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CES > Chapter 14 Thoracic Spine and Shoulder > Flashcards

Chapter 14 Thoracic Spine and Shoulder Flashcards

1
Q

how many vertebrae are in the thoracic spine?

A

12

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2
Q

what type of curvature is in the thoracic spine and sacrum?

A

outward curvature known as a kyphotic curve

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3
Q

what type of curvature is in the neck and low back?

A

inward curvature known as a lordotic curve

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4
Q

the shoulder joint is also known as

A

glenohumeral joint

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5
Q

shoulder girdle is a what type of joint?

A

ball in socket (like a golf ball resting on a t) and it has the biggest ROM of any joint

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6
Q

glenohumeral joints

A

Together with the clavicles, the scapulae form the shoulder girdle and connect with the humerus

synovial, ball-and-socket articulation

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7
Q

scapula

A

a flat, triangular-shaped bone (colloquially as the “shoulder blade

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8
Q

subscapularus

A

The subscapularis is one of the four muscles which compose the rotator cuff apparatus– internal rotation

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9
Q

sternoclavicular joint

A

where the clavicle and sternum meet

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10
Q

The rotator cuff is made up of

A

supraspinatus and subscapularis anteriorly, with the infraspinatus and teres minor posteriorly

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11
Q

tightness in the pectoralis minor

A

which inserts on the coracoid process of the scapula, will limit the effectiveness of the serratus anterior to upwardly rotate and posteriorly tilt the scapula. This alters the length-tension relationships of the rotator cuff, trapezius, and rhomboids, decreasing their ability to stabilize the glenohumeral joint

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12
Q

SITS (to remember music in rotator cuff)

A

supraspinatus, infraspinatus, teres minor, and subscapularis

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13
Q

Common symptoms associated with scoliosis

A

-One shoulder blade that is higher than the other
-One shoulder blade that sticks out more than the other
-Uneven hips
-A rotating spine
-Problems breathing because of reduced area in the chest for lungs to expand
-Back pain

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14
Q

to help shoulder girdle prior to push/pull ex

A

thoracic spine foam rolling (increased lower trapezius strength and increased middle trapezius activity)

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15
Q

if the thoracic spine isn’t moving properly what picks ups the slack?

A

the lumbar spine

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16
Q

what part of the spine is most flexible?

A

the cervical spine (neck area)

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17
Q

Hyperkyphosis is present when the normal thoracic kyphosis range exceeds what degree?

A

40 (20-40 is normal)

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18
Q

rounding of the upper back is typically overactive ______ and ________
underactive ____ and ____

A

typically caused by a combination of overactivity of the latissimus dorsi and pectoralis minor muscles paired with underactivity of shoulder and scapular retractor muscles

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19
Q

If an individual exhibits arms fall forward on the OHSA

A

thoracic extension above the lumbar spine may be a primary contributor. To help confirm this assumption, the hands-on-hips modification to the OHSA should be used

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20
Q

OSHA placing the hands on the hips

A

reduces tension in the latissimus dorsi and creates more ROM throughout the trunk. If an excessive anterior pelvic tilt is improved with the hands on the hips, this indicates that mobility restrictions above the hip at the shoulder (likely due to an overactive latissimus dorsi)

protocols to correct arms fall forward should help improve their lumbar dynamic posture

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21
Q

If placing the hands on the hips does not correct the excessive tilt

A

then the corrective program should focus on the LPHC

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22
Q

other areas of shoulder dysfunction may be best observed during pushing and pulling task

A

e.g. cable push or pull
the optimal position of the scapulae and shoulders is a depressed and retracted state while still allowing for normal scapulothoracic rhythm where scapular protraction is not excessive

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23
Q

Davies test

A

compensations in the Davies test are typically due to deficits in muscular stability and strength rather than ROM deficits

plank position place one hand on top of the other

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24
Q

Mobility of the shoulders and thoracic spine can be evaluated using tests for

A

shoulder flexion (latissimus dorsi length) and extension, shoulder retraction (pectoralis minor length), shoulder internal and external rotation, thoracic extension, and thoracic rotation

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25
Q

individuals with rounded shoulders will tend to

A

have limited external rotation ROM

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26
Q

Lack of full shoulder flexion may be due to which overactive muscle?

