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

Weeks 5 &6: Shoulder Complex Flashcards

Quiz 3/Exam 2 (106 cards)

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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
# Sternoclavicular jt What motions are available at the SC jt?
movement of clavical in all three planes | (relies on scapula for movement)
26
# Sternoclavicular jt What are the three ligaments of the SC jt?
1. anterior/posterior sternoclavicular 2. costoclavicular 3. interclavicular
27
# Sternoclavicular jt: sternoclavicular ligament Where is this ligament located? What motion(s) does it limit?
anterior/posterior surface of the jt between sternum and clavicle anterior/posterior displacement of medial clavicle
28
# Sternoclavicular jt: costoclavicular ligament Where is this ligament located? What motion(s) does it limit?
medial portion of clavicle and 1st rib limits excessive elevation
29
# Sternoclavicular jt: interclavicular ligament Where is this ligament located? What motion(s) does it limit?
spans across upper margin of sternum to connect the L and R clavicals limits excessive depression
30
# Acromioclavicular jt Where does it articulate? Which bones articulate?
lateral clavical to acromion process clavical and scapula
31
# Acromioclavicular jt What motions are available at the AC jt?
scapular rotation
32
# Acromioclavicular jt What are the two diagnoses of scapular diskenisia? | What is the improper motion? In which plane of motion does it occur?
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
33
# Acromioclavicular jt What are the three ligaments of the AC jt?
1. acromioclavicular 2. coracoclavicular 3. coracoacromial
34
# Acromioclavicular jt: acromioclavicular ligament Where is this ligament located? What motion(s) does it limit?
* surrounds the acromioclavicular jt on all sides * controls horizontal movement of the clavicle * prevents dislocation
35
# Acromioclavicular jt: coracoclavicular ligament Where is this ligament located? What motion(s) does it limit? | Made up of two ligaments
* spans coracoid process to clavicle * limits superior translation of the clavicle **primary support of AC jt** | trapezoid and conoid
36
# AC jt: coracoacromial ligament Where is this ligament located? What is its purpose? | Why is this a common site of impingement?
* arch over humeral head between coracoid process and acromion * protect glenohumeral jt ## Footnote rubbing between greater tubercle and humeral head impinges supraspinatus tendon which passes through
37
# Glenohumeral joint Where does it articulate? Which bones articulate?
convex head of humerus and glenoid fossa (scapula)
38
# Glenohumeral joint Which motions are available at the GH jt?
flex/ext AB/AD IR/ER horizontal AB/AD
39
# Glenohumeral joint What are the three ligaments on the GH jt?
* glenohumeral * coracohumeral * transverse humeral
40
# GH jt: glenohumeral ligament Where is this ligament located? What motion(s) does it limit?
* anterior attachment between glenoid fossa and humeral head * limits excessive ER (with AB) and excessive AD
41
# GH jt: coracohumeral ligament Where is this ligament located? What motion(s) does it limit?
* superior/proximal to coracoid process and attaches to greater/lesser tubercles * inferior translation of the humeral head
42
# GH jt: transverse humeral ligament Where is this ligament located? What motion(s) does it limit?
* spans bicipital groove from greater to lesser tubercles * keeps the long head of biceps tendon in bicipital groove
43
# RTC What four muscles compose the rotator cuff? | Where do they attach?
supraspinatus infraspinatus teres minor subscapularis | greater tubercle: supra/infra/teres lesser tubercle: subscap
44
# Bursas: subacromial bursa Where is this bursa located? What is its purpose?
* under the acromion * separate supraspinatus tendon from acromion and coracoid process
45
# Bursas: subdeltoid bursa Where is this bursa located? What is its purpose?
* beneath the deltoid * separate deltoid from head of humerus to allow for smooth gliding
46
