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ortho 3 > Shoulder MSI > Flashcards

Shoulder MSI Flashcards

(60 cards)

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1
Q

Scapular movement coordination deficits

A 
Depression
Abduction
Downward rotation 
Winging 
Tipping
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2
Q

Humeral movement coordination deficits

A

Anterior glide

Internal rotation

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3
Q

Scapular movement faults

A

Insufficient elevation/upward rotation
Excessive internal rotation/ winging
Insufficient posterior tilt

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4
Q

What is most likely to demonstrate altered kinematic?

A

Scapular plane

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5
Q

Scapular resting position

A

30-45 deg internal rotation 2-3 inches of abduction from spine Sits Superior angle of spine at T2, inferior angle of spine at T7 Scapula Upward rotation Neutral to 3 degrees Anterior tilt of scapula 10-20 degrees

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6
Q

Scapular elevation norm

A

Inferior angle to SC joint elevates 25 degrees
SC joint rotates posterior 25 degrees
SC joint retracts 15 degrees
AC joint upward rotates 35 degrees
Scapula posterior tilts 20 degrees
Glenohumeral must ER 45 degrees (more needed for abduction than flexion)
Glenohumeral motion is 120 degrees
Scapulothoracic motion is 60 degrees of upward rotation

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7
Q

Normal scapulohumeral rhythm

A

2:1
120 GH
60 scap

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8
Q

Shoulder elevation setting phase

A

60 deg flex, 30 deg abduction

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9
Q

Shoulder elevation scapular movement

A

Upward rotation
ER
Post tilt
Elevation

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10
Q

Two faults during setting phase of elevation

A

Downward rotation - rhomboids over active

Adduction - rhomboids plus everything else on

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11
Q

Upper traps in impingement/pain

A

Work too hard/early

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12
Q

SA in impingement/pain

A

Decreased LT to SA ratio

SA is delayed, decreased, or deactivates too early

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13
Q

Mid and low trap in impingement/pain

A

Decreased/delayed
Middle during ER
Lower during abduction

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14
Q

Thoracic kyphosis

A

Associated w/ abducted and downward rotated scap

Reducing it facilitates greater shoulder range

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15
Q

Scapular depression movement fault

A

Lower than normal scapular position
Lower than normal clavicle upward 20 deg angle
Lacks elevation to C6-7 during shoulder motion
Increased tension from lats/pecs pull downward
Lengthened U trap or levator, increased stress on Cspine

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16
Q

Movement faults associated w/ scapular depression

A

Scap down rotation or abduction
Humeral IR; cspine ext/rotation
Long arms/neck, heavy arms/chest

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17
Q

Scapular depression movement tests

A 
Shoulder flexion/abduction
Lat/pec length 
SA MMT
Cervical rotation
Scapular-thoracic movement
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18
Q

Scapular depression tax

A 
Tape to elevate
Unload/elevate on objects
Tape bra straps together
Normalize pec and lat length
B/L shoulder flexion w/ elevation
Improve M trap/SA strength
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19
Q

Scapular downward rotation movement fault

A

Downward rotated at rest
Lacks 60 deg upward rotation during elevation
GH may be moving too much for compensation

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20
Q

Scapular foward rotation movement fault - muscle imbalance

A

Levator scap and rhomboids
SA and L trap
LT best up rotator > 90 deg
UT and SA better when < 90

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21
Q

Scapular downward rotation associated faults

A

Scapular depression, abduction, Cervical ext/rotation

Long/heavy arms, increased T kyphosis

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22
Q

Scapular downward rotation movement tests

A 
Shoulder flexion/abduction
Lat/pec length test
SA MMT
Quadruped
C/s rotation
Scapulothoracic mobility
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23
Q

Scap downward rotation tx

A

Improve posture/alignment - tape
SA, L trap strength/activation
Rhomb, levator flex/inhibition
Retrain coordination w/ upward rotation

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24
Q

Scapular abduction movement fault

A

> 3” from spine at rest
1/2’ past MAL during shoulder elevation
Stabilizers lack strength against scapular-humeral muscles
(Pecs + SA dominant, short/strong RC, weak M and L trap, weak rhomb)
Excessive thoracic flexion

