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Medical Exercise Specialist > Shoulder > Flashcards

Shoulder Flashcards

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USMLE® Step 1 flashcards
1
Q

What are the 4 joints of the shoulder?

A

Gleno-humeral joint (GH)
Acromio-clavicular joint (AC)-Shoulder girdle
Sterno-clavicular joint (SC)-shoulder girdle
Scapulo-thoracic joint

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2
Q

Where is the glen-humeral joint? Motion?

A

Ball and socket joint at head of humerus where it meets with the scapula (glenoid fossa). Flexion, extension, hyperextension, abduction, adduction, internal and external rotation.

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3
Q

Where is the acromio-clavicular joint (AC)? What type of joint is it? What type of motion does it provide?

A

Arthrodial joint. Articulation btw the acromium process of the scapula and the acromial end of the clavicle. On top of shoulder. Gliding motion. Elevation, depression, rotation, protraction, retraction, winging, tipping.

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4
Q

Where is the sterno-clavicular joint? What type of joint is it? Motion?

A

Arthrodial. Where the clavicle meets the sternum. Slight gliding and rotation. Elevation, depression, rotation, protraction, retraction.

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5
Q

Where is the scapulo-thoracic joint? What type of joint is it? Motion?

A

False joint. Articulation of the scapula with the thorax. Elevation, depression, upward rotation and lateral tilt, downward rotation, and medial tilt.

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6
Q

What are the 4 muscles of the rotator cuff? Where are they located?

A

Suprasinatus
Infraspinatus
Subscapularis
Teres minor

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7
Q

What are the 3 muscles of the posterior shoulder girdle? where are they located?

A

Rhomboids
Serratus anterior
Trapezius

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8
Q

What is the location and function of the suprasinatus?

A

Abduction of GH joint, GH joint stability

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9
Q

What is the location and function of the infrapsinatus?

A

External rotation and extension of GH joint, GH joint stability

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10
Q

What is the location and function of the subscapularis?

A

Internal rotation of GH joint, GH joint stability (most important)

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11
Q

What is the location and function of the teres minor?

A

External rotation, extension, and adduction of GH joint, GH joint stability

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12
Q

What is the location and function of the serratus anterior?

A

Protraction of scapula. Keeps scapula along rib cage during movement.

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13
Q

Rhomboids function and location?

A

Between scapula on vertebral border. Retraction, Elevation and internal rotation of scapula.
Scapula stability-aducts-MES

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14
Q

Trapezius location and function?

A

Retraction, superior rotation, elevation and depression of scapula

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15
Q

Pectoralis major and minor function?

A

Major-Flexion, adduction, and internal rotation of GH joint

Minor-downward rotation os scapula

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16
Q

Deltoid funciton

A

Abduction of the arm; flexion and internal rotation via the anterior fibers; external rotation and extension via posterior fibers

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17
Q

Biceps function

A

Flexion of the elbow joint; supination of forearm; abduction and internal rotation of humerus

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18
Q

Triceps function

A

Extension of elbow, extension and adduction of GH joint

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19
Q

What can be a problem with the coraco-acromial ligament?

A

It is in the subacromial space and limits movement of humeral head, and can become thicken and inflamed, restricts motion. Frozen shoulder.

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20
Q

What is the subacromial bursa?

A

A fluid filled sac inside the subacromial space

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21
Q

What is the ligament group that forms the Z shape? What do they do?

A

Glen-humeral ligaments (superior, middle, inferior). Prevents humeral head from dislocating anteriorly. Inferior vitally important, if damaged, will make joint unstable for life.

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22
Q

Which ligament is very strong with calcium deposits in it, which allows very little movement?

A

Sterno-clavicular ligament

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23
Q

What should you ask if someone can sleep on their shoulder at night?

A

BC if they can’t, their joint capsule is probably inflamed. The inflammation of the synovial membrane will distend the capsule making it painful.

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24
Q

What collectively does the rotator cuff do when lifting OH?

A

Pulls humeral head down into glenoid fossa.

25
Q

How many degrees of freedom does the shoulder have?

A

3

26
Q

What muscles are part of the C5 myotome?

A

Deltoids

27
Q

What cutaneous area is part of the C6 dermatome?

A

the thumb and part of the forearm

28
Q

What structures are found in the subacromial space?

A

supraspinatus tendon, subacromial bursa, rotator cuff tendon, and joint capsule

29
Q

Describe the relationship of the deltoid to rotator cuff with impingement syndrome.

A

The delts want to pull the humeral head up, and the rotator cuff are suppose to counter balance that, pulling it into the glenoid fossa to keep it from riding up. If the rotator cuff is weak, then the delt will shrink the sub-acromial space.

30
Q

Explain the importance and precautions with the pendulum exercise.

A

Sub-acromial distraction

31
Q

Explain and describe the pathology associated with shoulder impingement.

A
  • diminished sub-acromial space
  • inflammation of supraspinatus tendon/rotator cuff
  • Rotator cuff weakness
  • parascapular muscle weakness
32
Q

List the MET criteria for shoulder impingement. (6)

A
  1. Full shoulder ROM
  2. Fair OH shoulder strength
  3. Minimal pain w/OH activities
  4. No radiating pain
  5. Clearance from MD
  6. Discharged from PT
33
Q

Describe the “pain scale” and when it should be used.

