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clin kines 2 > shoulder > Flashcards

shoulder Flashcards

1
Q

The shoulder complex is made up of what 5 structures?

A

Sternum
Clavicle
Ribs
Scapula
Humerus

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2
Q

What is the shoulder trade-off?

A

Great ROM
Unstable joint (bc shape)

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3
Q

Ant surface of clavicle is convex ___ and concave ___

A

Medially
Laterally

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4
Q

How is the clavicle oriented anatomically?

A

Slightly above horizontal plane and ~20 degrees posterior to frontal plane

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5
Q

Angles of scapula (3)?

A

Superior, inferior, lateral

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6
Q

Borders of scapula (3)?

A

Superior, lateral, medial

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7
Q

What is the scapular plane?

A

Scapula angled superiorly ~4 degrees (horizontal plane) and anteriorly 35 degrees (frontal plane)

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8
Q

What is retroversion of head of humerus?

A

Rotated posteriorly ~30 degrees w/in horizontal plane

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9
Q

Do we normally have 65 degrees of humeral retroversion?

A

No, it de-rotates as age (~16-20 y.o.)

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10
Q

What musc attaches to lesser tubercle?

A

Subscapularis

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11
Q

What musc attaches to greater tubercle?

A

Upper facet: supraspinatus
Middle: infraspinatus
Lower: teres minor

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12
Q

What musc attaches to bicipital groove?

A

Long head tendon of biceps brachii (and latissimus dorsi at floor)

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13
Q

Which joint is a true joint?

A

SC (sternoclavicular) joint

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14
Q

What type of joint is the SC?

A

Saddle (concave and convex surfaces)

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15
Q

What musc add stability to the SC joint?

A

Ant: SCM
Post: sternohyoid and sternothyoid
Inf: subclavius

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16
Q

What tissues stabilize the SC joint?

A

Ant and post sternoclavicular lig
Interclavicular lig
Costoclavicular lig
Articular disc

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17
Q

T/F: the ligaments that stabilize the SC joint through all motions

A

F: except downward depression

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18
Q

Mvt of clavicle

A

Elev/dep
Prot/Ret
Ant/post rot

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19
Q

Elev/dep of SC occur in which plane?

A

Frontal (parallel) (ant, post axis of rot)

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20
Q

___ degrees of elev and ___ degrees of dep

A

35-45
10

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21
Q

Elevation of SC roll and glide

A

Roll sup
Glide inf

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22
Q

Depression of SC roll and glide

A

Roll inf
Glide sup

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23
Q

Pro/ret of SC occur in which plane?

A

Horiz (vertical axis of rot)

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24
Q

T/F: there is ~15-30 degrees of port/ret

A

T

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25
Q

Retraction concave on convex sternum results in

A

Roll and glide post

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26
Q

T/F: protraction of SC roll and glide post

A

F: roll and glide ant

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27
Q

Axial rot of clavicle rotates ___ 20-35 degrees

A

Post

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28
Q

Closed pack pos of clavicle

A

Full post rot (elevation)

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29
Q

Loose pack pos of clavicle

A

Arm at side

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30
Q

SC joint saddle joint: ant and post indicates___, while sup and inf indicates PIC

A

Concave
Convex

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31
Q

Coracoclavicular lig is made up of

A

Trapezoid (sup, lat) and conoid ligs

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32
Q

Tissues that support AC joint

A

Sup and inf acromioclavicular lig
Coracoclavicular lig
Articular disc
Deltoid and upper trap

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33
Q

MVT AC joint

A

Upward/downward rot
Rotational adjustment mvts

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34
Q

Up/downward rot of AC occurs in which plane?

A

Frontal

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35
Q

T/F: there is 30 degrees of upward rotation at the SC joint as the arm is fully raised above head

A

F: AC

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36
Q

Rotational adjustment mvt of AC occur in which plane?

A

Horiz

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37
Q

Horizontal plane adjusting of AC joint is also known

A

IR/ER (vertical axis)

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38
Q

Sagittal plane adjusting of AC joint is also known

A

Ant and post tilting (med lat axis)

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39
Q

What is the closed pack pos of AC joint?

A

Full upward rot

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40
Q

T/F: clavicle facet faces down and laterally, while acromion facet faces up and medially

A

T

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41
Q

Scapula and thorax are separated by

A

Subscapularis
Serratus ant
Erector spine

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42
Q

Resting posture of scapula is

A

10 degrees of ant tilt
5-10 degrees of upward rot
35 degrees of IR

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43
Q

ST mvt is a cooperation between which joints?

