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Kinesiology > Shoulder Complex > Flashcards

Shoulder Complex Flashcards

1
Q

Purposeful Movement of the Shoulder

A
  • where the kinetic change starts
  • involved cooperative and synchronous motion of the scapula, clavicle, and humerus
  • allows us to position the arm in space for occupational performance
  • scapulohumeral rhythm
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2
Q

Components of the Shoulder Complex

A
  • scapulothoracic (ST) joint
  • glenohumeral (GH) joint
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3
Q

Scapulohumeral rhythm

A

Patterns of movement between the scapula and the humerus

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4
Q

Bony landmarks of the shoulder

A
  • medial and lateral border of the scapula
  • inferior and superior angle of the scapula
  • acromion process
  • humeral head
  • olecranon process
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5
Q

Scapulothoracic (ST) joint

A
  • the scapula glides, rotates, and tilts across the rib cage
  • serves as the foundation for kinetic chains of the upper extremity
  • functional movement involves a combination of scapular movement

movements:
- elevation/depression
- retraction/protraction
- upward/downward rotation

  • looking for symmetry in movement
  • can complete manual mobilization/PROM to assess mobility
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6
Q

Sternoclavicular (SC) joint

A

Movements:
- elevation/depression
- protraction/retraction (abduction/adduction)
- posterior/anterior rotation

  • only the bony attachment of the shoulder to the axial skeleton (meaning the only bony attachment of the upper extremity to the rest of the body)
  • cooperates with the scapula to facilitate the movement of the humerus
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7
Q

Acromioclavicular (AC) joint

A

Movements:
- anterior/posterior gliding
- superior/inferior gliding

  • assists in facilitating movement of the shoulder complex
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8
Q

Glenohumeral joint (GHJ)

A

Movements:
- flexion/extension
- abduction/adduction
- horizontal abduction/adduction
- internal/external rotation

  • movement depends on stability and mobility of the scapula and clavicle
    • 60 degrees = scapular rotation
    • 120 degrees = glenohumeral joint
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9
Q

Typical ROM of shoulder flexion (GHJ)

A

170 degrees

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10
Q

Prime movers of shoulder flexion (GHJ)

A
  • anterior deltoid
  • pectoralis major
  • biceps brachii
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11
Q

Typical ROM of shoulder extension (GHJ)

A

60 degrees

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12
Q

Primer movers of shoulder extension (GHJ)

A
  • posterior deltoid
  • latissimus dorsi
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13
Q

Typical ROM of shoulder abduction

A

170 degrees

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14
Q

Primer movers of shoulder abduction (GHJ)

A
  • deltoid
  • supraspinatus
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15
Q

Typical ROM of shoulder horizontal abduction (GHJ)

A

45 degrees

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16
Q

Prime movers of shoulder horizontal abduction (GHJ)

A
  • posterior deltoid
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17
Q

Typical ROM of shoulder horizontal adduction (GHJ)

A

135 degrees

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18
Q

Primer movers of shoulder horizontal adduction (GHJ)

A
  • anterior deltoid
  • pectoralis major
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19
Q

Typical ROM of shoulder external rotation (GHJ)

A

90 degrees

20
Q

Primer movers of shoulder external rotation (GHJ)

A
  • posterior deltoid
  • infraspinatus
  • teres minor
21
Q

Typical ROM of shoulder internal rotation

A

70 degrees

22
Q

Primer movers of shoulder internal rotation

A
  • subscapularis
  • teres major
  • anterior deltoid
23
Q

MMT of shoulder flexion

A
  • against gravity position = sitting with shoulder flexed to 90 degrees and forearm neutral (thumb up)
  • stabilizing hand = superior aspect of shoulder girdle
  • resistive hand = superior aspect of distal humerus
  • force application = against flexion
  • gravity eliminated position = side lying on non-test side; shoulder and forearm neutral
  • palpation = anterior deltoid
24
Q

