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PTA 160 > Weeks 5 &6: Shoulder Complex > Flashcards

Weeks 5 &6: Shoulder Complex Flashcards

Quiz 3/Exam 2

1
Q

Innvervations:

Axillary

A

deltoids
teres minor

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2
Q

Innvervations:

Pectoral

A

pectoralis major

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3
Q

Innervations:

long thoracic

A

serratus anterior

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4
Q

Innervations:

Suprascapular

A

supraspinatus
infraspinatus

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5
Q

Innvervations:

subscapular

A

subscapularis
teres major

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6
Q

Innervations:

thoracodorsal

A

latissumus dorsi

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7
Q

Innervations:

dorsal scapular

A

levator scapula
rhomboids

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8
Q

Innervations:

CN XI (accessory nerve)

A

trapezius

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9
Q

Which muscles perform this action?

scapular elevation

A

upper trapezius
levator scapulae

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10
Q

Which muscles perform this action?

scapular depression

A

lower trapezius
latissimus dorsi
pectoralis major
pectoralis minor

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11
Q

Which muscles perform this action?

scapular protraction

A

pectoralis minor
serratus anterior

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12
Q

Which muscles perform this action?

scapular retraction

A

middle trapezius
rhomboids

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13
Q

Which muscles perform this action?

scapular upward rotation

A

upper trapezius
lower trapezius
serratus anterior

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14
Q

Which muscles perform this action?

scapular downward rotation

A

levator scapulae
pectoralis minor
rhomboids

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15
Q

Which muscles perform this action?

shoulder flexion

A

anterior deltoid
biceps brachii
coracobrachialis
pectoralis major

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16
Q

Which muscles perform this action?

shoulder extension

A

posterior deltoid
latissimus dorsi
teres major
triceps brachii

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17
Q

Which muscles perform this action?

shoulder abduction

A

middle deltoid
supraspinatus

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18
Q

Which muscles perform this action?

shoulder adduction

A

latissimus dorsi
pectoralis major
teres major

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19
Q

Which muscles perform this action?

shoulder horizontal abduction

A

posterior deltoid
infrapsinatus
teres minor

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20
Q

Which muscles perform this action?

shoulder horizontal adduction

A

anterior deltoid
pectoralis major

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21
Q

Which muscles perform this action?

shoulder external rotation

A

posterior deltoid
infraspinatus
teres minor

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22
Q

Which muscles perform this action?

shoulder internal rotation

A

subscapularis
pectoralis major
latissimus dorsi
anterior deltoid
teres major

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23
Q

Joints

What are the articulating joints of the shoulder?

(three)

A
  1. sternoclavicular jt (SC jt)
  2. acromioclavicular jt (AC jt)
  3. glenohumeral jt
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24
Q

Sternoclavicular jt

Where does it articulate?
Which bones articulate?

A

manubrium of sternum
medial clavicle moves on sternum

(sternum remains stationary)

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25
Q

Sternoclavicular jt

What motions are available at the SC jt?

A

movement of clavical in all three planes

(relies on scapula for movement)

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26
Q

Sternoclavicular jt

What are the three ligaments of the SC jt?

A
  1. anterior/posterior sternoclavicular
  2. costoclavicular
  3. interclavicular
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27
Q

Sternoclavicular jt: sternoclavicular ligament

Where is this ligament located?
What motion(s) does it limit?

A

anterior/posterior surface of the jt between sternum and clavicle
anterior/posterior displacement of medial clavicle

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28
Q

Sternoclavicular jt: costoclavicular ligament

Where is this ligament located?
What motion(s) does it limit?

A

medial portion of clavicle and 1st rib
limits excessive elevation

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29
Q

Sternoclavicular jt: interclavicular ligament

Where is this ligament located?
What motion(s) does it limit?

A

spans across upper margin of sternum to connect the L and R clavicals
limits excessive depression

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30
Q

Acromioclavicular jt

Where does it articulate?
Which bones articulate?

