Quiz #6 Flashcards
what are common factors that lead to shoulder injury?
overuse, laxity, trauma, degenerative conditions, disuse, posture, and overhead use
what findings may overlap b/w various health conditions of the shoulder?
pain, paresthesia, limited ROM, weakness/atrophy, abnormal end feel
how do we differentiate shoulder pathologies?
special tests and MMT
what is the most mobile jt in the body and therefore the most prone to injury?
the GH jt (shoulder)
how much motion is provided by the GH jt in GH abduction?
120 deg abduction
how much motion is provided by the scapulothoracic jt in GH abduction?
60 deg upward rotation
how much motion is provided by the AC jt in GH abduction?
35 deg upward rotation
how much motion is provided by the SC jt in GH abduction?
25 deg elevation
25 deg upward rotation
how much GH jt external rotation is there with GH abduction?
45 deg external rotation
what are the motions at the SC joint?
elevation/depression
upward/downward rotation
protraction/retraction
what kind of jt is the SC jt?
synovial saddle jt
where is the synovial capsule of the SC jt the least robust?
inferiorly
SC ligaments reinforce and restrain what motions?
AP movements
the interclavicular lig of the SC jt restrains what motions?
superior and lateral motions
the costoclavicular ligs restrain what motion?
elevation
the costoclavicular ligs elevate and depress how many cm?
elevate: 4-6 cm
depress: 1-2 cm
when the SC jt elevates, what is the accessory glide?
downward glide
when the SC jt depresses, what is the accessory glide?
upward glide
what motion puts the costoclavicular ligs on slack?
depression
what motion makes the costoclavicular ligs taught?
elevation
what level of the spine is the inferior angle of the scapula?
T7
what level of the spine is the spine of the scapula?
T3
what level of the spine is the superior angle of the scapula?
T2
what planes does the scapular plane fall 45 deg between?
the frontal and sagittal planes
what part of the GH jt is convex?
the humeral head
what part of the GH jt is concave?
the glenoid fossa
what jt mimics a golf ball sitting on a tee?
the GH jt
the GH jt is retroverted about how many degrees?
7.4 deg
is the glenoid fossa angled superiorly or inferiorly?
superiorly
about how thick is the glenoid labrum?
2 mm
what is the glenoid labrum?
fibrocartilagenous ring that thickens the depth of the very shallow glenoid fossa to increase contact and stability
also serves as attachment for some tendons
what is the role of coracohumeral ligament?
to support the shoulder superiorly in the rotator interval
what is the primary restraint for posterior and inferior translation of the shoulder when the arm is at the side?
the coracohumeral ligament
when is the coracohumeral ligament tight?
in external rotation of the shoulder at the side
what are the 3 GH ligaments?
superior, middle, and inferior bands
what does the superior band of the GH ligament do?
resists inferior translation and external rotation when the arm is at the side
resists extension
what does the middle band of the GH ligament do?
resists external rotation
limits anterior translation from 0-45 deg of abduction
what does the inferior band of the GH ligament do?
resists anterior/posterior translation
resists internal/external rotation at 90 deg abduction
when is the inferior band of the GH ligament the tightest?
in external rotation at 90 deg of shoulder abduction
what is the role of the broad axillary pouch at the shoulder?
allows room to bring your arm over your head
what ligaments at the shoulder resist anterior translation in neutral?
the subscap and middle and inferior bands of the GH ligament
where is the transverse humeral ligament?
b/w the greater and lesser trochanters
what is the big dynamic support of the shoulder?
the rotator cuff
what motion(s) does the subscap resist?
external rotation
the supraspinatus and teres minor can produce and resist what motion?
posterior translation
the supraspinatus and teres minor protect from ____ instability by resisting ____ translation
anterior, anterior
what is the role of the rotator cuff?
stabilize the humeral head in the glenoid fossa
what does the rotator cuff do in arm elevation?
depresses the head of the humerus and keeps it centered in the fossa
what forces does the rotator cuff creates with the arm in elevation?
compression and depression
the rotator cuff creates a force couple with what muscle at the shoulder?
the deltoid
external rotation of the shoulder creates what accessory glide?
posterior glide
the follow are all causes of what shoulder problem?
space issue
anatomic variations
shoulder girdle kinematics
rotator cuff pathology
degenerative changes
overuse
subacromial impingement syndrome
what are intrinsic causes of subacromial impingement syndrome?
vascular changes in RC tendons
tissue tension overload
collagen disorientation
collagen degeneration
what are primary extrinsic causes of subacromial impingement syndrome?
structural posterior capsular tightness, anterior capsular tightness, or rotator cuff pathology
increased superior migration of the humeral head
why would the humeral head ride superiorly?
