Orthopedic Treatment PT600 - Shoulder Module

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Questions and Answers

What is the primary function of the shoulder complex?

To position or move the arm for hand function (correct)

To provide stability for the upper body

To support the weight of the upper body

To connect the arm to the torso

Which muscle is not part of the rotator cuff group?

Teres Major (correct)

Supraspinatus

Infraspinatus

Subscapularis

What anatomical structure provides a convex surface at the shoulder joint?

Glenoid cavity

Humeral head (correct)

Acromion process

Coracoid process

Which nerve innervates the Deltoid muscle?

Axillary nerve Signup and view all the answers

What is the resting position of the shoulder joint?

Neutral position with arm at the side Signup and view all the answers

Which of the following muscles is primarily responsible for shoulder external rotation?

Infraspinatus Signup and view all the answers

What type of joint is the shoulder classified as?

Ball-and-socket joint Signup and view all the answers

Which bursa is located deep to the tendon and superficial to the joint capsule?

Subscapular bursa Signup and view all the answers

What is the capsular pattern of the shoulder joint?

Flexion > Abduction > Internal Rotation Signup and view all the answers

Which blood supply is primarily responsible for the shoulder region?

Subclavian artery Signup and view all the answers

What is the primary relationship between scapulothoracic movements and other joint movements?

Movement in one joint enhances movement in the others. Signup and view all the answers

According to the concave/convex rule, when a concave surface is mobilized on a convex surface, what is the expected glide/slide direction?

Inferiorly. Signup and view all the answers

What is the arthrokinematic movement when a convex surface is mobilized on a concave surface?

Slide superiorly. Signup and view all the answers

What is the movement pattern expected at the sternal end of the clavicle?

Concave anterior/posterior and convex superior/inferior. Signup and view all the answers

Which muscles must have adequate length for normal overhead elevation of the arm?

Pectoralis major, pectoralis minor, latissimus dorsi, teres major, subscapularis, and rhomboids. Signup and view all the answers

Which arthrokinematic movement is associated with the inferior glide during scapulothoracic joint movements?

Glide inferior. Signup and view all the answers

In the context of scapular plane position, how much horizontal adduction is typically required?

20 degrees. Signup and view all the answers

What happens to the movement of the glenoid during a roll of the humerus in the arthrokinematic pattern with a convex surface?

It glides posteriorly. Signup and view all the answers

What bone is identified as concave on convex in the facet at the manubrium's clavicular notch?

Sternum. Signup and view all the answers

What does the sulcus sign indicate?

Dislocation or deltoid paralysis Signup and view all the answers

What is indicated by scapular winging when observed dynamically?

Injury to the serratus anterior or compromised long thoracic nerve Signup and view all the answers

Which movement is essential for assessing functional range of motion?

Reaching into the back pocket Signup and view all the answers

What is the 'painful arc' phenomenon associated with?

Pinching of structures under the acromial arch Signup and view all the answers

What should be avoided during active range of motion assessments?

Spinal exaggeration Signup and view all the answers

What happens to the superior joint capsule and coracoacromial ligaments when the stabilizing lip of the glenoid fossa is compromised?

They become lax and reduce stability. Signup and view all the answers

Which structures provide passive stability to the glenohumeral joint?

Glenoid fossa, joint capsule, and ligaments. Signup and view all the answers

What is the result of weak scapular muscles in a patient with muscle paresis?

Forward rotation of the scapula possibly leading to dislocation. Signup and view all the answers

How does the glenohumeral joint capsule contribute to shoulder abduction?

By twisting and pulling the humerus into the glenoid cavity. Signup and view all the answers

What role do the deltoid and rotator cuff muscles play in shoulder elevation?

They exert forces that work against each other to stabilize the joint. Signup and view all the answers

What may occur if the rotator cuff muscles are significantly affected in a patient with muscle paresis?

Compromised stability leading to inferior dislocation or subluxation. Signup and view all the answers

What does active stabilization of the GH joint refer to?

The dynamic action of the rotator cuff and other muscles. Signup and view all the answers

What stage of healing typically involves significant inflammation and pain?

Acute Signup and view all the answers

Which of the following locations would indicate a possible diagnosis of supraspinatus tendonitis?

Lateral brachial pain Signup and view all the answers

Which mechanism of injury is most likely associated with adhesive capsulitis?

Insidious onset Signup and view all the answers

During shoulder assessment, which finding may indicate a bicipital tendonitis?

