Shoulder MSI Flashcards
Scapular movement coordination deficits
Depression Abduction Downward rotation Winging Tipping
Humeral movement coordination deficits
Anterior glide
Internal rotation
Scapular movement faults
Insufficient elevation/upward rotation
Excessive internal rotation/ winging
Insufficient posterior tilt
What is most likely to demonstrate altered kinematic?
Scapular plane
Scapular resting position
30-45 deg internal rotation 2-3 inches of abduction from spine Sits Superior angle of spine at T2, inferior angle of spine at T7 Scapula Upward rotation Neutral to 3 degrees Anterior tilt of scapula 10-20 degrees
Scapular elevation norm
Inferior angle to SC joint elevates 25 degrees
SC joint rotates posterior 25 degrees
SC joint retracts 15 degrees
AC joint upward rotates 35 degrees
Scapula posterior tilts 20 degrees
Glenohumeral must ER 45 degrees (more needed for abduction than flexion)
Glenohumeral motion is 120 degrees
Scapulothoracic motion is 60 degrees of upward rotation
Normal scapulohumeral rhythm
2:1
120 GH
60 scap
Shoulder elevation setting phase
60 deg flex, 30 deg abduction
Shoulder elevation scapular movement
Upward rotation
ER
Post tilt
Elevation
Two faults during setting phase of elevation
Downward rotation - rhomboids over active
Adduction - rhomboids plus everything else on
Upper traps in impingement/pain
Work too hard/early
SA in impingement/pain
Decreased LT to SA ratio
SA is delayed, decreased, or deactivates too early
Mid and low trap in impingement/pain
Decreased/delayed
Middle during ER
Lower during abduction
Thoracic kyphosis
Associated w/ abducted and downward rotated scap
Reducing it facilitates greater shoulder range
Scapular depression movement fault
Lower than normal scapular position
Lower than normal clavicle upward 20 deg angle
Lacks elevation to C6-7 during shoulder motion
Increased tension from lats/pecs pull downward
Lengthened U trap or levator, increased stress on Cspine
Movement faults associated w/ scapular depression
Scap down rotation or abduction
Humeral IR; cspine ext/rotation
Long arms/neck, heavy arms/chest
Scapular depression movement tests
Shoulder flexion/abduction Lat/pec length SA MMT Cervical rotation Scapular-thoracic movement
Scapular depression tax
Tape to elevate Unload/elevate on objects Tape bra straps together Normalize pec and lat length B/L shoulder flexion w/ elevation Improve M trap/SA strength
Scapular downward rotation movement fault
Downward rotated at rest
Lacks 60 deg upward rotation during elevation
GH may be moving too much for compensation
Scapular foward rotation movement fault - muscle imbalance
Levator scap and rhomboids
SA and L trap
LT best up rotator > 90 deg
UT and SA better when < 90
Scapular downward rotation associated faults
Scapular depression, abduction, Cervical ext/rotation
Long/heavy arms, increased T kyphosis
Scapular downward rotation movement tests
Shoulder flexion/abduction Lat/pec length test SA MMT Quadruped C/s rotation Scapulothoracic mobility
Scap downward rotation tx
Improve posture/alignment - tape
SA, L trap strength/activation
Rhomb, levator flex/inhibition
Retrain coordination w/ upward rotation
Scapular abduction movement fault
> 3” from spine at rest
1/2’ past MAL during shoulder elevation
Stabilizers lack strength against scapular-humeral muscles
(Pecs + SA dominant, short/strong RC, weak M and L trap, weak rhomb)
Excessive thoracic flexion
Scap abduction associated movement faults
Scapular depression and down rotation
Anterior humeral glide
Thoracic flexion, large breasts, obesity
Scap abduction movement tests
Shoulder elevation and return
Pec major/ teres length
B/E ER by side
Horizontal adduction length test
Scap abduction tx
Improve scap position at rest (tape, hands on hip, tape bra straps)
Improve MT, LT, Rhob strength
Decreased pec/teres major stiffness