A

lateral clavical to acromion process
clavical and scapula

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31
Q

Acromioclavicular jt

What motions are available at the AC jt?

A

scapular rotation

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32
Q

Acromioclavicular jt

What are the two diagnoses of scapular diskenisia?

What is the improper motion?
In which plane of motion does it occur?

A

Tipping:
1. inferior angle of scapula protrudes
2. saggital plane of motion

Winging:
1. entire medial/vertebral border of scapula protrudes
2. transverse plane of motion

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33
Q

Acromioclavicular jt

What are the three ligaments of the AC jt?

A
  1. acromioclavicular
  2. coracoclavicular
  3. coracoacromial
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34
Q

Acromioclavicular jt: acromioclavicular ligament

Where is this ligament located?
What motion(s) does it limit?

A
  • surrounds the acromioclavicular jt on all sides
  • controls horizontal movement of the clavicle
  • prevents dislocation
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35
Q

Acromioclavicular jt: coracoclavicular ligament

Where is this ligament located?
What motion(s) does it limit?

Made up of two ligaments

A
  • spans coracoid process to clavicle
  • limits superior translation of the clavicle
    primary support of AC jt

trapezoid and conoid

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36
Q

AC jt: coracoacromial ligament

Where is this ligament located?
What is its purpose?

Why is this a common site of impingement?

A
  • arch over humeral head between coracoid process and acromion
  • protect glenohumeral jt

rubbing between greater tubercle and humeral head impinges supraspinatus tendon which passes through

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37
Q

Glenohumeral joint

Where does it articulate?
Which bones articulate?

A

convex head of humerus and glenoid fossa (scapula)

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38
Q

Glenohumeral joint

Which motions are available at the GH jt?

A

flex/ext
AB/AD
IR/ER
horizontal AB/AD

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39
Q

Glenohumeral joint

What are the three ligaments on the GH jt?

A
  • glenohumeral
  • coracohumeral
  • transverse humeral
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40
Q

GH jt: glenohumeral ligament

Where is this ligament located?
What motion(s) does it limit?

A
  • anterior attachment between glenoid fossa and humeral head
  • limits excessive ER (with AB) and excessive AD
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41
Q

GH jt: coracohumeral ligament

Where is this ligament located?
What motion(s) does it limit?

A
  • superior/proximal to coracoid process and attaches to greater/lesser tubercles
  • inferior translation of the humeral head
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42
Q

GH jt: transverse humeral ligament

Where is this ligament located?
What motion(s) does it limit?

A
  • spans bicipital groove from greater to lesser tubercles
  • keeps the long head of biceps tendon in bicipital groove
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43
Q

RTC

What four muscles compose the rotator cuff?

Where do they attach?

A

supraspinatus
infraspinatus
teres minor
subscapularis

greater tubercle: supra/infra/teres
lesser tubercle: subscap

44
Q

Bursas: subacromial bursa

Where is this bursa located?
What is its purpose?

A
  • under the acromion
  • separate supraspinatus tendon from acromion and coracoid process
45
Q

Bursas: subdeltoid bursa

Where is this bursa located?
What is its purpose?

A
  • beneath the deltoid
  • separate deltoid from head of humerus to allow for smooth gliding
46
Q

Closed pack positions

What is the closed pack position for the GH jt?

A

ABD & ER

47
Q

Closed pack positions

What is the closed pack position of the SC jt?

A

maximum shoulder elevation

48
Q

Closed pack positions

What is the closed pack position of the AC jt?

A

ABD to 90º

49
Q

What is scapulohumeral rhythm?

A

The GH jt and scapulothoracic jt work simultaneously to elevate the humerus above the head in a 2:1 ratio:

For every 2º of GH motion, there is 1º of scapulothoracic motion

50
Q

Scapulohumeral rhythm

Where does the motion primarily occur for the first 30º of elevation?

A

GH jt

51
Q

Which scapular motion accompanies GH motion in scapulohumeral rhythm?

