Shoulder Complex - General Shoulder Prognosis Flashcards by Jessica Chambers

What are we looking for with our observation of the shoulder complex?

normal side dominance asymmetries
- ipsilateral shoulder depression
- Less shoulder IR/Reaching behind back
- Ipsilateral thoracolumbar SB and Rotation
- More hyperextended knee
- flatter foot

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What is the shoulder complex functional ROM for washing hair?

120 degrees flexion
(75 degrees flexion of the trunk)

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What is the functional ROM of the shoulder complex for donning/doffing a shirt?

90 degrees flexion

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What is the functional ROM of the shoulder complex for reaching to a high shelf?

150 degrees flexion

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What is the functional ROM for the shoulder complex for fastening a bra behind the back?

50 degrees extension, 70 degrees of horizontal abduction, full IR

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What are movements of the humerus accompanied by?

Scapula - primarily

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What other smaller joints help with shoulder complex motion?

AC, SC, Upper thoracic, and upper costotransverse joints

secondarily

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What does the use of companion motions do?

Assists with optimal motion
prevents impingement
Keeps actin/myosin overlap efficient to prevent active insufficiency

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What humeral and scapular motions do you observe during 150 degrees of reaching overhead?

Elevation, upward rotation, possibly protraction

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What muscles make up the rotator cuff?

SITS
* Supraspinatus
* Infraspinatus
* Teres Minor
* Subscapularis

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What does the humerus do with 0-150 degrees of overhead reaching?

Flexion/Abduction/ER

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What are the concentric controllers of the humerus during overhead reaching (0-150)

Flexors, abductors and ER

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What are the eccentric controllers of the humerus during overhead reaching (0-150)

opposite muscles

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What is the scapula doing during 0-150 degrees of overhead reaching?

Elevation, upward rotation, and protraction - Primarily at the AC Joint

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What are the concentric controllers of the scapula during 0-150 degrees of overhead reaching?

Elevators, Upward rotators, Protractors

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What are the eccentric controllers of the scapula during 0-150 degrees of overhead reaching?

Opposite muscles

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When is there max tension on the brachial plexus? Why?

At 150 degrees as clavicle posteriorly rotates

** fascia connected to clavicle decreases tension on brachial plexus, when flx tenses fascia, if its up too long can contribute to TOS

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What is the motion of the humerus during 150-200 degrees of overhead reaching? Muscles?

Flexion/Abduction/ER

Same muscles as those below 150 degrees

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What does the scapula do during 150-200 degrees of overhead reaching?

Depression/ retraction/ posterior tilt, primarily at SC joint

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What is the concentric control of the scapula at 150-200 degrees of overhead reaching?

depression, retraction, posterior tilt muscle groups, especially LT if the following occur
- 150 degrees of motion with GH and scapulothoracic motion
- upper t spine ext

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What can keep the lower trap from elevating the scapula?

GH and scapulothoracic motion
Upper t spine ext

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What does eccentric control of the scapula at 150-200 degrees of overhead reaching?

opposite muscles of concentric

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What does the thoracic spine do during 150-200 degrees of overhead reaching?

Ipsilateral SB / rotation / extension

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Why is unilateral motion of the upper thoracic spine during overhead reaching important?

Triggers concentric control of LT along with subclavius for scapular and clavicle motions
Prevents excessive tension on brachial plexus by limiting more posterior clavicular rotation

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Why is unilateral motion important with shoulder complex motion hypomobility?

GH and AC joints may become hypomobile to compensate for the upper thoracic spine

What will happen if the upper thoracic spine is hypermobile?

It can inhibit LT activity and lead to impaired scapular motion

What is limited about LT activation with upper thoracic spine hypomobility?

Upward rotation up to 150 degrees and depression > 150 degrees during overhead reaching

What does a hypomobile thoracic spine allow with shoulder complex motion?

* allows excessive posterior clavicular rotation and excessive tension on medial cord of brachial plexus -> so median and ulnar paresthesias from cutaneous nerve can occur with overhead activities

What is different about median and ulnar cutaneous nerve paresthesias vs. TOS?

Pulses remain normal with testing with tension on med cord of brachial plexus (median and ulnar nerve cutaneous paresthesias)

What joints are moving with reaching behind the back?

AC and SC joints, with anterior clavicular rotation which you can feel

What does the humerus do with reaching behind the back?

Hyper-extension/ adduction / IR

What does the scapula do with reaching behind the back?

Elevation / downward rotation / retraction

What muscles are the concentric controllers of the humerus during reaching behind the back?

hyperextenders, adductors, and IRs eccentric is opposite

What muscles work with the concentric control of the scapula during reaching behind the back?

Elevators, downward rotators, retractors eccentric is opposite

What can we do JMs for in general concerning the shoulder complex?

Variety of common RC disorders, shoulder, disorders, adhesive capsulitis, and soft tissue disorders

Are JMs an effective intervention for the shoulder complex joints?

YES

What can we prescribe therex for?

Various shoulder conditions

Is therex effective?

YES

Is there additional benefit when STM is added with non-specific shoulder pain, ROM, and function?

What muscles are we targeting with MET? They would be most inhibited and therefore most important to focus on?

Local muscles SITS

What is an example of what we should be thinking about with MET for local shoulder complex muscles?

Activate scapula then rotator cuff muscles - think about attachments and functions

What type of activity helps us better activate SA?

Closed chain

What are some examples of SA closed chain activities? Why?

* Wall slides - lower activation of LT/MT/LS/RM * Advance to UE weigh shifts, push ups, off/on unstable suface like physioball

What are some prone scapular exercises?

I, T, W, Y - in that order - all limit compensation of protective UT while activating more needed muscles

Why is doing exercises on both sides beneficial?

Cross talk for motor cortex activation with uninjured UE

What can activate the rotator cuff?

Tighter grip

What can create greater scapular muscle activity?

Externally rotate as appropriate for greater activity of LT/MT/LS/RMaj/Min

What are some global muscles we may be concerned with after local muscles start functioning properly?

Pec major, lat, deltoid

What are some higher level goals?

LE - shoulder helped by LEs - 50% of a tennis serve from LE and 25% from UE

What is an example of a multi-planar exercise?

PNF diagonals

would we want to use both JM and therex?

combination was equally effective to therex alone - one is not conclusively better than the other

Is exercise more beneficial than manual therapy?

Yes, according to a recent systematic review with RC tendinopathy

What are benefits of cervical manipulations?

- Diminished severity of shoulder and neck pain - improved shoulder and neck mobility

What is beneficial about C5-6 JM?

Immediate increased muscle force of the ERs - carries over for 10 minutes but not over 20 mins - not long term

What nerve roots innervate all shoulder complex muscles?

C3-T1

What conditions are a "Shoulder condition waiting to happen"?

Cervical trauma hypermobility/instability age-related changes prolonged FHP

What is regional interdependance?

Cervical dysfunction can alter shoulder muscle activity

What is NOT included with regional interdependance?

Loss of conduction

What can minimizing FHP address?

- Thoracic stiffness that may lead to previously mentioned impairments with motion and muscle activity - inhibited shoulder ERs and scapular retractors / depressors

What are benefits of dry needling for non-traumatic shoulder pain and disability?

moderate quality of evidence of a small and short-term effect

What are 4 positive factors for those referred to PT with shoulder symptoms?

Lower baseline disability Lower symptoms at rest Higher patient expectation with PT Higher self efficacy despite symptoms