Module #5: Shoulder Flashcards
What joint offers the greatest ROM?
Glenohumeral Joint
Which Joint is theoretical (not a real joint)?
Scapulathoracic Joint
What is the ratio for the Scapulohumeral rhythem? and how many phases?
2:1 Ratio. Humerus to Scapula
3 phases
Is the glenoid cavity shallow or deep?
Shallow
What is the purpose of the Glenohumeral ligaments?
connects humerus to glenoid, stabilizes shoulder to hold in place and keeps it from dislocating
Coracoclavicular Ligaments
Trapezoid, Conoid
Where is the subacromial bursa?
from the acromion, deltoid and rotator cuff tendons
Example of primary Shoulder impingement
Shape of Acromion Process
Example of secondary shoulder impingment
repetitive motions
Difference between shoulder dislocation and seperation
Dislocation, humeral head forced out of fossa and does not return on its own, separation it does return on its own.
What causes a labrum tear?
falling, dislocation, tensile forces. When humerus comes too inferior to glenoid.
Just like Menisci’s tear, what is a labrum tear like?
Cracking, Chipping, tear, Superior SLAP, Anterior/ Inferior Bankart Lesion
what is a main cause for frozen shoulder?
Idiopathic, perhaps autoimmune, Life altering.
Frozen Shoulder (FS) develops in three stages:
- Pain (Freezing)
- Stiffness (Frozen)
- Recovery (Thawing)
How long does frozen shoulder usually resolve?
1-3 years
What is the capsular pattern of the shoulder?
Abduction, Lateral and medial rotation
what arch helps to protect the rotator cuff tendons and subacromial bursa from direct trauma?
Coracoacromial Arch
For every inch of forward head posture, it increases the weight of the head by how many pounds?
10 pounds
What is Hyperhyphosis?
Excessive curvature of the thoracic spine
What are some different reasons seizures happen?
Brain trauma, drug/alcohol abuse, fever over 105 degrees, infections
Two types of hyperkyphosis
Functional and structural
What is hypolordosis?
loss or decrease in the lumbar spine “FLATBACK”
Where does shoulder separations happen?
Acromion
What muscles are involved in the Scapulohumeral Rhythem
Traps, Serratus Anterior, Rhomboids, Lev Scap.
What is Reverse Scapulohumeral Rhythm?
When the scapulamoves more during abduction of the shoulder than the humerus moves. Can be observed in frozen shoulder
What actions will brings the coracoclavicular ligaments to the surface more?
Seated of Supine, Abduct and medially rotate the shoulder. Ligaments will feel like taut bands
What are ligaments made of?
Connective tissues & Collagen
True or False. The coracoacromial ligament lies deep to the deltoid
True
Serratus Anterior is also known as what
“Boxer’s Muscle
Where is the subclavius located and what’s special about it?
Located between the clavicle and first rib, deep to pec major.
When hypertonic, it can draw first rib and clavicle close together, lessening the space and compressing neurovascular structures causing costoclavicular Syndrome. Can’t Control involuntarily
What makes up a bulk of the posterior Axillary fold?
Latissimus Dorsi and Teres Major
What are the four Rotator cuff muscles?
Infraspinatus, Supraspinatus, Subscapularis, Teres Minor
What does FOOSH mean?
Fall On Out Stretched Hand
Two types of Rotator Cuff injuries
- Acute Tears- result of sudden movement
- Chronic Tears- Develops over time, usually near end of tendon, as a result of the tendon rubbing against lower bone.
What are five postural muscles?
- Upper Trap
- Scalenes
- Quadratus Lumborum
- Hamstrings/ Rectus Femoris/adductors/TFL
5.Gastroc/ Soleus
What are five phasic muscles?
- Rectus Abdominis
2.Middle and Lowers Traps
3.Deltoid, Tib Anterior - ESG, Transverse Abdominis
- Vastus Lateralis, medialis, Glutes
Are postural muscles slow or fast twitch?