# Closed pack positions What is the closed pack position for the GH jt?
ABD & ER
47
# Closed pack positions What is the closed pack position of the SC jt?
maximum shoulder elevation
48
# Closed pack positions What is the closed pack position of the AC jt?
ABD to 90º
49
What is scapulohumeral rhythm?
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
# Scapulohumeral rhythm Where does the motion primarily occur for the first 30º of elevation?
GH jt
51
# Which scapular motion accompanies GH motion in scapulohumeral rhythm? GH flexion
upward rotation protraction
52
# Which scapular motion accompanies GH motion in scapulohumeral rhythm? GH ext
downward rotation retraction
53
# Which scapular motion accompanies GH motion in scapulohumeral rhythm? GH AB
upward rotation
54
# Which scapular motion accompanies GH motion in scapulohumeral rhythm? GH AD
downward rotation
55
# Which scapular motion accompanies GH motion in scapulohumeral rhythm? ER
retraction
56
# Which scapular motion accompanies GH motion in scapulohumeral rhythm? IR
protraction
57
# Which scapular motion accompanies GH motion in scapulohumeral rhythm? horizontal AB
retraction
58
# Which scapular motion accompanies GH motion in scapulohumeral rhythm? horizontal AD
protraction
59
# Diagnoses/Conditions: **Bursitis** 1. Definition 2. Etiology 3. Symptoms
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
# Diagnoses/Conditions: **Bicipital tendonitis** 1. Definition 2. Etiology 3. Symptoms
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
# Diagnoses/Conditions: **Rotator Cuff Tendonitis** 1. Definition 2. Etiology 3. Symptoms
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 ## Footnote What are the RTC muscles?
62
# Diagnoses/Conditions: **Impingement Syndrome** 1. Definition 2. Etiology 3. Symptoms
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
# Diagnoses/Conditions: **Impingement Syndrome** In impingement syndrome, what ROM is painful?
60º-120º
64
# Diagnoses/Conditions: **Impingement Syndrome** What are the two types of impingement?
1. Primary impingement: compression due to reduced mechanical space 2. Secondary impingement: GH instability caused by scapulothoracic weakness
65
# Diagnoses/Conditions: **Impingement Syndrome** What are the scapulothoracic muscles?
middle/lower trapezius rhomboids serratus anterior
66
# Diagnoses/Conditions: **Tears** 1. Definition 2. Etiology 3. Symptoms
1. tear of tendon/labrum (3 degrees) 2. repetitive/sustained use of arms OH 3. resisted ER significant weaknesss, night pain
67
# Diagnoses/Conditions: **Tears** What are the three degrees of tears?
Small: <1 cm Medium: <3 cm Large: >5 cm
68
# Diagnoses/Conditions: **GH Dislocation** 1. Definition 2. Etiology 3. Symptoms
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
# Diagnoses/Conditions: **GH Dislocation** Non-surgical protocol
Immobilized in sling **6 weeks** Avoid AB with ER for **3 months**
70
# Diagnoses/Conditions: **Bankart Lesion** 1. Definition 2. Etiology 3. Symptoms
1. anterior inferior labrum tear 2. recurrent anterior dislocations 3. visibly out of place shoulder, swelling, bruising, intense pn, inability to move jt
71
# Diagnoses/Conditions: **Hills-Sachs Lesion** 1. Definition 2. Etiology 3. Symptoms
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
# Diagnoses/Conditions: **Hills-Sachs Lesion** What aspect of recurrent dislocations leads to a Hills-Sachs lesion?
posteriolateral head abutting anterior glenoid fossa when dislocating
73
# Diagnoses/Conditions: **Bankart Lesion** What aspect of recurrent dislocations leads to a Bankart lesion?
combined force of AB, ext, ER
74
# Diagnoses/Conditions: **Subluxation** 1. Definition 2. Etiology 3. Symptoms
1. incomplete/partial dislocation 2. commonly after stroke/paralysis 3. visibly out of place shoulder that will slide back in on its own ## Footnote Immobilized in sling
75
# Diagnoses/Conditions: **Adhesive Capsulitis** 1. Definition 2. Etiology 3. Symptoms
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
