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MSK > E3 - Shoulder Complex 1 & 2 > Flashcards

E3 - Shoulder Complex 1 & 2 Flashcards

1
Q

Why are dominant side asymmetries common?

A

more stress on muscle causes more contraction with leads to increased muscles tone

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2
Q

movement of the humerus is accompanied by what other structures

A

primarily scapula
other smaller joints

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3
Q

what is the importance of actin/myosin overlap to prevent active insufficiency

A

too much overlap will not allow for the muscle to further contract

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4
Q

what position of the scapula exerts max tension on the brachial plexus

A

150 degrees

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5
Q

what is the motion of the humerus during 0-150 degrees of overhead reaching

A

flexion, abduction, external rotation

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6
Q

what is the motion of the scapula during 0-150 degrees of overhead reaching

A

elevation, upward rotation, and protraction around the AC joint

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7
Q

what is the motion of the humerus during 0-150 degrees of overhead reaching

A

flexion, abduction, external rotation

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8
Q

what is the motion of the scapula during 0-150 degrees of overhead reaching

A

Elevation, upward rotation, protraction around AC joint

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9
Q

what muscles are concentrically controlled during upper t-spine unilateral motion in 150-200 degrees of overhead reaching

A

lower trap and subclavius for scapular and clavicle motions

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10
Q

what is the importance of unilateral motion in upper t-spine during 150-200 degrees of overhead reaching

A

prevents excessive tension on brachial plexus by limiting more posterior clavicular rotation

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11
Q

what would occur if the upper t-spine is hypomobile during 150-200 degrees of overhead reaching

A

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

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12
Q

what will occur if the clavicle excessively posteriorly rotates due to upper t-spine hypomobility

A

excessive tension on med cord of brachial plexus which leads to median and ulnar cutaneous nerve paresthesis’s will occur with overhead activities

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13
Q

T/F
TOS is commonly misdiagnosed due to compression of the brachial plexus by excessive clavicle rotation.

A

true

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14
Q

what are the motions of the humerus when reaching behind the back

A

hyper-extension, adduction, internal rotation

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15
Q

what are the motion of the scapula when reaching behind your back

A

elevation, downward rotation, retraction

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16
Q

what is the effectiveness of joint mobilizations with the shoulder

A

effective intervention
should be used with exercise

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17
Q

what is the effectiveness of TherEx with the shoulder

A

effective intervention

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18
Q

what are the primary muscles that are targeted with MET

A

Supraspinatus, infrapsinatus, teres minor, subscapularis

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19
Q

what is the order of MET within the shoulder

A

tighter grip to activate rotator cuff
external rotation
local muscles
prone scapular exercises
global muscles
higher level goals

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20
Q

T/F
the scapula needs to be stable in order to increase use of shoulder

A

true

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21
Q

what exercises cause for better activation of serratus anterior

A

closed chain

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22
Q

what are some exercises that activate serratus anterior

A

wall slides
UE weight shifts
push ups

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23
Q

give examples of prone scapular exercises

A

I, T, W, Y
all limit activation of upper trap, allows for activation of other weaker muscles

