Podcast
Questions and Answers
What is the correct sequence for assessing range of motion (ROM) during goniometry?
What is the correct sequence for assessing range of motion (ROM) during goniometry?
- Perform assessments on the affected side first.
- Measure PROM first before AROM.
- Always start by observing AROM before the contralateral side. (correct)
- Conduct the assessment without palpating landmarks.
Which of the following is a key focus during palpation?
Which of the following is a key focus during palpation?
- To understand the anatomy and know what you’re feeling for. (correct)
- To perform deep palpation before superficial assessment.
- To palpate with no specific goal in mind.
- To document findings using subjective measures only.
What is an important factor to consider when assessing shoulder strength?
What is an important factor to consider when assessing shoulder strength?
- Assessing only the shoulder muscles without consideration of scapular muscles.
- Isolating and stabilizing the muscles being tested. (correct)
- Document subjective reports without objective measures.
- Testing should always be done without considering trunk position.
In the context of muscle length testing, which of the following aspects is essential to assess?
In the context of muscle length testing, which of the following aspects is essential to assess?
Which statement about gross strength assessment is true?
Which statement about gross strength assessment is true?
What is the primary reason the shoulder sacrifices stability?
What is the primary reason the shoulder sacrifices stability?
Which joint is classified as a synovial ball-and-socket joint?
Which joint is classified as a synovial ball-and-socket joint?
Which statement about the Glenoid Labrum is correct?
Which statement about the Glenoid Labrum is correct?
What are the additional movements of the shoulder beyond the primary movements?
What are the additional movements of the shoulder beyond the primary movements?
How much does the Glenoid Labrum increase glenoid depth?
How much does the Glenoid Labrum increase glenoid depth?
Which joint does not have a true anatomical structure but functions as a joint?
Which joint does not have a true anatomical structure but functions as a joint?
What is the primary limitation in the capsular pattern of the Glenohumeral Joint?
What is the primary limitation in the capsular pattern of the Glenohumeral Joint?
What type of joint is the Sternoclavicular Joint?
What type of joint is the Sternoclavicular Joint?
How many degrees of freedom does the Acromioclavicular Joint have?
How many degrees of freedom does the Acromioclavicular Joint have?
What is the primary function of the joint capsule in the Glenohumeral Joint?
What is the primary function of the joint capsule in the Glenohumeral Joint?
What is the correct order of steps for assessing range of motion (ROM) using goniometry?
What is the correct order of steps for assessing range of motion (ROM) using goniometry?
Which of the following statements best describes palpation techniques?
Which of the following statements best describes palpation techniques?
When performing muscle length testing, which factor is essential to consider for accuracy?
When performing muscle length testing, which factor is essential to consider for accuracy?
What is a critical aspect to document during the assessment of range of motion?
What is a critical aspect to document during the assessment of range of motion?
Which of the following is a recommended practice when assessing shoulder strength?
Which of the following is a recommended practice when assessing shoulder strength?
What is the role of the glenoid labrum in the shoulder complex?
What is the role of the glenoid labrum in the shoulder complex?
Which joints contribute to the overall range of motion of the shoulder complex?
Which joints contribute to the overall range of motion of the shoulder complex?
What is true about the acromioclavicular joint's structure?
What is true about the acromioclavicular joint's structure?
Which muscle function is significantly supported by the structures of the glenohumeral joint?
Which muscle function is significantly supported by the structures of the glenohumeral joint?
What movement occurs at the sternoclavicular joint?
What movement occurs at the sternoclavicular joint?
How does the shoulder's design impact its functional capabilities?
How does the shoulder's design impact its functional capabilities?
Which joint is not classified as a traditional joint but functions as one?
Which joint is not classified as a traditional joint but functions as one?
What is the primary reason for the capsular pattern of limitation in the glenohumeral joint?
What is the primary reason for the capsular pattern of limitation in the glenohumeral joint?
During which motion does the humerus move relative to the scapula?
During which motion does the humerus move relative to the scapula?
Which ligament is critical for the stability of the sternoclavicular joint?
Which ligament is critical for the stability of the sternoclavicular joint?