MMT of shoulder extension

A
  • against gravity position = prone with shoulder in midrange extension
  • stabilizing hand = posterior scapula
  • resistive hand = distal posterior humerus
  • force application = against extension
  • gravity eliminated position = side lying on non-test side
  • palpation = posterior deltoid
25
Q

MMT of shoulder abduction

A
  • against gravity position = sitting, with shoulder abducted to 90 degrees, shoulder externally rotated and forearm supinated (thumb up)
  • stabilizing hand = superior aspect of shoulder girdle
  • resistive hand = lateral aspect of distal humerus
  • force application = against abduction
  • gravity eliminated position = supine
  • palpation = middle deltoid, supraspinatus
  • you don’t test shoulder adduction for MMT
26
Q

MMT of shoulder horizontal abduction

A
  • against gravity position = prone with shoulder abducted to 90 degrees and elbow flexed to 90 degrees in midrange horizontal abduction
  • stabilizing hand = posterior scapula
  • resistive hand = posterior aspect of distal humerus
  • force application = against horizontal abduction
  • gravity eliminated position = sitting with shoulder supported in 90 degrees abduction and elbow in 90 degrees flexion
  • palpation = posterior deltoid
27
Q

MMT of shoulder horizontal adduction

A
  • against gravity position = supine with shoulder abducted to 90 degrees and elbow flexed to 90 degrees in midrange horizontal adduction
  • stabilizing hand = anterior shoulder girdle over clavicle (opposite shoulder)
  • resistive hand = anterior aspect of distal humerus
  • force application = against horizontal adduction
  • gravity eliminated position = sitting with shoulder supported in 90 degrees abduction and elbow in 90 degrees flexion
  • palpation = pectoralis major
28
Q

MMT of shoulder external rotation

A
  • against gravity position = prone with shoulder abducted to 90 degrees and elbow flexed to 90 degrees, shoulder in midrange external rotation
  • stabilizing hand = posterior humerus against plinth
  • resistive hand = dorsal aspect of distal forearm
  • force application = against external rotation
  • gravity eliminated position = sitting with upper arm against side of body and elbow flexed to 90 degrees
  • palpation = posterior deltoid, infraspinatus, and teres minor
29
Q

MMT of shoulder internal rotation

A
  • against gravity position = prone with shoulder abducted to 90 degrees and elbow flexed to 90 degrees, shoulder in midrange internal rotation
  • stabilizing hand = posterior humerus
  • resistive hand = volar aspect of distal forearm
  • force application = against internal rotation
  • gravity eliminated position = sitting with upper arm against side of body and elbow flexed to 90 degrees
  • palpation = anterior deltoid and subscapularis anterior shoulder
30
Q

Clinical implications

A
  • scapular winging
  • postural compromise
  • subacromial impingement
  • thoracic outlet syndrome
  • glenohumeral subluxation
  • bicipital tendinitis
  • rotator cuff tear
  • joint dislocation
  • osteoarthritis
31
Q

Scapular winging

A
  • caused by weakness of the serratus anterior which stabilizes the scapula against the rib cage
  • can be caused by neurological conditions
  • interventions = strengthening serratus anterior and other scapular stabilizers
32
Q

Postural compromise

A
  • balanced upright posture is important for maintaining purposeful movement of the shoulder
  • sitting for long periods of time can lead to trunk fatigue and slouching
  • pec muscles tighten and scapular stabilizing muscles weaken and lengthen
  • can lead to subacromial impingement and thoracic outlet syndrome
  • interventions = postural education, workplace modifications, exercises to counteract postural difficulties
33
Q

Subacromial impingement

A

Compression of the soft tissue between the acromion and the humeral head

34
Q

Thoracic outlet syndrome

A

Compression of the structures beneath the clavicle and pectoralis muscles

35
Q

Glenohumeral subluxation

A
  • partial dislocation of the GHJ due to elongating of ligaments of the joint capsule
  • often caused by hemiparesis after CVA where gravity pulls the joint apart
  • interventions = supportive tray/positioning or GivMor Sling
36
Q

