Shoudler mechanics and counterstrain

Question 1

the upper extremity dysfunction will frequently take care of itself or will be easier to treat if….

Answer 1

if you treat SD in the upper thoracic spine, upper ribs and lower cervical spine FIRST

Question 2

does the shoulder motion involve just one joint or articulation?

Answer 2

NO

sternoclavicular
Acromioclavicular
Head of humerus/glenoid fossa
scapula articulating over ribs scapulothoracic articulation

Question 3

major motions of the shoulder? x6

Answer 3

flexion
extension
abduction
adduction
external rotation
internal rotation

Question 4

what is the glenohumeral joint designed for?

Answer 4

maximum motion at the expense of decreased stability

shallow glenoid fossa as compared to the deep acetabular socket of the hip

Question 5

where does the first 30 degrees of shoulder abduction occur? and by what muscle

Answer 5

glenohumeral joint

supraspinatous

Question 6

for every 2 degrees of motion at what joint is there 1 degree of motion at another articulation?

Answer 6

after the supraspinatous has initiated abduction
… thereafter for every 2 degrees of motion at the glenohumeral joint, there is 1 degree of motion at the scapulothoracic articulation

Question 7

if the scapulothoracic articulation is restricted (which is frequently associated with thoracic spine and rib dysfunction) what may happen?

Answer 7

glenohumeral joint may have to compensate with increased motion

predisposes to instability, impingement rotator cuff tendonitis and tear

Question 8

what type of motion is allowed at the sternoclavicular joint?

Answer 8

anteroposterior
superoinferior
rotational motion

Question 9

why do you need to treat dysfunction in the thoracic spine and ribs ?

Answer 9

to allow the scapulothoracic articulation to optimally function

Question 10

what type of motion is allowed at the acromioclavicular joint?

Answer 10

anterior/posterior
superior / inferior
rotational (minor)

Question 11

what joint frequently becomes separated when someone lands or is hit on the point of the shoulder

Answer 11

acromioclavicular

Question 12

what are the primary flexors of the upper arm 3

Answer 12

deltoid
pectoralis major muscle
coracobrachialis

Question 13

cord levels/ nerve of pec major

Answer 13

medial and lateral pectoral nerves

C5-T1

Question 14

deltoid innervation (anterior portion)

Answer 14

axillary C5, C6

Question 15

Coracobrachialis muscle innervation

Answer 15

musculocutaneous C5, 6, 7

Question 16

primary extensors of the arm 4

Answer 16

lat dorsi
teres major
deltoid (posterior portion)
long head of triceps brachii

Question 17

innervation lat dorsi

Answer 17

thoracodorsal nerve C6,7 8

Question 18

teres major innervation

Answer 18

C5, 6 (lower subscapular nerve)

Question 19

deltoid muscle innervation (posterior portion)

Answer 19

C5, 6

axillary nerve

Question 20

long head of triceps brachii muscle innervation

Answer 20

C6, C7, C8 (radial nerve)

Question 21

primary abductors 2

Answer 21

deltoid (axillary nerve C5,6)

supraspinatous (C4 (minor), 5, 6,–> suprascapular nerve)

Question 22

primary adductors of upper limb 4

Answer 22

pectoralis major muscle (C5-T1)
latissimus dorsi (C6, 7, 8)
Teres major muscle (C5, C6)
long head of triceps brachii muscle

Question 23

primary external rotators? 3

Answer 23

infraspinatous (suprascapular n.)
Teres minor muscle (C5, 6, axillary nerve)
Deltoid muscle (C5, 6, axillary n. )

Question 24

primary internal rotators 5

Answer 24

subscapularis (upper and lower subscapular nerves C5, 6, 7)

pectoralis major

lat dorsi

deltoid

teres major

Question 25

what are the 4 rotator cuff muscles

Answer 25

Supraspinatous Infraspinatous Teres minor Subscapularis

Question 26

what happens if any one of the rotator cuff muscles is out of balance or if the scapulothoracic joint is not moving in concert with the glenohumeral joint?

Answer 26

the glenohumeral joint will be less stable and more predisposed to injury

Question 27

what is the arterial supply of the upper limb derived from?

Answer 27

left and right subclavian arteries

Question 28

what can affect the arterial supply of the upper limb?

Answer 28

somatic dysfunction of the anterior and middle scalene muscles upper thoracic and cervical vertebrae upper ribs clavicles fascia of the neck and upper extremity

Question 29

what is the final venous drainage of the upper limb

Answer 29

subclavian brachiocephalic these pass ANTERIOR to the scalene muscles

Question 30

somatic dysfunction anywhere along the course of the venous drainage can lead to ....

