Anatomy of the Shoulder Joint

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Questions and Answers

What type of joint is the glenohumeral joint?

Pivot

Hinge

Fibrous

Synovial, ball & socket (correct)

Which muscle function is NOT relevant to the scapulohumeral rhythm?

Rotating the shoulder joint

Depression of the shoulder girdle

Elevation of the arm

Adduction of the shoulder (correct)

Which ligaments provide structural integrity to the glenohumeral joint?

Collateral and cruciate ligaments

Interosseous and lateral ligaments

Coracohumeral and transverse humeral ligaments (correct)

Deltoid and radial ligaments

What describes a characteristic of the shoulder joint capsule?

Weak and lax inferiorly Signup and view all the answers

Which clinical condition is characterized by inflammation of the bursa surrounding the shoulder joint?

Bursitis Signup and view all the answers

What is NOT a major consideration when performing an anatomical palpation of shoulder muscles?

Determining joint positioning Signup and view all the answers

What is the correct definition of active stability in the glenohumeral joint?

Stability achieved through muscular control Signup and view all the answers

Which of the following best describes the term 'capsular pattern of restriction'?

Specific loss of motion in multiple directions based on joint type Signup and view all the answers

Which of these is NOT a mechanism to provoke musculotendinous tissue during assessment?

Thermal application Signup and view all the answers

What is the primary role of the glenoid labrum in the shoulder?

Increasing the depth of the glenoid fossa Signup and view all the answers

What is the primary role of the biceps tendon?

Humeral stabilizer and elbow decelerator Signup and view all the answers

Which condition is characterized by calcified deposits and may lead to impingement under the acromial arch?

Calcific Tendonitis Signup and view all the answers

What is a common symptom of acute bursitis?

Pain that is deep, constant, and intense Signup and view all the answers

In which test would a patient report localized pain in the anterior shoulder indicating potential bicipital tendonitis?

Speed's Test Signup and view all the answers

What factors contribute to the development of bursitis?

Repetitive movements and poor biomechanics Signup and view all the answers

Which of the following describes a positive Drop Arm sign?

Patient cannot control movement and arm drops Signup and view all the answers

What is a common treatment approach for chronic tendinopathy?

Break and build strength through mobilization and stretching Signup and view all the answers

What is a notable sign of calcific tendonitis as it develops?

Presence of burning pain and swelling Signup and view all the answers

What condition may arise due to constant compression of the biceps tendon in the bicipital groove?

Subluxation of the tendon Signup and view all the answers

What can happen if there is repeated cortisone injection in the biceps tendon?

Weakening of the tendon and possible rupture Signup and view all the answers

Which bursa is situated underneath the acromion and deltoid muscle and is most susceptible to impingement?

Subacromial bursa Signup and view all the answers

Which term describes the protective mechanism of calcium deposits being reabsorbed in calcific tendonitis?

Self-limiting Signup and view all the answers

Which of the following describes a common symptom of chronic bursitis?

Localized pain associated with activity or compression Signup and view all the answers

What is the primary aim when improving the subacromial space?

Facilitating humeral gliding and scapula rotation Signup and view all the answers

Which muscle is primarily affected in cases of GH joint instability?

Supraspinatus Signup and view all the answers

What mechanism of injury (MOI) is most commonly associated with anterior shoulder dislocation?

Excessive abduction and external rotation Signup and view all the answers

Which sign may indicate a subluxed joint following a shoulder injury?

Sulcus sign Signup and view all the answers

During the acute phase of shoulder dislocation treatment, which action should be avoided?

Mobilizing the joint actively Signup and view all the answers

How is a Grade II AC separation characterized?

Partial dislocation of the clavicle with mild step deformity Signup and view all the answers

Which condition is a complication of shoulder dislocation?

Avascular necrosis Signup and view all the answers

Which test is specifically used for assessing posterior shoulder instability?

Push-Pull test Signup and view all the answers

What precaution should be taken in the acute stage of healing for shoulder injuries?

Avoid promoting circulation distal to the joint Signup and view all the answers

What is a critical characteristic of chronic shoulder instability?

Localized joint capsule pain Signup and view all the answers

What should be the main focus during the late subacute/chronic phase of shoulder injury rehabilitation?

