ATH_301_shoulder

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itzlinds
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253124
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ATH_301_shoulder
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2013-12-16 22:50:35
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ATH Shoulder
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ATH Shoulder
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  1. The glenohumeral joint trades joint stability for:
    The glenohumeral joint trades joint stability for: increased range of motion
  2. the sternum, thorax, clavicle, and the scapula for a _______________ that must fxn in unison to produces the desired glenohumeral motion.
    the sternum, thorax, clavicle, and the scapula for a closed kinetic chain that must fxn in unison to produces the desired glenohumeral motion.

    Dysfxn within this chain will produce dysfnx at the other segments, including the glenohumeral joint
  3. during overhead motions, the scapula must provide:
    during overhead motions, the scapula must provide: a stable base of motion
  4. weakness of he scapular msucles leads to subtle, unwanted motions that alter the mechanics and increases:
    weakness of he scapular msucles leads to subtle, unwanted motions that alter the mechanics and increases: the energy expenditure in overhead motions
  5. why is there a vicious cycle that exists between rotator cuff tendinopathy, rotator cuff impingement, and rotator cuff tears?
    one of these conditions inevitably leads to another
  6. a differential diagnosis must be made between which 3 injuries:
    • insidious AC joint trauma
    • bicipital tendinopathy
    • and superior labral anterior to posterior lesions (SLPA)
  7. which ligaments stabilized the sternoclavicular joint?
    • anterior and posterior sternoclavicular ligaments
    • costoclavicular ligament
    • interclavicular ligament
  8. what movements does the acromioclavicular joint contribue to:
    • internal and external rotation around a verticle axis
    • upward and downard rotation around a axis perpendicular to the plane of the scapula
    • anterior and posterior scauplar tipping around a horizontal axis
  9. list and describe the ligaments that support the AC joint:



    • AC ligament
    • divided into 2 seperate bands: superior and inferior
    • prevents calvicle from riding up over the acromion process

    • coracoclavicular ligament
    • suspend the scaupla from the clavicle
    • most of the AC joints intrinsic stability arises from this ligament
    • divided into 2 portions: trapezoid ligament and conoid ligament
  10. what is the cause for the common misconception that the "tip of the shoulder" is synonymous with the the AC joint?
    the most lateral portion of the acromion hooks around medially to articulate with the clavicle
  11. how can you palpate the coracoid process:
    passively moving the pt's GH joint through 15 to 30 degrees off abduction-adduction
  12. what ligaments and muscles attach on the coracoid process:
    • ligaments
    • coracohumeral ligament
    • coracoacromial ligament (posterior portion)

    • muscles
    • pectoralis minor
    • coracobrachialis
    • short head of the beceps brachii
  13. what actions do the pectoralis major (5 actions) and minor perform?
    • pectoralis major
    • ADD the humerus
    • Horizontal ADD the humerus
    • humeral flexion
    • internal humeral rotation
    • depress the shoulder gridle



    • pectoralis minor
    • forward (anterior) titling
  14. where do the heads of the biceps originate:
    • long head: supraglenoid tuberosity of the scapula
    • short head: coracoid process of the scapula
  15. what are the actions performed by each of the 3 divisions of the deltoid:
    • anterior deltoid
    • flexion
    • ABD
    • horizontal ADD
    • internal roation

    • middle deltoid
    • ABD
    • flexion

    • posterior deltoid
    • extension
    • horizontal ABD
    • ABD
    • external rotation
  16. what actions does the biceps perform at the shoulder:
    • flexion
    • ABD
  17. where does the long head of the triceps brachii insert?
    infraglenoid tubercle
  18. what actions does the triceps perform at the shoulder?
    • extension (long head)
    • ADD
  19. which rotator cuff muscle belly is not palpable?
    subscapularis muscle
  20. what motions does the latissimus dorsi perform at the GH joint?
    • extension
    • internal rotation
    • ADD
    • depression of shoulder girdle
  21. the medial spine of the scapula is approximately located at teh level of the:
    the medial spine of the scapula is approximately located at teh level of the: 3rd throacic vertebrae
  22. what is the origin of the levator scapulae:
    transverse processes of C1-C4
  23. do the rhomboids rotate the scapula in an upward or a downward direction?
    downward rotation
  24. the condition involves the clavicle riding above the acromion process, indicating an AC sprain is called:
    step- off deformity
  25. bobbing of the clavicle when downward pressure is applied is called:
    piano key sign
  26. the presences of the inferior angle lifting away from the thorax is called:

