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Winter 2023 - Essential Biomechanics and Kinesiology > Shoulder - WK5 ( CH5) > Flashcards

Shoulder - WK5 ( CH5) Flashcards

1
Q

What type of joint is the SCJ joint ?

A

complex saddle joint; medial end of clavicle normally convex longitudinally and concave transversely; the clavicular portion of sternum is reciprocally shaped ( see fig 5.12)

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2
Q

How many degrees of freedom does the SCJ have ?

A

3 degrees of freedom

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3
Q

Name the motions, planes, and axes for SCJ movement.

A

Elevation/ Depression: frontal plane; saggital axis
Retraction/ Protraction: horizontal plane; vertical axis
Posterior Rotation: sagittal; frontal axis

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4
Q

What osteokinematic motions of the arm are associated with each movement of the SCJ ?

A

Elevation/Depression: Arm Abduction/Adduction
Retraction/Protraction: Arm Flexion/ Extension
Posterior Rotation: Arm flexion and Abduction

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5
Q

Describe the arthrokinematic movement of the clavicular partner during: Protraction, Retraction, Elevation, Depression

A

Concave on Convex:
Protraction ( 15-30 degrees): anterior roll and slide
Retraction ( 15-30 degrees): posterior roll and slide
Convex on Concave:
Elevation ( 35-40 degrees): clavicle rolls superiorly and slide inferiorly
Depression ( 10 degrees ): clavicle rolls inferiorly and slides superiorly

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6
Q

Which ligaments restrict the following motions ( SCJ ): elevation, depression, retraction.

A

Elevation: costoclavicular, anterior and posterior bundles
Depression: interclavicular ligament
Retraction: costoclavicular, ant. and post. bundles, ant. capsular ligament

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7
Q

What type of joint is the ACJ ?

A

gliding/plane joint; thus, roll and slide arthrokinematics do not apply.

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8
Q

What ligaments are associated with the ACJ and what are their respective jobs ?

A

Superior and inferior capsular ligaments: surround joint and keep it from subluxing
Coracoclavicular Ligament: made up of conoid and trapezoid ligaments; suspend scapula from clavicle

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9
Q

How many degrees of freedom does the ACJ have ?

A

3 degrees of freedom

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10
Q

Name the motions planes and axes for ACJ movement.

A

primary:
upward/downward rotation: sagittal axis; frontal plane
secondary:
IR/ER: horizontal plane; vertical AoR
Ant./Post. Tilt: sagittal plane; frontal axis

( See Fig 5.19)

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11
Q

What osteokinematic motions of the arm are associated with each movement of the ACJ ?

A

upward/downward rotation: abduction/adduction of shoulder

IR/ER: Internal and External Rotation of the arm

Ant./Post. Tilt: extension/ flexion

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12
Q

What is meant by the terms plane of the scapula and scaption.

A

Plane of the scapula: the scapulas resting place; 10 degrees ant. tilt, 5-10 degrees upward rotation, 30-40 degrees IR.

Scaption: elevation of the arm within the scapular plane

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13
Q

What occurs at the SCJ and ACJ during scapular: elevation, depression, protraction, retraction, upward rotation, downward rotation

A

Elevation:
SCJ: elevation
ACJ: downward rotation

Depression:
SCJ: depression
ACJ: upward rotation

Protraction:
SCJ: protraction
ACJ: varying IR

Retraction:
SCJ: retraction
ACJ: varying ER

Upward Rotation:
SCJ: elevation
ACJ: upward rotation

Downward Rotation:
SCJ: depression
ACJ: downward rotation

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14
Q

What ostekinematic motions of the arm accompany the following scapular motions ? Elevation, Depression, Protraction, Retraction, Upward Rotation, Downward Rotation, Ant. Tilt, Post. Tilt

A

Elevation: superior translation
Depression: inferior translation
Protraction: Arm IR
Retraction: Arm ER
Upward Rotation: Abduction
Downward Rotation: Adduction
Ant. Tilting: Arm Ext.
Post. Tilting: Arm Flex.