A

SC & AC

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44
Q

Neutral scapula position

A

Between ribs #2-7
6 cm away from spine
Slight ant tilt and upward rot

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45
Q

ST joint mvt

A

Elev/dep
Prot/ret
Up/downward rot

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46
Q

ST elev is a combination of ___ @ SC & ___ @ AC

A

Elev
Downward rot

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47
Q

ST protraction is a combination of ___ @ SC & ___ @ AC

A

Protraction
Slight IR

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48
Q

T/F: decreasing motion at AC will compensate by increasing motion at SC?

A

T

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49
Q

ST upward rot combination of ___ @ SC & ___ @ AC

A

Elev
Upward rot

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50
Q

30 degrees of the 60 degrees of upward rot at the ST joint results from

A

Upward rot of AC
Elev of clavicle?

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51
Q

What is the importance of full upward rotation of ST during elev?

A
  1. preserve Subacromial space
  2. maximal stability to support humerus by positioning glenoid fossa advantageously during elev
  3. maximal length tension rel of deltoid and supraspinatus (active insufficiency= musc shorten, weak position)
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52
Q

T/F: raising the arm overhead is called flexion when it is near the frontal/scapular plane

A

F: ABD
(flex= sagittal)

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53
Q

How is the articular surface of the glenoid fossa oriented in anatomical pos?

A

Ant-lat in scapular plane (sup)

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54
Q

In anatomical pos how is the humeral head pos?

A

Sup, med and post (retroversion) in scapular plane

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55
Q

T/F: in anatomical pos/ ADD pos, inferior portion of GH capsule (axillary pouch) appears taut (stretch)

A

F: ABD

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56
Q

What structures stabilize GH?

A

Passive: capsular lig
Active: rotator cuff musc, long head biceps tendon
Glenoid Labrum
ST posture (static stability)

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57
Q

What are the passive stabilizers of GH?

A

Everything except musc

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58
Q

What are the active stabilizers of GH?

A

Musc

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59
Q

T/F: GH is unstable bc rotator cuff musc insert into capsule?

A

F: stable

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60
Q

T/F: capsular lig and musc provide stability when stretched at extreme motions

A

F: musc prod stability at any joint position

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61
Q

T/F: long head biceps tendon = dynamic stabilizer of GH bc maint articular stability during active motions

A

F: rotator cuff musc

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62
Q

Sup GH capsular lig restricts?

A

Inf and ant translation
ER
ADD

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63
Q

What happens to the sup capsular lig when the GH joint is ABD beyond 35-45 degrees?

A

Slackens

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64
Q

Middle GH capsular lig restricts?

A

Ant translation
ER

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65
Q

Inf GH capsular lig restricts?

A

ABD

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66
Q

What happens to the inf capsular lig when the GH joint is ABD 90 degrees?

A

Taut (stretch, tight)

67
Q

What are the 3 parts of the Inf GH capsular lig?

A

Anterior band
Axillary pouch
Posterior band

68
Q

T/F: post band restricts/tenses during ER, ABD

A

F: IR

69
Q

T/F: Coracohumeral is taut during ABD and stretches during ADD, and restricts inf translation

A

F: taut ADD, stretch ABD, restricts ER

70
Q

T/F: glenoid labrum deepens fossa by 30%?

A

F: 20%

71
Q

What does the glenoid labrum act like?

A

Suction cup (joint fluid provides stability)

72
Q

When the scapula loses upward rot and capsular lig stretches, what happens to humerus?

A

Slides down

73
Q

T/F: the height of the Subacromial space is about 2 cm when the arm is at the side

A

F: 1 cm

74
Q

What structures are under the Subacromial arch?

A

Superior capsule
Supraspinatus
Long head Biceps brachii tendon
Subacromial bursa

75
Q

What are the bursae around the shoulder?

A

Subacromial bursa
Subdeltoid bursa

76
Q

Closed pack pos of GH

A

Full flex, ABD, ER
Full ext, ADD, IR

77
Q

Loose pack pos of GH

A

30-30-10
ABD, flex, ER

78
Q

Mvt at GH joint

A

Flex/ext
ABD/ADD
IR/ER
(Horizontal) ABD/ADD

79
Q

GH ABD/ADD occur in which plane?

A

Frontal (ap axis)

80
Q

T/F: normal person has ~120 degrees of ABD at GH

A

T

81
Q

T/F: full ABD of shoulder complex requires 60 degrees of downward rot of scapula

A

F: upward rot

82
Q

GH ABD roll and glide

A

Roll sup
Glide inf

83
Q

T/F: Supraspinatus can pull sup capsule taut, thus pinching between the humeral head and undersurface of acromion

A

F: protects from pinch

84
Q

GH flex/ext occur in which plane?

A

Sagittal (ml axis)

85
Q

T/F: 180 degrees of flexion available at GH

A

F: 120
180 degrees includes upward rot of ST

86
Q

Full ext of shoulder occurs to a pos of ___ degrees actively and ___ degrees passively behind the frontal plane

A

65
80

87
Q

Flexion in respect to coracoacromial arch rolls ___ and glides ___

A

Anterior
Posterior

88
Q

GH IR/ER (axial rot of humerus) occurs in what plane?