Answer 30

congestion in the upper extremity it takes alot LESS SD to affect veins

Question 31

what can lead to reduced healing of the upper extremity

Answer 31

SD affecting the thoracic inlet can produce a mechanical restriction to lymph flow (low pressure system) and congestion in the upper extremity

Question 32

what can lead to increased swelling within the upper extremity

Answer 32

decreased lymphatic drainage due to upper thoracic SD , which may increase sympathetic tone to the upper extremity this is because cell bodies of preganglionic neurons concerned with the upper extremity are located in the upper thoracic spinal segments smooth muscle in walls of lymphatic vessels contract when sympathetic nerves are stimulated REDUCED SIZE OF LUMEN, decrease drainage f ribs and thoracics affect sympathetics of the upper limbs so its important to treat thoracic and ribs first

Question 33

what does tensegrity have to do with this lecture at all?

Answer 33

well the entire body is interconnected by a vast network of connective tissue when one area is tight that can transmit to all areas Predisposes all interconnected areas to injury and keeps them from operating at optimum function and potential

Question 34

throwing mechanics

Answer 34

force is transmitted from the ground up through the lower extremity and spine to the shoulder and entire upper extremity If 1 structure breaks down, the entire kinetic chain is compromised, especially putting the shoulder at risk

Question 35

During overhead movements (fast-pitch softball), what percentage of the kinetic energy of the upper extremity is generated by the legs and trunk?

Answer 35

48 %

Question 36

what muscles inferiorly contribute to scapular stabilization and control?

Answer 36

engagement of the gluteal muscles helps stabilize the pelvis and this contributes to scapula stabilization

Question 37

what happens with weak gluteal muscles or altered firing patterns (from SD)

Answer 37

can destabilize the pelvis, contributing to shoulder injury

Question 38

what other muscles does scapular stabilization involve?

Answer 38

lower trapezius, lower rhomboids and serratus anterior

Question 39

what muscle alters hip extension, contributing to scapular destabilization?

Answer 39

psoas major contributes to scapular destabilization and is frequently involved with shoulder (rotator cuff) injury.

Question 40

which muscles fire to decelerate the glenohumeral joint (braking mechanisms)

Answer 40

posterior shoulder muscles | especially posterior deltoid

Question 41

The presence of somatic dysfunction anywhere along the entire kinetic chain will reduce what?

Answer 41

effective force transference to the shoulder - remember the anatomy trains!! To compensate and maintain the same performance, more force will have to be generated by the shoulder, predisposing this area to overuse, breakdown and injury

Question 42

common areas associated with shoulder dysfunction?

Answer 42

``` sacrum innominates lumbar spine lat dorsi thoracolumbar junction (T10-L2) ```

Question 43

what can contribute to adrenal fatigue in overtrained athletes

Answer 43

SD of the thoracolumbar junction This is associated with altered function of the thoracolumbar fascia (latissimus dorsi muscle), psoas major muscle and diaphragm. May also see somatovisceral reflex to the adrenal glands

Question 44

what does prolonged sitting cause

Answer 44

increased kyphodic curve protracts scapula the pec mionr and biceps muscles subsequently tighten hamstring and psoas major frequently tighten NET RESULT--> rotator cuff imbalance, and greater predisposition to shoulder injury!!!

Question 45

to effectively treat shoulder problems docs may need to ....

Answer 45

combine OMM with ROM and strengthening exercises (core, scapular stabilizers and rotator cuff) to improve balance and function throughout the entire system

Question 46

what tender points are frequently seen in shoulder injuries

Answer 46

supraspinatus, subscapularis and biceps

Question 47

general steps of counterstrain

Answer 47

Locate a tender point Establish a pain scale (10 point) Find a position that reduces the discomfort by at least 70% but preferably 100%. The patient remains passive (relaxed) throughout the technique Hold the position for 90 seconds (resetting nerves, arterial, venous, lymph) Slowly return the patient to the starting position Reassess

Question 48

timing of nerve regrowth?

Answer 48

approximately 1 inch per month

Question 49

what if the shoulder problem is slow or non-responsive?

Answer 49

think of systemic problems like diabetes or hypothyroidism! The shoulder may not respond until these are under control Failure to respond to conservative treatment and/or progressive neurologic symptoms (significant or progressive muscle atrophy) are indications for further evaluation and possible surgery

Question 50

what are the stages of Spencer's technique

Answer 50

``` Extension Flexion Compression with circumduction Traction with circumduction Adduction and external rotation Abduction Internal rotation Finish: Traction with inferior glide "Joint pump" ```

Question 51

is there an MET modification in the compression with circumduction or traction with circumduction>

Answer 51

no

Question 52

. Treat the upper thoracics (and upper ribs) before addressing the upper extremity why?

Answer 52

Most problems in the upper extremity are associated with a component of upper thoracic somatic dysfunction. The sympathetic nerves innervating the upper extremity arise from the upper thoracic spine. This will reduce the amount of sympathetic tone to the upper extremity, thereby relaxing the muscles and improving arterial supply to and lymphatic and venous return from the area.