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The G/H joint has 3 degrees of freedom and performs:
flexion-extension, abduction-adduction, and medial-lateral rotation
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For full ROM the G/H joint requires
humeral, scapular, and clavicular motion
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G/H joint capsular pattern:
lateral rotation, abduction, medial rotation
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Arthrokinematics of the G/H joint: motion occurs as a _____ and _______ of the head of the humerus on the glenoid fossa.
rolling; sliding
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The Shoulder Girdle consists of four distinct joints:
- Glenohumeral (G/H) Joint
- Sternoclavicular (SC)Joint
- Acromioclavicular (AC) Joint
- Scapularthoracic Joint- “functional joint”
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Normal shoulder ROM-Flexion
0-180 degrees
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Normal shoulder ROM-Extension
0-60 degrees
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Normal shoulder ROM-Abduction
0-180 degrees
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Normal shoulder ROM-Medial (internal) rotation
0-70 degrees
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Normal shoulder ROM-Lateral (external) rotation
0-90 degrees
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Considered a functional rather than anatomical joint
S/T joint
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Osteokinematics: scapular elevation-depression, upward-downward rotation, anterior-posterior tilting, protraction-retraction
S/T joint
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S/T joint surfaces are
anterior surface of scapula and posterior surface of thorax
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Anatomy: a synovial joint linking scapula and clavicle
Acromioclavicular (A/C) Joint
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Acromioclavicular Joint= 3 degrees of freedom; permits movement of scapula on clavicle in _ planes
3
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Upward-downward rotation, tilting (tipping), protraction-retraction
A/C joint
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A/C joint arthrokinematics: sliding of the concave acromial facet on the convex clavicular facet; acromial sliding on clavicle occurs in ____ direction as movement of scapula
same
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S/T joint arthrokinematics: _______ of scapula on thorax
sliding
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Osteokinematics: 3 degrees of freedom = Elevation-depression, protraction-retraction, anterior-posterior rotation
S/C joint
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Anatomy: SC joint is a synovial joint; links medial end of clavicle with sternum and cartilage of first rib; ________ shaped joint surfaces
saddle
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S/C joint elevation-depression: convex surface of the clavicle slides on the concave manubrium in direction __________ to the movement of lateral end of clavicle)
opposite
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S/C joint protraction-retraction: concave surface of clavicle slides on concave manubrium in _____ direction as lateral end of clavicle
same
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S/C joint Rotation: clavicular joint surface _____ on opposing joint surface
spins
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Humeral head slides posteriorly and inferiorly in flexion, anteriorly and superiorly in extension, inferiorly in abduction, and superiorly in adduction
S/T joint arthrokinematics
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Measuring Shoulder Flexion ROM Test Position:
supine, with knees flexed. Place shoulder in 0 degrees of ABD, ADD, rotation. Place elbow in full extension. Forearm in 0 degrees of supination (palm faces body)
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Measuring Shoulder Flexion-Goniometer Alignment:
- Axis: lateral aspect of the greater tubercle
- Proximal (stationary) arm: parallel to the midaxillary line of the thorax
- Distal (moving) arm: lateral midline of the humerus
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Measuring Shoulder Flexion-stabilization:
- G-H flexion: stabilize scapula to prevent posterior tilting, upward rotation, and elevation of scapula
- Shoulder complex flexion: stabilize thorax to prevent extension of spine and movement of ribs
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End Feel:
- G-H: firm due to tension of posterior band of coracohumeral ligament, posterior joint capsule, and teres minor, teres major, and infraspinatous muscles.
- Shoulder complex: firm because of tension in latissimus dorsi muscle and costosternal fibers of pectoralis major muscle.
