Shoulder Mechanisms and Counterstrain

Question 1

if you treat SD in T spine, upper ribs, lower C spine?

Answer 1

upper extremity dysfunction will frequently take care of itself

Question 2

does shoulder motion involved just one joint or articulation?

Answer 2

no

Question 3

shoulder motion?

Answer 3

dynamic interplay between scapulothoracic articulation and the glenohumeral, acromioclavicular and sternoclavicular joints

Question 4

motions of shoulder

Answer 4

flex/extend
abduct/adduct
internal/external rotation

Question 5

glenohumeral joint

Answer 5

designed for maximum motion at expense of decreased stability

very little osseous support
shallow glenoid cavity

Question 6

scapulothoracic articulation?

Answer 6

scapula glides over ribcage with shoulder motion

Question 7

scapulothoracic rhythm?

Answer 7

first 30 degrees of shoulder abduction occurs at glenohumeral joint (supraspinatus)

thereafter, for every 2 degrees of motion the glenohumeral joint, there is 1 degree of motion at scapulothracic articulation

Question 8

scapulothoracic articulation restricted?

Answer 8

thoracic spine and rib dysfunction

glenohumeral joint compensates
-overuse to instability impingement rotator cuff tendonitis and tear

Question 9

sternoclavicular joint

Answer 9

capable of anteroposterior, superoinferior rotational motions

injury, infections, and other can cause problems

Question 10

posterior dislocation of sternoclavicular joint?

Answer 10

can compromise important neurovascular structures

ex/ seatbelt injury

Question 11

acromioclavicular joint

Answer 11

allows anteroposterior, superoinferior, and rotational motion

frequently becomes separated

Question 12

upper extremity innervation?

Answer 12

C5-T1 brachial plexus

between anterior and middle scalene
between first rib and clavicle
underneath pectoralis minor

Question 13

SD in cervical spine, upper thoracic spine, upper ribs, scalene muscles, clavicle, pectoralis?

Answer 13

can have negative impact on brachial plexus and upper extremity dysfunction

Question 14

primary flexors of glenohumeral?

Answer 14

pectoralis major
deltoid (anterior)
coracobrachialis

Question 15

nerve of pectoralis major?

Answer 15

C5-T1

Question 16

nerve of deltoid (anterior)

Answer 16

axillary nerve C5 C6

Question 17

corachobrachialis innervation?

Answer 17

musculocutaneous nerve

C5, C6, C7

Question 18

primary extensors of glenohumeral?

Answer 18

lat dorsi
teres major
deltoid (posterior)
long head triceps brachii

Question 19

nerve of lat dorsi?

Answer 19

thoracodorsal (C6 7 8)

Question 20

nerve of teres major

Answer 20

lower subscapular

C5 C6

Question 21

deltoid muscle (posterior) nerve?

Answer 21

C5 C6 axillary

Question 22

long head triceps muscle

Answer 22

radial nerve

C 6 7 8

Question 23

primary abductors of glenohumeral

Answer 23

deltoid

supraspinatus

Question 24

nerve of supraspinatus

Answer 24

suprascapular nerve

C4 5 6

Question 25

primary adductors of glenohumeral?

Answer 25

pec major lat dorsi teres major long head triceps brachii

Question 26

primary external rotators of glenohumeral?

Answer 26

infraspinatus teres minor deltoid

Question 27

teres minor innervation?

Answer 27

C5 6 axillary nerve

Question 28

infraspinatus innervation?

Answer 28

suprascapular nerve C5 C6

Question 29

primary internal rotators glenohumeral?

Answer 29

``` subscapularis pec major lat dorsi deltoid teres major ```

Question 30

subscapular nerve?

Answer 30

C5 6 7 | upper and lower subscapular nerves

Question 31

SD and nerves?

Answer 31

can affect nerve roots resulting in weakness of innervated muscles

Question 32

four muscles of rotator cuff?

Answer 32

supraspinatus infraspinatus teres minor subscapularis keep head of humerus centered in glenoid fossa -move and stabilize glenohumeral joint

Question 33

arterial supply of glenohumeral joint?

Answer 33

left and right subclavian arteries pass over top of first rib between anterior and middle scalene muscles

Question 34

upper extremity arterial supply?

Answer 34

may be affected by SD of anterior and middle scalenes, upper thoracic and cervical vertebrae, upper ribs, clavicles, and fascia of neck and upper extremity

Question 35

venous drainage of upper extremity?

Answer 35

subclavian and brachiocephalic veins anterior to scalene muscles SD in venous drainage - can lead to congestion of upper extremity

Question 36

lymphatic drainage of upper extremity?

Answer 36

drain through thoracic inlet SD can produce mechanical restriction to lymph flow and congestion can occur -slower healing

Question 37

sympathetics of upper extremity?

Answer 37

T2-T6 -cell bodies of preganglionic neurons concerned with upper extremity located in upper thoracic spinal segements smooth muscles in walls of lymphatics contract when sympathetic stimulation reduces size of lumen, thereby impairing lymphatic drainage

Question 38

upper thoracic SD?

Answer 38

increases sympathetic tone to upper extremity decreased lymphatic dgainage may lead to swelling, impaired function and recovery

Question 39

tensegrity and kinetic chain

Answer 39

entire body is interconnected by a vast network of connective tissue one area is tight, whole system gets tight

Question 40

mechanics of throwing?

Answer 40

force transmitted from ground to upper extremity

Question 41

during overhead movements, what percentage of kinetic energy of upper extremity is generated by legs and trunk?

Answer 41

48%

Question 42

what stimulates scapular retraction?

Answer 42

ipsilateral hip and trunk extension

Question 43

what muscles decelerate glenohumeral joint when throwing

Answer 43

posterior shoulder muscles | posterior deltoid and teres minor

Question 44

lat dorsi tightness?

Answer 44

reduced shoulder flexion

Question 45

thoracolumbar junction

Answer 45

frequently find SD at T10-L2 psoas major, diaphragm, lat dorsi, thoracolumbar fascia may also see somatovisceral reflex? -adrenal glands

Question 46

posture imbalance?

Answer 46

sitting - kyphosis protracts scapula pec minor and biceps tighten hamstring and psoas major also frequently tighten with prolonged sitting

Question 47

counterstrain

Answer 47

shoulder injuries frequently associated with tender points supraspinatus, subscapularis, biceps are common

Question 48

supraspinatus tender point

Answer 48

in supraspinous fossa

Question 49

subscapularis tender point

Answer 49

in posterior axillary fold

Question 50

biceps tender point

Answer 50

along long head through bicipital groove

Question 51

principles of counterstrain?

Answer 51

``` locate tender point establish pain scale find position reducing 70-100% of pain hold position 90 seconds slowly return to position reassess ```

Question 52

shoulder problem slow or non-responsive to treatment?

Answer 52

think of systemic problems like diabetes or hypothyroidism

Question 53

nerve growth?

Answer 53

inch per month