
Elevation, upward rotation, protraction around AC joint
what muscles are concentrically controlled during upper t-spine unilateral motion in 150-200 degrees of overhead reaching
lower trap and subclavius for scapular and clavicle motions
what is the importance of unilateral motion in upper t-spine during 150-200 degrees of overhead reaching
prevents excessive tension on brachial plexus by limiting more posterior clavicular rotation
what would occur if the upper t-spine is hypomobile during 150-200 degrees of overhead reaching
GH and AC joints will become hypermobile to compensate
inhibits lower trap activity which leads to impaired scapular motion
posterior clavicular rotation will be excessive
what will occur if the clavicle excessively posteriorly rotates due to upper t-spine hypomobility
excessive tension on med cord of brachial plexus which leads to median and ulnar cutaneous nerve paresthesis’s will occur with overhead activities
T/F
TOS is commonly misdiagnosed due to compression of the brachial plexus by excessive clavicle rotation.
true
what are the motions of the humerus when reaching behind the back
hyper-extension, adduction, internal rotation
what are the motion of the scapula when reaching behind your back
elevation, downward rotation, retraction
what is the effectiveness of joint mobilizations with the shoulder
effective intervention
should be used with exercise
what is the effectiveness of TherEx with the shoulder
effective intervention
what are the primary muscles that are targeted with MET
Supraspinatus, infrapsinatus, teres minor, subscapularis
what is the order of MET within the shoulder
tighter grip to activate rotator cuff
external rotation
local muscles
prone scapular exercises
global muscles
higher level goals
T/F
the scapula needs to be stable in order to increase use of shoulder
true
what exercises cause for better activation of serratus anterior
closed chain
what are some exercises that activate serratus anterior
wall slides
UE weight shifts
push ups
give examples of prone scapular exercises
I, T, W, Y
all limit activation of upper trap, allows for activation of other weaker muscles
what is the importance of working uninjured side along with injured side
increase coordination of both sides
what are some of the global muscles are activated during MET
pec major, lat, delt, etc
why would you also consider lower extremity MET for a shoulder injury
higher level goals
50% of tennis serve is from LE
what are higher level goals of MET for the shoulder
multi-planar exercises - PNF diagonals
LE
what is an effective intervention for RC tendinopathy
exercise is more beneficial than MT
do cervical manipulations improve shoulder pain/increase function? If so, how?
diminished severity of shoulder/neck pain
improved shoulder and neck mobility
C5-6 had immediate increase of muscle strength in ERs
T/F
mobilizing c/t spine improved symptoms and function of the shoulder
true
what are the nerve roots for all shoulder complex muscles
C3-T1
what are some pathologies that can become a shoulder condition
cervical trauma
hypermobility/instability
age-related changes
prolonged FHP
what muscle group is overworked to compensate for excessive and prolonged trunk flexion and decreased diaphragm function
thoracic extensors
what is the effectiveness of dry needling for non-traumatic shoulder pain/disability
moderate quality of evidence
short term effect
what are the 4 positive factors for those referred to PT with shoulder symptoms
lower baseline disability
lower symptoms at rest
higher pt expectation with PT
higher self-efficacy despite symptoms
what is the prevalence of impingement syndrome
44-65% of all shoulder cases
what are the 2 mechanisms of impingement syndrome\
sub- and coracoacromial space compromised resulting in impingement or compression of tendons
posterior/superior glenoid impingement
describe the mechanism of tendon compression in impingement syndrome
increased tension on tendons when loaded as the tendons wrap around the bone resulting in compression
what tendon is the most commonly involved in impingement syndrome
supraspinatus tendon
what affects the healing abilities of tendons
vascularity supply
t/f
limited vascularity in distal supraspinatus does not affect healing
false
decreased blood supply = decreases healing ability
what are the most common structures involved in impingement syndrome
supraspinatus tendon
biceps tendon
labrum
subacromial bursa
what occurs during primary impingement syndrome
limited/hypomobility
what can cause primary impingement syndrome
trauma with fibrotic capsular changes
disuse/immobilization
persistent FHP
regional interdependence
spurring/hooking of acromion
how does trauma with fibrotic capsular changes influence impingement syndrome
humeral head can’t roll superiorly and slide inferiorly
how does disuse/immobilization influence impingement syndrome
muscle/capsule shortening
muscle inhibition
how does persistent FHP influence impingement syndrome
leads to shortened IRs/anterior capsule tightness sand limited ERs
everything rolls forward and down
how does regional interdependence influence impingement syndrome
insufficient motion by shoulder muscles due to cervical dysfunction - leads to decreased muscle function
how does spurring or hooking of the acromion occur
repetitive contact of humerus on acromion that causes acromion to be hooked instead of straight
how does spurring or hooking of acromion influence impingement syndrome
greater tubercle can’t get out of the way of the acromion without external rotation
what is secondary impingement syndrome
excessive motion/hypermobility
what can cause secondary impingement syndrome or hypermobility
trauma or adjacent joint hypomobility resulting in laxity
disuse/immobilization
regional interdependence
how does disuse/immobilization influence impingement syndrome
muscle inhibition limits stabilization
how does regional interdependence influence impingement syndrome
insufficient shoulder stabilization
proprioceptive impairment greatest at higher elevations
kinesthetic impairment > proprioceptive impairment
t/f
a damaged joint can lead to decreased proprioception/coordination
true
impingement syndrome is a combination of both primary and secondary etiologies. what is an example of this?