# Diagnoses/Conditions: **Adhesive Capsulitis** What are the four stages and their characteristic symptom(s)?
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
# Diagnoses/Conditions: **Adhesive Capsulitis** What are the two etiologies?
1. idiopathic 2. secondary - induced by immobilization/trauma as a result of pain or systemic disease, *e.g. diabetes*
78
# Diagnoses/Conditions: **Adhesive Capsulitis** What are the acute and chronic symptoms?
* acute: constant pn at deltoid region * pn at end range and resisted movements, decreased pn at rest
79
# Diagnoses/Conditions: **AC Sprain/Subluxation/Dislocation** What are the three grades of AC sprains?
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
# Diagnoses/Conditions: **Thoracic Outlet Syndrome** 1. Defnition 2. Symptoms
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
# Diagnoses/Conditions: **Thoracic Outlet Syndrome** What are the three locations of possible entrapment?
1. scalene-anticus and cervical rib 2. costoclavicular 3. hyperabduction
82
# Diagnoses/Conditions: **Thoracic Outlet Syndrome** Where does hyperabduction entrapment occur?
between pec minor and coracoid process
83
# Special Tests Bicipital Tendonitis | (1)
**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
# Special Tests Rotator Cuff Tears | (3)
1. Drop Arm Test 2. Supraspinatus/Empty Can Test 3. Lag Sign/Lift Off Test
85
# Special Tests: RTC Procedure for Drop Arm Test
Clinician ABD pt arm to 90º and pt slowly lowers arm | inability to slowly lower arm/pain with lowering = positive test
86
# Special Tests: RTC Supraspinatus/Empty Can Test
1. clinician ABD pt arm to 90º and horizontal ABD to 30º, thumb down 2. clinician applies resistance | weakness and pain = positive test
87
# Special Tests Impingement Syndrome | (2)
1. Hawkins-Kennedy Impingement Test 2. Neer Impingement Test
88
# Special Tests: RTC Lag Sign/Lift Off Tests
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
# Special Tests: Impingement Hawkins-Kennedy Test
1. clinician flexes pt shoulder to 90º, elbow flexed 2. clinicial IR arm | pain = positive test ## Footnote may also be helpful to rule out subacromial pn as a negative test
90
91
# Special Tests Neer Test
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 ## Footnote may indicate impingement OR supraspinatus tendon tear
92
# Special Tests Dislocations/Subluxations | (1)
Apprehension Test 1. pt in supine 2. clinician AB and ER the shoulder | for anterior shoulder dislocation
93
# Special Tests Thoracic Outlet Syndrome (TOS) | (4)
1. Adson's Maneuver 2. Military Brace/Wright's Test 3. Roo's Test 4. Hyperabduction Test
94
# Special Tests: TOS Adson's Maneuver
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 ## Footnote absent/diminished pulse OR reproduction of pain/paresthesia = positive test
95
# Special Tests: TOS Military Brace/Wright's Test
1. pt sitting, clinician monitoring radial pulse 2. pt depresses/retracts shoulder while taking a deep breath | for costoclavicular entrapment ## Footnote absent/diminished pulse OR reproduction of pain/paresthesia = positive test
96
# Special Tests: TOS Roo's Test
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 ## Footnote reproduction of pain/paresthesia = positive test
97
# Special Tests: TOS Hyperabduction Test
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 ## Footnote absent/diminished pulse OR reproduction of pain/paresthesia = positive test
98
# Goniometry Shoulder flex
180º
99
# Goniometry Shoulder ext
60º
100
# Goniometry Shoulder ER
90º
101
# Goniometry Shoulder IR
70º
102
SWIC RTC Protocol | 5 required, 2 if indicated
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
Exercises for non-surgical frozen shoulder
* pendulum/Codman's * cane/wand * pulleys * mobilizations * aggressive stretching
104
# Precautions for Ex Impingement
exercises past 90º (OH) and painful arc of 60º-90º until pain-free
105
# Precautions for Ex GH Dislocations
avoid AB with ER for 3 months
106
# Precautions for Ex AC Dislocations
avoid OH position of dislocation

PTA 160 (11 decks)

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