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MSK Exam 3 > Shoulder Complex Introduction > Flashcards

Shoulder Complex Introduction Flashcards

1
Q

What are common/ normal side dominance asymmetries?

A
  • 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
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2
Q

What kind of ROM do you need to wash you hair and trunk?

A
  • 120 degrees of flexion to wash your hair
  • 75 degrees of flexion to wash your trunk
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3
Q

What kind of ROM do you need to Don/Doff a shirt?

A

90 degrees of flexion

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4
Q

What kind of ROM do you need to reach a high shelf? (this is considered overhead reaching)

A

150 degrees of flexion

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5
Q

What kind of ROM do you need to fasten a bra behind your back?

A
  • 50+ degrees of extension
  • 70 degrees of horizontal adduction
  • Full internal rotation
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6
Q

What bones and joints move with shoulder complex motions?

A
  • Bones: Humerus, Scapula, Clavicle, Spine
  • Joints: GH, SC, AC, ST
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7
Q

Movement of the humerus is accompanied by movements of what?
These joints are companions (friends), they move together

A
  • 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)
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8
Q

What are companion motions? (they do 3 things)

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

What is active insufficiency?

A
  • 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
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10
Q

What humeral motions happen during 150 degrees of reaching overhead?

A
  • Flexion
  • Abduction
  • External Rotation
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11
Q

What provides concentric control and eccentric control at the humerus during 150 degrees of over head reaching?

A
  • Concentric Control: Flexors, Abductors, and External Rotators
  • Eccentric Control: opposite muscles
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12
Q

What scapular motions happen during 150 degrees of reaching overhead?

A
  • Elevation
  • Upward Rotation
  • Protraction (primarily at the AC joint)
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13
Q

What provides concentric control and eccentric control at the scapula during 150 degrees of over head reaching?

A
  • Concentric Control: Elevators, Upwards Rotators, and Protractors
  • Eccentric Control: Opposite Muscles
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14
Q

What kind of tension is placed on the brachial plexus at 150 degrees as the clavicle posteriorly rotates?

A

Max Tension

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15
Q

What humeral motions happen during 150-200 degrees of reaching overhead?

A

same as below 150 degrees
- Flexion
- Abduction
- External Rotation

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16
Q

What provides concentric control and eccentric control at the humerus during 150-200 degrees of over head reaching?

A

same as below 150 degrees
- Concentric Control: Flexors, Abductors, and External Rotators
- Eccentric Control: opposite muscles

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17
Q

What scapular motions happen during 150-200 degrees of reaching overhead?
this is different then below 150 degrees

A
  • Depression
  • Retraction
  • Posterior Tilt (primarily at the SC joint)
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18
Q

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

A
  • Concentric Control: muscle groups for depression, retraction, and posterior tilt, especially the lower traps
  • Eccentric Control: opposite muscles
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19
Q

The lower traps are important for concentric control when what occurs at the scapula?

A
  • 150 degrees of glenohumeral and scapulothoracic motion
  • Upper thoracic spine extension
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20
Q

What muscles make up the rotator cuff?

A
  • Supraspinatus (ABD)
  • Infraspinatus (ER)
  • Teres Minor (ER)
  • Subscapularis (ADD/IR)
    (S.I.T.S)
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21
Q

What motions do the upper thoracic spine produce?

A
  • Ipsilateral Side Bend
  • Ipsilateral Rotation
  • Extension
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22
Q

Why are unilateral motion important? (3 reasons)

A
  • 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
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23
Q

What happens if the upper t-spine is hypomobile?

A
  • 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
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24
Q

What is a part of the medial cord of the brachial plexus?

A
  • Median Cutaneous Nerve
  • Ulnar Cutaneous Nerve
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25
Q

What can happen if there is excessive posterior clavicular rotation and excessive tension on the medial cord of the brachial plexus?

A

Paresthesias can occur in the median and ulnar nerves with over head activities

26
Q

What can paresthesias in the median and ulnar nerve be misdiagnosed as?

A

Misdiagnosed as TOS but pulses remain normal with testing

27
Q

What is happening at both the AC and SC when you reach behind your back?

A

Anterior clavicular rotation

28
Q

What is happening at the humerus when you reach behind your back?

A
  • Hyper-extension
  • Adduction
  • Internal rotaiton
29
Q

What is concentrically controlling the humerus when you reach behind your back?

