The Shoulder Flashcards
Objectives
9: Differentiate among ROM, AAROM, AROM and FROM
11: Perform PROM on the trunk, UEs and Cspine
12: Measure functional, active, and passive ROM with a goniometer and accurately record
13: Discuss manual muscle testing principles
14: Recognize a variety of muscle strength scales used in PT
15: Demonstrate accurate technique for performing manual muscle tests
16: Interpret results from a manual muscle test
fyi
ROM of the humerus on the glenoid cavity where motion at the scapula is STABILIZED
Think pure ROM of the GHJ
Glenohumeral motion
ROM of the humerus and the scapula moving together
- Brings us to the 2:1 ratio of scapulohumeral rhythm
- More of a functional motion of your patient or how your patient moves at home when you’re not there to cue or assist them
Shoulder complex motion
The scapula
Bones and Landmarks of the Shoulder Girdle
These make up the girdle (Scapula, Clavicle,& Sternum)
Name the landmarks of the Scapula
- Superior angle – levator scapula attaches here
- Inferior angle – determines scapular rotation
- Vertebral border – rhomboid, serratus anterior attaches here
- Axillary border – the lateral side between glenoid and inferior angle attachments of teres major/minor
- Spine of scapula – middle and lower trapezius attach here
- Coracoid process – attachment of pectoralis minor
- Acromion process – attachment of upper trapezius and attachment of middle deltoid
- Glenoidfossa – concave surface that articulates with the humerus
What are the landmarks of the clavicle?
- Sternal end – articulates on the medial end with the sternum
- Acromial end – attaches laterally to the scapula and provides attachment with the upper trapezius
- Body – Between the two ends
The Sternum- parts
- Manubrium – the superior end, providing attachment for the clavicle and first rib
- Body – the middle 2/3rds of the sternum, providing attachment for the ribs
- Xiphoid Process – the inferior tip
Sternoclavicular joint “SC joint” – name the ligaments
- Sternoclavicular ligament(capsular ligament)
- Costoclavicular ligament
- Interclavicular ligament
- Acromioclavicular ligament
Scapulohumeral Rhythm
explain The relationship between the shoulder girdle and the shoulder joint
- The first 30 degrees of shoulder motion are PURE shoulder motion (glenohumeral joint only)
- After the first 30 degrees, for every 2 degrees of shoulder flexion or abduction, the scapula must rotate upwardly 1 degree
- 2:1 ratio
This provides the shoulder girdle with its only direct attachment to the trunk.
This is a plane type, synovial joint and has a double gliding motion.
Motion occurs in 3 planes: elevation/depression, protraction/rectraction, and rotation
Sternoclavicular joint “SC joint”
what are the 4 scapular motions?
- Elevation/Depression
- Protraction/Retraction
- Upward/ Downward Rotation
- Tilt
These are Scapular companion motions of the shoulder girdle that occur with shoulder jt motions(i made seperate slides as well)
(think when you flex your shoulder, your shoulder blade does what…..)
These are the shoulder jt motions. Name what motions that are occuring in the shoulder girdle at the same time.
- Flexion –goes with number 1 on flipside
- Extension –
- Hyperextension –
- Abduction
- Adduction –
- Medial rotation –
- Lateral rotation –
- Horizontal abduction –
- Horizontal adduction –
- upward rotation, protraction
- donward rotation, retraction
- scapular tilt
4 upward rotation
- downward rotation
- protraction
- retraction
- retraction
- protraction
name the Scapular Muscles
TLRSP
(tell her (r) shes pretty =when she shimmies her shoulers)
- Trapezius – all divisions
- Levator Scapulae
- Rhomboids
- Serratus Anterior
- Pectoralis Minor
what is defined as muscles pulling in different directions to accomplish the same motion?
Force couples
what muscles are involved in a force couple of Upward rotation of the right scapula?
- Upper trapezius- up counter clockwise medially
- Lower trapezius- up counter clockwies laterally
- Serratus anterior- downward straight
What muscle are involve in force couple of Downward rotation of the Right scapula?
