Shoulder Complex Introduction Flashcards
What are common/ normal side dominance asymmetries?
- Ipsilateral shoulder depression (dominant side depression)
- Less shoulder internal rotation/ reaching behind the back
- Ipsilateral thoracolumbar side bend and rotation
- More hyperextended knee
- Flatter foot
What kind of ROM do you need to wash you hair and trunk?
- 120 degrees of flexion to wash your hair
- 75 degrees of flexion to wash your trunk
What kind of ROM do you need to Don/Doff a shirt?
90 degrees of flexion
What kind of ROM do you need to reach a high shelf? (this is considered overhead reaching)
150 degrees of flexion
What kind of ROM do you need to fasten a bra behind your back?
- 50+ degrees of extension
- 70 degrees of horizontal adduction
- Full internal rotation
What bones and joints move with shoulder complex motions?
- Bones: Humerus, Scapula, Clavicle, Spine
- Joints: GH, SC, AC, ST
Movement of the humerus is accompanied by movements of what?
These joints are companions (friends), they move together
- The scapula (this is the primary accompanied movement)
- Other small joints like the acromioclavicular (AC), sternoclavicular (SC), upper thoracic and upper costotransverse joints (secondary movement)
What are companion motions? (they do 3 things)
- Assist with optimal motion
- Prevent impingement
- Keeps actin/myosin overlap efficient to prevent active insufficiency
What is active insufficiency?
- Decreased tension of a muscle when it is shortened across a joint
- Basically if a muscle shortens too much it cant shorten more, so now it is insufficient
What humeral motions happen during 150 degrees of reaching overhead?
- Flexion
- Abduction
- External Rotation
What provides concentric control and eccentric control at the humerus during 150 degrees of over head reaching?
- Concentric Control: Flexors, Abductors, and External Rotators
- Eccentric Control: opposite muscles
What scapular motions happen during 150 degrees of reaching overhead?
- Elevation
- Upward Rotation
- Protraction (primarily at the AC joint)
What provides concentric control and eccentric control at the scapula during 150 degrees of over head reaching?
- Concentric Control: Elevators, Upwards Rotators, and Protractors
- Eccentric Control: Opposite Muscles
What kind of tension is placed on the brachial plexus at 150 degrees as the clavicle posteriorly rotates?
Max Tension
What humeral motions happen during 150-200 degrees of reaching overhead?
same as below 150 degrees
- Flexion
- Abduction
- External Rotation
What provides concentric control and eccentric control at the humerus during 150-200 degrees of over head reaching?
same as below 150 degrees
- Concentric Control: Flexors, Abductors, and External Rotators
- Eccentric Control: opposite muscles
What scapular motions happen during 150-200 degrees of reaching overhead?
this is different then below 150 degrees
- Depression
- Retraction
- Posterior Tilt (primarily at the SC joint)
What provides concentric control and eccentric control at the scapula during 150-200 degrees of over head reaching?
this is different then below 150 degrees
- Concentric Control: muscle groups for depression, retraction, and posterior tilt, especially the lower traps
- Eccentric Control: opposite muscles
The lower traps are important for concentric control when what occurs at the scapula?
- 150 degrees of glenohumeral and scapulothoracic motion
- Upper thoracic spine extension
What muscles make up the rotator cuff?
- Supraspinatus (ABD)
- Infraspinatus (ER)
- Teres Minor (ER)
- Subscapularis (ADD/IR)
(S.I.T.S)
What motions do the upper thoracic spine produce?
- Ipsilateral Side Bend
- Ipsilateral Rotation
- Extension
Why are unilateral motion important? (3 reasons)
- Triggers concentric control of the lower traps along with the subclavius for scapular and clavicle movement
- Prevents excessive tension tension on the brachial plexus by limiting more posterior clavicular rotation
- If they are hypomobile then the GH and AC joints may become hypermobile to compensate
What happens if the upper t-spine is hypomobile?
- Inhibits lower trap activity and leads to impaired scapular motion
- Allows excessive posterior clavicular rotation and excessive tension on the medial cord of the brachial plexus
What is a part of the medial cord of the brachial plexus?
- Median Cutaneous Nerve
- Ulnar Cutaneous Nerve
What can happen if there is excessive posterior clavicular rotation and excessive tension on the medial cord of the brachial plexus?
Paresthesias can occur in the median and ulnar nerves with over head activities
What can paresthesias in the median and ulnar nerve be misdiagnosed as?
