Upper extremity

Question 1

Functional articulations of shoulder complex

Answer 1

Shoulder girdle inc ROM with less compromise of stability

Question 2

Jts of shoulder

Answer 2

Sterno-clavicular
Acromio-clavicular
Scapulo-thoracic
Gleno-humeral (ball and socket)
Supra-humeral/sub-acromial
LH biceps and bicipital groove

Question 3

Role of long and short head of bicep

Answer 3

Ant stability of GH, therefore failure of stabilisation of LHB can have damaging effects on GH and rotator cuff function
Achieved through compression of humeral head against glenoid fossa

Humeral head stability= compression of humeral head to glenoid fossa, doesn’t go into subacromial space

Question 4

Evidence that LHB enables GH stability

Answer 4

LHB hypertrophies in Px with rotator cuff tears

Question 5

Scapulo-humeral rhythm

Answer 5

Rare at ahwihc scapula moves relies on rate at which humerus moves
Permits larger ROM
Shoulder girdle inc ROM with less compromises to stability
Facilitate movement of upper extremity by positioning GH favourably

Question 6

Force coupling

Answer 6

Around a pivot (SC Jt)
Opposing forces in scapula rotate around pivot point
Multiple forces at once
Can be equal or unequal, depending on function required and balance of stabilising elements such as ligaments

Question 7

Roll and glide GH

Answer 7

Convex-concave- convex rolls and slides in opposite directions
Helps maintain Jt congruity and articular surface contact through ROM
Concave= glenoid fossa of scapula
Covnex= head of humerus (spins in flex/ext)
Scapular is fixed
Active movement driven by humerus

Question 8

Roll and glide principle SC

Answer 8

Convex-concave- convex rolls and slides in opposite directions
Helps maintain Jt congruity and articular surface contact through ROM

Concave= manubrium
Convex= proximal clavicle
Clavicle and manbrium passive
Active driven by humerus and scapula

Question 9

Importance of sub acromial space

Answer 9

Location of bicep tendon, rotator cuff and bursa
Can become pinched during some shoulder movements

Question 10

Role of clavicle

Answer 10

Attaches axial and appendicular
Only attachment point for upper limb
Elevates, depresses, rotates, protracts, retracts- all movements passive and accessory
All movements allow acceptance of head of humerus by scapular
All movements of GH Jt involve some movement of clavicle around pivot point of SC jt

Question 11

Role of coracoid process

Answer 11

Ant anchor of scapula- e.g., pec minor, corocobrachialis, short head of bicep

Question 12

Movers GH

Answer 12

Deltoid
Supraspinatous
Biceps brachii
Brachioradialis
Pec major

Question 13

Stabilisers GH

Answer 13

Subscapularis
Serratus ant
Lats
Coracobrachialis
Pec major
Ligaments also necessary

Question 14

Identify cause of painful and weak shoulder

Answer 14

Rotator cuff related shoulder P
Subacromial impingement syndrome
SLAP lesion

Question 15

Identify cause of painful and stiff shoulder

Answer 15

Adhesive capsulitis
OA (bony remodelling) of GH, AC

Question 16

Identify cause of painful and unstable shoulder

Answer 16

Dislocations
Repeated dislocations

Question 17

Elbow torques

Answer 17

Flexion torques are 70% greater than ext torque
Torque forces needed for bicep curl are 70% greater than an ext push down
Flex torque with supination is 20% greater than with pronation
Brachioradialis in mid prone inc power of flexion

Question 18

Elbow levers

Answer 18

3rd class lever- during flexion
Effort= muscle (at point of insertion)- e.g. bicep
Load= weight of body and additional resistance
Fulcrum= Jt itself

Question 19

Elbow roll and glide

Answer 19

The concave-convex surface movement, the concave surface rolls and slides in the same direction
This helps maintain articular surface contact and Jt congruity through ROM

Concave= ulnar
Convex= humerus
Humerus is passive in both flex and ext, driven by active movement of ulnar and radius

Question 20

Mechanics of grip

Answer 20

Lumbricals allow for L-shape grip

Question 21

Examples of mechanical principles in elbow

Answer 21

• Lever- 3rd class
• Force- torque in pronation/supination
• Roll/slide- proximal humerus-radius/ulnar roll- slide in same direction
• Flexion force- 70% greater than ext, 3x bicep, 1x triceps
• Stabiliser- interosseous membrane
• 90 pro/supination, 140-150 flex

Question 22

Examples of mechanical principles of wrist

Answer 22

• Ulnar/radial deviation ROM- 30-45, 15
• Roll and slide mechanism in radial/ulnar deviation
• Movement driven by carpals, radius is passive, carpals roll and slide in different directions around pivot point of capitate
• Role of lumbricals- allow for L-shaped grip, inc stability

Question 23

Describe kinematics of pro/sup of forearm
Comment on ROM, types of movement, roll and slide concept

Answer 23

90 pro/sup
Torque force
Roll + slide mechanism- same direction- radial/ulnar/humeral
Roll + slide- radial/ulnar Jt
Stabilising effects of interosseous membrane

Question 24

Describe kinematics of flex of elbow
ROM, type of movement, roll and slide concept, type of lever

Answer 24

3rd class
120-140 flex
Humerus convex, ulnar concave
Roll + slide in same direction
Flexibility of capsule allows flex/ext