    what is pathology caused by:
    • winging scapula
    • caused by: weakness of the serratus anterior or inhibition of the long thoriacic nerve
  27. a congenitally undecended, or high riding, scapula is called:
    sprengle's deformity
  28. with overhead throwing athletes the arm position that produces pain and throwing deficits yeild information regarding the possible underlying pathology:

    pain on the follow thru:
    pain in cocked position:
    pain in deceleration:
    loss of control and/or velocity:
    • pain on the follow thru: possible rotator cuff patholgy
    • pain in cocked position: instability or impingement
    • pain in deceleration: SLAP lesion, biceps tendon pathology
    • loss of control and/or velocity: internal impingement, limitation in external roation
  29. complete clavicular fx are indicated by:
    where do these fxs usually occur:
    how do patients tend to present with clavicular fxs:
    • complete clavicular fx are indicated by:gross defomity of the clavicular shaft
    • where do these fxs usually occur:  between the concave/convex (distal third of the shaft)
    • how do patients tend to present with clavicular fxs: tend to suppor the involved arm next to the body and rotate the head to the opposite side
  30. atrophy of the deltoid muscle group may indicate a lack of use in the involved are or may reflect pathology to which nerve roots:
    C5 and C6 (axillary nerve involvement)
  31. dislocations of the sternoclaicular joint tend to displace the clavicular head:

    describe why a posterior SC joint dislocation are a medical emergency:

    list the structures that are potentially threatened with a posterior dislocation:
    dislocations of the sternoclaicular joint tend to displace the clavicular head: medial and superior to the clavicular notch

    • describe why a posterior SC joint dislocation are a medical emergency:
    • may jeopardize the integrity of the neurovascular structures directly posterior to the joint
    • or
    • place pressure on the trachea, lung or both


    • potential threats
    • subclavian artery
    • subclavian vein
    • treachea
    • esophaugs
  32. how would you position a pt. to make the inferior angle of the scapula more prominate:
    ask the pt. to touch the inferior angle of the opposite scapula from below, causing the scapula undergoing examination to wing and making the inferior angle more easily palpable.
  33. which muscle is a common trigger point in swimmers and in athletes who participate in sports with overhead movements:
    teres major
  34. pro baseball players do not display a significant difference in the amount of peak torque produced during internal rotation when compared bilaterally, so when does a signifiant difference arise?
    high speed (greater than or equal to 300 degrees per second) during external rotation, with the dominate arm producing more torque
  35. list the  following ROMS:

    GH flexion:
    Elevation thru flexion:
    GH extension:

    how much is the shoulder complex capable of producing thru flexion- extension in the sagittal plane:
    • GH Flexion: 0-120 degrees
    • elevation thru flexion: 0- 180 degrees
    • GH extension: 0 - 60 degrees

    how much is the shoulder complex capable of producing thru flexion- extension in the sagittal plane: 220 - 240 degrees
  36. list the following ROMS...

    GH Abduction:
    Elevation thru Abduction:
    • GH Abduction: 0 - 120  degrees
    • elevation thru abduction: 0 - 180 degrees


    adduction is blocked in the anatomical position and  further movement requires that the GH joint flexed or extended so the humerus can pass the torso
  37. list the following ROMS...

    internal rotation:
    external rotation:
    • internal rotation: 0 - 90 degrees
    • external rotation: 0 - 100 degrees
  38. list the following ROMS...

    horizontal ABD:
    horizontal ADD:
    • horizontal ABD: 0 - 90 degrees
    • horizontal ADD: 0 - 50 degrees
  39. drop arm test for rotator cuff tendinopathy..