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Study Notes
Shoulder Motion
- Shoulder has 3 degrees of freedom: flexion-extension, abduction-adduction, internal and external rotation
- Additional movements include horizontal abduction and horizontal adduction
- The shoulder sacrifices stability for mobility
Range of Motion
- Full ROM of the shoulder complex requires motion at three bones: humerus, scapula and clavicle
- Joints involved in shoulder motion include: glenohumeral, sternoclavicular, acromioclavicular and scapulothoracic
Glenohumeral Joint (GHJ)
- Synovial ball-and-socket joint
- Humeral head is convex, glenoid fossa is concave
- Relies heavily on soft tissue structures for stability: glenoid labrum, joint capsule, ligaments and musculature
Glenoid Labrum
- Provides stability to the shoulder
- Increases glenoid depth by 30-50%
- Injury can contribute to limited function, pain and instability
‘Glenohumeral Clock’
- Helps to understand the components of stability in the shoulder
- Describes structures injured or repaired during surgery
- Provides a visual representation of the many components to GHJ stability
Capsular Pattern of Limitation (GHJ)
- External Rotation is the most limited movement
- Abduction is the second most limited movement
- Internal Rotation is the least limited movement
Scapulothoracic Joint
- Not a real joint, but a "functional joint"
- Motions are caused by the independent or combined motions of the sternoclavicular and acromioclavicular joints
Sternoclavicular Joint (SCJ)
- Connects the clavicle to the sternum and cartilage of the 1st rib
- Synovial joint, saddle shaped
- Strong joint capsule supported by: anterior and posterior SC ligament, costoclavicular ligament and interclavicular ligament
SC Joint
- Motion occurs at the clavicle on a fixed sternum
- 3 degrees of freedom: elevation-depression, protraction-retraction, anterior-posterior rotation
Acromioclavicular Joint (ACJ)
- Connects the scapula to the clavicle
- Weak joint capsule supported by: superior and inferior AC ligament, coracoclavicular ligament
AC Joint
- 3 degrees of freedom: upward-downward rotation, horizontal plane adjustments, sagittal plane adjustments
Tests and Measures
- Begin with observation and palpation
- Assess gross ROM, strength, flexibility, sensation bilaterally
- Relate findings to the patient's primary complaint, functional limitations and activity limitations
- Palpate systematically from superficial to deep with purpose
- Understand the anatomy and what you are feeling for
ROM/Goniometry
- Observe posture and starting position
- Perform on the contralateral side first
- Observe active ROM
- Palpate landmarks for goniometry
- Measure active and passive ROM using an appropriate device
- Assess end feel
- Document objective measures, end feel and subjective reports
- Consider quality in addition to quantity
- Repeat all steps on the affected side
Shoulder Strength
- Assess strength of both scapular and "shoulder" muscles
- Isolate and stabilize as necessary
- Trunk/spine position can alter testing
Shoulder Motion
- 3 degrees of freedom: Flexion and Extension, Abduction and Adduction, Internal and External Rotation
- Additional movements: horizontal abduction and horizontal adduction
- Shoulder sacrifices stability for mobility
Range of Motion
- Full range of motion of the shoulder complex requires motion at three bones: Humerus, Scapula and Clavicle
- Joints involved in shoulder motion: Glenohumeral, Sternoclavicular, Acromioclavicular, Scapulothoracic
Glenohumeral Joint (GHJ)
- Synovial ball-and-socket joint
- Humeral head is convex; Glenoid fossa is concave
- Relies heavily on soft tissue for stability: Glenoid labrum, joint capsule, ligaments, musculature
Glenoid Labrum
- Provides stability to the shoulder
- Increases glenoid depth by 30-50%
- Injury can contribute to limited function, pain, and instability
Glenohumeral "Clock"
- Helpful way to understand the components of stability in the shoulder
- Used to describe structures injured and/or repaired during surgical procedures
- Provides a visual of the many components to stability of the GHJ
Capsular Pattern of Limitation (GHJ)
- Describes the order of limitation from most restricted to least restricted
- External Rotation > Abduction > Internal Rotation
Scapulothoracic Joint
- A "functional joint"- not a true joint
- Motions are caused by independent or combined motions of the sternoclavicular and acromioclavicular joints
Sternoclavicular Joint (SCJ)
- Clavicle articulates with the sternum and cartilage of the first rib
- Synovial joint, saddle shaped
- Strong joint capsule: Anterior and posterior SC ligament, costoclavicular ligament (inferior clavicle), interclavicular ligament
SC Joint Motion
- Clavicle moves on a fixed sternum
- 3 degrees of freedom: Elevation and Depression, Protraction and Retraction, Anterior and Posterior Rotation
Acromioclavicular Joint (ACJ)
- Scapula articulates with the clavicle
- Fibrocartilagenous disc surrounded by a weak joint capsule
- Superior and inferior AC ligament, coracoclavicular ligament
AC Joint Motion
- 3 degrees of freedom: Upward and Downward Rotation, Horizontal Plane Adjustments (rotation), Sagittal Plane Adjustments (tipping/tilting)
Tests and Measures
- Start with observation and palpation
- Assess gross ROM and strength, as well as flexibility, sensation, and bilateral comparisons
- Palpate superficially to deeply, understanding the relevant anatomy and its function
- Document objective measures, end feel, and subjective reports
ROM/Goniometry
- Observe posture and starting position
- Perform on the contralateral side first
- Observe active range of motion (AROM)
- Palpate landmarks for goniometry
- Measure AROM and passive range of motion (PROM) using appropriate devices
- Assess end feel
- Document objective measure, end feel, and any subjective reports
- Assess quality of movement
Shoulder Strength Assessment
- Assess both scapular and "shoulder" muscle strength
- Isolate muscles and stabilize as necessary
- Trunk/spine position can alter testing results
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