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OPP exam 2 > Shoudler mechanics and counterstrain > Flashcards

Shoudler mechanics and counterstrain Flashcards

1
Q

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

A

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

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2
Q

does the shoulder motion involve just one joint or articulation?

A

NO

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

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3
Q

major motions of the shoulder? x6

A 
flexion
extension
abduction
adduction
external rotation
internal rotation
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4
Q

what is the glenohumeral joint designed for?

A

maximum motion at the expense of decreased stability

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

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5
Q

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

A

glenohumeral joint

supraspinatous

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6
Q

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

A

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

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7
Q

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

A

glenohumeral joint may have to compensate with increased motion

predisposes to instability, impingement rotator cuff tendonitis and tear

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8
Q

what type of motion is allowed at the sternoclavicular joint?

A

anteroposterior
superoinferior
rotational motion

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9
Q

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

A

to allow the scapulothoracic articulation to optimally function

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10
Q

what type of motion is allowed at the acromioclavicular joint?

A

anterior/posterior
superior / inferior
rotational (minor)

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11
Q

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

A

acromioclavicular

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12
Q

what are the primary flexors of the upper arm 3

A

deltoid
pectoralis major muscle
coracobrachialis

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13
Q

cord levels/ nerve of pec major

A

medial and lateral pectoral nerves

C5-T1

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14
Q

deltoid innervation (anterior portion)

A

axillary C5, C6

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15
Q

Coracobrachialis muscle innervation

A

musculocutaneous C5, 6, 7

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16
Q

primary extensors of the arm 4

A

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

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17
Q

innervation lat dorsi

A

thoracodorsal nerve C6,7 8

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18
Q

teres major innervation

A

C5, 6 (lower subscapular nerve)

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19
Q

deltoid muscle innervation (posterior portion)

A

C5, 6

axillary nerve

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20
Q

long head of triceps brachii muscle innervation

A

C6, C7, C8 (radial nerve)

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21
Q

primary abductors 2

A

deltoid (axillary nerve C5,6)

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

22
Q

primary adductors of upper limb 4

A

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

23
Q

primary external rotators? 3

A

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

24
Q

primary internal rotators 5

A

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

pectoralis major

lat dorsi

deltoid

teres major

25
Q

what are the 4 rotator cuff muscles

A

Supraspinatous
Infraspinatous
Teres minor
Subscapularis

26
Q

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?

A

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

27
Q

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

A

left and right subclavian arteries

28
Q

what can affect the arterial supply of the upper limb?

A

somatic dysfunction of the anterior and middle scalene muscles

upper thoracic and cervical vertebrae

upper ribs

clavicles

fascia of the neck and upper extremity

29
Q

what is the final venous drainage of the upper limb

A

subclavian
brachiocephalic

these pass ANTERIOR to the scalene muscles

30
Q

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

A

congestion in the upper extremity

it takes alot LESS SD to affect veins

31
Q

what can lead to reduced healing of the upper extremity

A

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

32
Q

what can lead to increased swelling within the upper extremity

A

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

33
Q

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

A

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

34
Q

throwing mechanics

A

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

35
Q

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

A

48 %

36
Q

what muscles inferiorly contribute to scapular stabilization and control?

A

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

37
Q

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

A

can destabilize the pelvis, contributing to shoulder injury

38
Q

what other muscles does scapular stabilization involve?

A

lower trapezius, lower rhomboids and serratus anterior

39
Q

what muscle alters hip extension, contributing to scapular destabilization?

A

psoas major

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

40
Q

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

A

posterior shoulder muscles

especially posterior deltoid

41
Q

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

A

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

42
Q

common areas associated with shoulder dysfunction?

A 
sacrum
innominates
lumbar spine
lat dorsi
thoracolumbar junction (T10-L2)
43
Q

what can contribute to adrenal fatigue in overtrained athletes

A

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

44
Q

what does prolonged sitting cause

A

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!!!

45
Q

to effectively treat shoulder problems docs may need to ….

A

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

46
Q

what tender points are frequently seen in shoulder injuries

A

supraspinatus, subscapularis and biceps

47
Q

general steps of counterstrain

A

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

48
Q

timing of nerve regrowth?

A

approximately 1 inch per month

49
Q

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

A

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

50
Q

what are the stages of Spencer’s technique

A 
Extension 
Flexion
Compression with circumduction
Traction with circumduction
Adduction and external rotation
Abduction
Internal rotation
Finish: Traction with inferior glide "Joint pump"
51
Q

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

A

no

52
Q

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

A

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.

OPP exam 2 (7 decks)

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