The shoulder

  1. The G/H joint has 3 degrees of freedom and performs:
    flexion-extension, abduction-adduction, and medial-lateral rotation
  2. For full ROM the G/H joint requires
    humeral, scapular, and clavicular motion
  3. —G/H joint capsular pattern:
    lateral rotation, abduction, medial rotation
  4. Arthrokinematics of the G/H joint: motion occurs as a _____ and _______ of the head of the humerus on the glenoid fossa.
    rolling; sliding
  5. —The Shoulder Girdle consists of four distinct joints:—
    • Glenohumeral (G/H) Joint
    • —Sternoclavicular (SC)Joint
    • —Acromioclavicular (AC) Joint
    • —Scapularthoracic Joint- “functional joint”
  6. —Normal shoulder ROM-Flexion
    0-180 degrees
  7. Normal shoulder ROM-Extension
    0-60 degrees
  8. Normal shoulder ROM-Abduction
    0-180 degrees
  9. Normal shoulder ROM-Medial (internal) rotation
    0-70 degrees
  10. Normal shoulder ROM-Lateral (external) rotation
    0-90 degrees
  11. Considered a functional rather than anatomical joint
    S/T joint
  12. —Osteokinematics: scapular elevation-depression, upward-downward rotation, anterior-posterior tilting, protraction-retraction
    S/T joint
  13. S/T —joint surfaces are
    anterior surface of scapula and posterior surface of thorax
  14. —Anatomy: a synovial joint linking scapula and clavicle
    Acromioclavicular (A/C) Joint
  15. Acromioclavicular Joint= 3 degrees of freedom; permits movement of scapula on clavicle in _ planes
    3
  16. Upward-downward rotation, tilting (tipping), protraction-retraction
    A/C joint
  17. —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
  18. —S/T joint arthrokinematics: _______ of scapula on thorax
    sliding
  19. —Osteokinematics: 3 degrees of freedom = Elevation-depression, protraction-retraction, anterior-posterior rotation
    S/C joint
  20. —Anatomy: SC joint is a synovial joint; links medial end of clavicle with sternum and cartilage of first rib; ________ shaped joint surfaces
    saddle
  21. 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
  22. S/C joint protraction-retraction: concave surface of clavicle slides on concave manubrium in _____ direction as lateral end of clavicle
    same
  23. S/C joint Rotation: clavicular joint surface _____ on opposing joint surface
    spins
  24. —Humeral head slides posteriorly and inferiorly in flexion, anteriorly and superiorly in extension, inferiorly in abduction, and superiorly in adduction
    S/T joint arthrokinematics
  25. 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)
  26. —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
  27. 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
  28. —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
  29. —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
  30. STABILIZATION:
    • Shoulder: exam table and weight of trunk sufficient to stabilize thorax
    • Measuring Shoulder Extension
  31. 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
  32. 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
  33. —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
  34. Measuring Shoulder Abduction (Test Position):
    — supine, shoulder in lateral rotation and 0 degrees of flexion/extension. Extend elbow
  35. 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
  36. When measuring shoulder abduction, G/H joint and shoulder end feel is usually ______.
    firm
  37. —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
  38. —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
  39. 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
  40. —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
  41. 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
  42. —Goniometer Alignment same as Internal Rotation
    External rotation
  43. 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
  44. When MMT Scapular ABD and Upward Rotation which muscle is tested and in what position?
    Serratus Anterior; short sitting
  45. 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
  46. In which grade of MMT scapular ABD and upward rotation does the PT/PTA observe for scapular winging?
    2
  47. When MMT scapular elevation, which muscle is being tested?
    Upper trapezius
  48. What position is the pt. in when MMT scapular elevation grades 5,4?
    short sitting , hands relaxed in lap
  49. What position is the pt. in when MMT scapular elevation grades 2,1,0?
    prone or supine
  50. 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)
  51. GM=
    Gravity Minimized
  52. Scapular Adduction MMT test which muscles?
    Lower trapezius, Rhomboid major
  53. 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
  54. 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.
  55. Scapular Depression and Adduction MMT test which muscle?
    Lower trapezius
  56. 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)
  57. Rhomboid major and minor are tested during which MMT?
    Scapular ADD and Downward Rotation
  58. 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
  59. 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
  60. Manual Muscle Testing for Shoulder Test;
    • Flexion/Extension 
    • Abduction
    • Horizontal Abduction/Horizontal Adduction 
    • Internal Rotation/External Rotation
  61. Shoulder Flexion:
  62. Shoulder Flexion MMT which muscles?
    Anterior Deltoid, Coracobrachialis
  63. When MMT grades 5,4,3 for shoulder flexion, pt. position is?
    short sitting with arms at sides, elbow slightly flexed, forearm pronated
  64. 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
  65. Shoulder Extension MMT test:
    Latissimus dorsi, Posterior deltoid, Teres major
  66. Shoulder Extension (generic) MMT pt. positioning grades 5,4:
    prone with arms at sides and shoulders internally rotated
  67. Shoulder Extension MMT pt. positioning grades 3,2:
    prone with arms at sides and shoulders internally rotated
  68. Shoulder Extension MMT pt. positioning grades 1,0:
    prone with arms at sides and shoulders internally rotated
  69. Shoulder Scaption MMT which muscles?
    Anterior and middle deltoid, Supraspinatous
  70. —Scaption MMT positioning: Grades 5, 4, 3, 2, 1, 0
    Short sitting
  71. Shoulder Abduction MMT test which muscles?
    Middle deltoid, Supraspinatous
  72. —Pt. positioning for shoulder ABD MMT, Grades 5, 4, 3, 2
    short sitting arm at side, elbow slightly flexed
  73. Pt. positioning for shoulder ABD MMT, Grades 1,0
    short sitting arm at side, elbow slightly flexed-gravity resistance only
  74. Which muscle does MMT for Shoulder Horizontal Abduction test?
    Posterior deltoid
  75. 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
  76. Pt. positioning for shoulder horizontal ABD MMT (grades 2,1,0):
    short sitting
  77. Which muscle is tested during Shoulder Horizontal Adduction MMT?
    Pectoralis major
  78. Pt. position for Shoulder Horizontal Adduction MMT (grades 5,4,3): Whole muscle
    supine, shld ABD 90 degrees, elbow flex 90 degrees
  79. Pt. position for Shoulder Horizontal Adduction MMT (grades 5,4,3): –Clavicular head
    shld in ABD 60 degrees
  80. Pt. position for Shoulder Horizontal Adduction MMT (grades 5,4,3): –Sternal head
    shld in ABD 120 degrees
  81. Pt. position for Shoulder Horizontal Adduction MMT (grades 2,1,0):
    supine, arm supported in 90 degrees of ABD and elbow 90 degrees flexed
  82. Shoulder External Rotation MMT test the __________& ___________ muscles.
    Infraspinatous, Teres minor
  83. 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
  84. 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
  85. 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.
  86. Shoulder Internal Rotation MMT test the _____________.
    Subscapularis
  87. 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
  88. Shoulder Joint Special Tests:
    • —Empty Can—
    • Speed’s Test
    • —Cross-over Impingement Test—
    • Anterior Apprehension Test—
    • Sulcus Sign—
    • Posterior Drawer Test—
    • Roos Test
Author
ALMitrchell05
ID
327900
Card Set
The shoulder
Description
Shouder joint
Updated