Shoulder Complex I - exam 3

Question 1

What are two examples of normal side dominance asymmetries in the UE?

Are asymmetries normal?

Answer 1

ipsilateral shoulder depression
less shoulder IR/reaching behind back

yes

Question 2

What is functional shoulder ROM for

• washing?
• donning/doffing a shirt?
• reach to high shelf?
• fasten bra behind back?

Answer 2

• 120 flexion for hair
  75 flexion for trunk
• 90 flexion
• 150 flexion
• 50+ extension, 70 horizontal adduction, full IR

Question 3

movement of the humerus is primarily accompanied by movements of what?

Answer 3

scapula

Question 4

movement of the humerus is secondarily accompanied by movements of what?

Answer 4

other smaller joints
AC, SC, upper thoracic, upper costotransverse jts

Question 5

what do companion motions prevent? what is it?

Answer 5

active insufficiency
so much overlap of actin and myosin that they can’t contract anymore
* need optimal overlap

Question 6

0-150 deg reaching overhead @ humerus:
- actions:
- concentric control:
- eccentric control:

Answer 6

• flexion, abduction, ER
• flexors, abductors, ERs
• extensors, adductors, IRs

Question 7

0-150 deg reaching overhead @ scapula:
- actions:
- concentric control:
- eccentric control:

Answer 7

• elevation, upward rotation, protraction around AC jt
• elevators, upward rotators, protractors
• depressors, downward rotators, retractors

Question 8

max tension on ______ _______ at 150 deg. as clavicle posteriorly rotates

Answer 8

brachial plexus

Question 9

true or false. humerus does the same actions and isotonic controls in 0-150 deg as 150-200 deg

Answer 9

true

Question 10

150-200 deg reaching overhead @ scapula:
- actions:
- concentric control:
- eccentric control:

Answer 10

• depression, retraction, posterior tilt around SC jt (down and out of way of humerus)
• depressors, downward rotators, retractors
• elevators, upward rotators, protractors
  esp. lower trap if: 150 deg motion with GH and ST motion and upper T spine extension (helps move scap out of way of humerus)

Question 11

what motions does the upper t spine do during 150-200 deg of overhead reaching?

Answer 11

ipsilateral SB and RT and extension

Question 12

why is unilateral motion important in 150-200 deg overhead reaching?

Answer 12

triggers concentric control of lower trap along with subclavius for scapular and clavicle motions
prevents excessive tension on brachial plexus by limiting more posterior clavicle rotation

Question 13

if upper T spine is hypomobile, then

Answer 13

GH and AC jts become hypermobile to compensate
inhibits lower trap activity and leads to impaired scapular motion

Question 14

if upper T spine is hypomobile, excessive posterior clavicle rotation occurs. This allows tension on ________ which leads to ______ & _______ impingement/paresthesia’s

Answer 14

medial cord of brachial plexus
median n. & ulnar n.

Question 15

reaching behind your back requires movement at BOTH ____ and _____ joints with ________ clavicular rotation

Answer 15

AC and SC
anterior

Question 16

reaching behind back @ humerus:
- action:
- concentric control:
- eccentric control:

Answer 16

• hyper extension, adduction, IR
• hyperextenders, adductors, IRs
• flexors, abductors, ERs

Question 17

reaching behind back @ scapula:
- action:
- concentric control:
- eccentric control:

Answer 17

• elevation, downward rotation, retraction
• elevators, downward rotators, retractors
• depressors, upward rotators, protractors

Question 18

Joint mobilizations are effective with or without?

Answer 18

exercise and/or multimodal therapy

Question 19

true or false. therex is not an effective intervention for the shoulder complex

Answer 19

false - effective intervention

Question 20

which muscles would be inhibited and most important to focus on in the shoulder complex?

Answer 20

local muscles - tight grip activates RC

Question 21

what should you do to create greater scapula muscle activity?

Answer 21

externally rotate

Question 22

activate _____ then ______ muscles

Answer 22

scapula then rotator cuff muscles
- scapula needs to be stable in order for muscles to work properly

Question 23

what activities activate the SA best?
give example

Answer 23

closed chain
wall slides
advance to UE weight shifts, push ups, off/on unstable surface like physio ball

Question 24

what is an example of prone scapular exercises? what do they limit?

Answer 24

I, T, W, Y (in that order)
limits compensation of protective UT while activating more needed muscles

Question 25

why should you perform exercises on both UEs?

Answer 25

cross talk for motor cortex activation with uninjured UE - coordination from the brain

Question 26

true or false. activate local muscles before global muscles

Answer 26

true

Question 27

when working on global muscles in the shoulder, what should be incorporated?

Answer 27

LE exercises
multi-planar exercise (PNF diagonals)

Question 28

true or false. JM is more conclusive than therex

Answer 28

false - equally conclusive, one is not better than the other

Question 29

cervical manipulation for shoulder complex:
- diminished:
- improved:

Answer 29

• diminished severity of shoulder pain and neck pain
• improved shoulder and neck mobility

Question 30

what effect does C5-6 JM have?

Answer 30

immediate increase muscle strength of ERs
- carry over for 10 minutes but not after 20

Question 31

true or false. C/T JM mobilization improves movement and function

Answer 31

true

Question 32

why would cervical instability, trauma, age related changes, FHP, etc. lead to shoulder problems?

Answer 32

C3-T1 innervates all shoulder complex muscles

Question 33

what term describes:
cervical dysfunction can alter shoulder muscle activity

Answer 33

regional interdependence

Question 34

why should you work on minimizing FHP to address the shoulder complex?

Answer 34

thoracic extensors overwork to compensate for excessive and prolonged flexion and decreased diaphragm function

Question 35

what evidence does dry needling for non traumatic shoulder P! have?

Answer 35

moderate quality and small and short term effect for non-traumatic P!

Question 36

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

Answer 36

• lower baseline disability
• lower symptoms at rest
• higher patient expectation with PT
• higher self-efficacy despite symptoms