A

Latissimus dorsi

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27
Q

Arms Fall Forward phase 1 inhibit

A

with foam rolling include the latissimus dorsi and pectorals. A small massage ball or medicine ball placed between the client and a wall are often more effective than using a roller on the pectorals. Self-myofascial rolling the thoracic spine is primarily done to reduce tension, reinforce scapular retraction, and improve thoracic extension.

28
Q

arms fall forward stage 2 lengthen

A

Key lengthening exercises with static stretches include the latissimus dorsi, pectorals, and thoracic extension over a foam roller.

29
Q

arms fall forward stage 3 activate

A

Key activation exercises with isolated strengthening exercises include the middle and lower trapezius, rhomboids, and rotator cuff (ball combo 2 with dowel rod is an effective exercise to engage rotator cuff external rotation). The ball combo 2 exercise can also be performed with dumbbells, as needed.

30
Q

arms fall forward stage 4 integrate

A

should be implemented first to emphasize scapular retraction and depression, such as a squat to row. Note that the sagittal plane row is largely dominated by the latissimus dorsi and that the latissimus dorsi are often overactive. Thus, the Corrective Exercise Specialist should place importance on form and scapular mechanics

31
Q

shoulder elevation goal

A

broad objectives of the program are to improve the position of the scapula

32
Q

shoulder elevation phase 1: inhibit

A

Key regions to inhibit with foam rolling and apparatus-assisted modalities include the pectoralis minor, thoracic spine, upper trapezius, and levator scapulae.

33
Q

shoulder elevation phase 2: lengthen

A

Key lengthening exercises with static stretches include the pectoralis minor, upper trapezius, and levator scapulae. Reinforcing thoracic extensibility over a foam roller is also effective for shoulder elevation.

34
Q

shoulder elevation phase 3: activate

A

Key activation exercises with isolated strengthening exercises include the ball cobra and ball scaption to reinforce scapulothoracic rhythm and downward rotation and depression of the scapula.

35
Q

shoulder elevation phase 4: integrate

A

An integration progression should be implemented first to emphasize scapular depression and cervical spine stability. An integration exercise that may be implemented includes a single-leg Romanian deadlift with PNF (proprioceptive neuromuscular facilitation) pattern. One additional integration exercise that can be implemented is a standing lat pulldown. During this exercise, it is vital to ensure the client is focusing on scapular retraction and depression first, and then humeral adduction. This movement may be progressed by reducing the base of support or performing with a single arm

36
Q

scapular winging

A

impairment that affects the shoulder blades. The scapulae usually rest flat against the back of the rib cage. Winging occurs when a shoulder blade “sticks out” or appears as if the medial portion of the scapula is coming off of the rib cage

37
Q

scapular winging phase 1: inhibit

A

Key regions to inhibit with foam rolling include the pectoralis minor, latissimus dorsi, upper trapezius, and thoracic spine.

38
Q

scapular winging phase 2; lengthen

A

Key lengthening exercises with static stretches include the pectoralis minor, latissimus dorsi, and upper trapezius.

39
Q

scapular winging phase 3: activate

A

Key activation exercises with isolated strengthening include the serratus anterior (e.g., push-up plus) and middle and lower trapezius (e.g., ball combo 1)

40
Q

scapular winging phase 4: integrate

A

An integration exercise that could also be implemented for this compensation might be a standing one-arm cable chest press

41
Q

What isolated strengthening exercise would be most appropriate as a response to the arms fall forward compensation?

A

ball combo 2

42
Q

What muscle is best inhibited for the scapular winging compensation?