Improve TSpine extension
Improve GH motion (post capsule or post cuff)
Scapular tilting movement fault
Anterior tilted at rest/lack of post tilt during elevation
Inferior angle protruding off thorax
Secondary to tightness in pec major/minor
Weakness in Ltrap
Associated w/ excessive thoracic flexion, humeral ant glide
Scapular tipping movement test
Shoulder abduction
Pec length
Lower trap MMT
Scapular tipping movement to
Improve pec inhibition/tightness
Improve lower trap strength
Taping into post tilt
Improve thoracic position
Scapular winging movement fault
Scap IR
SA weak/control (M trap and rhomb also weak)
Concentric or eccentric winging
Scapular winging movement tests
Shoulder elevation and lowering
HBB
SA and LT MMT
Quadruped rocking foward
Scapular wining tax
Strengthen scapulothoraic muscles
Stretch scapular-humeral muscles
Concentric control of SA
Eccentric control
Humeral anterior glide
Anterior translation of humeral head compared to acromion hood (norm >1/3)
Laxity in anterior capsule
Stiffness in posterior capsule/ER
Poor GH PICR
Most common humeral movement fault
Anterior glide
anterior glide associated med dx
impingements
instabilities
rotator cuff pathologies
anterior glide movement tests
shoulder elevation: retest w/ post glide
pec and biceps length
horizontal adduction length
shoulder IR/ER at 90 deg: retest w/ post glide
ant glide tx
normalize scap posting
improve GH rotation PICR
improve rotator cuff strength and control
decrease stiffness: post capsule, post delt/rotator cuff, biceps and pecs
humeral IR fault
excessive IR at rest
insufficient ER during shoulder elevation
tightness in IR muscles
weakness in ER muscles
humeral IR associated movement faults
thoracic flexion
scapular abduction/tipping
humeral IR movement tests
shoulder flex/ab
humeral ER by side
shoulder IR/ER supine and prone
muscle length tests
humeral IR tx
improve coordination (emphasize ER during movements)
improve length/stiffness (pecs, lats, subscap, T major)
improve strength/endurance (infra spin, T minor)
shoulder specific posture assessment - lateral
thoracic spine excessive flexion
arms IR, elbow flexion
humeral head ant glide
shoulder specific posture assessment - anterior
clavicle angle 20 deg
pec muscle bulk
cubital fossa Ir, abduction
shoulder elevation abnormal
asymmetrical cervical movement scapular faults lack post GH creasing humeral IR excess/early UT activation CT junction ext at end range
early shrug w/ shoulder activation
adhesive capsulitis
full rotator cuff tear
corrected shoulder elvation
scapular reposition/assistance
change humeral position
change/improve muscle timing w/ cueing
normal return from shoulder elevation
symmetrical scapular downward rotation, controlled speed
abnormal return from shoulder elevation
winging
retraction
very fast/slow
B/L shoulder ER by side - normal
60 deg ER
no scap movement first 50%
B/L shoulder ER by side - abnormal
limited ROM
excessive scap retraction
excessive Tspine extension
supine BL shoulder flexion- normal
to 120 deg
maintained humeral ER
stable Lspine and rib cage
supine BL shoulder flexion - abnormal
C or L spine ext
rib flare
humeral IR
wall slides
w/ humeral ER w/ scap elevation SA activation w/ TB resisted ER lift off for LT activation
mid and lower trap progression
wrist forearm arms y lift offs standing side lying
best exercise for SA
serratus punch 120 deg
upward rotation, post tilt external rotation
scapular protraction and upward rotation movement
lower trap activation
upward rotation, post tilt, ER
best lower to upper w/ prone horizontal abduction at 90 deg w/ ER
best middle trap activation
prone row and prone horizontal abduction at 90 ab w/ ER have high EMG activity
greatest lower-upper trap ratio
B/L ER at 0 deg abduction
other things to look at
muscle length
MMT
STM
therex slides