Restoring range of motion and strength Signup and view all the answers

When is a shoulder apprehension sign most commonly performed?

During the initial contact after a dislocation Signup and view all the answers

What is the initial area of adhesion in frozen shoulder?

Between subscapularis and biceps tendons Signup and view all the answers

What is commonly assessed during active range of motion (AROM) in shoulder injuries?

Pain with specific movements Signup and view all the answers

Which type of frozen shoulder is classified as idiopathic?

Primary Frozen Shoulder Signup and view all the answers

What distinguishes a complete tear from a partial tear in shoulder injuries?

Total loss of integrity of the muscle or ligament Signup and view all the answers

In which phase of frozen shoulder does severe pain diminish but stiffness become the primary complaint?

Phase 2 - Frozen phase Signup and view all the answers

What is a common systemic disease that increases the risk of frozen shoulder?

Diabetes - type II Signup and view all the answers

During which phase may patients experience the main complaint of pain in the lateral brachial region?

Phase 1 - Freezing phase Signup and view all the answers

What type of movement pattern is commonly observed in AROM with frozen shoulder?

Reverse scapulohumeral rhythm Signup and view all the answers

Which of the following is NOT a characteristic of the Thawing phase?

Full range of motion is always regained Signup and view all the answers

What finding may indicate the presence of adhesive capsulitis during the assessment?

Capsular pattern of restriction Signup and view all the answers

What is a possible indicator of a complete rupture or neural compromise in RROM assessment?

Weak/painless Signup and view all the answers

What is the typical duration for the Thawing phase in frozen shoulder?

2 years Signup and view all the answers

What is the capsular pattern of restriction for the glenohumeral joint?

ER > AB > IR Signup and view all the answers

Which joint has a closed packed position at arm maximally elevated?

Sternoclavicular Joint Signup and view all the answers

What is the range of motion for external rotation in the glenohumeral joint?

90 degrees Signup and view all the answers

Which option describes the arthrokinematics for the acromioclavicular joint?

Concave on Convex Signup and view all the answers

Which ligament checks elevation with medial movement at the sternoclavicular joint?

Costoclavicular Ligament Signup and view all the answers

What is the resting position of the acromioclavicular joint?

Arm by side Signup and view all the answers

Which degree of freedom is NOT associated with the sternoclavicular joint?

Flexion Signup and view all the answers

Which statement is true about joint mobilization of the sternoclavicular joint?

It rolls superior and glides inferior. Signup and view all the answers

What is the end feel for internal rotation of the glenohumeral joint?

Firm Signup and view all the answers

When the arm is in the scapular plane, what is the required degree of horizontal adduction?

20 degrees Signup and view all the answers

What describes the role of the shoulder joint capsule during movement?

Relatively lax and relies on muscles for stabilization Signup and view all the answers

Which motion does NOT occur in the acromioclavicular joint?

Flexion Signup and view all the answers

What is the maximum range of motion for flexion in the glenohumeral joint?

180 degrees Signup and view all the answers

During which position is the glenohumeral joint not in a closed packed position?

55 – 70 degrees abduction & 30 degrees horizontal adduction Signup and view all the answers

What is one of the key principles of REMEX programs?

They should not cause pain or inflammation. Signup and view all the answers

Which of the following muscle contraction types is appropriate during the acute stage?

Isometric contractions. Signup and view all the answers

In the context of exercise selection, when should gravity be added?

After performing exercises without weight. Signup and view all the answers

What indicates that a program might be too challenging during the acute stage?

Post-exercise discomfort lasting more than 2 hours. Signup and view all the answers

Why is it recommended to start with eccentric exercises before concentric ones?

Eccentric exercises result in greater muscle stability. Signup and view all the answers

Which exercise is appropriate for the later stages of rehab for tendonitis?

Eccentric strengthening. Signup and view all the answers

What is a goal of home care in rehabilitation?

To improve proprioception by removing vision. Signup and view all the answers

During which stage is isometric exercise in mid-range recommended?

Subacute stage. Signup and view all the answers

What is a sign that a program is too challenging for a chronic stage patient?

Discomfort post-exercise lasting more than 4 hours. Signup and view all the answers

What is the recommended progression for exercises during rehabilitation?