scapular hypomobility and GH hypermobility
what population is posterior/superior glenoid impingement (PSGI) more common
overhead athletes
what motions are excessive in PSGI
ER ROM and anterior GH glide
where is the impingement located in PSGI
posterior-superior glenoid on labrum
where is the pain typically localized with impingement syndrome
tip of shoulder and referred into lateral shoulder and arm
those with impingement syndrome will most likely have pain in what motions
elevation
lifting/pushing/pressing asctivities
reaching behind back
how would you know if nociplastic pain has occurred with impingement syndrome
how long the pain has lasted
sensation the patient is feeling
what would you observe with a patient that has impingement syndrome
possible scapular compensations
FHP
what scapular compensations would be found in someone that has shoulder impingement
increased elevation
inconsistent upward rotation (increased/decreased)
t/f
scapular dyskinesia is more prevalent in those with shoulder impingement and those who experience symptoms than those that do not experience symptoms
false
scapular dyskinesia is equally prevalent in symptomatic and asymptomatic individuals
what is the scapula assistance test
SAT
shows how the scapula is moving but muscles aren’t moving the scap
passive upward rotation
what is the scapular repositioning test
passive upward rotation and posterior tilt
shows how the scap will move without muscle involvement
what test is testing the voluntary contraction of muscles around the scapula
scapular retraction test
what is the use of taping the lower trap for assistance
short term
settles symptoms when patient is away which can increase function
what are you learning from scapular assistance tests?
with changing a small segment of pt’s motion, you can better understand what muscles/structures are involved and have better treatment options
what functions will be difficult for patients with impingement syndrome
limited and painful reaching overhead and behind back and with lifting
FLX, ABD, ER
what does posterior shoulder pain with ER indicate
posterior impingement
where are proprioceptive impairments the greatest
higher elevations
what are the signs that indicate impingement syndrome with RST/MMT
inhibited scapular/cuff muscles
mostly scapular muscle groups except elevators
what is indicated with hypomobility with accessory motion testing with impingement
primary type
posterior shoulder tightness with limited posterior glide
what is indicated with hypermobility with accessory motion testing with impingement
secondary type
t/f
external rotation increases as internal rotation decrease in overhead athletes
true
what is the glenohumeral IR deficit (GIRD) ratio
IR/ER at 90 degrees ABD > 1
influences humeral head position on glenoid
what is the infraspinatus or ER test in 0 degrees abd
painful or giving away
high specific
what is the internal rotation resisted strength test
IR weaker than ER @ 90 degrees abd
what age group is most prevalent with RC injuries
oldest
t/f
RC pathology is not associated with impingement syndrome
true
t/f
pitchers 18-22 years of age experience labral changes with symptoms
false
10% had RC and labral changes without symptoms
describe the makeup of tendons
type 1 collagen
low elastin
fibrocytes
parallel fibers for more unidirectional loads
what is the function of a tendon
resists tension and releases energy with muscle actions
more stiffness = better force transmission or storing of potential energy
better for a tendon to have increased stiffness to allow for increased recoil
where is the tendon hypovascular and hyponeural
mid portion
where is the tendon hypervascular and hyperneural
insertion
what is tendinitis
inflammation of tendon without structural changes due to overuse
uncommon
what are the signs and symptoms of tendinitis
typically acute and classic presentation
tender to palpation (TTP)
pain/limitation with lengthening
pain with resisted testing/MMT (lengthened position)
what is more common: tendinosis or tendinitis
tendinosis
degenerative changes with some inflammation in tendinosis is due to
repetitive stress and repetitive tendonitis
impingement pathomechanics
neural/vascular insufficiency
exercise-induced hyperthermia
older age
hormonal fluctuation
what are the symptoms of tendinosis
persistent often with previously failed PT
decreased tendon tolerances
what would cause failed PT with tendinosis
PT treated tendonitis, not tendinosis
tendinosis is often mislabeled as tendinitis and treated as such
what would you observe with a pt that has tendinosis
enlarged tendon if superficial
caused by fat infiltration
what ROM would be present with pt that has tendinosis
possibly pain and limitation with lengthening if aggravated
maybe WNL
what would occur with RST/MMT with tendinosis
possible pain/weakness - lengthened position if aggravated
could be strong and painless
why is tendinosis TTP
localized TTP with decreased pain thresholds
increased in-growth of vessels and nerves
elevated pain neurotransmitters
t/f
if tendinosis is not acutely irritated, ROM could be WNL, RST/MMT WNL, but very TTP
true
what is the pathogenesis of tendinosis
little/no inflammation
fiber changes
corticospinal (voluntary movement) influences
what movements will most likely cause an acute tendon tear
higher/oblique forces during fast concentric load
why are tendon tears more common with increased age and disuse
elastin and vascularity decrease
atrophy and drying
shorter and smaller tendon is less pliable and durable
what is the time frame of tendon healing with tendinitis
at most 4-6 weeks
what is the main goal of treating tendinitis
resolution of inflammation
what is the primary goal of treating tendinosis and tears
proliferating tendon
about when does tensile strength initially improves
3-5 weeks
when does dense fibrous tissue fill in to increase tensile strength
8-12 weeks
what is the timeframe for normal strength to be reached after surgery
10-12 months