Anterolateral shoulder pain Signup and view all the answers

Which of the following observations may suggest a shoulder separation?

Step deformity at the distal end of the clavicle Signup and view all the answers

What does 'compromised stability' refer to in shoulder biomechanics?

Loss of passive support from joint structures Signup and view all the answers

Which force couple is primarily responsible for maintaining shoulder stability?

Rotator cuff and biceps brachii Signup and view all the answers

Which of the following factors could exacerbate pain during shoulder abduction?

Poor shoulder alignment Signup and view all the answers

Which symptom would most likely indicate the presence of an AC sprain?

Swelling at the distal end of the clavicle Signup and view all the answers

Which observation might suggest that a patient is protecting their affected shoulder?

Arm held close to the body Signup and view all the answers

What characterizes the movement of the scapula when there is a disruption to the normal scapulohumeral rhythm during abduction?

The scapula moves more than the humerus Signup and view all the answers

What type of movements contribute approximately 20 degrees to the full range of motion in arm elevation?

Osseous structures movements Signup and view all the answers

Which joint movement occurs at the sternal end of the clavicle during abduction?

Elevation/Depression Signup and view all the answers

What is the arthrokinematic glide direction when the clavicle moves inferiorly during arm elevation?

Superior glide of the manubrium Signup and view all the answers

Which of the following movements does NOT occur in the upper thoracic spine to facilitate unilateral abduction of the arm?

Flexion Signup and view all the answers

How does bilateral abduction affect spinal movement?

Causes extension in the thoracic spine Signup and view all the answers

In a disrupted scapulohumeral rhythm, what is a common compensation mechanism observed?

Gross compensation through scapular elevation Signup and view all the answers

Which osseous structure primarily descends and moves posteriorly during the initial phase of arm elevation?

First rib Signup and view all the answers

What is the shape of the sternal facet of the clavicle?

Apple core Signup and view all the answers

What role do fixed spinal deformities play in arm elevation?

They obstruct full arm elevation. Signup and view all the answers

What role does the long head of the biceps play during arm abduction?

It depresses the head of the humerus Signup and view all the answers

During the first phase of scapulohumeral rhythm (0-30 degrees of abduction), what is the position of the scapula?

It is stabilized against the thorax with minimal movement Signup and view all the answers

What is the ratio of scapulohumeral rhythm during the second phase of abduction (30-90 degrees)?

2:1 Signup and view all the answers

What movement does the clavicle perform in the third phase of scapulohumeral rhythm (90-180 degrees)?

It elevates and rotates posteriorly Signup and view all the answers

How many degrees of elevation does the clavicle undertake during the second phase of scapulohumeral rhythm?

15 degrees Signup and view all the answers

In scapulohumeral rhythm, what is the initial action performed by the glenohumeral joint?

Abduct the arm Signup and view all the answers

What function do the trapezius and serratus anterior muscles serve in relation to the scapula?

They create a force coupling for scapular rotation Signup and view all the answers

Which of the following movements occurs during the last phase of scapulohumeral rhythm (90-180 degrees)?

The humerus laterally rotates 90 degrees Signup and view all the answers

What is the scapulohumeral rhythm ratio during the final stage of shoulder abduction?

2:1 Signup and view all the answers

What is a significant characteristic of pain during the freezing phase of adhesive capsulitis?

Pain is most severe at night and affects sleep. Signup and view all the answers

Which factor is NOT associated with the development of adhesive capsulitis?

High activity levels in the affected arm. Signup and view all the answers

What anatomical structure is primarily affected in frozen shoulder during abduction?

Axillary recess Signup and view all the answers

In the context of adhesive capsulitis, what does the new school thought suggest about loss of motion?

Loss of motion is responsible for pain. Signup and view all the answers

Which phase of adhesive capsulitis involves a gradual onset of pain and is known as the freezing phase?

Phase 1 - Freezing phase Signup and view all the answers

What is a primary cause of tendonitis in the shoulder region?

Overuse during repetitive movements Signup and view all the answers

What condition may result from continuous cortisone injections in the biceps tendon?

Tendon rupture Signup and view all the answers

Which muscle is most commonly associated with supraspinatus tendinopathy?

Supraspinatus Signup and view all the answers

What indicates a self-limiting process in calcific tendonitis?

Reabsorption of calcium deposits Signup and view all the answers

What structural change occurs during later stages of rotator cuff tendonitis?

Calcium deposits form Signup and view all the answers

What effect does kyphosis have on the rotator cuff?

