105 Questions
What is the primary role of the shoulder?
To place the hand in a functional position
What type of joint is the scapulocostal joint?
Physiological joint
What is the purpose of the glenoid labrum?
To increase the surface area of contact for the humerus
What is the shape of the clavicle?
S-shaped
What is the angle formed between the articular surface and the shaft of the humerus?
45-degree angle
What is the orientation of the distal articular surface of the clavicle?
Anteriorly and superiorly
What may be the result of the poor blood supply near the insertion of the supraspinatus?
Insufficient nutrition to meet the demands of the tendon tissue
What is the term used to describe the laying down of scar tissue or calcific deposits in response to inflammation?
Calcific tendinitis
What is the primary cause of bursitis?
Secondary progression from tendinitis
Which bursae are most frequently involved in bursitis?
Subacromial and subdeltoid bursae
What is the result of continued immobility in capsulitis?
Capsular tightening and eventual fibrosis
What is a common source of referred pain in the shoulder and arm?
Cervical spine
What is the purpose of the intra-articular disc in the clavicle and manubrium joint?
To prevent medial dislocation of the clavicle
What is the angle formed by the scapula with the coronal plane?
30 degrees
What is the function of the coracohumeral ligament?
To reinforce the superior aspect of the joint capsule
What is the role of the transverse humeral ligament?
To contain the tendon of the long head of the biceps muscle
What happens to the acromioclavicular ligament when a force is applied to the acromion process or glenohumeral joint from above?
It gives way
What is the function of the conoid ligament?
To prevent excessive superior movement of the clavicle
What is the primary function of the trapezoid ligament?
To check lateral movement of the clavicle
What is the main action of the anterior deltoid muscle?
Flexion
What is the role of the serratus anterior muscle during abduction?
To tip the scapula
What is the result of 15 degrees of arm abduction?
10 degrees of glenohumeral joint movement and 5 degrees of scapulocostal joint movement
What is the primary function of the trapezius, serratus anterior, and rhomboids muscles in the shoulder?
Scapular stabilization
What prevents downward dislocation of the humerus?
The coracohumeral ligament and the slope of the glenoid fossa
What is the primary function of the rotator cuff muscles?
Preventing dislocation of the humerus
What is the unique characteristic of the long head of the biceps muscle?
It originates from within the joint capsule
What is the movement that occurs between the meniscus and the clavicle during arm abduction?
Hinging movement
What is the primary function of the scapula during arm abduction?
Elevation of the clavicle
What is the common mechanism of injury to the acromioclavicular joint?
Fall on the point of the shoulder
What is the most frequent surface motion of the glenohumeral joint?
Rotational motion
What is the function of the costoclavicular ligament during shoulder motion?
It serves as a fulcrum
What is the most common tendon to be injured in the rotator cuff?
Supraspinatus tendon
What is the primary function of the shoulder joint complex?
To place the hand in a functional position
What type of joint is the glenohumeral joint?
Anatomical joint
What is the purpose of the glenoid labrum?
To increase the surface area of the glenohumeral joint
What is the shape of the clavicle that allows for more movement during elevation of the arm?
S-shaped
What is the orientation of the distal articular surface of the clavicle?
Anteriorly and superiorly
What is the angle formed between the articular surface and the shaft of the humerus?
45-degree angle
What is the primary consequence of poor blood supply near the insertion of the supraspinatus?
Reduced tendon tissue nutrition
What is the likely outcome of acute bulging of the tendon compressing the bursa against the coracoacromial arch?
Severe limitation of motion and pain
What is the result of continued immobility in capsulitis?
Capsular tightening and eventual fibrosis
What is the common source of referred pain in the shoulder and arm?
The cervical spine, myocardium, gallbladder, liver, diaphragm, and breast
What is the term used to describe the laying down of scar tissue or calcific deposits in response to inflammation?
Calcific tendinitis
What is the outcome of the bursal walls adhering to the supraspinatus and deltoid muscles?
The supraspinatus and deltoid muscles becoming 'stuck together'
What is the primary function of the sternoclavicular joint capsule?
To reinforce the joint capsule anteriorly and posteriorly
During the second phase of abduction, which muscles are responsible for tipping the scapula?