Misdiagnosed as TOS but pulses remain normal with testing
What is happening at both the AC and SC when you reach behind your back?
Anterior clavicular rotation
What is happening at the humerus when you reach behind your back?
- Hyper-extension
- Adduction
- Internal rotaiton
What is concentrically controlling the humerus when you reach behind your back?
- Hyperextenders
- Adductors
- Internal rotators
What is eccentrically controlling the humerus when you reach behind your back?
- Opposite muscles
- Flexors
- Abductors
- External rotators
What is happening at the scapula when you reach behind your back?
- Elevation
- Downward Rotation
- Retraction
What is concentrically controlling the scapula when you reach behind your back?
- Elevators
- Downward rotators
- Retractors
What is eccentrically controlling the scapula when you reach behind your back?
- Opposite muscles
- Depressors
- Upward rotators
- Protractors
What should you use JMs for?
- Variety of common RC disorders
- Shoulder disorders
- Adhesive capsulitis
- Soft tissue disorders
What joints do you apply JMs to?
Shoulder complex joints (GH, ST, SC, and AC)
Are joint mobs an effective intervention for the shoulder?
Yes
A more recent systematic review with RC tendinopathies says you should not rely on what alone?
Manual therapies
What was shown in regards to therapeutic exercises when it comes to shoulder conditions?
- They are an effective intervention for various shoulder conditions
- There is no additional benefit when STM (soft tissue mobilization) was added with non-specific shoulder pain, ROM and function
When you go to preform METs which muscles do you think will be inhibited and the most important to focus on?
- Local muscles!
- Ex:
- Rotator Cuff: supraspinatus, infraspinatus, teres minor, subscapularis
- Serratus Anterior
- Rhomboid major and minor
- Lower trapezius
When the rotator cuff is injured what other muscles do you need to focus on and why?
The scapula muscles, because the rotator cuff originates on the scapula so by focusing on the scapula muscles this allows you to help stabilize the joint
When we focus on local muscles it allows us to activate what first?
Activate the scapula and then the rotator cuff muscles
You can get better activation of the serratus anterior with closed chained activities like …
- Wall slides: lower activation of lower traps, levator, rhomboids, middle traps
- Advance to UE weight shifts, push ups, off/on unstable surface like physio ball
What order should you preform prone scapular exercises in?
- I then T, then W, then Y
- All limit compensation of protective upper trap while activating more needed muscles (upper trap is always trying to take over)
For the shoulder complex what is your MET order and emphasis?
- Prone Scapular Exercise
- Rotator Cuff Muscle
- Cross talk for motor cortex (frontal planning) activation with uninjured upper extremity so preform exercises on both upper extremities
If you make a fist (tighter grip), it activates what?
The rotator cuff
If you externally rotate during activities what will this help with?
Greater scapular muscle activation (lower traps, middle traps, levator, rhomboid major, rhomboid minor)
What are examples of global muscles in the shoulder?
- Pectoralis Major
- Latissimus Dorsi
- Deltoid
- Etc.
What is an example of the way the lower extremities help the shoulder?
50% of a tennis serve if from the lower extremities and 25% if from the upper extremities
What is an example of multi-planar exercises?
PNF Diagonals
What is as equally effective as therapeutic exercise alone?
- Combination of joint mobilizations and therapeutic exercise
- One is not conclusively better than the other
When it comes to rotator cuff tendinopathies what is more beneficial than manual therapy?
Exercise
Cervical manipulations help with what?
- Diminish severity of shoulder pain and neck pain
- Improve shoulder and neck mobility
- 2016 CPR is not supported
Joint manipulations at C5-C6 help with what?
- Immediate increase in muscle force of the external rotators
- Carry over for 10 minutes but not after 20 minutes
Cervicothoracic joint manipulations help with what?
Mobilizing the cervicothoracic spine improves symptoms and functions
What innervates all shoulder complex muscles?
C3 - T1
Any evidence of cervical trauma, hyper-mobility/ instability, age-related changes, or prolonged forward head postural (FHP) is a …
Shoulder condition waiting to happen
What is regional interdependence?
- Cervical dysfunction can alter shoulder muscle activity
- Not a loss of conduction
What can you address if you minimize forward head posture (FHP)?
- Thoracic stiffness that may lead to previously mentioned impairments with motion and muscle activity
- Inhibited shoulder external rotators and scapular retractors and depressors
Dry needling for non-traumatic shoulder pain and disability has a _____ quality of evidence of a small and short-term effect.
Moderate
*Low risk of bias
What are the four 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