GH flexion

A

upward rotation
protraction

52
Q

Which scapular motion accompanies GH motion in scapulohumeral rhythm?

GH ext

A

downward rotation
retraction

53
Q

Which scapular motion accompanies GH motion in scapulohumeral rhythm?

GH AB

A

upward rotation

54
Q

Which scapular motion accompanies GH motion in scapulohumeral rhythm?

GH AD

A

downward rotation

55
Q

Which scapular motion accompanies GH motion in scapulohumeral rhythm?

ER

A

retraction

56
Q

Which scapular motion accompanies GH motion in scapulohumeral rhythm?

IR

A

protraction

57
Q

Which scapular motion accompanies GH motion in scapulohumeral rhythm?

horizontal AB

A

retraction

58
Q

Which scapular motion accompanies GH motion in scapulohumeral rhythm?

horizontal AD

A

protraction

59
Q

Diagnoses/Conditions: Bursitis

  1. Definition
  2. Etiology
  3. Symptoms
A
  1. inflammation of the bursa
  2. repeated stress, constant muscle pressure, calcification deposits within the bursa
  3. constant pain, intensified by activity or use of muscles overlying the jt
60
Q

Diagnoses/Conditions: Bicipital tendonitis

  1. Definition
  2. Etiology
  3. Symptoms
A
  1. inflammation of the biciptial tendon
  2. impingement, labral tear, compensation of RTC dirsorders
  3. intemittent pain with OH activity, no pn at rest
61
Q

Diagnoses/Conditions: Rotator Cuff Tendonitis

  1. Definition
  2. Etiology
  3. Symptoms
A
  1. inflammation of the RTC muscles
  2. repeated activity/stress, inflammation within the tendon sheath from impingement
  3. intermittent anterolateral pn and weakness, loss of ROM, no pn at rest

What are the RTC muscles?

62
Q

Diagnoses/Conditions: Impingement Syndrome

  1. Definition
  2. Etiology
  3. Symptoms
A
  1. impingement of RTC muscles between greater tubercle and acromion process
  2. repetetive/sustained use of arms overhead
  3. painful arc of motion with flex/AB, no pn with PROM, resisted ER weak, tenderness over greater tubercle
63
Q

Diagnoses/Conditions: Impingement Syndrome

In impingement syndrome, what ROM is painful?

A

60º-120º

64
Q

Diagnoses/Conditions: Impingement Syndrome

What are the two types of impingement?

A
  1. Primary impingement: compression due to reduced mechanical space
  2. Secondary impingement: GH instability caused by scapulothoracic weakness
65
Q

Diagnoses/Conditions: Impingement Syndrome

What are the scapulothoracic muscles?

A

middle/lower trapezius
rhomboids
serratus anterior

66
Q

Diagnoses/Conditions: Tears

  1. Definition
  2. Etiology
  3. Symptoms
A
  1. tear of tendon/labrum (3 degrees)
  2. repetitive/sustained use of arms OH
  3. resisted ER significant weaknesss, night pain
67
Q

Diagnoses/Conditions: Tears

What are the three degrees of tears?

A

Small: <1 cm
Medium: <3 cm
Large: >5 cm

68
Q

Diagnoses/Conditions: GH Dislocation

  1. Definition
  2. Etiology
  3. Symptoms
A
  1. displacement of bone from normal jt position
  2. anterior dislocation caused by combo of forced AB + ext + ER, posterior dislocation caused by forced AB + flex + IR
  3. visibly out of place, swelling, bruising, intense pn, inability to move jt

More common in men

69
Q

Diagnoses/Conditions: GH Dislocation

Non-surgical protocol

A

Immobilized in sling 6 weeks
Avoid AB with ER for 3 months

70
Q

Diagnoses/Conditions: Bankart Lesion

  1. Definition
  2. Etiology
  3. Symptoms
A
  1. anterior inferior labrum tear
  2. recurrent anterior dislocations
  3. visibly out of place shoulder, swelling, bruising, intense pn, inability to move jt
71
Q

Diagnoses/Conditions: Hills-Sachs Lesion

  1. Definition
  2. Etiology
  3. Symptoms
A
  1. cortical depression on posterior lateral humeral head
  2. recurrent anterior dislocations
  3. visibly out of place shoulder, swelling, bruising, intense pn, inability to move jt
72
Q

Diagnoses/Conditions: Hills-Sachs Lesion

What aspect of recurrent dislocations leads to a Hills-Sachs lesion?

