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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
Q

what are some of the global muscles are activated during MET

A

pec major, lat, delt, etc

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26
Q

why would you also consider lower extremity MET for a shoulder injury

A

higher level goals
50% of tennis serve is from LE

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27
Q

what are higher level goals of MET for the shoulder

A

multi-planar exercises - PNF diagonals
LE

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28
Q

what is an effective intervention for RC tendinopathy

A

exercise is more beneficial than MT

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29
Q

do cervical manipulations improve shoulder pain/increase function? If so, how?

A

diminished severity of shoulder/neck pain
improved shoulder and neck mobility
C5-6 had immediate increase of muscle strength in ERs

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30
Q

T/F
mobilizing c/t spine improved symptoms and function of the shoulder

A

true

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31
Q

what are the nerve roots for all shoulder complex muscles

A

C3-T1

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32
Q

what are some pathologies that can become a shoulder condition

A

cervical trauma
hypermobility/instability
age-related changes
prolonged FHP

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33
Q

what muscle group is overworked to compensate for excessive and prolonged trunk flexion and decreased diaphragm function

A

thoracic extensors

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34
Q

what is the effectiveness of dry needling for non-traumatic shoulder pain/disability

A

moderate quality of evidence
short term effect

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35
Q

what are the 4 positive factors for those referred to PT with shoulder symptoms

A

lower baseline disability
lower symptoms at rest
higher pt expectation with PT
higher self-efficacy despite symptoms

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36
Q

what is the prevalence of impingement syndrome

A

44-65% of all shoulder cases

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37
Q

what are the 2 mechanisms of impingement syndrome\

A

sub- and coracoacromial space compromised resulting in impingement or compression of tendons

posterior/superior glenoid impingement

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38
Q

describe the mechanism of tendon compression in impingement syndrome

A

increased tension on tendons when loaded as the tendons wrap around the bone resulting in compression

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39
Q

what tendon is the most commonly involved in impingement syndrome

A

supraspinatus tendon

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40
Q

what affects the healing abilities of tendons

A

vascularity supply

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41
Q

t/f
limited vascularity in distal supraspinatus does not affect healing

A

false
decreased blood supply = decreases healing ability

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42
Q

what are the most common structures involved in impingement syndrome

A

supraspinatus tendon
biceps tendon
labrum
subacromial bursa

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43
Q

what occurs during primary impingement syndrome

A

limited/hypomobility

44
Q

what can cause primary impingement syndrome

A

trauma with fibrotic capsular changes
disuse/immobilization
persistent FHP
regional interdependence
spurring/hooking of acromion

45
Q

how does trauma with fibrotic capsular changes influence impingement syndrome

A

humeral head can’t roll superiorly and slide inferiorly

46
Q

how does disuse/immobilization influence impingement syndrome

A

muscle/capsule shortening
muscle inhibition

47
Q

how does persistent FHP influence impingement syndrome

A

leads to shortened IRs/anterior capsule tightness sand limited ERs

everything rolls forward and down

48
Q

how does regional interdependence influence impingement syndrome

A

insufficient motion by shoulder muscles due to cervical dysfunction - leads to decreased muscle function

49
Q

how does spurring or hooking of the acromion occur

A

repetitive contact of humerus on acromion that causes acromion to be hooked instead of straight

50
Q

how does spurring or hooking of acromion influence impingement syndrome

A

greater tubercle can’t get out of the way of the acromion without external rotation

51
Q

what is secondary impingement syndrome

A

excessive motion/hypermobility

52
Q

what can cause secondary impingement syndrome or hypermobility

A

trauma or adjacent joint hypomobility resulting in laxity
disuse/immobilization
regional interdependence

53
Q

how does disuse/immobilization influence impingement syndrome

A

muscle inhibition limits stabilization

54
Q

how does regional interdependence influence impingement syndrome

A

insufficient shoulder stabilization
proprioceptive impairment greatest at higher elevations
kinesthetic impairment > proprioceptive impairment

55
Q

t/f
a damaged joint can lead to decreased proprioception/coordination

A

true

56
Q

impingement syndrome is a combination of both primary and secondary etiologies. what is an example of this?

A

scapular hypomobility and GH hypermobility

57
Q

what population is posterior/superior glenoid impingement (PSGI) more common

A

overhead athletes

58
Q

what motions are excessive in PSGI

A

ER ROM and anterior GH glide

59
Q

where is the impingement located in PSGI

A

posterior-superior glenoid on labrum

60
Q

where is the pain typically localized with impingement syndrome

A

tip of shoulder and referred into lateral shoulder and arm

61
Q

those with impingement syndrome will most likely have pain in what motions

A

elevation
lifting/pushing/pressing asctivities
reaching behind back

62
Q

how would you know if nociplastic pain has occurred with impingement syndrome

A

how long the pain has lasted
sensation the patient is feeling

63
Q

what would you observe with a patient that has impingement syndrome

A

possible scapular compensations
FHP

64
Q

what scapular compensations would be found in someone that has shoulder impingement

A

increased elevation
inconsistent upward rotation (increased/decreased)

65
Q

t/f
scapular dyskinesia is more prevalent in those with shoulder impingement and those who experience symptoms than those that do not experience symptoms

A

false

scapular dyskinesia is equally prevalent in symptomatic and asymptomatic individuals

66
Q

what is the scapula assistance test

A

SAT
shows how the scapula is moving but muscles aren’t moving the scap
passive upward rotation

67
Q

what is the scapular repositioning test

A

passive upward rotation and posterior tilt
shows how the scap will move without muscle involvement

68
Q

what test is testing the voluntary contraction of muscles around the scapula

A

scapular retraction test

69
Q

what is the use of taping the lower trap for assistance

A

short term
settles symptoms when patient is away which can increase function

70
Q

what are you learning from scapular assistance tests?

