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Kinesio > Shoulder Biomechanics > Flashcards

Shoulder Biomechanics Flashcards

1
Q

How many degrees of freedom does the shoulder have

A

3… Can argue 4 (Horizontal ADD/ABD)

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2
Q

Which ways does the UE elevate (3)

A
  1. Flexion
  2. Abduction
  3. Scaption
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3
Q

What are the 7 motions of the UE

A
  1. Elevation
  2. ER
  3. IR
  4. Extension
  5. Adduction
  6. H ADD
  7. H ABD
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4
Q

What is the amount of elevation of the UE

A

170-180

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5
Q

What plane and axis does scaption occur in

A

Plane of the scapula and perpendicular axis

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6
Q

What is the angle for the POS

A

30 degrees anterior to coronal plane

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7
Q

What is ER at base of UE

A

40-60

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8
Q

What is ER at 90 ABD

A

90-100

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9
Q

What is IR at 90 ABD

A

45-60

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10
Q

What motions occur with FIR (3)

A

IR, Ext, ADD

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11
Q

What motions occur with FER (3)

A

ER, Flx, ABD

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12
Q

What is normal FIR

A

Spinous process T5

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13
Q

What is normal FER

A

Spinous process T3

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14
Q

What is horizontal ABD of UE

A

120-140

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15
Q

What is horizontal ADD of UE

A

40-60

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16
Q

What is extension of the UE

A

60-80

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17
Q

What position does the long head prevent the most motion

A

Elbow extension and pronation

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18
Q

What are the 4 joints of the shoulder

A
  1. GH
  2. ST
  3. AC
  4. SC
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19
Q

Where is the superior angle located in relation to spine

A

T2

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20
Q

Where is the inferior angle located in relation to spine

A

T7

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21
Q

What is the distance between spine of scapula and T3

A

2”

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22
Q

What is normal upward rotation of scapula at rest

A

3-5 degrees

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23
Q

Which rotation of the scapula is pathologic

A

Downward rotation

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24
Q

Upward rotation promotes what

A

Inferior stability

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25
Q

What happens with a downward rotated shoulder

A

Adaptive lengthening

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26
Q

What ligaments are adaptively lengthened with downward rotated shoulder (2)

A
  1. Superior GH

2. Coracohumeral

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27
Q

What is scapular dumping

A

Humeral head out of glenoid

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28
Q

What become tension loaded during scapular dumping (2)

A
  1. Superior GH

2. Coracohumeral

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29
Q

What does scapular dumping potentially cause

A

False positive sulcus test

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30
Q

What is the surgery for inferior instability

A

Vest over pants

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31
Q

What does AMBRI stand for

A

Atraumatic Multidirectional Bilateral Rehabilitation and rarely requires Inferior capsular shift

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32
Q

What does TUBS stand for

A

Traumatic Unilateral with Bankart lesion requires Surgery

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33
Q

What position normally causes scapular dumping

A

Kyphotic psture

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34
Q

What is the anterior tilt of the scapula

A

9-20

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35
Q

What is another name for anterior tilt

A

Anteflexion

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36
Q

Does the anterior tilt of scapula increase or decrease with age

A

Increase

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37
Q

What does exaggerated thoracic kyphosis and/or an abnormally elevated scapula cause

A

Increased anterior tilt of scapula

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38
Q

How big is the subacromial space

A

5 dimes

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39
Q

What 3 things are housed in the subacromial space

A
  1. RC muscles
  2. Long head of biceps
  3. Subacromial bursa
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40
Q

What type of impingement occurs at the subacromial space

A

External

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41
Q

How does anterior tilting effect impingement

A

Increases the chances of impingement

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42
Q

Where does internal impingement occur

A

Between humeral head and glenoid (posterior side)

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43
Q

What is the scapulo-clavicular angle at rest

A

50 degrees

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44
Q

What is the clavicular retraction angle at rest

A

20 degrees

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45
Q

What is the purpose of the scapula

A

Position the glenoid to allow optimal motion

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46
Q

What are the 5 motions of the scapulothoracic joint

A
  1. Elevation/Depression
  2. Protraction/Retraction
  3. Upward/Downward rotation
  4. Anterior/Posterior tilting
  5. Medial/Lateral rotation
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47
Q