A

posteriolateral head abutting anterior glenoid fossa when dislocating

73
Q

Diagnoses/Conditions: Bankart Lesion

What aspect of recurrent dislocations leads to a Bankart lesion?

A

combined force of AB, ext, ER

74
Q

Diagnoses/Conditions: Subluxation

  1. Definition
  2. Etiology
  3. Symptoms
A
  1. incomplete/partial dislocation
  2. commonly after stroke/paralysis
  3. visibly out of place shoulder that will slide back in on its own

Immobilized in sling

75
Q

Diagnoses/Conditions: Adhesive Capsulitis

  1. Definition
  2. Etiology
  3. Symptoms
A
  1. adherence of folds in articular capsule restricting jt motion
  2. more common in non-dominant arm, more common in women 40-60 y/o
  3. restricted rOM in capsular pattern
76
Q

Diagnoses/Conditions: Adhesive Capsulitis

What are the four stages and their characteristic symptom(s)?

A
  1. pre-freezing: 1-3 months, pain
  2. freezing: 3-6 months, pain & stiffness
  3. frozen: 9-12 months, stiffness
  4. thawing: 12-18 months, stiffness resides
77
Q

Diagnoses/Conditions: Adhesive Capsulitis

What are the two etiologies?

A
  1. idiopathic
  2. secondary - induced by immobilization/trauma as a result of pain or systemic disease, e.g. diabetes
78
Q

Diagnoses/Conditions: Adhesive Capsulitis

What are the acute and chronic symptoms?

A
  • acute: constant pn at deltoid region
  • pn at end range and resisted movements, decreased pn at rest
79
Q

Diagnoses/Conditions: AC Sprain/Subluxation/Dislocation

What are the three grades of AC sprains?

A
  1. Grade 1: partial tearing of the AC ligaments
  2. Grade 2: complete rupture of AC ligaments, partial tearing of coracoacromial ligaments
  3. Grade 3: dislocation between acromion and clavicle where both AC and coracoclavicular ligaments are ruptured, distal clavicle displaced superiorly
80
Q

Diagnoses/Conditions: Thoracic Outlet Syndrome

  1. Defnition
  2. Symptoms
A
  1. nerves/vessels compressed in the neck or axilla
  2. numbness, tingling, heaviness, temperature/skin changes of the neck, UE, and hand

Symptoms exacerbated with OH activities, static posture, or carrying

81
Q

Diagnoses/Conditions: Thoracic Outlet Syndrome

What are the three locations of possible entrapment?

A
  1. scalene-anticus and cervical rib
  2. costoclavicular
  3. hyperabduction
82
Q

Diagnoses/Conditions: Thoracic Outlet Syndrome

Where does hyperabduction entrapment occur?

A

between pec minor and coracoid process

83
Q

Special Tests

Bicipital Tendonitis

(1)

A

Speed’s Test
1. Pt shoulder flex 90º, elbow ext, forearm sup
2. Clinician hand over bicipital groove and ant forearm
3. Resist active shoulder flex

Pain = positive test

84
Q

Special Tests

Rotator Cuff Tears

(3)

A
  1. Drop Arm Test
  2. Supraspinatus/Empty Can Test
  3. Lag Sign/Lift Off Test
85
Q