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24
Q

what is the importance of working uninjured side along with injured side

A

increase coordination of both sides

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25
what are some of the global muscles are activated during MET
pec major, lat, delt, etc
26
why would you also consider lower extremity MET for a shoulder injury
higher level goals 50% of tennis serve is from LE
27
what are higher level goals of MET for the shoulder
multi-planar exercises - PNF diagonals LE
28
what is an effective intervention for RC tendinopathy
exercise is more beneficial than MT
29
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
30
T/F mobilizing c/t spine improved symptoms and function of the shoulder
true
31
what are the nerve roots for all shoulder complex muscles
C3-T1
32
what are some pathologies that can become a shoulder condition
cervical trauma hypermobility/instability age-related changes prolonged FHP
33
what muscle group is overworked to compensate for excessive and prolonged trunk flexion and decreased diaphragm function
thoracic extensors
34
what is the effectiveness of dry needling for non-traumatic shoulder pain/disability
moderate quality of evidence short term effect
35
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
36
what is the prevalence of impingement syndrome
44-65% of all shoulder cases
37
what are the 2 mechanisms of impingement syndrome\
sub- and coracoacromial space compromised resulting in impingement or compression of tendons posterior/superior glenoid impingement
38
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
39
what tendon is the most commonly involved in impingement syndrome
supraspinatus tendon
40
what affects the healing abilities of tendons
vascularity supply
41
t/f limited vascularity in distal supraspinatus does not affect healing
false decreased blood supply = decreases healing ability
42
what are the most common structures involved in impingement syndrome
supraspinatus tendon biceps tendon labrum subacromial bursa
43
what occurs during primary impingement syndrome
limited/hypomobility
44
what can cause primary impingement syndrome
trauma with fibrotic capsular changes disuse/immobilization persistent FHP regional interdependence spurring/hooking of acromion
45
how does trauma with fibrotic capsular changes influence impingement syndrome
humeral head can't roll superiorly and slide inferiorly
46
how does disuse/immobilization influence impingement syndrome
muscle/capsule shortening muscle inhibition
47
how does persistent FHP influence impingement syndrome
leads to shortened IRs/anterior capsule tightness sand limited ERs everything rolls forward and down
48
how does regional interdependence influence impingement syndrome
insufficient motion by shoulder muscles due to cervical dysfunction - leads to decreased muscle function
49
how does spurring or hooking of the acromion occur
repetitive contact of humerus on acromion that causes acromion to be hooked instead of straight
50
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
51
what is secondary impingement syndrome
excessive motion/hypermobility
52
what can cause secondary impingement syndrome or hypermobility
trauma or adjacent joint hypomobility resulting in laxity disuse/immobilization regional interdependence
53
how does disuse/immobilization influence impingement syndrome
muscle inhibition limits stabilization
54
how does regional interdependence influence impingement syndrome
insufficient shoulder stabilization proprioceptive impairment greatest at higher elevations kinesthetic impairment > proprioceptive impairment
55
t/f a damaged joint can lead to decreased proprioception/coordination
true
56
impingement syndrome is a combination of both primary and secondary etiologies. what is an example of this?
scapular hypomobility and GH hypermobility
57
what population is posterior/superior glenoid impingement (PSGI) more common
overhead athletes
58
what motions are excessive in PSGI
ER ROM and anterior GH glide
59
where is the impingement located in PSGI
posterior-superior glenoid on labrum
60
where is the pain typically localized with impingement syndrome
tip of shoulder and referred into lateral shoulder and arm
61
those with impingement syndrome will most likely have pain in what motions
elevation lifting/pushing/pressing asctivities reaching behind back
62
how would you know if nociplastic pain has occurred with impingement syndrome
how long the pain has lasted sensation the patient is feeling
63
what would you observe with a patient that has impingement syndrome
possible scapular compensations FHP
64
what scapular compensations would be found in someone that has shoulder impingement
increased elevation inconsistent upward rotation (increased/decreased)
65
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
66
what is the scapula assistance test
SAT shows how the scapula is moving but muscles aren't moving the scap passive upward rotation
67
what is the scapular repositioning test
passive upward rotation and posterior tilt shows how the scap will move without muscle involvement
68
what test is testing the voluntary contraction of muscles around the scapula
scapular retraction test
69
what is the use of taping the lower trap for assistance
short term settles symptoms when patient is away which can increase function
70
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
71
what functions will be difficult for patients with impingement syndrome
limited and painful reaching overhead and behind back and with lifting FLX, ABD, ER
72
what does posterior shoulder pain with ER indicate
posterior impingement
73
where are proprioceptive impairments the greatest
higher elevations
74
what are the signs that indicate impingement syndrome with RST/MMT
inhibited scapular/cuff muscles mostly scapular muscle groups except elevators
75
what is indicated with hypomobility with accessory motion testing with impingement
primary type posterior shoulder tightness with limited posterior glide
76
what is indicated with hypermobility with accessory motion testing with impingement
secondary type
77
t/f external rotation increases as internal rotation decrease in overhead athletes
true
78
what is the glenohumeral IR deficit (GIRD) ratio
IR/ER at 90 degrees ABD > 1 influences humeral head position on glenoid
79
what is the infraspinatus or ER test in 0 degrees abd
painful or giving away high specific
80
what is the internal rotation resisted strength test
IR weaker than ER @ 90 degrees abd
81
what age group is most prevalent with RC injuries
oldest
82
t/f RC pathology is not associated with impingement syndrome
true
83
t/f pitchers 18-22 years of age experience labral changes with symptoms
false 10% had RC and labral changes without symptoms
84
describe the makeup of tendons
type 1 collagen low elastin fibrocytes parallel fibers for more unidirectional loads
85
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
86
where is the tendon hypovascular and hyponeural
mid portion
87
where is the tendon hypervascular and hyperneural
insertion
88
what is tendinitis
inflammation of tendon without structural changes due to overuse uncommon
89
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)
90
what is more common: tendinosis or tendinitis
tendinosis
91
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
92
what are the symptoms of tendinosis
persistent often with previously failed PT decreased tendon tolerances
93
what would cause failed PT with tendinosis
PT treated tendonitis, not tendinosis tendinosis is often mislabeled as tendinitis and treated as such
94
what would you observe with a pt that has tendinosis
enlarged tendon if superficial caused by fat infiltration
95
what ROM would be present with pt that has tendinosis
possibly pain and limitation with lengthening if aggravated maybe WNL
96
what would occur with RST/MMT with tendinosis
possible pain/weakness - lengthened position if aggravated could be strong and painless
97
why is tendinosis TTP
localized TTP with decreased pain thresholds increased in-growth of vessels and nerves elevated pain neurotransmitters
98
t/f if tendinosis is not acutely irritated, ROM could be WNL, RST/MMT WNL, but very TTP
true
99
what is the pathogenesis of tendinosis
little/no inflammation fiber changes corticospinal (voluntary movement) influences
100
what movements will most likely cause an acute tendon tear
higher/oblique forces during fast concentric load
101
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
102
what is the time frame of tendon healing with tendinitis
at most 4-6 weeks
103
what is the main goal of treating tendinitis
resolution of inflammation
104
what is the primary goal of treating tendinosis and tears
proliferating tendon
105
about when does tensile strength initially improves
3-5 weeks
106
when does dense fibrous tissue fill in to increase tensile strength
8-12 weeks
107
what is the timeframe for normal strength to be reached after surgery
10-12 months

MSK (7 decks)

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