Causes fatigue and stress Signup and view all the answers

Which condition can commonly arise from the degenerative changes associated with hypovascularity in the rotator cuff?

Impingement Syndrome Signup and view all the answers

What is a common sign of shoulder tendinopathy when palpating the affected area?

Pain with palpation of the tendon(s) Signup and view all the answers

Which test is used specifically to assess the supraspinatus tendon?

Empty Can test Signup and view all the answers

What treatment approach is indicated for chronic tendinopathy?

Break & Build strategy Signup and view all the answers

Which symptom is least likely associated with shoulder tendinopathy?

Intensified pain while resting Signup and view all the answers

What common misconception exists about the pain referral pattern in shoulder tendinopathy?

Pain is primarily referred to the elbow area Signup and view all the answers

What is a common reason for differentiating between tendonitis and bursitis in the shoulder?

To guide proper rehabilitation strategies Signup and view all the answers

Which treatment principle is important for acute tendinopathy management?

Rest and ice to decrease inflammation Signup and view all the answers

What common precaution should be taken when treating individuals with calciﬁc tendonitis of the supraspinatus?

Implementing friction therapy as needed Signup and view all the answers

Which of the following is NOT a typical characteristic of bursitis in the shoulder?

Direct damage to muscle fibers Signup and view all the answers

What does a strong but painful response with an intact tendon typically indicate?

A possible tendon tear Signup and view all the answers

Which special test is used to assess the supraspinatus tendon?

Empty Can Test Signup and view all the answers

What should be avoided if there is bony change in a patient with shoulder issues?

Joint mobilizations Signup and view all the answers

What kind of treatment can be applied to biceps tendonitis and supraspinatus tendonitis?

Similar approach to treatment Signup and view all the answers

Which muscle is NOT typically targeted to improve the subacromial space?

Levator scapulae Signup and view all the answers

Which symptom might signify subacromial bursitis?

Painful arc phenomenon Signup and view all the answers

What is the role of the serratus anterior in shoulder rehabilitation?

Stimulate scapula rotation Signup and view all the answers

In the context of shoulder treatment, what do inferior humeral glides aim to achieve?

Enhance abduction range Signup and view all the answers

What does scapulohumeral rhythm refer to?

The coordinated movement between shoulder and scapular joints Signup and view all the answers

What may be a sign of altering the normal scapulohumeral rhythm?

Compensation mechanisms during abduction Signup and view all the answers

Which stage of Impingement Syndrome typically requires surgical intervention?

Stage 3 Signup and view all the answers

What is the most commonly involved tendon during Impingement Syndrome?

Supraspinatus tendon Signup and view all the answers

Which factor does NOT contribute to repeated trauma leading to Impingement Syndrome?

Abundant vascular supply Signup and view all the answers

What is a sign or symptom commonly associated with Stage 1 of Impingement Syndrome?

Insidious onset of toothache-like pain Signup and view all the answers

Which theory does NOT explain the etiology of Impingement Syndrome?

Environmental exposure theory Signup and view all the answers

Which treatment is typically indicated in Stage 2 Impingement Syndrome?

Conservative care Signup and view all the answers

Which adjustment is crucial in managing kinesiological factors for Impingement Syndrome?

Improving scapular rotation Signup and view all the answers

What is likely to occur in the later stages of Impingement Syndrome during range of motion tests?

Empty end feels due to pain Signup and view all the answers

Which anatomical structure forms the roof of the shoulder and is relevant in Impingement Syndrome?

Coracoacromial arch Signup and view all the answers

Which symptom is particularly noted during activities of daily living (ADLs) in someone with Impingement Syndrome?

Pain with overhead movements Signup and view all the answers

Study Notes

###Orthopedic Treatment FT400 PT600 - Shoulder Module

The shoulder is the most mobile joint in the body.
The shoulder complex positions and moves the arm for hand function, being a complex of multiple joints working sequentially and in a coordinated manner for efficient movement.
Increased mobility sacrifices stability, leading to orthopedic problems.

###Muscles Palpate & MMT

Muscles include Deltoid (all fibers), Subscapularis, Teres Minor, Teres Major, Supraspinatus, Coracobrachialis, Levator Scapula/Rhomboids, Serratus Anterior, Infraspinatus, Pectoralis Major, Latissimus Dorsi, Trapezius (all fibers).