- Levator scapula- sraight up
- Rhomboids- up clockwise medially
- Pectoralis minor- down clockwise medially
Name the landmarks of the scapula when you are talking about the shoulder joint. pg 133
- Glenoid fossa- articulates wiht humerus
- Glenoid labrum – fibrocartilaginous ring attached to the GF rim, deepening the articular cavity
- Subscapular fossa – provides attachment of subscapularis
- Infraspinatous fossa – provides attachment of infraspinatous
- Supraspinatous fossa – provides attachment of supraspinatous
- Axillary Border- attacment for teres minor and major
- Acromion process- provides attacment for middle deltoid
Name the important landmarks of the Humerus when talking about the shoulder joint.
- Head – articulates with the scapula
- Surgical neck – just below the tubercles where the head meets the body
- Anatomical neck – the circumferential groove separating the head from the tubercle
- Shaft – the body of the humerus
- Greater tubercle – attachment for supraspinatous, infraspinatous, teres minor
- Lesser tubercle – attachment for subscapularis
- Deltoid tuberosity – on lateral side near tmidpoint but not well defined
- Biciptial groove - contains the tendon of the long head of the biceps
-
Bicipital ridges-(lat & med lips of the bicipital groove)
- Lateral – pectoralis major
- Medial – latissimusdorsi and teres major
Fibrocartilaginous ring attached to the GH rim, deepening the articular cavity
Glenoid labrum
provides attachment of subscapularis on the scapula.
Subscapular fossa
provides attachment of infraspinatous on the scapula
Infraspinatous fossa
provides attachment of supraspinatous
Supraspinatous fossa
on the humerus it articulates with the scapula
Head
on the humerus just below the tubercles where the head meets the body
Surgical neck
On the humerus the circumferential groove separating the head from the tubercle
Anatomical neck
what is the body of the humerus known as?
The Shaft
name attachment on the humerus for supraspinatous, infraspinatous, teres minor
Greater tubercle
attachment for subscapularis on humerus
Lesser tubercle
on the humerus this is on the lateral side near the midpoint but not well defined
Deltoid tuberosity
on the humerus this contains the tendon of the long head of the biceps
Biciptial groove
where do these attach on the humerus?
Lateral – pectoralis major
Medial – latissimusdorsi and teres major
Bicipital ridges
These ligaments reinforce the anterior portion of the capsule. They are not well defined ligaments but acutally pleated folds of the capsule
The superior, middle, and inferior Glenohumeral ligaments
This attaches from the lateral side of the coracoid process and spans the joint anteriorly to the medial side of the greater tubercle. pg 134
It strengthens the upper part of the joint capsule.
Coracohumeral ligament
a fibrous ring that surrounds the fossa to deepen the cavity of the joint
Glenoid labrum
tendonous bands of the SITS muscles. What else is this called?
- Supraspinatous,
- infraspinatous,
- teres minor
- subscapularis
The Rotator cuff
On the trunk, this provides a broad attachment for the latissimusdorsi muscles
Thoracolumbar fascia
name the Muscles of the Shoulder joint-there are 11
pg 134
BCDILPSSTTT
- Deltoid – anterior, middle and posterior
- Supraspinatus
- Infraspinatus
- Pectoralis major
- Latissimus dorsi
- Teres major
- Teres minor
- Subscapularis
- Coracobrachialis
- Biceps brachii
- Triceps – long head
how do the Force Couple of the Deltoid/SITS work?
The deltoid and rotator cuff muscles rotate the humeral head in the glenoid fossa during shoulder abduction
Did you know the shoulder is the only joint in the body that has _______degrees of motion?
360
true or false
The shoulder joint is the most mobile joint in the body.
true
The stability of the shoulder joint is maintained by the combined effort of the _______ muscles and the _______ ________muscles.
Force couples are two equal forces acting in opposite directions to rotate the bones of the girdle around an axis
deltoid muscle
rotator cuff
A situation that occurs when the space between the humeral head below the acromion becomes narrowed
- The bones then squeeze the structures that occupy the interval space.