A

1->10 scale
1-3 within acceptable limits
4-6 questionable
7-10 unacceptable

34
Q

List the key assessment techniques for shoulder impingement. (5)

A
  • rotator cuff strength
  • ROM-painful arc
  • Para-scapular strength
  • differentiate bicipital tendonitis and/or AC joint involvement-speed’s test and crossover
  • assess pain using pain scale
35
Q

Describe the “painful arc” and the signs indicating shoulder impingement.

A

The painful arc test is having the client abduct or flex the shoulder and noting if they have pain anywhere in the arc. If it is between 60-120 degrees-then it is GH impingement. If there is pain above 150 degrees, then the AC joint is involved.

36
Q

List the condition with similar symptoms to shoulder impingement.

A

Bicipital tendonitis

37
Q

List the three keys to MET management of shoulder impingement.

A
  • open the subacromial space
  • strengthen the rotator cuff
  • strengthen the parascapular muscles
38
Q

List the MET precautions for shoulder impingement. (4)

A
  • avoid OH activities
  • avoid deltoid and pec work initially
  • check sleep status
  • beware of bicipital tendonitis/AC involvement
39
Q

List and describe the importance and appropriate use of the shoulder assessment procedures. (5)

A

-Painful Arc-Gleno-humeral impingement (pain btw 60-120 degrees), and AC joint
involvement (pain above 150 degrees)
-Speed’s Test -bicipital tendonitis
-Horizontal Adduction-AC joint problems
-Apprehension Sign-Gleno-humeral tendon damage
-Adson’s and Allen’s Test -thoracic outlet

40
Q

Explain the importance and precautions with the pendulum exercise.

A

Sub-acromial distraction. To increase subacromial space. Beware if they have a rotator cuff tear. Keep weight light and do often.

41
Q

List three key exercises for shoulder impingement.

A
  • Pendulum
  • Int/ext rubber tubing
  • Rowing
42
Q

Describe the layers of the rotator cuff and their relationship to cuff tears.

A

Superficial tears (partial thickness tear) are painful but functional

Full thickness tear is painless but dysfunctional

43
Q

List MET criteria for rotator cuff tear. (6)

A
  • Full shoulder ROM
  • Minimal pain (<4)
  • no radiating pain
  • fair OH strength
  • medical clearance
  • discharged from PT
44
Q

List the keys to MET management of the rotator cuff tear. (5)

A
  • limit further damage
  • manage pain
  • avoid OH activity
  • strengthen rotator cuff
  • strengthen and stabilize scapula
45
Q

Describe and explain the use of the ‘coupled training-1:2” concept with shoulder conditions.

A

For every one exercise of the big muscle groups like deltoids and pecs, you do 2 of the rotator cuff and parascapula muscles

46
Q

List the three key exercises when managing rotator cuff tear.

A

Seated push up
Int/ext rubber tubing
Rowing

47
Q

Describe the symptoms associated with bicipital tendonitis.

A

Pain in anterior shoulder, very similar to impingement

-shoulder instability

48
Q

List the MET criteria for bicipital tendonitis. (4)

A
  • full shoulder ROM
  • minimal pain (<4)
  • medical clearance
  • no radiating pain
49
Q

List he three key exercises for MET management of bicipital tendonitis.

A
  • scapular strength/stability exercise
  • int/ext rubber tubing
  • caution w/bicep curls
50
Q

Describe the difference between frozen shoulder and adhesive capsulitis.

A

Frozen shoulder happens out of the blue and has to run it’s course

Adhesive capsulitis is the result of trauma.

51
Q

List the MET criteria for frozen shoulder. (5)

A
  • initiate shoulder elevation
  • minimal pain (<4)
  • no radiating pain
  • discharged from PT
  • medical clearance
52
Q

List the three key exercises when managing frozen shoulder.

A
  • stretching-pulleys/pendulum
  • int/ext rubber tubing
  • scap strengthening
53
Q

List the MET criteria for shoulder dislocation. (6)

A
  • minimal pain
  • fair OH strength
  • no radiating pain
  • medical clearance
  • discharged from PT
  • no longer using immobilizer
54
Q

Describe the ‘apprehension sign’ when managing shoulder dislocation.

A

When you take their arm back and externally rotate, they feel like it is going to dislocate again

55
Q

List he three keys to MET management of shoulder dislocation.

A
  • strengthen pecs and anterior shoulder girdle
  • improve shoulder stability thru ROM
  • emphasize functional strengthening
56
Q

List the three key exercises for shoulder dislocation.

A
  • Rotator cuff internal and external rotation with bands
  • Push ups at different angles
  • Chest press and flys with limited ROM
57
Q

List the MET criteria for the TSR. (6)

A
  • clearance from operating surgeon
  • 10 weeks post-op
  • minimal pain
  • 90 degrees of shoulder elevation
  • independent scapular movement
  • no open wounds
58
Q

List the three keys to MET management of TSR.

A
  • improve shoulder and scapular ROM
  • improve shoulder and scapular strength
  • improve rotator cuff strength
59
Q

List he three key exercises for MET management of the TSR.

A
  • seated push ups to chest press
  • int/ext rubber tubing
  • shoulder and w/tubing to lateral raise

Medical Exercise Specialist (9 decks)

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