weak rotator cuff/rotator cuff pathology
what are secondary extrinsic causes of subacromial impingement syndrome?
instability, impaired muscle coordination, or weakness of the scapular stabilizers
what are tertiary extrinsic causes of subacromial impingement syndrome?
contact of the greater tuberosity with the posterosuperior aspect of the glenoid when the arm is abducted and externally rotated
what is the definition of aging?
accumulated results of reduced cellular fxn, cell injury, and cell death
the inability to deal with physiological (emotional and corporal) stressors that heretofore had minimal functional, physiological, and societal impact
what is the primary theory of aging?
aging is pre-programmed (finite lifespan)
what is the secondary theory of aging?
aging is the result of environmental insults that eventually overwhelm the body (free radicals, environmental toxins, bacterial viruses, trauma)
what is the inflammaging theory of aging?
chronic inflammation is thought to be a risk factor for a board range of age-related diseases such as HTN, DM, atherosclerosis, and cancer
how is inflammation defined?
elevation of serum and local pro-inflammatory cytokines
what is a complex process that results from a combo of environmental, genetic, and epigenetic factors?
aging
what is a pervasive feature of aging?
chronic pro-inflammatory status
what is inflammaging?
chronic low grade inflammation in the absence of an overt infection that represents a significant risk factor for morbidity/mortality in the elderly
what are some examples of pro-inflammatory factors in the body?
LDL cholesterol and the renin-angiotensin system (RAS)
what protein can measure inflammation in the body?
c-reactive protein
increased in pro-inflammatory stimuli= __ aging
faster
t/f: there is a decrease in muscle strength with age even if activity remains consistent
true
with consistent activity, when does muscle decline begin? when does it continue until?
teens/early 20s, 60
after what age does muscle decline accelerate?
60
at 25 y/o, muscle mass contributes up to ___% of body weight
50
what 80 y/o, muscle mass contributes up to __% of body weight
25
what is the primary cause of muscle decline with age?
decreased cross sectional area of the muscles due to loss of motor fibers and decreased size of motor fibers
there is a preferential loss of what type of fibers with aging?
type 2
loss of strength__loss of endurance
>
what is sarcopenia?
low muscle mass and function
t/f: even with exercise, aging brings about increased deposits of fat b/w and w/in skeletal muscles and intra-muscular adipose tissue (IMAT)
true
what happens with IMAT in aging?
it replaces lean muscle mass
what does replacement of lean muscle mass with IMAT do to muscle strength and performance?
it decreases muscle strength and performance
why does IMAT lead to systemic inflammation?
IMAT releases pro-inflammatory cytokines
what happens to muscle capillary diameter with age?
it decreases
t/f: IMAT is shown to blunt the effects of resistance training
true:(
what scan is used to quantify IMAT and lean muscle tissue?
MRI
systemic inflammation associated with aging is exacerbated by what 3 things?
- disuse
- hormonal changes
- disease
IMAT results in microvascular changes in what corporal systems?
muscle, bone, brain, heart, and kidney
lack of perfusion leads to what
cerebrovascular ischemia
IMAT
chronic renal insufficiency
exercise __ times a week for ___ weeks has been shown to lower the IMAT to lean muscle ratio in skeletal muscle
3, 12
what are the proposed causes of loss of muscle fibers?
microvascular changes, decreased testosterone and estrogen, increased insulin resistance, vit D deficiency, decreased human growth hormone, increased parathyroid hormone (breaks down bone), disuse atrophy, diminished protein intake, and decreased ability to extract O2 from blood due to microvascular changes
what factors can accelerate loss of muscle mass?
diabetes, metabolic syndrome, COPD, CHF/cardiomyopathy, osteoarthritis, Parkinson’s disease cancer, inflammatory diseases, stroke, and disuse
how does diabetes contribute to loss of muscle mass?
insulin resistance
micro/macrovascular changes
narrowed vessels and stenosis from prolonged hyperglycemia
how does metabolic syndrome contribute to loss of muscle mass?
large waistline
increased triglyceride levels
decreased HDL levels
increased BP
how does COPD contribute to loss of muscle mass?
decreased vital capacity
hypoxic and hypercapnic respiratory failure
increased resting and exercise HR due to hypoxia
steroid meds leading to proximal muscle weakness, weight gain, and insomnia
how does CHF/cardiomyopathy contribute to loss of muscle mass?
decreased EF=decreased CO=decreased exercise tolerance
beta-blockers+decreased resting and exercise HR
diuretics=hypokalemia and low blood volume
how does Parkinson’s disease contribute to loss of muscle mass?
rigidity, bradykinesia, festinating gait, and difficulty intimating movement makes exercise difficult
how does cancer contribute to loss of muscle mass?
pro-inflammatory effects of the tumor, pain, chemo, radiation, and surgery
how do inflammatory diseases contribute to loss of muscle mass?
systemic effects of pro-inflammatory cytokines
steroids
proximal muscle weakness, increased insulin resistance, fluid gain, and osteoporosis
how can a stroke contribute to loss of muscle mass?
functional limitations
what is an ideal muscle strength training regime to produce strength gains in all ages?