Bicipital tendinitis

A
  • weakness of the rotator cuff that causes the long head of the biceps to become inflamed
  • caused by repetitive shoulder flexion
  • interventions = activity modification, rest, pain management
37
Q

Rotator cuff tear

A
  • SITS = subscapularis, infraspinatus, teres minor, supraspinatus
  • incidence increases with age
  • can develop slowly or develop suddenly with acute injury
  • supraspinatus is the most often injured
38
Q

Joint dislocation

A
  • most commonly dislocated joint = GHJ
  • can involve damage to the labrum
  • depending on severity, injury may require surgical intervention
  • conservative interventions = strengthening of rotator cuff to promote dynamic stability
39
Q

Osteoarthritis

A
  • caused by repetitive use over time
  • may require activity modification due to functional limitations and pain
  • interventions = surgery, adaptive equipment
40
Q

ROM of shoulder flexion (GHJ)

A
  • prime movers = anterior deltoid, pectoralis major, and biceps brachii
  • patient position = sitting with arm relaxed at the side, forearm neutral (thumb pointing anteriorly)
  • goniometer axis = lateral aspect of the humeral head
  • stationary arm = lateral midline of the trunk
  • moving arm = midline of lateral humerus
  • compensatory movement = trunk rotation, trunk extension, scapular elevation
41
Q

ROM of shoulder extension (GHJ)

A
  • prime movers = posterior deltoid, latissimus dorsi
  • patient position = prone
  • goniometer axis = lateral aspect of the humeral head
  • stationary arm = lateral midline of the trunk
  • moving arm = midline of the lateral humerus
  • compensatory movement = trunk extension, trunk rotation, scapular retraction
42
Q

ROM of shoulder abduction (GHJ)

A
  • prime movers = deltoid, supraspinatus
  • patient position = sitting with arm relaxed at the side, forearm supinated and thumb pointing laterally
  • goniometer axis = posterior or anterior aspect of the humeral head
  • stationary arm = parallel to the trunk and perpendicular to the floor
  • moving arm = posterior or anterior midline of the humerus
  • compensatory movement = scapular elevation, contralateral trunk flexion
43
Q

ROM of horizontal abduction (GHJ)

A
  • prime movers = posterior deltoid
  • patient position = sitting with the shoulder abducted to 90 degrees
  • goniometer axis = superior aspect of humeral head
  • stationary arm = parallel to frontal plane at midline of trunk
  • moving arm = superior aspect of humerus
  • compensatory movement = trunk extension, trunk rotation, scapular retraction
44
Q

ROM of horizontal adduction (GHJ)

A
  • prime movers = anterior deltoid, pectoralis major
  • patient position = sitting with the shoulder abducted to 90 degrees and elbow flexed to 90 degrees
  • goniometer axis = superior aspect of the humeral head
  • stationary arm = parallel to frontal plane at midline of the trunk
  • moving arm = superior aspect of the humerus
  • compensatory movement = trunk flexion, trunk rotation, scapular protraction
45
Q

ROM of external rotation (GHJ)

A
  • prime movers = posterior deltoid, infraspinatus, teres minor
  • patient position = prone with shoulder abducted to 90 degrees and elbow flexed to 90 degrees
  • goniometer axis = olecranon process
  • stationary arm = perpendicular to ceiling
  • moving arm = midline of the ulna
  • compensatory movement = shoulder abduction, trunk rotation
46
Q

ROM of internal rotation (GHJ)

A
  • prime movers = subscapularis, teres major, anterior deltoid
  • patient position = prone with shoulder abducted to 90 degrees and elbow flexed to 90 degrees
  • goniometer axis = olecranon
  • stationary arm = perpendicular to ceiling
  • moving arm = midline of the ulna
  • compensatory movement = shoulder adduction, trunk rotation

Kinesiology (11 decks)

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