Slow to fast. Signup and view all the answers

Which exercise is best to improve muscular endurance?

Isometric exercises against resistance. Signup and view all the answers

Which type of exercise should be performed before attempting to perform concentric exercises?

Eccentric exercises. Signup and view all the answers

What type of exercise is suggested for adhesive capsulitis during the early stages?

Manual PROM or AAROM. Signup and view all the answers

What is a recommended initial exercise for proprioception improvement?

Removing vision during balance tasks. Signup and view all the answers

Study Notes

Learning Objectives

Describe the actions of major muscles related to a joint, including all muscles listed on the Anatomy Review Sheet.
Accurately palpate major muscles related to a joint, including all muscles listed on the Anatomy Review Sheet.
Perform manual muscle tests for major muscles related to a joint, including all muscles listed on the Anatomy Review Sheet.
Assess the full range of motion for a joint complex.
Describe closed-pack positions and capsular restriction patterns for a joint.
Describe arthrokinematics and joint mobilization theory for the glenohumeral and sternoclavicular joints.
Describe the function of major structural ligaments (coracohumeral, transverse humeral, acromioclavicular, coracoclavicular).
Describe the function of the joint capsule and accessory structures (bursae, glenoid labrum).
Describe scapulohumeral rhythm.
Describe scapular malposition and responsible muscles (SICK scapula).
Describe the 3 force couples of shoulder function.
Describe passive stability of the GH joint.
Describe active and compromised stability of the GH joint.
Describe 3 ways to provoke musculotendinous tissue in assessments.
Describe all special tests (indications, procedure, positive findings, and explanations of results) found within the special tests document.
Perform all special tests (using the full NEER protocol) found within the special tests document.
Describe definitions, affected tissues, signs, and symptoms of tendonitis, bursitis, impingement, shoulder instability, AC separation, and adhesive capsulitis.
Describe treatment plans (key questions, physical assessments, clinical impressions, treatment approaches, precautions, and home care) for impingement syndrome, shoulder instability, adhesive capsulitis, general tendinopathy, and general muscle strain through all healing stages.
Perform indicated treatments (intake, treatment, home care) for the same conditions mentioned above through all healing stages.
Perform joint mobilization for the sternoclavicular joint.

Anatomy: Glenohumeral Joint

Joint type: Synovial, ball-and-socket.
Articulating surfaces: Head of humerus (medial, slightly posterior, and superior); glenoid fossa of scapula (lateral, forward, and superior).
Capsular strength/coaptation: Weak and lax, especially inferiorly (inferior axillary pouch).
Ligaments: Superior/middle/inferior GH ligament (anterior strengthening, limit lateral rotation); coracohumeral ligament (strengthens superior capsule); transverse humeral ligament (holds biceps tendon).
Dynamic ligaments: Tendons from rotator cuff muscles blend with joint capsule fibers.
Glenoid labrum: Deepens glenoid cavity, improves articulation.

Anatomy: Acromioclavicular Joint

Joint type: Synovial, modified gliding.
Articulating surfaces: Medial acromion surface; incomplete articular disc; acromial facet of clavicle.
Capsular strength/coaptation: Weak and lax.
Ligaments: Superior/inferior acromioclavicular ligament; coracoclavicular complex (trapezoid and conoid ligaments).
Intra-articular disc: Incomplete, dangling from the superior part of the capsule.

Anatomy: Sternoclavicular Joint

Joint type: Synovial, modified gliding.
Articulating surfaces: Clavicular notch of manubrium; sternal end of clavicle.
Capsular strength/coaptation: Weak and lax, especially inferiorly.
Ligaments: Anterior/posterior sternoclavicular ligament; interclavicular ligament; costoclavicular ligament.
Intra-articular disc: Complete, prevents medial separation.

Biomechanics: Joint Stabilization

Shoulder joint capsule is lax, relies on muscles for active stabilization.
Passive stability is limited and depends on glenoid fossa, superior GH ligament, and coracohumeral ligament.
Active stability uses rotator cuff muscles to maintain congruency and stabilization.
Compromised stability: Excess thoracic kyphosis or muscle paresis can cause scapular malposition and potentially lead to impingement syndrome or inferior dislocation/subluxation.