6-25 weeks using at least 1 rep of 70-80% max torque
is reaction time affected with increased strength?
no
is improved balance likely more due to muscle strength or increased rxn time?
muscle strength
do men or women experience more bone loss with age?
women
when does bone density peak?
in late 20s/early 30s
by age 65, __ women will have a vertebral fx
1/3
by age 80, __ women will have a hip fx
1/3
by age 90 men lose about __% of bone and women lose about __% of bone
20, 30
what factors cause skeletal changes in aging?
microvascular changes, decreased calcium and vit D intake, decreased weightbearing exercises, and decreased estrogen in women
what are some risk factors for osteoporosis?
gender
thin/small frame
age
Asians>Caucasians>African American descent
early menopause
decreased calcium intake
excessive alcohol
family hx
hypocalemia and decreased serum vit D levels
malnutrition, eating disorders, gastric bypass
hx of long term steroids
nicotine
sedentary lifestyle (Wolff’s Law)
what is the most common femoral fx?
intertrochanteric (greater to lesser troch)
what is the most problematic femoral fx?
transcervical/subcapital (need partial hip arthroplasty)
what are 3 different proximal femoral fxs?
intertrochanteric
transcervical/subcapital
subtrochanteric
what is a DEXA scan?
dual x-ray absorptiometry that shows bone mineral density
what DEXA score is being described?:
- “young normal”
- indicates how much bone mineral density (BMD) compares to that of a healthy 30 y/o
the T score
what DEXA score is being described?:
- “age-matched”
- compares BMD to expected for comparable age and body size
Z score
what is normal BMD T score?
+1 to -1
what T scores would indicate osteopenia?
-1 to -2.5
what T scores would indicate osteoporosis?
<-2.5
what T scores would indicate severe osteoporosis?
<-3.0
t/f: lower BMD in adults is common, so age-matched comparison may be misleading
true
what are common meds for osteoporosis?
calcium and vit D, biphosphanates, and others
t/f: all exercise will lessen bone loss
true
order the following exercises from most to least protective against bone loss:
- walking
- swimming
- intense weight bearing (running)
- bicycling
- weight lifting
intense weight bearing>walking>weight lifting>bicycling>swimming
t/f: people with Alzheimers disease tend to develop osteoporosis
true
why do ppl with Alzheimers tend to develop osteoporosis?
leakage of beta amyloid into the blood stream resulting in increased osteoclastic activity
why do ppl with osteoporosis tend to develop AD?
decreased serum vit D which may be neural protective against development of amyloid deposits
t/f: most prostate cancers are hormone dependent
true
what does it mean when cancers are hormone dependent?
the higher the hormones in the body, the faster the tumor will grow
t/f: lowering testosterone can slow tumor growth
true
what are the effects of low testosterone on the body?
mimic multisystem aging
what is the role of hyaline cartilage?
line articular surfaces to provide shock absorption, lubrication, and protect jts from damaging transarticular forces
what is the purpose of the elastic component of cartilage?
shock absorption
what provides the strength of the scaffolding of the fibrils of cartilage?
negative charge b/wfibrils and proteoglycans=repellent each other
what molecules reinforce scaffolding?
water molecules
what happens to water molecules during weightbearing that allows WB cartilage to deform?
they are squeezed to NWB areas
what is the effect of dehydration of cartilage with aging?
decreased deformation with WB, so fibrils break down with constant WB forces
why is bone on bone contact painful?
there are a lot of nociceptive receptors on the bones that the cartilage doesn’t have
what does more white bone on an x-ray mean?
increased bone density from increased forces
t/f: the rate of hip fx doubles each decade after 50 y/o
true
what % of women and men will have a fx hip by age 90?
32% of women and 17% of men
what % of pts who have had an hip fx never resume ambulation?
50%
what are arthrokinesiological implications of aging?
obesity
age related PNS changes (proprioception, kinesthesia, light touch, pain, temp, vision, hearing)
preferential loss of slow fibers>fast twitch
stiffness in periarticular CT
decreased in extremes of ROM
natural neural adaptive mechanism to improve safety
loss of gluten med strength secondary to aging hip
COM moving anteriorly to the BOS secondary to senile kyphosis
what are the impacts of aging on movement systems?
decreased dynamic and standing balance
difficulty with motor planning when performing secondary fxns (singing, talking, reading, listening)
loss of ROM
weakness
decreased voice amplitude
