27 Questions
Which structure is palpated during the observation/inspection step of physical examination?
Medial/lateral scapular borders
What is assessed in the Apley scratch test?
Glenohumeral abduction/adduction
Which movement is part of the range of motion assessment for the shoulder?
Scapula retraction/protraction
What is checked during the assessment of passive range of motion?
End feel
In shoulder rehabilitation, what does 'closed chain' refer to?
Exercises where the distal limb is fixed, such as push-ups
Which aspect is evaluated during resisted range of motion in the shoulder?
Muscle strength
What is a common deformity observed in patients with issues at the AC joint?
Elevated distal clavicle
During physical examination, which structure's position is checked at T4 and T7 levels of the spine?
Superior/inferior angles of scapula
Which aspect of shoulder rehabilitation focuses on proprioception and balance?
Closed chain activities
What movement pattern is evaluated during horizontal abduction/adduction in shoulder assessment?
Shoulder abduction/adduction away from the body midline
What is the primary symptom of rotator cuff strain/impingement?
Painful arc during passive abduction
Which muscle is primarily involved in impingement syndrome of the shoulder?
Supraspinatus
What is the most common mechanism of anterior glenohumeral dislocation?
Direct force with shoulder in abduction, external rotation, and extension
Which structure cushions the rotator cuff muscles from the acromion?
Subacromial bursa
In which phase of the throwing motion does the deceleration and follow-through phase occur?
Deceleration and follow-through phase
What is the primary management approach for bursitis of the subacromial bursa?
Corticosteroid injections
Which injury results in a 'step deformity' appearance in the shoulder?
Acromioclavicular separation
What are common contributing factors to rotator cuff impingement syndrome?
'Hypermobile' shoulder joints
What is the most characteristic symptom of bicipital tendinitis?
'Pain with internal and external rotation of shoulder'
Which ligament may be abutted in rotator cuff impingement syndrome?
Coracoacromial ligament
Which joint in the shoulder complex has the most range of motion?
Glenohumeral joint
Which of the following movements is NOT permitted by the Scapulothoracic joint?
Side-to-side lateral bending
Which muscle is part of the rotator cuff muscles that form a cuff around the glenohumeral joint?
Subscapularis
Which joint in the shoulder complex involves the acromion process of the scapula?
Acromioclavicular joint
Which joint is described as having minimal movement permitted in the shoulder complex?
Coracoclavicular joint
What is the function of the Coracoclavicular joint in the shoulder complex?
Provides strong stability
Which muscle attached to the scapula is responsible for downward rotation?
Pectoralis minor
Study Notes
Shoulder Complex
- The shoulder complex is extremely mobile, but has minimal stability.
- It consists of three joints: sternoclavicular joint, acromioclavicular joint, and coracoclavicular joint.
- The scapulothoracic joint permits movement of the scapula with the trunk and thorax.
Joints
- Sternoclavicular joint: connects the superior sternum (manubrium) with the medial (sternal) end of the clavicle.
- Acromioclavicular joint: connects the acromion process of the scapula with the lateral end of the clavicle.
- Coracoclavicular joint: connects the coracoid process of the scapula with the inferior surface of the clavicle.
- Glenohumeral joint: connects the glenoid fossa of the scapula with the head of the humerus, allowing for the most ROM of any joint in the body.
Rotator Cuff
- The rotator cuff muscles (SITS) form a collagenous cuff around the glenohumeral joint.
- The tendons of the rotator cuff muscles help hold the head of the humerus against the glenoid fossa.
Muscles
- The following muscles are involved in shoulder movement:
- Subscapularis
- Teres major
- Latissimus dorsi
- Subclavius
- Pectoralis minor
- Per maior
- Anterior/middle/posterior deltoid
- Trapezius
- Rhomboid major/minor
- Serratus anterior
- Supraspinatus
- Infraspinatus
- Levator scapulae
Bursa
- The subacromial bursa lies in the subacromial space and cushions the rotator cuff muscles from the acromion.
- It is compressed during overhead arm action.
Nerves and Blood Vessels
- The brachial plexus innervates the upper extremity.
- The subclavian and axillary blood vessels supply the shoulder region.
Kinematics
- The throwing motion involves three phases: wind-up, cocking, and acceleration.
- The cocking phase involves maximum shoulder external rotation, while the acceleration phase involves maximum shoulder internal rotation.
Prevention of Shoulder Conditions
- Protective equipment such as shoulder pads can help prevent injuries.
- Physical conditioning, flexibility, and strength training can also help prevent injuries.
- Proper skill technique, including throwing and falling techniques, is essential for preventing shoulder injuries.
Shoulder Injuries
- Sprains can occur in the sternoclavicular, acromioclavicular, and glenohumeral joints.
- Glenohumeral dislocation can occur anteriorly or posteriorly, and is characterized by tingling and numbness down the arm.
- Rotator cuff strain and impingement can occur due to repetitive overhead movement and weakness of the posterior cuff muscles.
- Bursitis, tendinitis, and fractures can also occur in the shoulder region.
Shoulder Assessment
- History: consider referred pain, chief complaint, and previous injuries.
- Observation: look for step deformity, scapular position, and posture.
- Palpation: examine the SC joint, clavicle, AC joint, coracoid process, deltoid, humeral head, and bicipital groove.
Rehabilitation
- Restoration of motion, proprioception, and balance are essential for rehabilitation.
- Muscular strength, endurance, and power should be restored through open and closed chain exercises.
- Cardiovascular fitness and posture education are also important for rehabilitation.
Learn about the anatomy of the shoulder complex and common injuries associated with it. Explore the structure of the sternoclavicular, acromioclavicular, coracoclavicular, and scapulothoracic joints, along with the muscles that permit shoulder motion.
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