Do the motions of the scapulothoracic joint occur separate

A

No, they occur together

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48
Q

What occurs with scapular elevation

A

Clavicular elevation and anterior tilt of scapula

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49
Q

What occurs with scapular depression

A

Clavicular depression and posterior tilt of scapula

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50
Q

What occurs with scapular protraction

A

Clavicular protraction and medial rotation of the scapula

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51
Q

What occurs with scapular retraction

A

Clavicular retraction and lateral rotation of the scapula

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52
Q

What axis does sagittal plane motion occur about in the scapula

A

M-L axis at the AC joint

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53
Q

What axis does rotary motion occur about in the scapula

A

Vertical axis in region of AC joint

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54
Q

What does scapular winging result in

A

Posterior displacement of the medial border of the scapula

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55
Q

What causes scapula winging

A

Pathology of the serratus anterior

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56
Q

What causes pathology to the serratus anterior most commonly

A

Long thoracic nerve palsy

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57
Q

What clavicular motion occurs with upward rotation of the scapula

A

Elevation of the clavicle

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58
Q

What clavicular motion occurs with downward rotation of the scapula

A

Depression of the clavicle

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59
Q

What is the normal configuration of the AC joint

A

Convex clavicle and concave acromion

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60
Q

What type of joint is the AC joint

A

Synovial joint with fibrocartilage disc

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61
Q

What scapular motions occur with UE elevation

A

Elevation, anterior tilting, upward rotation, protraction, and medial rotation

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62
Q

What are the rotary scapular motions (3)

A
  1. Anterior/Posterior tilting
  2. Medial/Lateral rotation
  3. Upward/Downward rotation
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63
Q

What type of joint is the SC joint

A

Synovial joint with articular disc

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64
Q

What SC joints movements occur with scapular motion (3)

A
  1. Elevation/Depression
  2. Protraction/Retraction
  3. Posterior/Anterior tilting
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65
Q

What is the configuration of the clavicle and sternum in the frontal plane

A

Convex clavicle on concave sternum

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66
Q

What is the configuration of the clavicle and sternum in the sagittal plane

A

Concave clavicle on convex sternum

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67
Q

What 2 motions are you most likely to have trouble with at the sternoclavicular joint

A

Elevation and retraction

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68
Q

What is the amount of elevation at the SC joint

A

45

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69
Q

What is the amount of depression at the SC joint

A

15

70
Q

What is the amount of elevation at the SC joint from full depression

A

60

71
Q

What is the amount of protraction and retraction at the SC joint

A

15

72
Q

Rotation of the clavicle occurs about what type of axis

A

Longitudinal axis

73
Q

What type of clavicular motion occurs with scapular upward rotation

A

Posterior rotation and elevation

74
Q

When does the posterior rotation of the clavicle occur during scapular upward rotation

A

After 30 degrees of elevation of outer clavicle

75
Q

What is the max rotation of the clavicle

A

30-55

76
Q

Is the anterior rotation of the clavicle

A

Not from anatomical neutral

77
Q

GH joint analogy

A

GH joint = golf ball on a tee

78
Q

What is the max amount of the humeral head that is in contact with glenoid

A

1/3

79
Q

What is the shape of the glenoid fossa

A

Pear shaped

80
Q

Where does the glenoid have greater concavity and dimension

A

Superior to inferior

81
Q

Most common to least common dislocation of shoulder (3)

A
  1. Anterior
  2. Posterior
  3. Inferior
82
Q

Why are anterior and posterior dislocations more common than inferior dislocations

A

Due to decreased concavity of glenoid anterior to posterior

83
Q

What is the angle of inclination of the humeral head

A

130-150

84
Q

Which way does the humeral head face

A

Medially, superiorly, and posteriorly

85
Q

Which way does the glenoid fossa face

A

Laterally, superiorly, and anteriorly

86
Q

Is the glenoid and humeral head a perfect match

A

No 2/3 are perfect

87
Q

What is GH ER at base

A

40-60`

88
Q

What is GH ER at 90

A

90-100

89
Q

What is GH IR at 90

A

45-60

90
Q

What amount of elevation is the GH responsible for

A

0-120

91
Q

Does the glenohumeral elevate the UE

A

No it is entire shoulder complex and scapulothoracic joint

92
Q

For full UE elevation to occur what must happen

A

ER of humerus

93
Q

What does ER of humerus do during UE elevation (2)