A

Horizontal (vertical axis)

89
Q

GH ER: humeral head rolls ___ and glides ___

A

Post
Ant

90
Q

When GH ER, Infraspinatus ___ while Subscapularis ___ resulting in co-cxn (dynamic stability)

A

Contracts (concentric)
Stretches (eccentric)

91
Q

IMPORTANT YO

A
92
Q

Scapulohumeral rhythm (2:1) states that

A

For every 3 degrees shoulder ABD, 2 degrees occur by GH ABD and 1 degree from ST upward rot

93
Q

1st kinematic principle states of shoulder ABD that

A

Bc 2:1 scapulohumeral rhythm, full arc of 180 degrees of ABD results from 120 degrees GH ABD and 60 degrees of ST upward rot

94
Q

2nd kinematic principle of ABD states that

A

60 degrees of upward rot of scapula during full shoulder ABD, results from elev clavicle at SC and upward rot of scapula at AC

95
Q

3rd kinematic principle of ABD states that

A

Clavicle retracts at SC during full shoulder ABD

96
Q

T/F: clavicle retracts greater distance during shoulder ABD in horizontal plane than during ABD in scapular plane or w/ flexion

A

F: frontal plane

97
Q

4th kinematic principle of ABD states that

A

As shoulder reaches full ABD, upwardly rotating scapula post tilts and slightly ER

98
Q

5th kinematic principle of ABD states that

A

Clavicle rotates posteriorly along own axis

99
Q

6th kinematic principle of ABD states that

A

Humerus ER during shoulder ABD

100
Q

In order to perform complete frontal plane ABD, what does the humerus need to do?

A

ER (to avoid hitting acromion)

101
Q

T/F: Brachial plexus = ventral rami C8-T1

A

F: C5-T1

102
Q

How to remember brachial plexus?

A

Real–> root
Therapists–> trunk
Drink–> divisions
Cold–> cord
Beer–> branches

103
Q

Nerve roots C5-6 forms ___ trunk

A

Upper

104
Q

T/F: nerve root C7 forms middle trunk

A

T

105
Q

Nerve roots C8 and T1 forms ___ trunk

A

Lower

106
Q

T/F: ant divisions of upper and middle trunk form the lateral cord

A

T

107
Q

T/F: all ant divisions of the trunks form the posterior cord

A

F: all post divisions form cord

108
Q

Lateral cord forms ___ and ___ nerves

A

Musculocutaneous
Median (other half = medial cord)

109
Q

Post cord forms which 5 nerves

A

Subscapular (upper and lower)
Thoracodorsal
Axillary
Radial

110
Q

Medial cord forms median and ___ nerve

A

Ulnar

111
Q

What 2 regions of brachial plexus innervate shoulder complex?

A

Post cord
Prox segments: dorsal scapular, long thoracic, pectoral and suprascapular n

112
Q

SC joint receives afferent innervation by __ and __ nerve roots from ___ plexus

A

C3 & C4
Cervical

113
Q

AC and GH joints receives afferent innervation by __ and __ nerve roots via ___ and ___ nerves

A

C5 & C6
Suprascapular
Axillary

114
Q

T/F: proximal stabilizers are musc that originate on scapula and clavicle, insert on humerus or forearm

A

F: distal mobilizers
(prox= musc originate on spine, ribs, cranium and insert on scapula and clavicle)

115
Q

Examples of proximal stabilizers

A

Trapezius
Serratus ant

116
Q

Examples of distal mobilizers

A

Deltoids
Biceps brachii

117
Q

What are the ST elevator musc that support the shoulder girdle?

A

Upper trapezius
Levator scapulae
Rhomboids

118
Q

A depressed clavicle results in __ dislocation at __ joint

A

Superior
SC

119
Q

Depressors of ST joint

A

Lower trapezius
Latissimus dorsi
Pectoralis minor
Subclavius

120
Q

T/F: subclavius stabilizes SC joint

A

T

121
Q

Protractors of ST joint

A

Serratus ant

122
Q

Retractors of ST joint

A

Middle trapezius
Rhomboids
Lower trapezius

123
Q

Upward rotators of ST joint

A

Serratus ant
Upper and lower trapezius

124
Q

Downward rotators of ST joint

A

Rhomboids
Pectoralis minor

125
Q

GH joint musc that elevate arm

A

ABD: ant and middle deltoid, Supraspinatus

Flex: ant deltoid, Coracobrachialis, Biceps brachii

126
Q

T/F: when deltoids are paralyzed, Supraspinatus is capable of fully ABD GH

A

T

127
Q

T/F: when Supraspinatus is paralyzed, still able to fully ABD

A

F: difficult but still achievable

128
Q

When both deltoid and Supraspinatus are paralyzed, is full ABD still possible?

