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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
What structures live in the subacromial space?
supraspinatus, subacromial bursa, biceps LH, part of superior joint capsule
26
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 ?
- tension within the stretched posterior capsule may cause slight anterior translation of the humerus at the extremes of flexion.
27
What are the six principles needed for proper arm abduction kinematics ?
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
Explain in your own words the scapulohumeral rhythm.
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
What compensation during shoulder abduction might you see if the rotator cuff is not working properly and the upper trapezius is overactive ?
- Trapezius and Serratus Anterior Imbalance - Shoulder shrug during posture which is less efficient for arm abduction - prolonged use leads to pain
30
Explain the force couple mechanisms for: scapular upward rotation and glenohumeral abduction.
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
Explain the consequences of habitual rounded shoulders posture.
can lead to stress placed on SCJ and ACJ: subacromial impingement integrity should be assessed
32
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.
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
Why would one choose to strengthen the shoulder in the scapular plane rather than pure abduction ?
It is more natural and generally allows a greater AROM; avoiding narrowing of the subacromial space
34
Explain subacromial impingment syndrome to a patient.
a structure in the subacromial space is being pushed on like supraspinatus tendon, bursae, and biceps LH
35
What pathologies can arise from repetitive overhead throwing and why ?
-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
What is shoulder instability and what are some causes ?
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
What is the difference between a SLAP tear and a Bankart tear ?
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
How would hypomobility at each joint affect the other 2 ?
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
What are the CPP and OPP of each of the shoulder girdle joints ?
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
What are the AAOS ROM norms for shoulder... Flexion, Extension, Abduction, Adduction, IR, ER
Flexion: 180 Extension: 60 Abduction: 180 Adduction: 0 IR: 70 ER: 90
41
OIIA: Biceps Brachii
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
OIIA: Deltoids
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
OIIA: Latissimus Dorsi
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
OIIA: Teres Major
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
OIIA: Teres Minor
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
OIIA: Subscapularis
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
OIIA: Serratus Anterior
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
OIIA: Pectoralis Major
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
OIIA: Pectoralis Minor
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
OIIA: Supraspinatus
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
OIIA: Trapezius
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
OIIA: Rhomboids
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
OIIA: Subclavius
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
OIIA: Coracobrachialis
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
Draw the Brachial Plexus
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Winter 2023 - Essential Biomechanics and Kinesiology (16 decks)

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