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25
Scap abduction associated movement faults
Scapular depression and down rotation Anterior humeral glide Thoracic flexion, large breasts, obesity
26
Scap abduction movement tests
Shoulder elevation and return Pec major/ teres length B/E ER by side Horizontal adduction length test
27
Scap abduction tx
Improve scap position at rest (tape, hands on hip, tape bra straps) Improve MT, LT, Rhob strength Decreased pec/teres major stiffness Improve TSpine extension Improve GH motion (post capsule or post cuff)
28
Scapular tilting movement fault
Anterior tilted at rest/lack of post tilt during elevation Inferior angle protruding off thorax Secondary to tightness in pec major/minor Weakness in Ltrap Associated w/ excessive thoracic flexion, humeral ant glide
29
Scapular tipping movement test
Shoulder abduction Pec length Lower trap MMT
30
Scapular tipping movement to
Improve pec inhibition/tightness Improve lower trap strength Taping into post tilt Improve thoracic position
31
Scapular winging movement fault
Scap IR SA weak/control (M trap and rhomb also weak) Concentric or eccentric winging
32
Scapular winging movement tests
Shoulder elevation and lowering HBB SA and LT MMT Quadruped rocking foward
33
Scapular wining tax
Strengthen scapulothoraic muscles Stretch scapular-humeral muscles Concentric control of SA Eccentric control
34
Humeral anterior glide
Anterior translation of humeral head compared to acromion hood (norm >1/3) Laxity in anterior capsule Stiffness in posterior capsule/ER Poor GH PICR
35
Most common humeral movement fault
Anterior glide
36
anterior glide associated med dx
impingements instabilities rotator cuff pathologies
37
anterior glide movement tests
shoulder elevation: retest w/ post glide pec and biceps length horizontal adduction length shoulder IR/ER at 90 deg: retest w/ post glide
38
ant glide tx
normalize scap posting improve GH rotation PICR improve rotator cuff strength and control decrease stiffness: post capsule, post delt/rotator cuff, biceps and pecs
39
humeral IR fault
excessive IR at rest insufficient ER during shoulder elevation tightness in IR muscles weakness in ER muscles
40
humeral IR associated movement faults
thoracic flexion | scapular abduction/tipping
41
humeral IR movement tests
shoulder flex/ab humeral ER by side shoulder IR/ER supine and prone muscle length tests
42
humeral IR tx
improve coordination (emphasize ER during movements) improve length/stiffness (pecs, lats, subscap, T major) improve strength/endurance (infra spin, T minor)
43
shoulder specific posture assessment - lateral
thoracic spine excessive flexion arms IR, elbow flexion humeral head ant glide
44
shoulder specific posture assessment - anterior
clavicle angle 20 deg pec muscle bulk cubital fossa Ir, abduction
45
shoulder elevation abnormal
``` asymmetrical cervical movement scapular faults lack post GH creasing humeral IR excess/early UT activation CT junction ext at end range ```
46
early shrug w/ shoulder activation
adhesive capsulitis | full rotator cuff tear
47
corrected shoulder elvation
scapular reposition/assistance change humeral position change/improve muscle timing w/ cueing
48
normal return from shoulder elevation
symmetrical scapular downward rotation, controlled speed
49
abnormal return from shoulder elevation
winging retraction very fast/slow
50
B/L shoulder ER by side - normal
60 deg ER | no scap movement first 50%
51
B/L shoulder ER by side - abnormal
limited ROM excessive scap retraction excessive Tspine extension
52
supine BL shoulder flexion- normal
to 120 deg maintained humeral ER stable Lspine and rib cage
53
supine BL shoulder flexion - abnormal
C or L spine ext rib flare humeral IR
54
wall slides
``` w/ humeral ER w/ scap elevation SA activation w/ TB resisted ER lift off for LT activation ```
55
mid and lower trap progression
``` wrist forearm arms y lift offs standing side lying ```
56
best exercise for SA
serratus punch 120 deg upward rotation, post tilt external rotation scapular protraction and upward rotation movement
57
lower trap activation
upward rotation, post tilt, ER | best lower to upper w/ prone horizontal abduction at 90 deg w/ ER
58
best middle trap activation
prone row and prone horizontal abduction at 90 ab w/ ER have high EMG activity
59
greatest lower-upper trap ratio
B/L ER at 0 deg abduction
60
other things to look at
muscle length MMT STM therex slides

ortho 3 (12 decks)

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