Shoulder

Question 1

3 true synovial joints of the shoulder

Answer 1

glenohumeral (GH)
sternoclavicular (SC)
acromioclavicular (AC)

Question 2

3 bones of shoulder girdle

Answer 2

clavicle, humerus, scapula (coracoid, acromion)

Question 3

2 functional joints of shoulder girdle

Answer 3

suprahumeral, scapulothoracic

Question 4

2 accessory joints of shoulder girdle

Answer 4

costosternal, costovertebral

Question 5

What level is spine of scapula at?

Answer 5

T3

Question 6

What level is the inferior border of scapula?

Answer 6

T7

Question 7

shoulder flexion

Answer 7

180 degrees

Question 8

shoulder extension

Answer 8

60 degrees

Question 9

shoulder abduction

Answer 9

180 degrees

Question 10

horizontal adduction

Answer 10

130-140 degrees

Question 11

horizontal abduction

Answer 11

40-55 degrees

Question 12

external rotation

Answer 12

90 degrees

Question 13

internal rotation

Answer 13

90 degrees

Question 14

scapula downward rotation

Answer 14

turning on A/P axis so that the scapula rotates in frontal/coronal plane to tilt the glenoid fossa downward

Question 15

scapula upward rotation

Answer 15

turning on A/P axis so that the scapula rotates in frontal/coronal plane to tilt the glenoid fossa upward

Question 16

scapula elevation

Answer 16

superior/cephalad glide in vertical direction along the frontal/coronal plane

Question 17

What muscles are involved in scapula elevation?

Answer 17

upper trapezius and levator scapula

Question 18

scapula depression

Answer 18

inferior/caudal glide in vertical direction along the frontal/coronal plane

Question 19

What muscles are involved in scapula depression?

Answer 19

lower trapezius and lower rhomboids

Question 20

scapula abduction/protraction

Answer 20

scapula moves away from the spine, combined with lateral tilt around thorax

Question 21

What muscles are involved in scapula abduction/protraction?

Answer 21

serratus anterior

Question 22

scapula adduction/retraction

Answer 22

scapula moves closer toward the spine

Question 23

What muscles are involved in scapula adduction/retraction?

Answer 23

rhomboids and middle trapezius

Question 24

scapula backward tilt

Answer 24

turning on a horizontal axis so that the posterior surface faces downward and the inferior angle is anterior

Question 25

scapula forward tilt

Answer 25

turning on a horizontal axis so that the posterior surface faces upward and the inferior angle protrudes posteriorly

Question 26

scapulothoracic treatment

Answer 26

pt lateral recumbent, involved shoulder up physician faces pt front, contacting scapula with both hands 1. assess the ease and restrictions of scapular motions. apply direct or indirect MFR. 2. reassess motion

Question 27

stages of spencer's technique

Answer 27

1. extension 2. flexion 3. compression circumduction 4. traction circumduction 5A. adduction 5B. abduction 6. internal rotation 7. traction with inferior glide

Question 28

glenohumeral joint MET flexion/extension SD

Answer 28

stabilize shoulder girdle with one hand, contact elbow with other engage restrictive barrier in flexion/extension apply MET reassess

Question 29

SC joint abduction and adduction diagnosis

Answer 29

1. pt supine; examiner index finger on clavicular head next to sternum 2. pt shrugs (abduction) 3. inferior/caudal movement should be palpated with normal motion at SC joint 4. pt lowers shoulders downward (adduction) 5. superior/cephalad movement should be palpated with normal motion at SC joint

Question 30

SC joint flexion/extension diagnosis

Answer 30

1. pt supine; examiner index finger on clavicular head next to sternum; pt flexes shoulder 90 degrees and reaches for ceiling forcefully (flexion) 2. posterior movement of clavicular head should be palpated 3. pt lowers arms back toward table (extension) 4. anterior movement of clavicular head should be palpated

Question 31

SC joint elevated adducted SD articulatory treatment

Answer 31

pt supine with neck fully flexed resting against physician's chest who is seated at head of table 1. physician thumb over sternal end of clavicle, exerting downward/caudal pressure on clavicle 2. pt instructed to inhale and exhale fully. during exhalation, the physician springs the clavicle inferiorly/caudally to release restriction.

Question 32

SC joint elevated//adducted SD MET

Answer 32

pt supine, examiner on side of affected shoulder 1. physician places one hand on sternal/proximal clavicular head. other hand grasps pt's wrist and hold arm extended and internally rotated. 2. pt is instructed to raise arm against physician's hand toward ceiling (flexion at shoulder) for 3-5 seconds, then relax. 3. bring joint into new barrier, repeating until no new barriers reached or full ROM restored

Question 33

SC horizontal extension SD MET

Answer 33

pt supine, examiner on side affected shoulder 1. physician places one hand on the restricted clavicular head and other hand placed behind axilla to cover the scapula. pt holds physician's shoulder with the hand of the affected shoulder. 2. physician then flexes the clavicle toward the manubrium until movement is palpated in the SC joint by pulling scapula anteriorly. 3. posterior force simultaneously applied to proximal clavicle from anterior to posterior to engage restrictive barrier. 4. apply MET by having pt pull shoulder down toward table.

Question 34

SC clavicle anterior and superior glide SD

Answer 34

physician on contralateral side to SD 1. pt assists in gapping the SC by adducting the opposite arm (ipsilateral to SD) Physician's ipsilateral hand placed on the table under pt's axilla to create fulcrum. 2. articulatory springing applied laterally, posteriorly, and inferiorly over medial end of clavicle using hypothenar eminence of contralateral arm.

Question 35

cross-arm adduction test

Answer 35

physician monitors the posterior aspect of the AC joint pt is instructed to start with arm flexed to 90 degrees and add adduction across body motion should gap the joint posteriorly + if pt perceives pain at AC joint and/or increased tissue texture abnormality

Question 36

AC joint IR/ER

Answer 36

pt seated, physician standing behind pt 1 one hand contacts and stabilizes clavicular side of joint with index finger over AC joint noting tenderness 2 note assymmetry 3 flex, abduct 45 degrees to maximally engage AC component of GH rotation 4 IR and ER to assess for 90 degrees motion 5 note restriction and ease of motion 6 name somatic dysfunction based on direction of ease

Question 37

AC joint AC clavicle superior SD articulatory

Answer 37

pt supine, index fingerpad monitor AC joint and other fingers on superior aspect of clavicle; other hand grasps pt forearm proximal to wrist 1. apply traction force in caudad direction to gap AC joint 2. use enough force to register a change with the monitoring hand 3. while maintaining the traction force maximally flex the arm 4. reassess

Question 38

AC joint internal rotation SD

Answer 38

pt seated, physician stands behind pt 1. physician places hand on clavicle just medial to AC joint while grasping wrist with the other hand 2. add compressive force (blocking linkage) to stabilize clavicle/AC joint while flexing, abducting (45 degree) and externally rotate to restrictive barrier 3. apply the principles of MET by having the pt internally rotate against physician's resistance for 3-5 seconds 4. repeat 3-5 times or until motion is fully restored 5. reassess

Question 39

AC joint external rotation SD MET

Answer 39

1. physician places hand on clavicle just medial to AC joint while grasping wrist with the other hand 2. add compressive force (blocking linkage) to stabilize clavicle/AC joint while flexing, abducting (45 degree) and internally rotate to restrictive barrier 3. apply the principles of MET by having the pt externally rotate against physician's resistance for 3-5 seconds 4. repeat 3-5 times or until motion is fully restored 5. reassess