Upper Quarter Flashcards
Upper quadrant
Occiput
Cervical and upper thoracic vertebrae
Shoulder girdle
Upper limbs
Related tissue
Related nervous and circulatory systems
Shoulder girdle
Clavicle, humerus, scapula
Support for larger muscles that allow mobility
Clavicles
In only bone that connects the shoulder girdle with axial skeletal system
Cervical fascia
Start at the superior nuchal line
Mastoid process
Mandibles
Acromion
Clavicle
Manubrium sterni
Posture
Dynamic : refers to positional change that occurs during function
Static: position of the subject while relaxed standing sitting or lying down
Maintenance of normal posture from neurophysiology perspective
Weight bearing and physiological processes
*Vestibular sensation: located inner ear and help with balance and orientation and the orientation of semicircular canals detected rotational movements of and maintaining balance
*Proprioceptive impulses: ability body sense its position and they come from nerve endings in ligaments joint capsule tendons and muscles
*Muscle spindle: specialized receptors with in the muscle that respond to stretching
Scapulohumeral rhythm
Is depend on smooth synchronous motion
So to do full ROM
60 degrees I’d scapula rotation and 120 degrees of glenohumeral elevation and the ratio is 1:2
Upper crossed syndrome
- Facilitated : muscle are tight or overactive ( upper trapezius abs levator scapul for back and neck and scm for neck and pectorals for chest muscles
- Inhibition: muscles that are weak or under active ( deep cervical flexors of the neck and lower trapezius and serratus anterior which helps to stabilize the shoulder bladder
Lower crossed syndrome
Facilitated: refers to thoracolumber extensor and muscle of lower back and the ilipsoas and rectus femoris which are hip flexors muscles
Inhibited: gluteus medius/ minimum and maximum and abdominal which are often weak and under active in this syndrome
Long term posture impairment
Loss of glycosaminoglycan and water
Abnormal cross linking
Infiltration of joint by fibrofatty material
Increased joint stiffness
Altered arrhrokinematics
Joint capsules tightened
Forward head posture
Protracted and medically rotated scapulae
Internal rotation at the glenohumeral joint
Increased kyphosis of upper thoracic spine
Increase cervical spine lordosis
Craniomandibular backward bending
Craniocervical anglee
Forward head posture
Angle that btw c7 tragus and c7 horizontal line
Anterior tilt increase as angle degree decreases
Kyphosis
Abduct or protract of the scapula
Shorten of serratus anterior , latissimus dorsi
The humerus rotatss internally, shortening glenohumeral ligaments and anterior shoulder capsules
Rotation cuff muscles
Function is to maintain the humoral head at the glenoid fossa and resisting the upward pull of the deltoid is lost
Tos
Compression neuro vascular structure as they exist through the thoracic outlet
The two main categories of tos
Vascular form :
Neurological forms
Epidemiology of tos
Frequency to some 3-4 times
Btw 20 to 50 age
Mostly are affect the brachial plexus and others affect vascular structure
Congenital factors
Prolonged transverse process
Anomalous muscle
Abnormalities of the insertion of scalena muscle
Acquired condition
Posture factors
Dropped shoulder
Wrong work posture
Trauma
Clavicle or rib fracture
Whiplash
Muscles couses tos
Scalene hyper trophy
Increase of muscle tone of the Upper trapezius ,Levatorscapular and Pectoral muscle
Weakness of rhomboid and mid/lower trapeziu
Symptoms of tos
It’s get worse when the arm is abd overhead and externally rotated
Neurogenic tos
Most common and compression of branial plexus
For pain = you will feel it from neck face occipital chest shoulder and upper extremity
paresthesia in upper extremity
altered or absent sensation, weakness, fatigue, a feeling of heaviness in the arm and hand
Upper plexus c5,6,7 involvement of tos
Pain the side of the neck and radiate to ear and face
Pain = supraclavicular and parascapular ipsilaterly
And pain may move to later radia nerve area
Weakness= extensor muscle of the forearm, triceps and deltoid
Lower plexus involvement c8,t1
Pain anterior and posterior shoulder region and radiate down the ulnar side of the forearm into the hand, the ring and small fingers.
Weakness flexor muscles of the forearm
Atrophy abductor pollicis brevis,, hypothenar muscles
Parasthesia ulnar side of the forearm
Some patients feel pain like angina pectoris
Vascular semptom
Arterial tos =
Venous
Venous
Because of one or more of the vein under the clavicle is compressed resulting of blood clots
Symptoms are
feeling heaviness, cyanosis, parasthesia in fingers and hand
Edema of the arm
Arterial
Young adult with vigorous arm activity
Pain in the hand
Claudication = pain occures after repetitive activities, disappears in rest
Pallor
Cold intolerance
Paresthesias
Abnormal posture
Forward head= depression if the anterior chest
Shoulder = internal rotation
Space btw anterior and middle scalenes is reduced
Compression in the thoracic outlet
Examinations
Posture
Manual muscle test
Tendons reflex
Sensation test
Thoracic outlet text
Palpation
Resistant test
Costoclavicular test
Roos test
Ads on test
Treatment
Electro physical therapy
Soft tissue mobilization
Joint mobilization
Therapeutic exercise
Neuro mobility exercises