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15
Q

Which muscles control the following scapular movements ? Elevation, Depression, Protraction, Retraction, Upward Rotation, Downward Rotation, Post. Tilt, Ext. Rotation

A

Elevation: levator scapulae, upper trapezius, rhomboids
Depression: subclavius, lower traps, pec. minor, lats
Protraction: serratus anterior
Retraction: Rhomboids, lower and middle traps
Upward Rotation: Serratus Ant. , upper and lower traps
Downward Rotation: see upward rotation
Posterior Tilting: lower trap, serratus anterior
External Rotation: middle trap, serratus anterior

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16
Q

What type of joint is the GHJ ?

A

ball and socket, convex humeral head with concave glenoid cavity

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17
Q

How many degrees of freedom does the GHJ have ?

A

3 degrees

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18
Q

Name the motions, planes, and axes for GHJ movement.

A

Flex/Ext. : sagittal plane; frontal axis
Abduction/Adduction: frontal plane; sagittal axis
IR/ER: horizontal plane; vertical axis

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19
Q

Describe the arthrokinematic movement of the humerus partner of the joint during: flexion, extension, abduction, adduction, external rotation, internal rotation

A

flexion/ext.: humeral head spin
Abduction: humerus rolls superior and slides inferior
Adduction: rolls inferior and slides superior
ER: simultaneous posterior roll and anterior slide
IR: simultaneous anterior roll and post. slide

See table 5.2

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20
Q

Name each GHJ ligament and motion it restricts.

A

Superior: taut in anatomic position; resists ER, inf and ant translation
Middle: taut in 45-90 degrees abduction; resists anterior translation
Inferior: taut in 90 degrees of abduction and ER
Coracohumeral: taut in anatomical position; resist ER and inferior translation

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21
Q

What is meant by static and dynamic stabilizers of the GHJ ?

A

static: non-contractile tissues that contribute to joint stability at rest
dynamic: rotator cuff muscles that contribute to joint stability during movement

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22
Q

What is the rotator cuff interval ?

A

an opening where the RTC muscles do not cover the joint capsule; between subscapularis and supraspinatus

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23
Q

Which muscles are responsible for the following movements of the GHJ ? flex/ ext, abd/add, ER/IR

A

flexion: biceps brachii, anterior delt, coracobrachialis
Extension : posterior delt, lats, teres major, triceps LH, pec major ( sternal head )
Abduction: deltoids, supraspinatus, RTC muscles
Adduction: post. delt, lats, teres major, triceps LH, pec major ( sternal head )
ER: infraspinatus, teres minor, posterior delt
IR: subscapularis, pec major, lats, teres major, anterior delt

24
Q

What are the consequences of a downwardly rotated scapular position on the GHJ and subacromial space ?

A

GHJ: decreased compressive forces, can lead to plastification of superior capsular structures

Subacromial Space: could place strain on bursae and tendons, biceps LH, and supraspinatus

25
Q

What structures live in the subacromial space?

A

supraspinatus, subacromial bursa, biceps LH, part of superior joint capsule

26
Q

A tight post capsule of the GHJ will have what effect on the humeral head during arm elevation ? How does this affect structures in the subacromial space ?

A
  • tension within the stretched posterior capsule may cause slight anterior translation of the humerus at the extremes of flexion.
27
Q

What are the six principles needed for proper arm abduction kinematics ?

A
  1. scapulohumeral rhythm
  2. SC elevation and AC upward rotation
  3. clavicle retraction at SCJ
  4. Scapular posterior tilt and ER
  5. Clavicle posterior rotation
    6.GHJ ER
28
Q

Explain in your own words the scapulohumeral rhythm.

A

2:1

For every 3 degrees of arm abduction after 30 degrees; 2 degrees occur by GH movement and 1 degree by scapulothoracic upward rotation.

120 GHJ total + 60 STJ total = 180 degrees full abduction

29
Q

What compensation during shoulder abduction might you see if the rotator cuff is not working properly and the upper trapezius is overactive ?

