Session 6

Question 1

Describe how the RC and deltoid work together for dynamic stabilization of the GH joint.

Answer 1

• forces act to keep humeral head compressed into glenoid fossa with dynamic elevation
• force coupling with deltoid
• deltoid alone cannot abduct (elevate) UE.
• need another set of forces to work synergistically with deltoid force and achieve desired rotation (motion of elevation)
• all lines of action contribute to dynamic stabilization of GH joint.

Question 2

name the 6 motions of the scapula.

Answer 2

• depression/elevation
• protraction/retraction
• upward/downward rotation

Question 3

inferior angle moves away from vertebral column

Answer 3

upward rotation

Question 4

inferior angle moves toward vertebral column

Answer 4

downward rotation

Question 5

Describe scapulohumeral rhythm.

Answer 5

• there is a 2:1 ratio of glenohumeral to scapulothoracic movement during arm elevation.
• first 30 degrees is glenohumeral movement
• scapulothoracic movement contributes 50-60 degrees.
• GH joint contributes 100-120 degrees of flexion and 90-120 degrees of abduction

Question 6

name 3 purposes of scapulohumeral rhythm.

Answer 6

• mechanical stability
• prevents impingement
• maintains optimal length-tension ratio of deltoid and supraspinatus

Question 7

what is scapular winging?

Answer 7

excessive scapular internal rotation - causes prominence of the medial border and inferior angle of the scapula with attempted elevation of the arms.

Question 8

what can cause scapular winging?

Answer 8

loss of serratus anterior (SA muscles anchors the scapula against the rib cage)

Question 9

repeated compression of the humeral head against the contents of the subacromial space

Answer 9

shoulder impingement syndrome

Question 10

name 3 parts that shoulder impingement (compression) can cause trauma to.

Answer 10

• supraspinatus tendon (tendonitis; RC tear)
• subacromial/subdeltoid bursa (bursitis)
• long head of biceps tendon (biceps tendonitis)

Question 11

name the classic sign of shoulder impingement syndrome.

Answer 11

pain on shoulder abduction

Question 12

name 2 factors that allows excessive superior displacement of the humeral head that cause shoulder impingement syndrome.

Answer 12

• stiffness in GH inferior capsule

- instability of the GH joint from lax ligaments or weak RC muscles

Question 13

name 3 factors that decrease volume in the subacromial space that cause shoulder impingement syndrome.

Answer 13

• inflammation
• scar tissue
• bone spurs on clavicle or acromion

Question 14

how can we avoid shoulder impingement syndrome?

Answer 14

For GH abduction, past 90 degrees of shoulder elevation, externally rotate the humerus to avoid impact of greater tuberosity of humerus on the acromion.

Question 15

partial dislocation of shoulder joint; shoulder ligaments cannot hold the weight of the arm in the absence of muscular (RC) activity.

Answer 15

shoulder subluxation

Question 16

how are shoulder subluxations classified?

Answer 16

by finger space btwn the acromion and humeral head.*

Question 17

what is used to support the subluxed shoulder?

Answer 17

sling

Question 18

name 3 factors to consider when using a sling.

Answer 18

• instruct proper positioning for pt. when seated and in supine/sidelying in bed.
• typically used for pts. who are ambulating and for prolonged standing with ADL tasks.
• caution: use of slings all the the time even in elbow positions that do not allow shoulder or elbow motions

Question 19

name 2 splints used for the neurological hand.

Answer 19

• resting hand splint

- wrist cock up splint

Question 20

• flex wrist to extend the fingers (compromise wrist extension to get finger extension).
• splint in the anti-deformity position.

Answer 20

resting hand splint

Question 21

• do not immobilize active finger movement if present.

- consider this if pt. has active finger motion.

Answer 21

wrist cock up splint

Question 22

• a state in which the muscle is partially contracted and ready to act aka “resting muscle tone.”
• occurs from a complex sequence of activity among muscle spindles, gamma motor neurons, and alpha motor neurons, sensory and motor feedback loops.

Answer 22

muscle tone

Question 23

name the 5 components of the muscle tone continuum.

Answer 23

• flaccidity
• hypotonicity
• normal
• hypertonicity
• rigidity

Question 24

• no underlying muscle tone
• areflexive or loss of all reflexes
• hypermobile joint

Answer 24

flaccidity

Question 25

• no resistance to PROM
• some slight muscle tone
• floppy

Answer 25

hypotonicity

Question 26

increased resistance with increased velocity of movement during passive stretch

Answer 26

hypertonicity/spasticity

Question 27

• cogwheel or lead pipe

- increased stiffness of movement as opposing muscle groups become active and “bind movement.”

Answer 27

rigidity

Question 28

name 2 reasons why we may see abnormal muscle tone.

Answer 28

• a break down in muscle spindle activity and coordination of the alpha and gamma co-activating system
• an imbalance in agonist and antagonist muscle activity or a problem with inhibitory/excitatory actions btwn muscle groups.

Question 29

describe the quick stretch test.

Answer 29

• stabilize extremity at joints.
• check PROM slowly through full or available ROM
• provide a quick stretch and feel the “catch”
• note where in the range

Question 30

“catch” at the end of range

Answer 30

minimal

Question 31

“catch” at the middle of the range

Answer 31

moderate

Question 32

“catch” at the beginning of the range

Answer 32

severe

Question 33

name 4 groups of muscles that can be tested with the quick stretch test.

Answer 33

• elbow flexors
• finger flexors
• wrist flexors
• elbow extensors