Biomechanics: Shoulder Force Couples

Deltoid & Rotator Cuff: Deltoid pulls up and out, rotator cuff pulls down and in, centering humeral head in glenoid fossa.
Serratus Anterior & Upper Trapezius: Work together for upward scapular rotation during arm movements.
Long Head of Biceps Tendon: Acts as a pulley, depressing humeral head for centering.

Biomechanics: Shoulder Abduction

Scapulohumeral Rhythm: A 2:1 ratio of scapular to humeral movement in phases 2 & 3 of abduction.
Clavicle movement: Crucial for full range of abduction; influenced by SC and AC joints and axial skeleton (spine).
Reverse Scapulohumeral rhythm describes scapular movement exceeding humeral movement during abduction.
Axial Skeleton Movement: Upper/lower thoracic spine, manubrium, and first rib participate in maximum abduction.

Biomechanics: Clavicle Movement

Sternoclavicular joint movement: Clavicle movement on manubrium; anterior/posterior aspects are concave for protraction/retraction, causing a match between osteokinematic and arthrokinematic movements; superior/inferior aspects are convex for abduction/adduction causing an opposite match between osteokinematic and arthrokinematic movements.

Clinical Observations

Glenohumeral joint: Step deformity, sulcus sign, mal-alignment of clavicle, scapular winging, scapular tilting, painful arc.

Common Conditions: Tendons

Tendonitis/Tendinopathy, Supraspinatus, Bicipital, Calcific.
Causes include repetitive/repetitive overhead movements, sports (swimming, etc); Poor technique; muscle imbalances; postural changes.

Common Conditions: Bursae

Bursitis (Inflammation of bursae). This includes subacromial and subscapular bursae.
Conditions like calcific tendonitis can cause bursitis.

Common Conditions: Impingement

Impingement Syndrome: Inflammation involving coracoacromial arch and space between AC and GH joints.
Tissue impingement results from repeated humeral pushing into the coracoacromial arch.
Factors include muscle force coupling failure, loss of passive stability, poor external rotation, and previous conditions.

Common Conditions: GH Instability

Shoulder Dislocation/Luxation; Complete/partial dissociation of articulating surfaces, mostly anterior (subcoracoid, subglenoid, subclavicular).
Causes include excessive abduction and external rotation, direct/indirect trauma.
Indications include pain, bruising, protective muscle spasm, joint effusion/tears/strains, holding patterns.

Common Conditions: AC Separation

AC Separation/Sprain: Rupture/sprain of AC joint and potentially displacement of the AC joint,
Structures involved include AC joint capsule and ligaments and coracoclavicular complex.
Grades I-III of separation indicate varying levels of tissue damage and displacement.
Grades II/III include step deformity.

Common Conditions: Adhesive Capsulitis (Frozen Shoulder)

Adhesive Capsulitis: Self-limiting inflammation and fibrosis of joint capsule.
Etiology includes age (40-70), females more likely, high association with hyperkyphosis.
Types include primary (idiopathic) and secondary (related to impingement, bursitis, tendonitis, etc.).
Phases include freezing (painful), frozen (stiffening), and thawing (resolution) stages.
Indications include pain, decreased ROM, reverse scapulohumeral rhythm, substituted movements.

Joint Mobilization: Sterno-Clavicular Joint

Techniques involved, anterior/posterior/inferior/superior glides.

Home Care/Rehab

REMEX principles, exercise selection (loaded exercises in mid-range, exercises that increase range without weights), isometric exercises.
Progress can be made by increasing challenges, from submaximal to maximal, non-weight bearing to weight-bearing, single plane to multiple planes, simple to complex, slow to fast, and closed activity to open activity.
Eccentric exercises should precede concentric exercises (due to increased neural output, better stability).
Exercise/hydrotherapy considerations for different stages of various conditions.

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Description

This quiz focuses on the anatomy and physiology of the shoulder joint, covering major muscles, ligaments, and their functions. It will test your knowledge on palpation, muscle testing, and arthrokinematics related to the glenohumeral and sternoclavicular joints. Understanding scapulohumeral rhythm and capsular restrictions will also be assessed.