A

No

129
Q

What is Infraspinatus and Subscapularis role in GH ABD?

A

Have a limited potential to generate ABD torque, this occurs bc upper fibers pass slightly superiorly to ant-post AoR

130
Q

ST joint musc that elevate arm

A

Upward rot: serrates ant and trapezius (upper and lower fibers)

131
Q

Serratus ant pulls on inferior angle of scapula and rotates the glenoid fossa ___ and ___ during upward rot of scap

A

Upward
Laterally

132
Q

Upper trapezius upwardly rotates scap indirectly through ___ and ___ pull on clavicle during upward rot of scap

A

Superior
Medial

133
Q

Lower trapezius upwardly rotates the scap by inf and medial pull on ___ of the scapula

A

Spine

134
Q

During full ABD of shoulder, thoracic spine naturally extends _____ degrees

A

10-15

135
Q

Paralyzed trapezius = very difficult/unachievable to

A

Elevate arm in frontal plane (ABD) bc middle trapezius= required to generate strong retraction force on scap

136
Q

T/F: paralysis of serrates ant = great difficulty actively elevating arm above the head in frontal plane

A

F: regardless of plane of motion

137
Q

Supraspinatus drives the ___ roll of humeral head, while ITS musc drive ___ roll of humeral head during elevation of arm

A

Superior
Inferior

138
Q

Traumatic dislocations occur in the ___ direction due to fall or forceful collision

A

Ant

139
Q

Ant dislocation involves motion/position of

A

ABD, extreme ER

140
Q

Ant dislocation often injures/overstretches which structures?

A

Rotator cuff musc
Middle and inf GH lig
Ant-inf portion of glenoid labrum

141
Q

What is a Bankart lesion?

A

Part of capsule/labrum that detaches from glenoid fossa

142
Q

T/F: posttraumatic dislocation don’t lead to future reoccurrence

A

F: leads to future reoccurrence

143
Q

Atraumatic instability is when

A

Excessive ligamentous laxity

144
Q

T/F: atraumatic instability is congenital

A

T (hereditary)

145
Q

Acquired shoulder instability occurs in

A

Sports (high-velocity motions: extreme ER, ABD)

146
Q

T/F: Subscapularis is the most used musc in shoulder complex

A

F: Supraspinatus

147
Q

The Supraspinatus has an internal moment arm for shoulder ABD of about

A

2.5 cm (1 in)

148
Q

When injure/tear Supraspinatus, you should hold obj close to you. Why?

A

To minimize force demand of musc (red external moment arm of load)

149
Q

What predisposes Supraspinatus to degenerate?

A

Poor mechanical advantage
Small cross sectional area
Proximity to acromion
Compromised blood supply

150
Q

1:20 Supraspinatus ratio meaning

A

Ratio of internal moment arm of musc to external moment arm of load

Supraspinatus needs to generate force 20x greater than load

151
Q

What are the primary ADD and ext musc of shoulder?

A

Post deltoid
Latissimus dorsi
Teres major
Long head of triceps
Sternocostal head of pec maj

152
Q

T/F: ABD and flexors are generate the largest torque of any musc group in shoulder

A

F: ADD and extensors

153
Q

Which muscles have the largest moment arms for ADD and extension?

A

Latissimus dorsi
Terms major
Pectoralis major

154
Q

When we fully extend shoulder beyond neutral, it is associated w/ ant tilting. What musc primarily drives this?

A

Pectoralis minor

155
Q

T/F: none of the rotator cuff musc are activated during shoulder ADD and ext

A

F: all rotator cuff musc activated

156
Q

What is the rhomboids role in ADD and ext?

A

Actively downward rot/prevent upward rot

157
Q

What are the shoulder IR musc?

A

Subscapularis
Pec maj
Latissimus dorsi
Teres major
Ant deltoid

158
Q

Which musc has the greatest moment arm for IR? Least

A

Subscapularis
Ant deltoid

159
Q

When the scapula is fixed but the humerus moves we get a __ rel

A

Convex on concave (roll and glide oppo)

160
Q

When the thorax moves and the humerus is fixed, we get a ___ rel

A

Concave on convex (roll and glide same)

161
Q

What are the shoulder ER musc?

A

Infraspinatus
Teres minor
Posterior deltoid

162
Q

What musc assists w/ ER provided at GH between neutral and full ER?

A

Supraspinatus

163
Q

T/F: ext>flex, ADD>ADD, IR>ER

A

T

164
Q

Factors assoc w/ subacromial impingement

A

Abnormal GH kinematics (humerus/scap)
Poor posture (pos of scap)
Poor motor control
Adhesive capsulitis. instability, tight pos
capsule
Swelling, joint osteocytes, abnormal
acromion

clin kines 2 (6 decks)

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