Shoulder Complex - General Shoulder Prognosis Flashcards
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
What is the shoulder complex functional ROM for washing hair?
120 degrees flexion
(75 degrees flexion of the trunk)
What is the functional ROM of the shoulder complex for donning/doffing a shirt?
90 degrees flexion
What is the functional ROM of the shoulder complex for reaching to a high shelf?
150 degrees flexion
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
What are movements of the humerus accompanied by?
Scapula - primarily
What other smaller joints help with shoulder complex motion?
AC, SC, Upper thoracic, and upper costotransverse joints
- secondarily
What does the use of companion motions do?
- Assists with optimal motion
- prevents impingement
- Keeps actin/myosin overlap efficient to prevent active insufficiency
What humeral and scapular motions do you observe during 150 degrees of reaching overhead?
Elevation, upward rotation, possibly protraction
What muscles make up the rotator cuff?
SITS
* Supraspinatus
* Infraspinatus
* Teres Minor
* Subscapularis
What does the humerus do with 0-150 degrees of overhead reaching?
Flexion/Abduction/ER
What are the concentric controllers of the humerus during overhead reaching (0-150)
Flexors, abductors and ER
What are the eccentric controllers of the humerus during overhead reaching (0-150)
opposite muscles
What is the scapula doing during 0-150 degrees of overhead reaching?
Elevation, upward rotation, and protraction - Primarily at the AC Joint
What are the concentric controllers of the scapula during 0-150 degrees of overhead reaching?
Elevators, Upward rotators, Protractors
What are the eccentric controllers of the scapula during 0-150 degrees of overhead reaching?
Opposite muscles
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
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
What does the scapula do during 150-200 degrees of overhead reaching?
Depression/ retraction/ posterior tilt, primarily at SC joint
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
What can keep the lower trap from elevating the scapula?
GH and scapulothoracic motion
Upper t spine ext
What does eccentric control of the scapula at 150-200 degrees of overhead reaching?
opposite muscles of concentric
What does the thoracic spine do during 150-200 degrees of overhead reaching?
Ipsilateral SB / rotation / extension
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
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?
NO
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