    patient position:
    positive test:
    implications:
    • the drop arm test determins the pt's ability to control humeral motion via eccentric contraction ad the arm is slowly lowered from a full ABD to ADD
    • patien position: humerus full ABD and externally rotated and the forearm supinated
    • positive test: the arm falls uncontrollably from a position of approximaltely 90 degrees ABD to the side
    • implication: indicative of lesions to the rotator cuff, especially the supraspinatus
  40. gerber lift -off test for subscapularis pathology...

    patient position:
    positive test:
    implications:
    • gerber lift-off is a modificiation of a subscapularis manal muscle test
    • patien position: standing with the humerus internally rotated, the dorsal surface of the hand placed against the midlumbar spine
    • positive test: inability to lift the hand off the back
    • implications: tears or weakness of the subscapularis muscle, possible C5, C6, C7 nerve root pathology
  41. patients who present with equal limitations in active and passive ROM may have "frozen shoulder", known as:
    adhesive capsulitis
  42. describe the following gelnohumeral joint capsular patterns and end-feels:

    Elevation:
    Extension:
    Flexion:
    ABD:
    Horizontal ABD:
    Horizontal ADD:
    internal rotation:
    external roation:
    • Elevation: firm or hard
    • extension: firm
    • flexion: firm
    • ABD: firm or hard
    • Horiz ABD: firm
    • Horiz ADD: Firm or soft
    • internal roation: firm
    • external rotation: firm
  43. apprehension test for anterior glenohumeral laxity:

    patient position:
    positive test:
    implications:
    • the apprehension test, passive external rotation of the glenohumeral joint, places the joint in the closed pack position and replicates the mechansim of injury for anterior GH dislocations
    • pt position: the GH joint is ABD to 90 degrees and the elbow is flexed to 90 degrees
    • positive test: the pt. displays apprehension that the shoulder may dislocate, resist further movement. pain is centered in the anterior capusle of the GH joint
    • implications: anterior capsule, inferior GH ligament, or glenoid labrum have been compromised, allowing the humeral head to disolocate or subluxate anteriorly on the glenoid fossa
  44. the GH joint is palpated during passive internal/external rotation  to determin the presence of:
    • crepitus: may indicate rotator cuff or bicipital tendinitis and subacromial bursitis
    • clicks: labral tear
  45. Pain at the end-range of horizontal ADD is assoicated with which pathology:
    restriction in passive horizontal ADD may be indicitative of:
    • Pain at the end-range of horizontal ADD is assoicated with which pathology: AC joint pathology
    • restriction in passive horizontal ADD may be indicitative of: glenohumeral impingement
  46. applying a gliding pressure that forces the medial clavicle downward, upward, anteriorly, and posteriorly relative to the sternum... describe the structures stressed with each motion:
    • inferior: interclavicular ligament
    • superior: costoclavciular ligament (anterior and posterior fibers)
    • anterior: SC ligament (posterior)
    • posterior: SC ligament (anterior)
  47. apply a gliding pressure that forces the distal clavicle downward, upward, anteriorly, and posteriorly relative to the scapula for AC joint play.... describe the structures stressed with each motion:



    inferior: AC ligament (superior fibers)

    • superior
    • conoid ligament (portion of the coracoclavicluar)
    • trapezoid ligament (portion of the coracoclavicular) 
    • AC ligament (inferior fibers)

    • anterior
    • AC ligament
    • coracoclavciluar ligament (in the absence of the AC ligament)

    • posterior
    • claviclue contacting acromion (posterior block)
    • AC ligament
  48. explain why laxity and instablity are not synonymous:
    • a lax shoulder can still be fxnally stable.
    • an unstable shoulder may not demonstrate laxity.
  49. describe the implications of GH joint play if hyper or hypomobility is found in each of the following...

    inferior:
    anterior:
    posterior:
    • inferior
    • inferior joint capusle
    • superior GH ligament
    • coracohumeral ligament

    • anterior
    • coracohumeral ligament
    • superior and middle GH ligaments
    • anterior joint capsule