A
  • Trapezius and Serratus Anterior Imbalance
  • Shoulder shrug during posture which is less efficient for arm abduction
  • prolonged use leads to pain
30
Q

Explain the force couple mechanisms for: scapular upward rotation and glenohumeral abduction.

A

scapular upward rotation: like a revolving door with trap muscles pulling scapula up and in and delts abducting GH joint and Serratus Anterior

GH abduction: deltoid and supraspinatus pull on humerus supero-medially; RTC muscles pull infero-medially

31
Q

Explain the consequences of habitual rounded shoulders posture.

A

can lead to stress placed on SCJ and ACJ: subacromial impingement
integrity should be assessed

32
Q

What is scapular dyskinesis and what are its effects on ST and GH arthorkinematics, on regions near the shoulder girdle and other structures that live in the shoulder girdle.

A

abnormal movement of scapula ( for example in the case of damage to CN XI)

could lead to protraction during arm flexion and lack of retraction; affecting ROM depending on paralysis type

could lead to winging scapula; RTC degen, ; unstable joints

Could reduce volume in subacromial space leading to impingment

33
Q

Why would one choose to strengthen the shoulder in the scapular plane rather than pure abduction ?

A

It is more natural and generally allows a greater AROM; avoiding narrowing of the subacromial space

34
Q

Explain subacromial impingment syndrome to a patient.

A

a structure in the subacromial space is being pushed on like supraspinatus tendon, bursae, and biceps LH

35
Q

What pathologies can arise from repetitive overhead throwing and why ?

A

-subacromial impingement syndrome- superior migration of humeral head can have many causes; RTC syndrome; OA of ACJ: Ball throwers fracture- humeral spinal fracture from decelerating ER creating shear force; GIRD ( glenohumeral IR deficit ) - makes you more likely to develop shoulder issues

36
Q

What is shoulder instability and what are some causes ?

A

Excessive laxity w/ large translations of humerus

can be caused by GIRD, ligamental deformity/laxity, can be due to joint nature, anterior-inferior subluxation most common

37
Q

What is the difference between a SLAP tear and a Bankart tear ?

A

SLAP: superior labrum tear anterior to posterior; biceps LH “ peel back” mechanism on labrum; 90 degrees of abduction and end range ER

Bankart: anterior- inferior rim labrum tear: anterior instability

38
Q

How would hypomobility at each joint affect the other 2 ?

A

GHJ: total humeral ROM reduced; scapular substitution
SCJ: decreased clavicular motions, decreased scapular upward rotation, increased scapular IR
ACJ: scapular motion limited; SCJ motion limited due to SCJ and ACJ connection; clavicular protraction brings scapula into thorax

39
Q

What are the CPP and OPP of each of the shoulder girdle joints ?

A

GHJ:
OPP= 23-55 degrees of scaption; CPP=abduction and ER

ACJ:
OPP= arm resting by side; CPP: arm abducted 90 degrees

SCJ:
OPP= arm resting by side ; CPP: max shoulder elevation

40
Q

What are the AAOS ROM norms for shoulder… Flexion, Extension, Abduction, Adduction, IR, ER

A

Flexion: 180
Extension: 60
Abduction: 180
Adduction: 0
IR: 70
ER: 90

41
Q

OIIA: Biceps Brachii

A

O: SH: tip of coracoid process of scapula
LH: supraglenoid tubercle of scapula
I: Tuberosity radius and fascia of forearm via bicipital aponeurosis
I: Musculucutaneous Nerve ( C5-7)
A: Supinates forearm and when it is supine flexes forearm; short head resists dislocation of shoulder

42
Q

OIIA: Deltoids

A

O: lateral third of clavicle; acromion and spine of scapula
I: deltoid tuberosity
I: Axillary Nerve ( C5-6 )
A: clavicular part: flexes and medially rotates arm
middle: abducts arm
Spinal or posterior part; extends and laterally rotates arm