Serratus anterior, upper and lower trapezius
What is the result of the conoid ligament twisting on itself during humeral abduction?
Axial rotation of the clavicle
What muscles are responsible for scapular retraction?
Rhomboid major and minor
Which ligament is responsible for preventing overriding of the clavicle on the acromion process?
Trapezoid ligament
Which muscle tendons contribute to joint stability but do not prevent downward dislocation?
All muscle tendons around the glenohumeral joint
What is the relationship between glenohumeral movement and scapulocostal movement during abduction?
2 degrees of glenohumeral movement occur for every 1 degree of scapulocostal movement
What is the role of the trapezius, serratus anterior, and rhomboid muscles during the first 30 degrees of abduction?
To stabilize the scapula
What is the primary function of the coracohumeral ligament in the glenohumeral joint?
Tightening the upper part of the joint capsule
Which muscle is responsible for flexion of the arm up to 60 degrees?
Anterior deltoid
What is the result of a downward force of greater intensity on the acromioclavicular joint?
Separation of the acromioclavicular joint
What is the primary function of the rotator cuff muscles during abduction?
Checking lateral excursion of the glenoid cavity
What is the function of the glenohumeral ligaments?
To provide some reinforcement to the joint capsule anteriorly
What is the result of the scapula tipping during abduction?
The glenoid fossa is brought directly under the humeral head
What is the movement that occurs between the sternum and the meniscus during gliding motions?
Anterior-posterior gliding
What muscle is responsible for scapular elevation during abduction?
Levator scapulae
What is the role of the costoclavicular ligament during shoulder motion?
To check elevation of the clavicle
What is the result of capsular ligament fibroadhesions or improper functioning of the rotator cuff muscles during abduction?
Loss of full abduction with pain
What is the mechanism of injury to the acromioclavicular joint during a fall on the point of the shoulder?
Downward force of greater intensity on the first rib
What is the purpose of the doctor's knees grasping the patient's distal humerus just proximal to the epicondyles in the bimanual thumb thenar grasp technique?
To provide a fulcrum for the anterior-to-posterior glide
What is the primary difference between the bimanual thumb thenar grasp and the interlaced digital/proximal humerus techniques?
The direction of the glide
What is the importance of removing all jewelry and other items during the joint mobilization techniques?
To de-arfact the joint
In what position should the patient's involved arm be placed during the bimanual thumb thenar grasp technique?
Slightly abducted and guarding breast tissue
What is the role of the doctor's knees in the interlaced digital/proximal humerus technique?
To straddle the patient's leg
What is the purpose of the patient's glenohumeral joint being positioned off the edge of the table during the joint mobilization techniques?
To facilitate the glide of the joint
What is the direction of the impulse in the joint mobilization technique for the proximal humerus using interlaced fingers over the superior glenohumeral joint?
Anterior-to-posterior
What is the purpose of using the patient's elbow on the doctor's shoulder as a pivot point in the anterior-to-posterior glide technique for the proximal humerus?
To apply an anterior-to-posterior impulse
What is the role of the caudal hand in the bimanual thumb grasp technique for the proximal humerus?
To provide stabilization to the distal humerus
What is the direction of the impulse in the joint mobilization technique for the proximal humerus using a bimanual thumb grasp?
Lateral-to-medial
In the joint mobilization technique for the proximal humerus using interlaced fingers over the superior glenohumeral joint, what is the position of the patient's arm?
Abducted and externally rotated
What is the purpose of using the distal humerus as a pivot point in the bimanual thumb grasp technique for the proximal humerus?
To apply a lateral-to-medial impulse
What is the primary goal of the joint mobilization technique described in Figure 6-53?
To create a lateral distraction at the glenohumeral joint
What is the purpose of the scapular stabilization technique described in the text?
To control the movement of the scapula during abduction
What is the direction of the glide during the joint mobilization technique described in Figure 6-54?
Anterior to posterior
What is the primary purpose of the bimanual thumb grasp technique described in the text?
To mobilize the humerus with distraction
What is the position of the patient's arm during the joint mobilization technique described in Figure 6-53?
Flexed 90 degrees and abducted up to 90 degrees
What is the role of the doctor and patient during the joint mobilization technique described in the text?
The doctor and patient both remove jewelry and other distractions
What is the direction of the glide in the bimanual thumb thenar grasp/proximal humerus technique?