    • posterior
    • posterior joint capusle
    • labrum tear
  50. list to MOI for a sternoclavicular joint dislocation:
    force applied longitudinally to the clavicle, such as falling on an outstretched arm, or forceful distraction of the arm and distal shoulder complex

    indirect mechanisms include anterior or posterior forces exerted on the anterolateral or posterolateral shoulder
  51. the similarities in the signs and symptoms of an SC joint sprain or dislocation and those associated with an epiphyseal injury are simliar, known as:
    • pseudo-dislocation
    • injuries to the growth plate must be ruled out in patiens younger than 25 y/o
  52. list 3 MOI for an AC joint patholgoy:
    • landing on a foward-flexed outstretched arm or the point of the elbow, which drives the scapula posterior to the clavicle
    • a blow the the superior acromion process, which drives the scapula inferior to the clavicle
    • a force that drives the clavicle away from the scapula when the scapula is fixated
  53. describe the structures involved in the following grades of AC joint sprain:

    Type I:
    Type II:
    Type III:
    Type IV:
    • type I
    • slight to partial damage of the AC ligament and capusle
    • signs: point tenderness, no laxity or deformity

    • type II
    • rupture of the AC ligament and partial damage to the coracoclavicular ligament
    • signs: slight laxity and deformity, slight step deformity

    • Type III
    • complete tear of AC and coracoclavicular ligaments; possible involvement of deltoid and trapezius fascia
    • signs: obvious dislocation at distal end of the clavicle from acromion process

    • type Iv:
    • complete tear of the AC and coracoclavicular ligaments and tearing of the deltoid and trapezius muscles
    • signs: posterior clavicular displacement into the insertion of the upper fibers of the trapezius
  54. acromionclavicular traction test...

    patient position:
    positive test:
    implications:
    • patient position: the arm hanging naturally to the side
    • positive test: humerus/scapula move inferior to the clavicle, causing a step deformity, pain or both
    • implications: sprain of the AC or coracoclavicular ligament
  55. acromionclavicular compression test..

    patient position:
    positive test:
    implications:
    attempts to displace the clavicle over the acromion process, stressing the coracoclavicular ligament

    • patient position: arm hanging naturally at the side
    • positive test: pain at the AC joint or excursion fo the clavicle over the arcomion process
    • implications: damage to AC or coracoclavicular ligaments
  56. what is known as the indented superior region of the manubrium?

    A. jugular notch
    B. arcominal notch
    C. fermoal notch
    D. clavicular notch
    A. jugular notch
    (this multiple choice question has been scrambled)
  57. which ligament is responsible for restricting superior movement of the clavicle at the AC joint:

    A. trapazoid ligament
    B. conoid ligament
    C. coracoclavicular ligament
    D. costoclavicular ligament
    B. conoid ligament
    (this multiple choice question has been scrambled)
  58. injury to what nerve woould be indicated by scapular winging?

    A. subclavian nerve
    B. phrenic nerve
    C. axillary nerve
    D. long thoracic nerve
    D. long thoracic nerve
    (this multiple choice question has been scrambled)
  59. a weakness of which muscle in the shoulder complex can result in scapular winging?

    A. subscapularis
    B. supraspinatus
    C. serratus anterior
    D. spinalis capitis
    C. serratus anterior
    (this multiple choice question has been scrambled)
  60. for which muscle does the coracoid process serve as the point of insertion?

    A. anterior deltoid
    B. pectoralis major
    C. pectoralis minor
    D. upper trapezius
    C. pectoralis minor
    (this multiple choice question has been scrambled)
  61. what is GH instablity caused by:

    a. labral tears
    b. ligamentous pathology
    c. muscular weakness
    d. all of the above
    d. all of the above
  62. tears most commonly occur in which rotator cuff msucle:

    A. infraspinatus
    B. teres minor
    C. subscapularis
    D. supraspinatus
    D. supraspinatus
    (this multiple choice question has been scrambled)
  63. list the ligament that limits humeral motion in the following position...

    external roation in 0 degrees abduction:
    • superior GH ligament
    • coracohumeral ligament
  64. list the ligament that limits humeral motion in the following position...