A

with changing a small segment of pt’s motion, you can better understand what muscles/structures are involved and have better treatment options

71
Q

what functions will be difficult for patients with impingement syndrome

A

limited and painful reaching overhead and behind back and with lifting
FLX, ABD, ER

72
Q

what does posterior shoulder pain with ER indicate

A

posterior impingement

73
Q

where are proprioceptive impairments the greatest

A

higher elevations

74
Q

what are the signs that indicate impingement syndrome with RST/MMT

A

inhibited scapular/cuff muscles
mostly scapular muscle groups except elevators

75
Q

what is indicated with hypomobility with accessory motion testing with impingement

A

primary type
posterior shoulder tightness with limited posterior glide

76
Q

what is indicated with hypermobility with accessory motion testing with impingement

A

secondary type

77
Q

t/f
external rotation increases as internal rotation decrease in overhead athletes

A

true

78
Q

what is the glenohumeral IR deficit (GIRD) ratio

A

IR/ER at 90 degrees ABD > 1
influences humeral head position on glenoid

79
Q

what is the infraspinatus or ER test in 0 degrees abd

A

painful or giving away
high specific

80
Q

what is the internal rotation resisted strength test

A

IR weaker than ER @ 90 degrees abd

81
Q

what age group is most prevalent with RC injuries

A

oldest

82
Q

t/f
RC pathology is not associated with impingement syndrome

A

true

83
Q

t/f
pitchers 18-22 years of age experience labral changes with symptoms

A

false
10% had RC and labral changes without symptoms

84
Q

describe the makeup of tendons

A

type 1 collagen
low elastin
fibrocytes
parallel fibers for more unidirectional loads

85
Q

what is the function of a tendon

A

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
Q

where is the tendon hypovascular and hyponeural

A

mid portion

87
Q

where is the tendon hypervascular and hyperneural

A

insertion

88
Q

what is tendinitis

A

inflammation of tendon without structural changes due to overuse

uncommon

89
Q

what are the signs and symptoms of tendinitis

A

typically acute and classic presentation
tender to palpation (TTP)
pain/limitation with lengthening
pain with resisted testing/MMT (lengthened position)

90
Q

what is more common: tendinosis or tendinitis

A

tendinosis

91
Q

degenerative changes with some inflammation in tendinosis is due to

A

repetitive stress and repetitive tendonitis
impingement pathomechanics
neural/vascular insufficiency
exercise-induced hyperthermia
older age
hormonal fluctuation

92
Q

what are the symptoms of tendinosis

A

persistent often with previously failed PT
decreased tendon tolerances

93
Q

what would cause failed PT with tendinosis

A

PT treated tendonitis, not tendinosis

tendinosis is often mislabeled as tendinitis and treated as such

94
Q

what would you observe with a pt that has tendinosis

A

enlarged tendon if superficial
caused by fat infiltration

95
Q

what ROM would be present with pt that has tendinosis

A

possibly pain and limitation with lengthening if aggravated
maybe WNL

96
Q

what would occur with RST/MMT with tendinosis

A

possible pain/weakness - lengthened position if aggravated
could be strong and painless

97
Q

why is tendinosis TTP

A

localized TTP with decreased pain thresholds
increased in-growth of vessels and nerves
elevated pain neurotransmitters

98
Q

t/f
if tendinosis is not acutely irritated, ROM could be WNL, RST/MMT WNL, but very TTP

A

true

99
Q

what is the pathogenesis of tendinosis

A

little/no inflammation
fiber changes
corticospinal (voluntary movement) influences

100
Q

what movements will most likely cause an acute tendon tear

A

higher/oblique forces during fast concentric load

101
Q

why are tendon tears more common with increased age and disuse

A

elastin and vascularity decrease
atrophy and drying
shorter and smaller tendon is less pliable and durable

102
Q

what is the time frame of tendon healing with tendinitis

A

at most 4-6 weeks

103
Q

what is the main goal of treating tendinitis

A

resolution of inflammation

104
Q

what is the primary goal of treating tendinosis and tears

A

proliferating tendon

105
Q

about when does tensile strength initially improves

A

3-5 weeks

106
Q

when does dense fibrous tissue fill in to increase tensile strength

A

8-12 weeks

107
Q

what is the timeframe for normal strength to be reached after surgery

A

10-12 months

MSK (7 decks)

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