A
  1. Prevents impingement of greater tuberosity against acromion
  2. Provides greater humeral head articulating surface
94
Q

What is the amount of glide with any UE motion

A

2mm

95
Q

What is scapulohumeral rhythm

A

Humerus and scapula working together to provide smooth motion of UE

96
Q

what is the ratio of humeral motion to scapular motion

A

2:1

97
Q

What is it called when the scapula doesn’t move properly

A

Scapulodiskinesis

98
Q

What does scapulohumeral rhythm allow for (3)

A
  1. Increase elevation ROM
  2. Inferior stability of the GH joint
  3. Maintain optimal length tension relationship for scapulohumeral musculature
99
Q

How much flexion or scaption makes up phase 1A of UE elevation

A

Scaption: 0-30
Flexion: 0-60

100
Q

True or False:

The motion during phase 1A is predominantly GH motion

A

True

101
Q

Where is the axis of rotation during phase 1A

A

Medial part of scapular spine

102
Q

How much flexion or scaption occur during phase 1B UE elevation

A

Flexion: 60-90
Scaption: 30-90

103
Q

True or False:

In phase 1B there is consistent upward scapular rotation

A

True

104
Q

Where is the axis of rotation during phase 1B

A

Line connecting root of the spine of scapula and SC joint

105
Q

During phase 2A of UE elevation how much flexion and scaption occur

A

90-120

106
Q

What happens to clavicular elevation during phase 2A

A

It tension loads costoclavicular ligaments

107
Q

What is the limit of costoclavicular ligament elevation

A

30

108
Q

As the clavicle elevation slows what happens to the axis of rotation

A

Shifts to the AC joint

109
Q

How much flexion and scaption occur during phase 2B of UE elevation

A

120-end rang

110
Q

Where is the axis of rotation during phase 2B

A

The AC joint

111
Q

During phase 2B what is scapular upward rotation accompanied by

A

Coracoid depression

112
Q

Why is scapular upward depression accompanied by coracoid depression

A

Anterior tilting of scapula

113
Q

What does the depression of the coracoid process cause

A

Tension load to coracoclavicular ligaments

114
Q

What does the tension of the coracoclavicular ligament do to the clavicle

A

Imparts a downward force on the posterior clavicle through conoid ligament

115
Q

What does the downward force on the posterior clavicle cause

A

Posterior rotation of the clavicle

116
Q

What does the clavicles crank shape result in

A

30 further elevation of the lateral clavicle

117
Q

What does posterior clavicle rotation aid in

A

Scapular posterior tilting/tipping

118
Q

What are the muscles that cause upward rotation of the scapula (4)

A
  1. Upper trapezius
  2. Lower trapezius
  3. Upper serratus anterior
  4. Lower serratus anterior
119
Q

During phase 1B what causes upward rotation of the scapula (2)

A
  1. Upper trapezius

2. Lower serratus anterior

120
Q

During phase 2B what causes upward rotation of the scapula (2)

A
  1. Lower trapezius

2. Lower serratus anterior

121
Q

What is more important for abduction serratus or trapezius

A

Trapezius

122
Q

What is more important for flexion serratus or trapezius

A

Serratus

123
Q

With serratus paralysis what does abduction and flexion look like

A

Abduction: ROM may be full
Flexion: Reduced ROM

124
Q

With trapezius paralysis what does abduction and flexion look like

A

Abduction: ROM to 75 degrees
Flexion: ROM may be full

125
Q

How much upward rotation can the trapezius produce in the sagittal plane

A

20 degrees

126
Q

In anatomical neutral what motion occurs at the humerus due to the deltoid

A

Superior translation

127
Q

What helps start to UE elevation

A

Supraspinatus

128
Q

How does the supraspinatus help start UE elevation

A

It compresses the humeral head into the glenoid giving the humeral head something to pivot around

129
Q

What muscles help with inferior glide of the humeral head (3)

A
  1. Subscapularis
  2. Infraspinatus
  3. Teres minor
130
Q

True or False:

If you have shoulder instability you should strengthen all of the RC muscle

A

True

131
Q

What is the space below the coracoacromial arch and humeral head called

A

Outlet view for radiographs

132
Q

What is the space used for

A

Look at space to determine if it is narrowed and if so are osteophytes or hooking of acromion present