    external rotation in 45 degrees of ABD:
    • middle GH ligament
    • anterior band of the inferior GH ligament
  65. list the ligament that limits humeral motion in the following position...

    external rotation in 90 degrees in ABD:
    inferior GH ligament
  66. list the ligament that limits humeral motion in the following position...

    internal rotation in 90 degrees ABD
    posterior band of the inferior GH ligament
  67. list the ligament that limits humeral motion in the following position...

    inferior displacement in 0 degrees ABD:
    • superior GH ligament
    • corachohumeral ligament
  68. list the ligament that limits humeral motion in the following position...

    inferior displacement in 90 degrees of ABD:
    inferior GH ligament
  69. the inferior GH ligament may be avulsed from the labrum or may be avulsed along with a portion of the labrum forming a:
    bankart lesion
  70. a defect in the posterior humeral head's articular cartilage caused by the impact of the humeral head on the glenoid fossa as the humerus attempts to relocate is called:
    hill sachs lesion

    a common MRI finding assoicated with anterior GH dislocations
  71. lesions found on the anterior portion of the humeral head after a posterior dislocation are called:
    reverse hill-sachs lesions
  72. posterior aprehension test for glenohumeral laxity:

    patient position:
    positive test:
    implication:
    the humeral head is moved posterioly on the glenoid fossa. 

    • patient position:  sitting or supine; shoulder flexed to 90, and elbow flexed to 90
    • positive test: pt displays apprehension and produces muscle guarding to prevent the shoulder from subluxating posteriorly
    • implication: lax posterior GH capsule, torn posterior labrum
  73. sulcus sign for inferior glenohumeral laxity...

    patient position:
    positive test:
    implications:
    determins the amount of inferior glide of the humeral head when traction is applied to the humerus.

    • patient position: arm hanging at side
    • positive test: indentation (sulcus) appears beneath acromion process
    • implications: laxity in the superior GH ligament

    • grade I: 1cm or less
    • grade II:  1-2 cm
    • grade III: greater than 2 cm
  74. list the 5 muscles that contribute to scapular elevation:
    • levator scapulae
    • rhomboid major
    • rhomboid minor
    • serratus anterior (upper portion)
    • trapzeius (upper portion)
  75. list the 1 muscle that contributes to scapular protraction:
    serratus anterior
  76. list the 2 muscles that contribute to scapular upward rotation:
    • serratus anterior
    • trapeizus (upper and lower portion)
  77. list the 3 muscles that contribute to scapular depression:
    • serratus anterior (lower portion)
    • trapezius (lower portion)
    • pectoralis major ( claviclar portion)
  78. list the 4 muscles that contribute to scapular retraction:
    • rhomboid major
    • rhomboid minor
    • trapezius (middle fibers)
    • trapezius (lower fibers)
  79. list the 4 muscles that contribute to scapular downward rotation:
    • rhomboid major
    • rhomboid minor
    • levator scapulae
    • trapezius (lower portion)
  80. list the  5 muscles that contribute to humeral flexion:
    • biceps brachii
    • coracobrachialis
    • deltoid (anterior 1/3rd)
    • deltoid (middle 1/3rd)
    • pectoralis major (clavicular fibers)
  81. list the 4 muscles that contribute to humeral extension:
    • deltoid ( posterior 1/3rd)
    • latissimus dorsi
    • teres major
    • triceps brachii (long head)
  82. list the 5 muscles that contribute to humeral ADD:
    • coracobrachialis
    • latissimus dorsi
    • pectoralis major
    • teres major
    • triceps brachii
  83. list the 5 muscles that contribute to humeral ABD:
    • biceps brachii
    • deltoid (anterior)
    • deltoid ( middle)
    • deltoid (posterior)
    • supraspinatus
  84. list the 2 muscles that contribute to humeral horizontal ADD:
    • deltoid (anterior)
    • pectoralis major
  85. list the 3 muscles that contribute to humeral horziontal ABD:
    • deltoid (posterior)
    • infraspinatus
    • teres minor

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