Kines Shoulder Flashcards
1
Q
The Shoulder
At a Glance
A
Mobility at expense of stability 17-20 muscles 5-7 articulations act as a mechanism Effective control of hand in space Aids in lifting and pushing Considered a weight bearing joint
2
Q
Predisposed characteristics of shoulder
A
High mobility
Low stability
“Freely hanging” control of arm in space
3
Q
What are the steps in successful treatment of the shoulder complex?
A
Anatomical knowledge Biomechanics knowledge Systemic clinical exam Accurate MS diagnosis & classification Effective intervention Outcome assessment
4
Q
Outcome Assessment
A
What is most important to pt? Return to proper function Increase strength Decrease pain *No guarantees, just probability
5
Q
Clinical Approach in PT
A
Anatomical imperatives Pathomechanics Clinical decision making in exam Measurement scales and functional measures EBP issues (evidence based practice) Treatments Therapeutic exercises Post op surgical management Case examples
6
Q
Thoracic outlet syndrome
A
Poor posture, rounded shoulders
7
Q
Shoulder as a mechanism
A
Rigid bodies connected by joint in order to accomplish a desired force and/or motion.
Multi-Joint movement
Involves nerves, ligaments, muscles, joints
8
Q
Glenohumeral motions
A
(All in relation to Global vs. Remote vectors) Backward extension Abduction Horizontal flexion Horizontal extension Foward flexion External rotation Internal rotation
9
Q
Scapular motions
A
Elevation Depression Adduction Abduction Upward rotation Downward rotation
10
Q
Benefits of labrum in glenoid fossa
A
Creates deeper glenoid
Also provides some suction
Gives more surface area to improve stability
Wedge shape
11
Q
Changing radius of curvature
A
Increases ligamentous stretch with glenohumeral abduction
There are points where ligaments are tight and other points where they are loose.
Role of ligaments can never overtake muscles
12
Q
Why joint symmetry?
A
Accepts forces
Absorbs shock
Efficiency of articular space - gliding
Enhance lubrication & room for aberrations
13
Q
Torques at shoulder
A
Trying to pull up
14
Q
Gravity at shoulder
A
Trying to pull down
15
Q
Arthokinematics
A
Movement of joint surfaces
16
Q
Arthokinematics of shoulder
A
Rotation
Rolling
Translation
17
Q
Rotation
Arthokinematics
A
Moving contact point on moving surface
18
Q
Rolling
Arthokinematics
A
Both contact points move equally
19
Q
Translation
Arthokinematics
A
Contact point moves on stationary surface
20
Q
Convex-Concave Rule
A
When a concave member is moving on a fixed convex, accessory motion = in same direction as physiological
When convex member is moving on a fixed concave, accessory motion = in opposition direction as physiological
21
Q
Examples of Convex-Concave Rule
A
Flexion of knee
Posterior glide
(mobilize down/posterior)
Extension of knee
Anterior glide
(mobilize up/anterior)
22
Q
Angles of shoulder joint
A
Head to shaft 135*
Retroversion of head 30* posteriorly
23
Q
Subacromial space of shoulder
A
Gives 9-12mm of space
Significant
24
Q
Key to movement
A
Structure dictates function which dictates mobility
25
First goal of Rotator cuff muscles
Compress the joint
| Then movement of muscles
26
Bursae
| Function & Locations in Shoulder Joint
Prevent friction
Locations
Between infraspinatus and capsule
Superior surface of acromiom
Between coracoid and capsule
Under coracobrachialis
Between teres major and long head of triceps
In front of and behind tendon a latissimus
27
Circle of stability
```
Supraspinatus (superior)
SGHL (anterior)
Subscapularis (anterior)
MGHL (inferior)
IGHL (inferior)
Teres minor (posterior)
Infraspinatus (posterior)
```
28
Types of Labral Tears
Roman numeral I-IV
Type I - minimal
Type IV - severe
29
Proactive type tests
Give themes information in the clinic
30
Ligamentous support via outgrowths of capsule
Coracoclavicular ligaments
| Coroacromial ligament
31
Coracoclavicular ligament
```
Secondary restraint for humeral head
Prevents upward dislocation of head
Subacromial space (9-10mm ideal)
```
32
Glenohumeral ligaments
Superior, middle, and inferior GH lig.
Abduction
External rotation
Internal rotation
33
Glenohumeral ligaments
Superior, middle, and inferior GH lig.
Abduction (at 45* all lig. are lax)
External rotation
Internal rotation
34
Ligament function
Do not contract, just lose or gain tension!
35
Abduction degrees of GH lig.
at 45* all lig. are lax
at 90* superior lig. lax and IGH taught
(catches head underneath)
36
IGH ligament
Hammocking action
37
Capsular balance
If constantly out of position, then constantly pressuring capsule
38
Capsular laxity
Creates internal ROM restriction
39
Coracoumeral ligament
Resist extension and adduction
Prevents distraction of arm
Has two bands to it
40
Good posture significance
Functional and biomechanics significance
| Importance to moving and changing position
41
Long head tendon of biceps in GH stability
Biarticular muscle (crosses two joints)
Contributes 25% to abduction
Secondary stabilizers
42
Sternoclvicular and Acromioclavicular joints
Will often move both joints to same degree to keep congruency of clearance
43
Application for PT's
We often deal with compensations, not just the problem
44
Variance of Acromioclavicular joint
Flat
Curved
Hooked
45
Variance of Acromioclavicular joint
Flat
Curved
Hooked
46
Scapulothoracic joint
Loosely considered a joint
| Serratus involved in strong flexion of shoulder
47
Fundamental rule of nerves
Don't like to be stretched or compressed!