- Joint capsule
- Bursa
- Tendons of the rotator cuff
Impingement Syndrome
- Causes mechanical irritation of the cuff tendons resulting in hemorrhage and swelling
- Tendonitis of the rotator cuff, usually the supraspinatous
- This can also affect the bursa
- Bursitis
Impingement Syndrome
- Most common cause: Repetitive overhead use
- Common sports: baseball, tennis, swimming, volleyball
- Impingement with rotator cuff tendonitis is one of the most common shoulder injuries seen in athletes
Impingement Syndrome
S/S OF WHAT
- Pain or tenderness in the glenohumeral area
- Pain and/or weakness with active abduction in midrange
- Limited internal rotation compared to the uninvolved side
- Confirmation with special tests done by the PT
- Tenderness to palpate in subacromial area
Impingement Syndrome
Occur in both the young and the old
- Younger athletes typically suffer a traumatic rupture (such as a fall on outstreched hand [FOOSH]) or by putting unusual demands on the shoulder
- Tendons lose elasticity as people age and become more susceptible to tearing – often being injured while performing everyday activities
Rotator Cuff Tear
In repetitive use injuries, an action will lead to chronic etiology and ultimately a tear
- Partial thickness
- Full thickness
- Either can require surgery
Rotator Cuff Tear
Signs and Symptoms: OF WHAT?
- Pain but with Full/near full AROM
- Vague pain
- “Catching sensation” when the arm is moved
- The larger the tear in the tendon, the more weakness a person will have
- Inability to sleep on the affected side
- Small to partial tears usually respond well to an outpatient rehabilitation program
Partial Thickness Tear - RTC
Signs and Symptoms: OF WHAT?
- Pain with inability to move the joint through a normal range of motion
- Visible with a shoulder shrug or hike
- “Catching sensation” with movement
- Inability to sleep on the affected side
- Diagnosed by MRI, sometimes confused with impingement syndrome
- Surgical repair usually required
Full Thickness Tear - RTC
Signs and Symptoms: OF WHAT?
Caused by overuse or traumatic injuries
- Pain and tenderness in the area of the muscle belly
- Provoked by direct palpation, stretch, contraction against resistance
- Delayed onset muscles soreness (DOMS) can be seen a few days after the injury first occurs
Muscle Strains
Signs and Symptoms: OF WHAT?
Discomfort in the front of the shoulder
Caused by impingement
Tender to palpation
Biceps (Long Head) Tendonitis
Not common in athletics
Signs/Symptoms
- “Pop” during activity
- Drooping of the biceps muscle at the distal arm
- Grade 3 – complete rupture of the biceps tendon to the long head
- “Popeye” Muscle Deformity
- Bruising/Ecchymosis in the anterior arm
Biceps Tendon Rupture
- Caused when the shoulder is abducted to the side with the elbow bent and a force is applied to the arm that causes external rotation
- Anterior and posterior structures tear, allowing the humeral head to come out of the glenoidfossa resulting in a visual deformity
- Extremely painful
- Requires immediate medical care by a physician
Traumatic Anterior Dislocation
- Occurs with trauma or overuse/repetitive injury
- Signs and Symptoms:
- Pain
- Catching/popping sensation
- Limitation in use of the arm
- Diagnosed by special tests and an MRI
Glenoid Labrum Injuries
Often referred to as a “stinger” or “burner,” this a painful and debilitating injury when the head and neck are forcibly moved or hit to one side
- Stretches the brachial plexus on the opposite side and sometimes compresses the brachial plexus on the same side
- Irritating the nerves
Brachial Plexus Injury
Signs and Symptoms: OF WHAT?
- Causes intense pain from the neck down to the arm
- Sensation of the arm on fire and/or a sensation of pins and needles
- The arm or hand may be weak and numb with intense pain in the area of the brachial plexus in the shoulder
- Can last from several minutes to several hours or more
- Weakness can last for several days
Brachial Plexus Injury
Signs and Symptoms: OF WHAT?
