Posture Flashcards
Surface Condition
-changes in texture, color, moisture, scars
Surface contours
- circumferential and segmental bands of soft tissue may suggest instability
- flattened/tight areas suggest muscle imbalances
Soft Tissue Proportions
-asymmetries between sides, over development vs atrophy may indicate structural and/or biomechanical differences
Sternal-Rib Angle
Normal: 90*
>100=tight IO, weak EO
<75=tight EO
Tight EO
- lead to post pelvic tilt and lumbar flexion
- fully flex arms and inhale: if no increase in Sternal-Rib angle=EO short
Clavicular Angle
- 15-20* upward (medial to lateral)
- AC joint higher than SC joint
Horizontal Clavicle
- depressed shoulder girdle
- long upper trap
Excessive Upward angle of Clavicle
- elevated shoulder girdle
- tight upper trap
SC Joint
-Even bilaterally
SAM Test
- Spinal Activated Manubrium Test
- Pt: seated, hands in lap
- PT: facing pt, looking up at manubrium; hands on upper trap with thumbs midway between manubrial notch and manubriosternal junction
- Procedure: pt look down and up while PT monitors for asymetrical movement
- Flexion: if manubrium rotates right=T1/2 or T2/3 facet on right doesn’t flex properly
- Extension: same as above but facet doesn’t extend properly
Finding T1
- C6 moves ant with extension
- C7 stable with extension
- T1 SP translates posterior with pressure on sternum
Acromioclavicular Joint
- Find: pull humerus caudally
- high AC=severe sprain
Increased pain with exhalation & decreased pain with inhalation
-consider thoracic disc lesion
Increased pain with inhalation
-consider rib pathology
Transverse Process “Finger Rule”–TS
- T1-2=one finger cranial to SP
- T3-4=two fingers cranial
- T5-8=three fingers cranial
- T9-10=two fingers cranial
- T11-12=one finger cranial
Olecranon Position
- faces posteriorly in neutral
- faces forward with full shoulder flexion
Scapular Downward Rotation
- inf angle of scap medial to upper portion
- Cause: rhomboids and levator scapulae are short and upper trap long
- serratus ant long
Scapular Position
- Vertebral border is vertical & 3” from SP
- Superior angle: T1/2
- Scapular Spine: T3
- Inferior Angle: T7
Scapular Upward Rotation
- spine of scap medial to inferior angle
- Cause: trap (any/all) short
Scapular Elevation
- Sup border higher than T1/2
- Causes:
- If sup angle high but acromion not=short levator
- entire scap high and acromion high=short upper trap
Scapular Depression
- sup border scap below T2 (long neck)
- Cause: upper trap long
- pec major and lat dorsi short
Scapular Abduction
- vertebral border more than 3” from midline of thorax
- Cause: short serratus and/or pec major
Scapular Adduction
- vert border less than 3” from SP
- Cause: rhomboids, trap short
- Long serratus ant
Scapular Ant Tilt
- inferior angle of scap away from rib cage
- Cause: short pec minor and/or short biceps
- weak low trap
Scapular Winging
- vertebral border of scap away from thorax
- Cause: short/weak serratus, scoliosis
Normal Humerus Alignment
- <1/3 hum head in front of acromion
- antecubital crease faces forward
- olecranon face posterior
- palm faces body
- humerus vertical (from front and side)
Anterior Humerus
- > 1/3 head ant to acromion
- Causes:
- abd/tilted scapula
- tight post capsule
- lax ant capsule
Medially Rotated Humerus
- olecranon lateral/palm posterior
- causes
- Shortened IR Mm
Lat Rotated Humerus
- Rare: check if scap is Abducted
- Causes: shortened ER Mm
Flexion/Extension of Humerus
- distal portion of humerus is ant or post to proximal
- Causes: shortened Mm
If GH ROM is limited–Rule IN cervical involvement
- ROM in standing
- ROM in supine with cervical distraction
- Rule in Neck if supine ROM increases 10* or more
Lack of SC posterior rotation (with GH elevation)
-biomechanical problem with upward rotation of scap
Heavy Arms
- depressed/Abd/downwardly rotated scap
- unstable scap/scap lag with elevation
Long Arms
- ant tilted/downwardly rotated scap
- delayed/decreased upward rotation of scap
Long Trunk
-arm support of chair too low=depressed shoulder/SB trunk to reach
Large Breasts
- C-Spine: forward head
- Shoulders: anterior/med rotated
- T-Spine: increased thoracic kyphosis
- Scapulae: downward rotation/depression
- Sternum: depressed
- Clavicles: sloped
Scapula during first 30-60* GH flexion
-variable movement
Scapula at 140* GH flexion
-scap should stop moving
Scapular Movement
- 60* with max arm elevation
- inferior angle at midaxillary line
- only minimal elevation/no depression
- inf angle stays against thorax
- stable with ER/IR and H. add/abd (to 90*)
5 most common impairments of shoulder girdle
Sahrmann
- short/stiff ER Mm
- Insufficient activity of ER Mm
- Insufficient activity of Subscap
- Dominance of deltoid Mm, causing superior glide of humerus
- Shortness of capsule (post and inf)
Decreased GH ER
with arm abd to 45*=shor tsubscapularis
with arm abd to 90*=tight capsule
At end range GH elevation there should be rotation of ________
T1, T2, T3
Humerus Movement
- rotates in glenoid fossa (constant PICR)
- olecranon ant (flexion) or lat (abd) at end range
- capsular end feel
- no ant translation during lowering