- Shoulder Flexion
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Test Position: prone, face turned away from shoulder being tested. Shoulder in 0 degrees of ABD, ADD, rotation. Elbow in slight flexion. Forearm in 0 degrees supination and pronation (palm faces body)
Measuring Shoulder Extension
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STABILIZATION:
- Shoulder: exam table and weight of trunk sufficient to stabilize thorax
- Measuring Shoulder Extension
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When Measuring shoulder ext.-G-H: stabilize scapula at inferior angle or at acromion and coracoid processes to prevent ________ and anterior _______ of scapula
elevation; tilting
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Shoulder ext end feel:
- G-H: firm because of tension in anterior band of coracohumeral ligament, anterior joint capsule, and clavicular fibers of pectoralis major, coracobrachialis, and anterior deltoid muscles
- Shld: firm because of tension in SC capsule and ligaments, and in serratus anterior muscle
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Goniometer Alignment:
- Axis: laspect of greater tubercle
- Proximal (stationary) arm: parallel to midaxillary line of thorax
- Distal (moving) arm: lateral midline of humerus, using lateral epicondyle of humerus for reference
- Measuring Shoulder Extension
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Measuring Shoulder Abduction (Test Position):
supine, shoulder in lateral rotation and 0 degrees of flexion/extension. Extend elbow
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Measuring Shoulder Abduction-Stabilization:
- G-H: stabilize scapula to prevent upward rotation and elevation of scapula
- Shld: stabilize thorax to prevent lateral flexion of spine
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When measuring shoulder abduction, G/H joint and shoulder end feel is usually ______.
firm
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Goniometer Alignment when measuring shoulder ABD:
- Axis: close to anterior aspect of acromial process
- Proximal (stationary) arm: parallel to midline of anterior aspect of sternum
- Distal (moving) arm: anterior midline of humerus; medial epicondyle may be a helpful reference
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Test Position when measuring shoulder IR: _______, shoulder in 90 degrees of ___, forearm perpendicular to supporting surface and in 0 degrees of supination and pronation. Place pad (towel) under humerus; elbow should not be supported.
supine; ABD
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G-H: firm because of tension of posterior joint capsule and infraspinatous and teres minor muscles
- Shld: firm because of tension of sternoclavicular capsule and ligaments, costoclavicular ligaments, rhomboid and trapezius muscle
- Shoulder IR end feel
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Stabilization:
- G-H: initially distal end of humerus; toward end of ROM clavicle and coracoid and acromion processes
- Shld: distal end of humerus
- Measuring shouler IR
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Measuring Should Internal Rotation:
- Goniometer Alignment
- Axis: olecranon process
- Proximal (stationary) arm: either perpendicular to parallel to floor
- Distal (moving) arm: align with ulna, using olecranon process and ulnar styloid process for reference
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Goniometer Alignment same as Internal Rotation
External rotation
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ER Shoulder End Feel:
- G-H: firm because of tension in anterior joint capsule, three bands of g-h ligaments, and coracohumeral ligament, plus subscapularis, teres major, and pectoralis major
- Shld: firm because of tension of SC capsule and ligaments, latissimus dorsi, pectoralis major, pectoralis minor, and serratus anterior muscles
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When MMT Scapular ABD and Upward Rotation which muscle is tested and in what position?
Serratus Anterior; short sitting
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In what position is the patient when MMT Scapular ABD and Upward Rotation for grades 2,1,0 ?
short sitting with arm flexed above 90 degrees and supported by examiner
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In which grade of MMT scapular ABD and upward rotation does the PT/PTA observe for scapular winging?
2
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When MMT scapular elevation, which muscle is being tested?
Upper trapezius
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What position is the pt. in when MMT scapular elevation grades 5,4?
short sitting , hands relaxed in lap
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What position is the pt. in when MMT scapular elevation grades 2,1,0?
prone or supine
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What position is the pt. in when MMT scapular elevation grades 3?
Same as 4,5 (What position is the pt. in when MMT scapular elevation grades 2,1,0)
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Scapular Adduction MMT test which muscles?
Lower trapezius, Rhomboid major
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Pt. positioning for scapular adduction MMT grades 5,4,3?
prone w/ shoulder at edge of table, shoulder ABD to 90 degrees, elbow flexed to 90 degrees
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Pt. positioning for scapular adduction MMT grades 2,1,0?
prone w/ shoulder at edge of table, shoulder ABD to 90 degrees, elbow flexed to 90 degrees-no resistance, palpates for contractions.
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Scapular Depression and Adduction MMT test which muscle?
Lower trapezius
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Patient position: prone with test arm over head to about 145 degrees of ABD, thumb pointing to ceiling
Scapular Depression and Adduction MMT; all grades (2,1,0=no resistance)
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Rhomboid major and minor are tested during which MMT?
