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MSK 1 - Shoulder > Shoulder Complex - General Shoulder Prognosis > Flashcards

Shoulder Complex - General Shoulder Prognosis Flashcards

1
Q

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

A

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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2
Q

What is the shoulder complex functional ROM for washing hair?

A

120 degrees flexion
(75 degrees flexion of the trunk)

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3
Q

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

A

90 degrees flexion

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4
Q

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

A

150 degrees flexion

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5
Q

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

A

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

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6
Q

What are movements of the humerus accompanied by?

A

Scapula - primarily

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7
Q

What other smaller joints help with shoulder complex motion?

A

AC, SC, Upper thoracic, and upper costotransverse joints

  • secondarily
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8
Q

What does the use of companion motions do?

A
  • Assists with optimal motion
  • prevents impingement
  • Keeps actin/myosin overlap efficient to prevent active insufficiency
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9
Q

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

A

Elevation, upward rotation, possibly protraction

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10
Q

What muscles make up the rotator cuff?

A

SITS
* Supraspinatus
* Infraspinatus
* Teres Minor
* Subscapularis

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11
Q

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

A

Flexion/Abduction/ER

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12
Q

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

A

Flexors, abductors and ER

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13
Q

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

A

opposite muscles

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14
Q

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

A

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

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15
Q

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

A

Elevators, Upward rotators, Protractors

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16
Q

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

A

Opposite muscles

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17
Q

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

A

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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18
Q

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

A

Flexion/Abduction/ER

Same muscles as those below 150 degrees

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19
Q

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

A

Depression/ retraction/ posterior tilt, primarily at SC joint

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20
Q

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

A

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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21
Q

What can keep the lower trap from elevating the scapula?

A

GH and scapulothoracic motion
Upper t spine ext

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22
Q

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

A

opposite muscles of concentric

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23
Q

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

A

Ipsilateral SB / rotation / extension

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24
Q

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

A
  • 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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25
Q

Why is unilateral motion important with shoulder complex motion hypomobility?

A

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

26
Q

What will happen if the upper thoracic spine is hypermobile?

A

It can inhibit LT activity and lead to impaired scapular motion

27
Q

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

A

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

28
Q

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

A
  • 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
29
Q

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

A

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

30
Q

What joints are moving with reaching behind the back?

A

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

31
Q

What does the humerus do with reaching behind the back?

A

Hyper-extension/ adduction / IR

32
Q

What does the scapula do with reaching behind the back?

A

Elevation / downward rotation / retraction

33
Q

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

A

hyperextenders, adductors, and IRs

eccentric is opposite

34
Q

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

A

Elevators, downward rotators, retractors

eccentric is opposite

35
Q

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

A

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

36
Q

Are JMs an effective intervention for the shoulder complex joints?

A

YES

37
Q

What can we prescribe therex for?

A

Various shoulder conditions

38
Q

Is therex effective?

A

YES

39
Q

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

A

NO

40
Q

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

A

Local muscles
SITS

41
Q

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

A

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

42
Q

What type of activity helps us better activate SA?

A

Closed chain

43
Q

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

A
  • Wall slides - lower activation of LT/MT/LS/RM
  • Advance to UE weigh shifts, push ups, off/on unstable suface like physioball
44
Q

What are some prone scapular exercises?

A

I, T, W, Y - in that order

  • all limit compensation of protective UT while activating more needed muscles
45
Q

Why is doing exercises on both sides beneficial?

A

Cross talk for motor cortex activation with uninjured UE

46
Q

What can activate the rotator cuff?

A

Tighter grip

47
Q

What can create greater scapular muscle activity?

A

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

48
Q

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

A

Pec major, lat, deltoid

49
Q

What are some higher level goals?

A

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

50
Q

What is an example of a multi-planar exercise?

A

PNF diagonals

51
Q

would we want to use both JM and therex?

A

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

52
Q

Is exercise more beneficial than manual therapy?

A

Yes, according to a recent systematic review with RC tendinopathy

53
Q

What are benefits of cervical manipulations?

A
  • Diminished severity of shoulder and neck pain
  • improved shoulder and neck mobility
54
Q

What is beneficial about C5-6 JM?

A

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

55
Q

What nerve roots innervate all shoulder complex muscles?

A

C3-T1

56
Q

What conditions are a “Shoulder condition waiting to happen”?

A

Cervical trauma
hypermobility/instability
age-related changes
prolonged FHP

57
Q

What is regional interdependance?

A

Cervical dysfunction can alter shoulder muscle activity

58
Q

What is NOT included with regional interdependance?

A

Loss of conduction

59
Q

What can minimizing FHP address?

A
  • Thoracic stiffness that may lead to previously mentioned impairments with motion and muscle activity
  • inhibited shoulder ERs and scapular retractors / depressors
60
Q

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

A

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

61
Q

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

A

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

MSK 1 - Shoulder (5 decks)

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