43
Q

OIIA: Latissimus Dorsi

A

O: spinous processes and inferior six thoracic vertebrae, thoracolumbar fascia, iliac crest, and inferior 3 or 4 ribs
I: floor of intertubercular sulcus of humerus
I: thoracodorsal nerve ( C6-8)
A: extends, adducts, and medially rotates humerus; raises body toward arms during climbing

44
Q

OIIA: Teres Major

A

O: posterior surface of inferior angle of scapula
I: medial lip of intertubercular groove
I: lower subscapular nerve ( C5-6 )
A: Adducts and medially rotates arm

45
Q

OIIA: Teres Minor

A

O: middle part of lateral border of scapula
I: inferior facet of great tubercle of humerus
I: axillary nerve ( C5-6)
A: laterally rotates arm; and acts with the other rotator cuff muscles

46
Q

OIIA: Subscapularis

A

O: Subscapular fossa
I: lesser tubercle of humerus
I: upper and lower subscapular nerves ( C5-7)
A: medially rotates arm; as part of the rotator cuff, help hold head of humerus in glenoid cavity

47
Q

OIIA: Serratus Anterior

A

O: External Surfaces of lateral parts of 1st-8th ribs
I: anterior surface of medial border scapula, including superior and inferior angles
I : long thoracic nerve ( C5-C7 )
A: protracts scapula and holds it against thoracic wall; rotates scapula

48
Q

OIIA: Pectoralis Major

A

O: Clavicular head: anterior surface of medial half of clavicle
Sternocostal head: anterior surface of sternum, superior six costal cartilages, and aponeurosis of external oblique muscle

I: Lateral lip of intertubercular sulcus of humerus
I: lateral and medial pectoral nerves; clavicular head ( C5-6), and sternocostal head ( C7-T1)
A: adducts and medially rotates humerus; draws scapula anteriorly and inferiorly; acting alone clavicular head flexes humerus and sternocostal head extends it from the flexed position

49
Q

OIIA: Pectoralis Minor

A

O: 3rd-5th ribs near their costal cartilages
I : medial border and superior surface of coracoid process of scapula
I: medial pectoral nerve ( C8-T1); lateral pectoral n. ( variable )
A: stabilizes scapula by drawing it against inferiorly and anteriorly against the thoracic wall

50
Q

OIIA: Supraspinatus

A

O: supraspinous fossa
I: middle facet of greater tuberlce of humerus
I: suprascapular nerve ( C4-C6 )
A: initiates and assist deltoid in abdcution of arm and acts with the other rotator cuff muscles

51
Q

OIIA: Trapezius

A

O: Medial third of superior nuchal line; external occipital protuberance; nuchal ligament; spinous processes of C7–T12 vertebrae
I: Lateral third of clavicle; acromion and spine of scapula
I: spinal accessory nerve ( CN XI ), C3 and C4 propioceptive fibers
A: Descending part elevates; ascending part depresses; and middle part (or all parts together) retracts scapula; descending and ascending parts act together to rotate glenoid cavity superiorly

52
Q

OIIA: Rhomboids

A

O: Minor: nuchal ligament; spinous processes of C7 and T1 vertebrae
Major: spinous processes of T2–T5 vertebrae
I: Minor: smooth triangular area at medial end of scapular spine
Major: medial border of scapula from level of spine to inferior angle
I: dorsal scapular nerve ( C4-5 )
A: retract scapula and rotate its glenoid cavity inferiorly; fix scapula to thoracic wall

53
Q

OIIA: Subclavius

A

O:junction of 1st rib and its costal cartilage
I :inferior surface of middle third of clavicle
I: nerve to subclavius ( C5-6)
A: anchors and depresses clavicle

54
Q

OIIA: Coracobrachialis

A

O: tip of coracoid process of scapula
I: middle third of medial surface of humerus
I: Musculucutaneous Nerve ( C5-7)
A: helps flex and adduct arm; resists dislocation of shoulder

55
Q

Draw the Brachial Plexus

A

….

Winter 2023 - Essential Biomechanics and Kinesiology (16 decks)

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