Scapular ADD and Downward Rotation
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Pt positioning for scapular ADD and downward rotation MMT grades 5,4,3?
prone, shoulder internally rotated, arm adducted across back with elbow flexed and hand resting on back
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Pt positioning for scapular ADD and downward rotation MMT grades 2,1,0?
short sitting with shoulder internally rotated and arm extended and adducted behind back
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Manual Muscle Testing for Shoulder Test;
- Flexion/Extension
- Abduction
- Horizontal Abduction/Horizontal Adduction
- Internal Rotation/External Rotation
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Shoulder Flexion MMT which muscles?
Anterior Deltoid, Coracobrachialis
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When MMT grades 5,4,3 for shoulder flexion, pt. position is?
short sitting with arms at sides, elbow slightly flexed, forearm pronated
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When MMT grades 2,1,0 for shoulder flexion, pt. position is?
short sitting with arms at sides, elbow slightly flexed, forearm pronated- ◦palpation placed over superior border and anterior surface of deltoid over the shoulder
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Shoulder Extension MMT test:
Latissimus dorsi, Posterior deltoid, Teres major
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Shoulder Extension (generic) MMT pt. positioning grades 5,4:
prone with arms at sides and shoulders internally rotated
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Shoulder Extension MMT pt. positioning grades 3,2:
prone with arms at sides and shoulders internally rotated
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Shoulder Extension MMT pt. positioning grades 1,0:
prone with arms at sides and shoulders internally rotated
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Shoulder Scaption MMT which muscles?
Anterior and middle deltoid, Supraspinatous
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Scaption MMT positioning: Grades 5, 4, 3, 2, 1, 0
Short sitting
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Shoulder Abduction MMT test which muscles?
Middle deltoid, Supraspinatous
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Pt. positioning for shoulder ABD MMT, Grades 5, 4, 3, 2
short sitting arm at side, elbow slightly flexed
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Pt. positioning for shoulder ABD MMT, Grades 1,0
short sitting arm at side, elbow slightly flexed-gravity resistance only
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Which muscle does MMT for Shoulder Horizontal Abduction test?
Posterior deltoid
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Pt. positioning for shoulder horizontal ABD MMT (grades 5,4,3):
prone, shoulder ABD to 90 degrees, forearm off edge of table with elbow flexed
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Pt. positioning for shoulder horizontal ABD MMT (grades 2,1,0):
short sitting
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Which muscle is tested during Shoulder Horizontal Adduction MMT?
Pectoralis major
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Pt. position for Shoulder Horizontal Adduction MMT (grades 5,4,3): Whole muscle
supine, shld ABD 90 degrees, elbow flex 90 degrees
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Pt. position for Shoulder Horizontal Adduction MMT (grades 5,4,3): Clavicular head
shld in ABD 60 degrees
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Pt. position for Shoulder Horizontal Adduction MMT (grades 5,4,3): Sternal head
shld in ABD 120 degrees
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Pt. position for Shoulder Horizontal Adduction MMT (grades 2,1,0):
supine, arm supported in 90 degrees of ABD and elbow 90 degrees flexed
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Shoulder External Rotation MMT test the __________& ___________ muscles.
Infraspinatous, Teres minor
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Prone with head turned toward test side, shoulder ABD to 90 degrees with arm fully supported on table, forearm off edge of table with elbow flexed. Place towel under arm.
Pt. pos. for shoulder ER MMT grades 5,4,3
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Prone with head turned toward test side, the entire limb hangs loosely form the shoulder in neutral rotation, palm facing table
Pt. pos. for shoulder ER MMT grades 2,1,0
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Pt. pos. for shoulder IR MMT Grades 5, 4, 3
prone with head turned toward test side, shoulder ABD to 90 degrees with arm fully supported on table, forearm off edge of table with elbow flexed. Place towel under arm.
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Shoulder Internal Rotation MMT test the _____________.
Subscapularis
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Prone with head turned toward test side, the entire limb hangs loosely form the shoulder in neutral rotation, palm facing table
Pt. pos. for shoulder IR MMT Grades 2,1,0
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Shoulder Joint Special Tests:
- Empty Can
- Speed’s Test
- Cross-over Impingement Test
- Anterior Apprehension Test
- Sulcus Sign
- Posterior Drawer Test
- Roos Test
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