Posterior-to-anterior
What is the position of the affected arm in the bimanual thumb thenar grasp/proximal humerus with mobilization and distraction technique?
Abduction less than 90 degrees
What is the purpose of the doctor providing distraction with their knees in the bimanual thumb thenar grasp/proximal humerus with mobilization and distraction technique?
To facilitate mobilization and distraction
What is the position of the patient's humerus in the interlaced digital/proximal humerus technique?
Parallel to the ground and fully flexed
What is the purpose of the patient guarding breast tissue in the bimanual thumb thenar grasp/proximal humerus technique?
To protect the breast tissue from injury
What is the movement of the humerus in the interlaced digital/proximal humerus technique?
Circumduction
What is the position of the patient's elbow in the DP for interlaced digital proximal humerus technique?
On the doctor's shoulder closest to the front of the patient
What is the direction of the thrust in the interlaced digital proximal humerus technique?
Superior-to-inferior
What is the patient's stance in the PP for interlaced digital proximal humerus technique?
Standing with the affected arm abducted to almost 90 degrees or less
What is the position of the doctor's sternum in the DP for the third technique?
Blocking the patient's scapula on the involved side
What is the direction of the glide in the reinforced palmar/olecranon technique?
Anterior-to-posterior
What is the patient's arm position in the PP for the reinforced palmar/olecranon technique?
Flexed 90 degrees
What is the direction of the thrust/impulse at the elastic barrier in the scapula technique?
Lateral to Medial
What is the purpose of the contralateral hand in the side lying position?
To guard the breast tissue
What is the initial movement of the involved arm in the scapula technique?
Abduction
What is the contact point of the inferior hand in the scapula technique?
Lateral border of the scapula
What is the result of the rotation of the inferior pole of the scapula in the correct direction?
Medial movement of the scapula
What is the purpose of the cephalic hand in the scapula technique?
To grasp the spine of the involved scapula
What is the direction of the glide in the scapulocostal side posture with bimanual thumb thenar/lateral scapula?
Lateral-to-medial
In the scapulocostal side posture with bilateral mid-hypothenar, how should the patient's head be positioned?
Supported with a pillow and headpiece up
What is the purpose of the contralateral hand in the scapulocostal side posture?
To guard the breast tissue
In the scapulocostal side posture with bilateral mid-hypothenar, what is the direction of the vector?
Medial-to-lateral
How should the patient's involved arm be positioned in the scapulocostal side posture with bilateral mid-hypothenar?
Hanging forward off the edge of the table
What is the purpose of rolling the patient towards the therapist in the scapulocostal side posture with bilateral mid-hypothenar?
To facilitate access to the scapula
Study Notes
Shoulder Joint
- The primary role of the shoulder is to place the hand in a functional position.
- The shoulder is a four-joint complex, consisting of true anatomical joints (glenohumeral, sternoclavicular, and acromioclavicular) and physiological joints (scapulocostal).
Osseous Structures of the Shoulder
- The humerus forms a 45-degree angle with the articular surface and shaft.
- The glenoid fossa is not a deep impression in the scapula, but the glenoid labrum provides a greater surface area for the humerus.
- The clavicle forms an S-shape, allowing for more movement during arm elevation.
- The scapula lies at a 30-degree angle away from the coronal plane and forms a 60-degree angle with the clavicle.
Ligaments
- Glenohumeral ligaments provide reinforcement to the joint capsule anteriorly and check external rotation and abduction.
- Coracohumeral ligament reinforces the superior aspect of the capsule and checks external rotation and extension.
- Transverse humeral ligament serves to contain the tendon of the long head of the biceps muscle.
- Acromioclavicular ligament strengthens the superior aspect of the joint capsule, but is intrinsically weak.
- Conoid and trapezoid ligaments stabilize the acromioclavicular joint.
