PD - upper limb

Question 1

Shoulder complex: 3 joints and 1 articulation

Answer 1

glenohumeral joint
acromioclavicular joint
sternoclavicular joint
scapulothoracic articulation

Question 2

Muscles and tendons surrounding the shoulder joint

Answer 2

rotator cuff (SItS: supraspinatus, infraspinatus, teres minor, subscapularis)

Question 3

Causes of referred shoulder pain

Answer 3

coronary artery disease
pulmonary tumors
gallbladder disease

Question 4

Shoulder ROM 2 main components

Answer 4

GH motion
scapulothoracic motion
combined GH/scapulothoracic motion

Question 5

Shoulder ROM (motions and angle)

Answer 5

aBduction: 0-180 (2:1, GH and scapulothoracic) 
aDduction: 0-45
flexion: 90
extension: 45
internal rotation: 55
external rotation: 40-45

Question 6

2 general screening maneuvers to evaluate AROM of shoulder

Answer 6

1. Apley scratch test

2. “Shoulder Arc”

Question 7

Apley scratch test

Answer 7

tests AROM of shoulder

pt…
reaches up behind head and touches superior medial angle of opp scapula w/ fingertips (external rotation, abduction)

reaches in front of the chest to touch opposite acromion (internal rotation, adduction)

reaches down behind back to touch inferior aspect of opp scapula (internal rotation, adduction)

Question 8

shoulder arc

Answer 8

tests AROM of shoulder

pt aBducts arms to 90 degrees w/ elbows straight, turns palms up, then continues to aBduct until hands are over head

pain –> “painful arc”

• pain btwn 60-120 –> subacromial (tendonitis or impingement)
• pain after 120 –> acromioclavicular

Question 9

Grading of muscle strength

Answer 9

5 – Normal: Complete range of motion against gravity with full resistance
4 – Good: Complete range of motion against gravity with some resistance
3 – Fair: Complete range of motion against gravity
2 – Poor: Complete range of motion with gravity eliminated
1 – Trace: Evidence of muscle contraction, but no joint motion
0 – Zero: No evidence of muscle contractility

Question 10

Shoulder abduction muscles

Answer 10

middle deltoid (C5, 6)
supraspinatous (C5, 6) - 1st 15 

secondary: serratus anterior, remainder of deltoid

Question 11

Shoulder adduction muscles

Answer 11

pectoralis major (C5-T1) 
latissimus dorsi (C6-C8)) 

secondary: teres major, anterior deltoid