###Muscles and Joint Axis

Joint axis, structure, type: Concave/Convex surfaces, Closed packed position, Resting position, Capsular pattern.
Bones and Joints: Acromion, Coracoid process, Greater Tubercle, Lesser Tubercle, Conoid ligaments, Costoclavicular ligaments, Interclavicular ligaments, Coracohumeral ligaments, Bicipital Groove, Acromion Process, Coracoid Process, Scapula (aspects: angles, spine, fossae, borders).
LIGAMENTS: Coracohumeral, Transverse Humeral, Trapezoid, Conoid, Costoclavicular, Interclavicular.

###Range of Motion (ROM) & Strength (REMEX) - Shoulder

Covered in the presentation based on practice, protocol and end feels, flexion, extension, abduction, adduction, external rotation, and internal rotation. Data presented on how the ROM was tested / felt as well as strength and stretches for the relevant movements.
Review Jt Mobs

###Shoulder Anatomy

Different diagrams illustrate the scapula, glenoid cavity, articular cartilage, tendons of specific muscles (supraspinatus, infraspinatus, subscapularis, teres minor), synovial membrane, subtendinous bursa.
Diagrams depict the joint's opened lateral view, showing the layers of ligaments, tendons, and bursae.
Diagrams provide a deeper understanding of muscle attachments, bony landmarks, and the rotator cuff muscles.
Shoulder Abduction Biomechanics: Includes scapulohumeral rhythm, clavicle (SC & AC movement), and axial skeleton movement.
Scapulohumeral Rhythm Phases: Detailed analysis of phases 1 (0-30° abduction), 2 (30-90° abduction), and 3 (90-180° abduction) outlining scapula/humerus movement ratio and clavicle elevation.
Reverse Scapulohumeral Rhythm: Description of deviations from the typical rhythm, involving exaggerated scapular movements and compensatory mechanisms for arm elevation.
Clavicle Movement (SC Joint): Describes clavicle movement on the manubrium, noting its arthrokinematic movement (gliding) in abduction/adduction.
Axial Skeleton Movement: Describes the osseous structures (ribs, upper/lower thoracic spine, manubrium) and their movement in arm elevation.
Inferior Glide & Impingement: Illustrated diagram of inferior glide and impingement during abduction highlighting subacromial bursa involvement

###Scapulothoracic Mechanism

This mechanism, though not a typical joint, is crucial for shoulder function and involves coordinated movement of the sternoclavicular and acromioclavicular joints with the scapulothoracic joint.

###Comparative Anatomy of Shoulder

Shows the anatomy of various species (adult and juvenile)
Features of vertebral border length, shoulder spine orientation, supraspinous fossa, and glenoid orientation.

###Glenohumeral, Acromioclavicular, Sternoclavicular Joints

Covers synovial, capsule, ligament, and extra features for each of these joints.

###Osteokinematics and Arthrokinematics of the Shoulder

Includes resting position, closed packed position, capsular pattern of restriction, and ROM and end feel data.

###Passive Movements of the Shoulder Complex and Normal End Feel

Describes passive movement types and end feel data including tissue stretch, bone-to-bone, tissue approximation.
Passive movements are described in further detail, including elevation through flexion/abduction (tissue stretch and bone-to-bone variations), lateral/medial rotation, extension, adduction, and horizontal adduction/abduction. quadrant test noted.

###Bursae in Shoulder

Identifying and describing subacromial/subdeltoid bursae, as well as subscapular bursae within the specified region of the shoulder.

###Blood Supply in the Shoulder

Identifying the arteries: Subclavian, Axillary, Brachial, and their branches.
Note on supraspinatus as a hypovascular region.

###Joint Mobilization Review

Concepts of arthrokinematic movement, osteokinematic movement, spin, roll, slide/glide, concave/convex rule are addressed.

###Grades of Joint Mobilization (with charts/tables)

Covers the different grades of joint mobilization, including the distinction between acute, subacute, and chronic stages and the associated anatomical limits.

###Facets of Clavicle and Manubrium

Anatomical descriptions of facets of the clavicle and manubrium, noting their concave and convex orientations.

###Innervation and Nerve Groups

Review of nerve distributions for shoulder innervation (Including C5, C6, C7 roots for deep tendon reflexes).

###Deep Tendon Reflex Testing

Location of testing for biceps, brachioradialis, and triceps.

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Description

This quiz focuses on the anatomy and treatment of shoulder joint disorders. It covers the muscles involved in shoulder movement, joint structure, and the balance between mobility and stability. Test your knowledge on the key muscles, joint axis, and orthopedic implications.