133
Q

Why do we get superior glide of the humeral head

A

RC pathology or adhesive capsulitis

134
Q

What happens to the RC tendon when it is torn

A

Retract back toward origin

135
Q

What 5 things provide stability to the GH joint

A
  1. Negative intraarticular pressure
  2. Labral concavity compression
  3. Capsular constraint
  4. Scapulohumeral muscle
  5. Capsuloligamentou restraint
136
Q

What is venting of the GH joint

A

Lose negative pressure effect due to puncture in the GH capsule

137
Q

What does venting of GH joint produce

A

Immediate inferior subluxation

138
Q

True or False:

Full thickness RC tears can cause venting

A

True

139
Q

With the labrum in contact the GH joint resists dislocation forces up to what percent of the compressive loads

A

64%

140
Q

With the labrum removed how much does the resistance of dislocationdecrease

A

20%

141
Q

What is a bony bankart

A

Avulse anterior labrum with bone

142
Q

What muscles compress the humeral head into the glenoid cavity (4)

A
  1. Deltoid
  2. Supraspinatus
  3. Infraspinatus
  4. Teres minor
143
Q

What percent of your body weight can the GH joint resist at 90 degrees of elevation when everything is intact

A

90%

144
Q

What is cocontraction

A

Contracting muscles all the way around the joint

145
Q

True or False:

Closed chain allows for cocontraction

A

True

146
Q

True or False:

Scapulohumeral musculature aides in centering the humeral head in glenoid

A

True

147
Q

When are the GH ligaments able to restrain translation

A

When osteokinematic motion takes slack out of the structur

148
Q

Shoulder ligaments are stressed where

A

End range

149
Q

What are stressed at mid range

A

Shoulder musculature

150
Q

What is isometricity

A

There will always be some tension in the ligament no matter the range

151
Q

What does end range osteokinematic motion do

A

Take slack out of a specific ligament or capsule

152
Q

What happens when the ligament or capsule is passively tensioned

A

They contribute to an obligatory humeral head translation

153
Q

Which way is the humeral head translation in relation to tensioned ligament or capsule

A

The opposite direction

154
Q

What ligament or capsule is tension loaded during IR and which way is the translation

A

Posterior capsule is tension loaded and an anterior translation occurs

155
Q

What are the 4 main capsuloligamentous structures of the GH joint

A
  1. Superior GH ligament
  2. Middle GH ligament
  3. Inferior GH ligament
  4. Coracohumeral ligament
156
Q

What are the 3 parts of the Inferior GH ligament

A
  1. Anterior band
  2. Axillary pouch (accordion folder)
  3. Posterior band
157
Q

What is the main capsuloligamentous structures that provide stability during flexion

A

Anterior coracohumeral ligament

158
Q

What is the main capsuloligamentous structures that provide stability during abduction

A

Inferior posterior capsule

159
Q

What is the main capsuloligamentous structures that provide stability during IR

A

Middle posterior capsule

160
Q

What is the main capsuloligamentous structures that provide stability during ER

A

Superior GH ligament

161
Q

In anatomical neutral what is the primary stabilizer to ER and anterior head translation

A

SGHL

162
Q

In anatomical neutral what is the secondary stabilizer to ER and anterior head translation

A

MGHL

163
Q

True or False:

There is a relative lack of support by the posterior capsule against posterior translation in anatomical neutral

A

True

164
Q

What resists anterior humeral translation at 45 degrees of scaption

A

MGHL

165
Q

True or False:
The posterior band of IGHL provides some capsule stabilization against posterior translation of humeral head at 45 degrees scaption

A

True

166
Q

What stabilizes against anterior humeral head translation at 90 degrees of scaption

A

IGHL anterior band

167
Q

What stabilizes against posterior humeral head translationat 90 degrees of scaption

A

IGHL posterior band

168
Q

What happens to the anterior and posterior bands of the IGHL during IR

A

Anterior band goes below the equator

Posterior band goes above the equator

169
Q

What happens to the anterior and posterior bands of the IGHL during ER

A

Anterior band goes above the equator

Posterior band goes below the equator

170
Q

True or False:

When there is a tear or laxity on one side will eventually cause laxity or a tear on the opposite side

A

True

171
Q

What happens when you decrease the compressive force

A

You increase the shear force

172
Q

Motivation

A

It’s almost time to enjoy the break with your bebe

Kinesio (11 decks)

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