- Easily recognized by visual deformity or exposed bone
- Ecchymoses or bruising may be present
Fractures
a wind up or prerelease phase of a softball pitch, a blowing delivery, or a racing dive in swimming are examples of what scapular motion?
scapilar tilt
what motion happens when the inferior angle of the scapula rotates up and out, the superior angle moves down, and the glenoid fossa moves up and in?
scapular uppward rotation
what muscels are involved in scapular uppward rotation?
upper traps, lower traps, and serratus anterior
what muscles are involvled in scapular downward rotation?
levator scapula, rhomboids, and pectoralis major
This shoulder jt motion goes with what shoulder girdle motion?
Horizontal adduction
protraction
This shoulder jt motion goes with what shoulder girdle motion?
Horizontal ABduction
Retraction
This shoulder jt motion goes with what shoulder girdle motion?
Lateral rotation
retraction
This shoulder jt motion goes with what shoulder girdle motion?
medial rotation
protraction
This shoulder jt motion goes with what shoulder girdle motion?
Adduction
downward rotation
This shoulder jt motion goes with what shoulder girdle motion?
ABduction
upward rotation
This shoulder jt motion goes with what shoulder girdle motion?
Hyperextension
Scapular tilt
This shoulder jt motion goes with what shoulder girdle motion?
Extension
downward rotation and retraction
This shoulder jt motion goes with what shoulder girdle motion?
Flexion
upward rotation and protraction
Where do these each articulate?
shoulder girdle, the shoulder joint, and the shoulder complex.
Shoulder girdle- scapula and clavicle
Shoulder joint- scapula and humerus
Shoulder complex- scapula, clavicle, humerus,sternum, and rib cage
Given the scapula is shaped somewhat like a triangle, what landmark is commonly used to determine the direction the scapula is rotating?
The inferior angle
Given that the scapula is shaped somewhat like a triangle, what direction is the inferior angle moving if the scapula is rotating upwards or downwards?
Away from the vertebral border- upward rotation
Towards the vertebral border-downward rotation
Which shoulder girdle motions are mostly linear?
- Elevation/Depression
- protraction/retraction
Which shoulder girdle motions are mostly angular?
Upward/Downward rotation
How is Shoulder joint motion affected by the absence of scapulohumeral rhythm?
One cannot normall and completely raise the arm above the head.
From a functional perspective, why is the trapezius muscle referred to and separated into three muscles?
because the 3 different attachments of the trapezius muscle produce 3 different lines of pull, the 3 parts have different muscle action.
From a functional perspective, why are the rhomboid muscles described as one?
The have the same line of pull and thus the same muscle action. There is no functioanl difference bwtween the rhomboid muscles.
Raising your hand over your head requires the combined action of which 3 shoulder girdle muscles?
serratus anterior
upper trap
lower trap
Starting at the inferior angle and going clockwise, name the shoulder girdle muscles that attach to the posterior surface of the right scapula.
Rhomboids
lower and middle traps
levator scapula
upper traps
The pectoralis minor muscles is deep to what?
pectoralis major
As you look at the lateral chest wall, the serratus anterior is deep to what two muscles?
Pectoralis major
Latissimus dorsi
Identify the shoulder girdle motions that occur with the following actions. Accompanying shoulder joint motions are in parentheses.
Closing a window by pulling down shoulder girdle motion
(shoulder extension)
What type of contraction is occuring
Downward rotation
Concentric
Identify the shoulder girdle motions that occur with the following actions. Accompanying shoulder joint motions are in parentheses.
Opening a window by pulling up
(shoulder flexion)
What type of contraction is occuring
upward rotation
concentric
Identify the shoulder girdle motions that occur with the following actions. Accompanying shoulder joint motions are in parentheses.
Carrying a heavy suitcase
(no shoulder motion )
What type of contraction is occuring
Elevation
isometric
Identify the shoulder girdle motions that occur with the following actions. Accompanying shoulder joint motions are in parentheses.
Combing your hair in the back
(shoulder flexion, lateral rotation)
What type of contraction is occuring
upward rotation and retraction
isometric
Identify the shoulder girdle motions that occur with the following actions. Accompanying shoulder joint motions are in parentheses.
Reaching across the table
(shoulder flexion)
What type of contraction is occuring
prtotraction
concentric
