Shoulder Complex I - exam 3 Flashcards
What are two examples of normal side dominance asymmetries in the UE?
Are asymmetries normal?
ipsilateral shoulder depression
less shoulder IR/reaching behind back
yes
What is functional shoulder ROM for
- washing?
- donning/doffing a shirt?
- reach to high shelf?
- fasten bra behind back?
- 120 flexion for hair
75 flexion for trunk - 90 flexion
- 150 flexion
- 50+ extension, 70 horizontal adduction, full IR
movement of the humerus is primarily accompanied by movements of what?
scapula
movement of the humerus is secondarily accompanied by movements of what?
other smaller joints
AC, SC, upper thoracic, upper costotransverse jts
what do companion motions prevent? what is it?
active insufficiency
so much overlap of actin and myosin that they can’t contract anymore
* need optimal overlap
0-150 deg reaching overhead @ humerus:
- actions:
- concentric control:
- eccentric control:
- flexion, abduction, ER
- flexors, abductors, ERs
- extensors, adductors, IRs
0-150 deg reaching overhead @ scapula:
- actions:
- concentric control:
- eccentric control:
- elevation, upward rotation, protraction around AC jt
- elevators, upward rotators, protractors
- depressors, downward rotators, retractors
max tension on ______ _______ at 150 deg. as clavicle posteriorly rotates
brachial plexus
true or false. humerus does the same actions and isotonic controls in 0-150 deg as 150-200 deg
true
150-200 deg reaching overhead @ scapula:
- actions:
- concentric control:
- eccentric control:
- 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)
what motions does the upper t spine do during 150-200 deg of overhead reaching?
ipsilateral SB and RT and extension
why is unilateral motion important in 150-200 deg overhead reaching?
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
if upper T spine is hypomobile, then
GH and AC jts become hypermobile to compensate
inhibits lower trap activity and leads to impaired scapular motion
if upper T spine is hypomobile, excessive posterior clavicle rotation occurs. This allows tension on ________ which leads to ______ & _______ impingement/paresthesia’s
medial cord of brachial plexus
median n. & ulnar n.
reaching behind your back requires movement at BOTH ____ and _____ joints with ________ clavicular rotation
AC and SC
anterior
reaching behind back @ humerus:
- action:
- concentric control:
- eccentric control:
- hyper extension, adduction, IR
- hyperextenders, adductors, IRs
- flexors, abductors, ERs
reaching behind back @ scapula:
- action:
- concentric control:
- eccentric control:
- elevation, downward rotation, retraction
- elevators, downward rotators, retractors
- depressors, upward rotators, protractors
Joint mobilizations are effective with or without?
exercise and/or multimodal therapy
true or false. therex is not an effective intervention for the shoulder complex
false - effective intervention
which muscles would be inhibited and most important to focus on in the shoulder complex?
local muscles - tight grip activates RC
what should you do to create greater scapula muscle activity?
externally rotate
activate _____ then ______ muscles
scapula then rotator cuff muscles
- scapula needs to be stable in order for muscles to work properly
what activities activate the SA best?
give example
closed chain
wall slides
advance to UE weight shifts, push ups, off/on unstable surface like physio ball
what is an example of prone scapular exercises? what do they limit?
I, T, W, Y (in that order)
limits compensation of protective UT while activating more needed muscles
why should you perform exercises on both UEs?
cross talk for motor cortex activation with uninjured UE - coordination from the brain
true or false. activate local muscles before global muscles
true
when working on global muscles in the shoulder, what should be incorporated?
LE exercises
multi-planar exercise (PNF diagonals)
true or false. JM is more conclusive than therex
false - equally conclusive, one is not better than the other
cervical manipulation for shoulder complex:
- diminished:
- improved:
- diminished severity of shoulder pain and neck pain
- improved shoulder and neck mobility
what effect does C5-6 JM have?
immediate increase muscle strength of ERs
- carry over for 10 minutes but not after 20
true or false. C/T JM mobilization improves movement and function
true
why would cervical instability, trauma, age related changes, FHP, etc. lead to shoulder problems?
C3-T1 innervates all shoulder complex muscles
what term describes:
cervical dysfunction can alter shoulder muscle activity
regional interdependence
why should you work on minimizing FHP to address the shoulder complex?
thoracic extensors overwork to compensate for excessive and prolonged flexion and decreased diaphragm function
what evidence does dry needling for non traumatic shoulder P! have?
moderate quality and small and short term effect for non-traumatic P!
what are the 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