48
Long thoracic nerve to right shoulder
Subtle scapular winging in resting position
Decreased ROM in shoulder flexion
Winging in push test against wall
Symptoms of less ROM and full scap winging
49
Ultimate balancing act of shoulder
Force vectors as sum tests
| All influence
50
Muscles from shoulder girdle to humerus, radius, or ulna
```
Deltoid
Surpaspinatus
Infraspinatus
Teres minor
Subscapularis
Teres major
Coracobrachialis
Biceps
Triceps
```
Many fibers longitudinal but also multi-pennate
51
Muscle from trunk to shoulder girdle
```
Serratus Anterior
Trapezius
Rhomboids
Pectoralis Minor
Levator Scapuale
Subclavius
```
52
Muscle from trunk to humerus
Latissimus dorsi
| Pectoralis major
53
Types of muscle fiber orientation
Longitudinal
Unipennate
Bipennate
Multipennate
54
Does adduction or abduction of shoulder region take more muscles?
Adduction
55
Testing IR
Subscapularis IR
| Belly test in clinic
56
Testing ER
Spin muscles being able to roll and glide
| Use tubing for exercises
57
RC Muscles
Subscapularis
Supraspinatus
Infraspinatus
Teres minor
58
Movements of RC
Very strong
Elevate
Depress
Allow you to position for movements
Protract
Retract
Spin joint in that direction:
Upward rotation
Downward rotation
59
Poor Posture-Movement relationship
Not just how you look, how you function.
These stresses cause microtrauma
60
Nerves involved in improper scapular positioning
Long thoracic nerve injury (serratus pulling)
| Spinal accessory nerve injury (levator stretched)
61
Factors in GH stability
```
Adequate size of glenoid
Posterior tilt of glenoid
Humeral head retroversion
Intact capsule and labrum
Function of cuff muscles to control head
```
62
Factors in GH Forces
```
Articular
Deltoid muscle
Supraspinatus
Arm weight
Cuff performance
Passive restraints
Shoulder girdle posture (dynamic & static)
```
63
Force couples
two forces acting in opposite directions to give rotation in same direction
64
Force couples - Trap/SA
| Muscle/Syngery/Individually Movement
UR
| Ret/Pro
65
Force couples - Trap/Rhom
| Muscle/Syngery/Individually Movement
Ret
| UR/DR
66
Force couples - UT/LT
| Muscle/Syngery/Individually Movement
UR
| Elev/Dep
67
Force couples - Ant D/Post D
| Muscle/Syngery/Individually Movement
Abd
| IR/ER
68
Force couples - Subscap/Infra
| Muscle/Syngery/Individually Movement
Dep
| IR/ER
69
Are plyometrics necessary for pt?
Strength is enough
| Functionally better for physical therapy
70
Kinematics
Motion of objects without reference to the forces which cause motion
71
Kinetics
Branch of bio-chem concerned with measuring and studying the rates or reactions
72
Symptoms of Proximal humeral fracture
```
Can't raise arm to full position
No scap retraction
Pain
Weakness actively (AROM)
Hypermobilty (PROM) - capsule, impingement
```
73
Capsulitis issue
AROM & PROM restricted
74
Contractile tissue issue
AROM restricted, but PROM okay
75
Mechanics of Elevation
```
Initiation of Delta/supra force couple*
Scap fixation
Inferior glide of humeral head
Upper trap/serratus force couple*
Clavicular elevation
Maintain L/T of supra and deltoid
ICOR root to AC (zero velocity on scap)
Serratus/lower trap force couple* (final movement)
Post rotation of clavicle
```
76
Proper arthrokinematics dictate osteokinematics
Set by making delt and serratus work together
Horizontal compression force to center head
Abduction force from deltoid causes serratus to pull out
77
Kinematic chain
Combo of several joints uniting sequential segments
78
Mechanism
Parts working together to cause some predetermined response
79
Degrees of freedom
Summation of all segments involved.
| Max of 3 rotations and 3 translations
80
Adhesive capsulitis
Frozen shoulder
Goes through freezing and thawing phases
Will not get better on own
Can lose functional biomechanics
81
Mechanics of Elevation
```
Delt/supra force couple*
Scapular fixation
Inferior glide of humeral head
Upper trap/serratus force couple*
Clavicular elevation
Maintain L/T of supra and delt
ICOR root to AC
Serratus/lower trap force couple*
Post rotation of clavicle
```
82
Common shoulder pathologies
Impingement
RC tears
Adhesive capsulitis
Instability
83
Considerations for Rehab
```
Body position and posture
Stabilize strengthening
Capsular balance
Propioception
Variety of resistance patterns
Multi-planar and dynamic movements
```
84
Open
Speed through summation of velocity
85
Closed
Force generation and transmission
86
Surgical Interventions
```
Subacromial decompression
Open & arthroscopic cuff repair
Rotator interval repair
Anterocapsular reconstruction
Bankart repair
Thermal capsular shift
AC repair (weaver-dunn)
```