A

upper trapezius

43
Q

Shoulder Impingement Syndrome (SIS)

A

produced by a variety of subacromial pathologies, including subacromial bursitis, partial rotator cuff tears, biceps tendinitis, scapular dyskinesis, a tight posterior capsule, and postural abnor-malities

compression of the rotator cuff and the subacromial bursa against the anteroinferior aspect of the acromion and the coracoacromial ligament, leading to pain and/or weakness around the shoulder joint, especially with overhead activity

44
Q

Internal impingement often occurs

A

due to repetitive microtrauma to the rotator cuff tendons

45
Q

acromioclavicular joint separation

A

clavicle separates from the scapula. It is usually caused by a fall directly on the point of the shoulder or a hit to the AC joint in a contact sport like football

46
Q

Rotator Cuff Strain

A

overuse or injury when the tendons that connect muscles to bones can overstretch (strain) or tear partially or completely (rupture)

47
Q

Biceps Tendinopathy

A

pain and dysfunction of the tendon around the long head of the biceps muscle. Not usually found in isolation, it is usually caused by overuse, tendon impingement, shoulder joint instability, or trauma. Therefore, it coexists with other pathologies of the shoulder, including rotator cuff impingement syndrome, rotator cuff tears, labral tears, superior labrum from anterior to posterior (SLAP) lesions, and shoulder instability

48
Q

Frozen Shoulder and Osteoarthritis

A

inflammation in the shoulder
houlder progresses, movement in the shoulder can be severely limited. The etiology of frozen shoulder is unknown, and it often self-resolves within 12 months

49
Q

Shoulder Instability

A

Shoulder instability occurs when the head of the humerus is forced out of the shoulder socket and causes laxity in the structures that hold the humeral head in place. This can happen as a result of a sudden injury or from overuse

50
Q

Among Olympic weight lifters, power lifters, and Crossfit athletes how many experience some form of shoulder injury?

A

50%

51
Q

QUIZ Q: The glenohumeral joint is what type of joint?

A

synovial

52
Q

QUIZ Q:
What muscle attaches to the coracoid process of the scapula?

A

Pectoralis minor

53
Q

QUIZ Q: What attaches to the head of the humerus?

A

The subscapularis

54
Q

QUIZ Q: Hanging effectively from a tree branch with an outstretched hand requires which full range of motion?

A

flexion

55
Q

QUIZ Q: A ligament injury to the acromioclavicular joint is best classified as what?

A

AC separation

56
Q

What best describes a closed-packed position of the shoulder?

A

The glenohumeral joint is at 90 degrees of abduction and full external rotation.

57
Q

What is the abnormal curvature of the thoracic spine in the frontal plane called?

A

scoliosis

58
Q

During a session, a Corrective Exercise Specialist notices hyperkyphosis of the thoracic spine. What technique would improve the resultant neck and shoulder position?

A

Mobilize the thoracic spine with a foam roller and stretch the pectoralis group.

59
Q

The thoracic spine has how many vertebrae?

A

12

60
Q

During a push-up, a client demonstrates scapular winging. After 2 weeks of attempted strengthening, there is no improvement. What is the best course of action?

A

Revisit the shoulder assessments to re-evaluate the potential root cause.

61
Q

The thoracic spine is unique because of what articulation?

A

ribs

62
Q

The anterior side of the scapula (subscapular fossa) is designed to house which muscle of the rotator cuff?

A

Subscapularis

63
Q

What is the most appropriate term for an overuse injury to a tendon?

A

Tendinopathy

64
Q

“Weightlifter’s shoulder” is a term associated with what clinical presentation?

A

Osteoarthritis of the AC joint

65
Q

During a session, a Corrective Exercise Specialist notices hyperkyphosis of the thoracic spine. What technique would improve the resultant neck and shoulder position?

A

Mobilize the thoracic spine with a foam roller and stretch the pectoralis group.

66
Q

What is the trade-off for enhanced mobility in the glenohumeral joint structure?

A

reduced stability

CES (9 decks)

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