Musculature
- Flexion: anterior deltoid, coracobrachialis, and pectoralis major (clavicular)
- Extension: latissimus dorsi, teres major, and posterior deltoid
- Abduction: middle deltoid, supraspinatus, and serratus anterior (scapular stability)
- Adduction: pectoralis major and latissimus dorsi
- External rotation: infraspinatus, teres minor, and posterior deltoid
- Internal rotation: subscapularis, pectoralis major, latissimus dorsi, teres major, and anterior deltoid
- Scapular stabilization: trapezius, serratus anterior, and rhomboids
- Scapular retraction: rhomboid major and minor
- Scapular elevation: trapezius and levator scapulae
Rotator Cuff
- Rotator cuff muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) prevent downward dislocation of the humerus.
- The horizontal running fibers of the rotator cuff check lateral excursion of the glenoid cavity.
Acromioclavicular Joint
- Abduction requires axial rotation of the clavicle, with 4 degrees of clavicle elevation for every 10 degrees of arm abduction.
- Rotational movements occur through the conoid ligament and between the acromion and meniscus.
Glenohumeral Joint
- Abduction involves depression of the humerus by the rotator cuff muscles and external rotation by the glenohumeral joint capsule.
- Rotational movements are the most frequent surface motion.
Evaluation
- Acromioclavicular joint injuries occur due to force applied to the acromion process or glenohumeral joint from above.
- Rotator cuff injuries occur due to falls on outstretched hand, impingement against the coracoacromial arch, and repetitive stresses.
- Bursitis and capsulitis are secondary progressions of tendinitis.
- Referred pain can occur from the cervical spine, myocardium, gallbladder, liver, diaphragm, and breast.
Shoulder Joint
- The primary role of the shoulder is to place the hand in a functional position.
- The shoulder is a four-joint complex, consisting of true anatomical joints (glenohumeral, sternoclavicular, and acromioclavicular) and physiological joints (scapulocostal).
Osseous Structures of the Shoulder
- The humerus forms a 45-degree angle with the articular surface and shaft.
- The glenoid fossa is not a deep impression in the scapula, but the glenoid labrum provides a greater surface area for the humerus.
- The clavicle forms an S-shape, allowing for more movement during arm elevation.
- The scapula lies at a 30-degree angle away from the coronal plane and forms a 60-degree angle with the clavicle.
Ligaments
- Glenohumeral ligaments provide reinforcement to the joint capsule anteriorly and check external rotation and abduction.
- Coracohumeral ligament reinforces the superior aspect of the capsule and checks external rotation and extension.
- Transverse humeral ligament serves to contain the tendon of the long head of the biceps muscle.
- Acromioclavicular ligament strengthens the superior aspect of the joint capsule, but is intrinsically weak.
- Conoid and trapezoid ligaments stabilize the acromioclavicular joint.
Musculature
- Flexion: anterior deltoid, coracobrachialis, and pectoralis major (clavicular)
- Extension: latissimus dorsi, teres major, and posterior deltoid
- Abduction: middle deltoid, supraspinatus, and serratus anterior (scapular stability)
- Adduction: pectoralis major and latissimus dorsi
- External rotation: infraspinatus, teres minor, and posterior deltoid
- Internal rotation: subscapularis, pectoralis major, latissimus dorsi, teres major, and anterior deltoid
- Scapular stabilization: trapezius, serratus anterior, and rhomboids
- Scapular retraction: rhomboid major and minor
- Scapular elevation: trapezius and levator scapulae
Rotator Cuff
- Rotator cuff muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) prevent downward dislocation of the humerus.
- The horizontal running fibers of the rotator cuff check lateral excursion of the glenoid cavity.
Acromioclavicular Joint
- Abduction requires axial rotation of the clavicle, with 4 degrees of clavicle elevation for every 10 degrees of arm abduction.
- Rotational movements occur through the conoid ligament and between the acromion and meniscus.
Glenohumeral Joint
- Abduction involves depression of the humerus by the rotator cuff muscles and external rotation by the glenohumeral joint capsule.
- Rotational movements are the most frequent surface motion.
Evaluation
- Acromioclavicular joint injuries occur due to force applied to the acromion process or glenohumeral joint from above.
- Rotator cuff injuries occur due to falls on outstretched hand, impingement against the coracoacromial arch, and repetitive stresses.
- Bursitis and capsulitis are secondary progressions of tendinitis.
- Referred pain can occur from the cervical spine, myocardium, gallbladder, liver, diaphragm, and breast.
Learn about the primary role of the shoulder and its complex structure, including the true anatomical and physiological joints that form the shoulder.
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