A
  • Hyperextenders
  • Adductors
  • Internal rotators
30
Q

What is eccentrically controlling the humerus when you reach behind your back?

A
  • Opposite muscles
  • Flexors
  • Abductors
  • External rotators
31
Q

What is happening at the scapula when you reach behind your back?

A
  • Elevation
  • Downward Rotation
  • Retraction
32
Q

What is concentrically controlling the scapula when you reach behind your back?

A
  • Elevators
  • Downward rotators
  • Retractors
33
Q

What is eccentrically controlling the scapula when you reach behind your back?

A
  • Opposite muscles
  • Depressors
  • Upward rotators
  • Protractors
34
Q

What should you use JMs for?

A
  • Variety of common RC disorders
  • Shoulder disorders
  • Adhesive capsulitis
  • Soft tissue disorders
35
Q

What joints do you apply JMs to?

A

Shoulder complex joints (GH, ST, SC, and AC)

36
Q

Are joint mobs an effective intervention for the shoulder?

A

Yes

37
Q

A more recent systematic review with RC tendinopathies says you should not rely on what alone?

A

Manual therapies

38
Q

What was shown in regards to therapeutic exercises when it comes to shoulder conditions?

A
  • 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
39
Q

When you go to preform METs which muscles do you think will be inhibited and the most important to focus on?

A
  • Local muscles!
  • Ex:
  • Rotator Cuff: supraspinatus, infraspinatus, teres minor, subscapularis
  • Serratus Anterior
  • Rhomboid major and minor
  • Lower trapezius
40
Q

When the rotator cuff is injured what other muscles do you need to focus on and why?

A

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

41
Q

When we focus on local muscles it allows us to activate what first?

A

Activate the scapula and then the rotator cuff muscles

42
Q

You can get better activation of the serratus anterior with closed chained activities like …

A
  • 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
43
Q

What order should you preform prone scapular exercises in?

A
  • 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)
44
Q

For the shoulder complex what is your MET order and emphasis?

A
  • 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
45
Q

If you make a fist (tighter grip), it activates what?

A

The rotator cuff

46
Q

If you externally rotate during activities what will this help with?

A

Greater scapular muscle activation (lower traps, middle traps, levator, rhomboid major, rhomboid minor)

47
Q

What are examples of global muscles in the shoulder?

A
  • Pectoralis Major
  • Latissimus Dorsi
  • Deltoid
  • Etc.
48
Q

What is an example of the way the lower extremities help the shoulder?

A

50% of a tennis serve if from the lower extremities and 25% if from the upper extremities

49
Q

What is an example of multi-planar exercises?

A

PNF Diagonals

50
Q

What is as equally effective as therapeutic exercise alone?

A
  • Combination of joint mobilizations and therapeutic exercise
  • One is not conclusively better than the other
51
Q

When it comes to rotator cuff tendinopathies what is more beneficial than manual therapy?

A

Exercise

52
Q

Cervical manipulations help with what?

A
  • Diminish severity of shoulder pain and neck pain
  • Improve shoulder and neck mobility
  • 2016 CPR is not supported
53
Q

Joint manipulations at C5-C6 help with what?

A
  • Immediate increase in muscle force of the external rotators
  • Carry over for 10 minutes but not after 20 minutes
54
Q

Cervicothoracic joint manipulations help with what?

A

Mobilizing the cervicothoracic spine improves symptoms and functions

55
Q

What innervates all shoulder complex muscles?

A

C3 - T1

56
Q

Any evidence of cervical trauma, hyper-mobility/ instability, age-related changes, or prolonged forward head postural (FHP) is a …

A

Shoulder condition waiting to happen

57
Q

What is regional interdependence?

A
  • Cervical dysfunction can alter shoulder muscle activity
  • Not a loss of conduction
58
Q

What can you address if you minimize forward head posture (FHP)?

A
  • Thoracic stiffness that may lead to previously mentioned impairments with motion and muscle activity
  • Inhibited shoulder external rotators and scapular retractors and depressors
59
Q

Dry needling for non-traumatic shoulder pain and disability has a _____ quality of evidence of a small and short-term effect.

A

Moderate
*Low risk of bias

60
Q

What are the four 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 Exam 3 (9 decks)

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