Special Tests: RTC

Procedure for Drop Arm Test

A

Clinician ABD pt arm to 90º and pt slowly lowers arm

inability to slowly lower arm/pain with lowering = positive test

86
Q

Special Tests: RTC

Supraspinatus/Empty Can Test

A
  1. clinician ABD pt arm to 90º and horizontal ABD to 30º, thumb down
  2. clinician applies resistance

weakness and pain = positive test

87
Q

Special Tests

Impingement Syndrome

(2)

A
  1. Hawkins-Kennedy Impingement Test
  2. Neer Impingement Test
88
Q

Special Tests: RTC

Lag Sign/Lift Off Tests

A
  1. pt standing or prone with arm behind back (dorsal aspect of hand to back, IR)
  2. pt lifts hand off back

inability to lift hand/pain with lifting = positive test

89
Q

Special Tests: Impingement

Hawkins-Kennedy Test

A
  1. clinician flexes pt shoulder to 90º, elbow flexed
  2. clinicial IR arm

pain = positive test

may also be helpful to rule out subacromial pn as a negative test

90
Q
A
91
Q

Special Tests

Neer Test

A
  1. clinician places hand on posterior aspect of pt scapula and stabilizes elbow
  2. clinician elevates pt arm through flex while maintaining IR

pain at 90º = positive test

may indicate impingement OR supraspinatus tendon tear

92
Q

Special Tests

Dislocations/Subluxations

(1)

A

Apprehension Test
1. pt in supine
2. clinician AB and ER the shoulder

for anterior shoulder dislocation

93
Q

Special Tests

Thoracic Outlet Syndrome (TOS)

(4)

A
  1. Adson’s Maneuver
  2. Military Brace/Wright’s Test
  3. Roo’s Test
  4. Hyperabduction Test
94
Q

Special Tests: TOS

Adson’s Maneuver

A
  1. pt sitting, clinician monitors for radial pulse
  2. pt roates head to face test shoulder
  3. pt extends head while clinician ext/ER the pt’s shoulder

for scalene-anticus and cervical rib entrapment

absent/diminished pulse OR reproduction of pain/paresthesia = positive test

95
Q

Special Tests: TOS

Military Brace/Wright’s Test

A
  1. pt sitting, clinician monitoring radial pulse
  2. pt depresses/retracts shoulder while taking a deep breath

for costoclavicular entrapment

absent/diminished pulse OR reproduction of pain/paresthesia = positive test

96
Q

Special Tests: TOS

Roo’s Test

A
  1. pt sitting/standing
  2. pt AB shoulder to 90º, elbow flex 90º, full ER of shoulders
  3. pt opens/closes fists as quickly as possible for 1 min

for hyperabduction entrapment

reproduction of pain/paresthesia = positive test

97
Q

Special Tests: TOS

Hyperabduction Test

A
  1. pt sitting, clinician monitoring radial pulse
  2. clinician AB pt’s arm until arm is OH
  3. pt breathes in deeply

for hyperabduction entrapment

absent/diminished pulse OR reproduction of pain/paresthesia = positive test

98
Q

Goniometry

Shoulder flex

A

180º

99
Q

Goniometry

Shoulder ext

A

60º

100
Q

Goniometry

Shoulder ER

A

90º

101
Q

Goniometry

Shoulder IR

A

70º

102
Q

SWIC RTC Protocol

5 required, 2 if indicated

A

Required:
1. SL ER
2. ER with shoulder at neutral
3. IR with shoulder at neutral
4. Prone horizontal AB
5. Prone shoulder ext

If indicated:
6. serratus anterior strengthening (punches)
7. Sahrmann lower trap series

103
Q

Exercises for non-surgical frozen shoulder

A
  • pendulum/Codman’s
  • cane/wand
  • pulleys
  • mobilizations
  • aggressive stretching
104
Q

Precautions for Ex

Impingement

A

exercises past 90º (OH) and painful arc of 60º-90º until pain-free

105
Q

Precautions for Ex

GH Dislocations

A

avoid AB with ER for 3 months

106
Q

Precautions for Ex

AC Dislocations

A

avoid OH position of dislocation

PTA 160 (11 decks)

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