Slow and phasic are fast
What is Cerebral Palsy (CP)?
Blanket term for Motor Function loss due to brain damage during fetal development and up to one week after baby is born.
Treatment goals for Hyperkyphosis
Address Upper crossed syndrome, Reduce TRPs and HT pec muscles. Teach diaphragmatic breathing, posterior neck, flush then stimulate rotator cuff muscles, abdominal work, adhesions around diagphragm
What do you want to avoid with frozen shoulder?
Intense Stretching and joint play greater than Grade 1-3 in acute stage
what is also known as frozen shoulder?
Adhesive Capsulitis
What is Calcific Tendinitis?
Deposits of calcium hydroxyapatite crystals in tendon.
Where is a common area that Calcific Tendonitis occurs in?
Supraspinatus
What condition is similar to calcific tendonitis?
Shoulder impingement but comes on suddenly in a 24-48 hour period.
What are the four phases of calcific tendonitis?
- Formative
- Resting-Pain, dysfunction if large enough
3.Resorptive- Inflammations breaks down deposit-painful - Post-Calcific- Tendon healed
What are the treatment goals for Calcific Tendonitis?
moist heart to reduce pain, stretch surrounding muscles.
With Bicipital Tendinosis- which head is more common to be injured?
Long head due to increased friction in bicipital groove.
What is some history of Bicipital Tendinosis?
-aching pain anterior shoulder
-pain down to elbow
-pain flexion of elbow and supination
-rest relieves it
-Pain in overhead motions
What are some treatment goals for Bicipital Tendinosis?
-reduce HT in adjacent muscles
-stretch ROM GH JOINT
-Reduce tension on tendon-long way stripping
With Rotator Cuff tears and tendinosis, what strain grade should be referred out?
Grade 3- not until initial healing has taken place
What are some treatment goals for Rotator Cuff Tears and Tendinosis?
-Encourage collagen production-Deep transverse friction
-Lengthen affected muscles- Deep stripping
-Passive Stretching
With someone with subacromial bursitis, where would you put heat?
Surrounding muscles- not on the bursa
What are the different stages of shoulder impingement?
Stage 1: <25 years-Acute inflammation, edema, hemorrhage
Stage 2: 25-40 years- Progressive degeneration in rotator cuff
Stage 3.> 40 years, tears in bicep tendon, supra, bone spurs.
What are the treatment goals for Glenoid Labrum Injuries
Massage treatment not often helpful, refer to physio
reduce HT in surrounding muscles, ice to reduce pain and inflammation
Perform the Drop Arm Test
Client Seats-Bringing arm into 90 degrees abduction, then back down to adduction with therapist placing extra resistance on it. may guard, drop arm, or show pain=positive.
Perform the Painful Arc Test
Client is seated or Standing, bring arm into full abduction. should feel pain between 60 degrees and 120 degrees. no pain before or after
Perform Apley Scratch Test
What is speeds test testing for?
Bicipital Tendinosis
perform SPEEDS TEST and explain
Client Seated, shoulder in flexion, elbow in extension, supination out in front of them at 90 degrees. Therapist placing downward pressure on arm, slow contraction. this puts tensile load on the tendon
What type of joint is the shoulder?
Synovial ball and socket
What is the closed packed position of the shoulder
maximal abduction and external rotation
Perform crossover test
Client seated, therapist passively brings arm across chest to minimize pain and muscle contracture. positive if pain. Tests the integrity of the acromioclavicular or Coraclavicular integrity.
What test can you do when testing for suprspinatus strength?
Empty can test. client has both arms into 90 degrees of abduction with arms in nuetral position, therapist applies downward pressure. Client is asked to medially rotate both arms and angle forward 30 degrees into horizontal abduction. therapist applies pressure.
What are the three bones of the shoulder?
Clavicle, Humerus, scapula (shoulder bone)
