PTH 151 Unit 5 Lab #1A - UE Joints (Shoulder) 2024 PDF

TIDEWATER COMMUNITY COLLEGE PTA PROGRAM VA BEACH CAMPUS **PTH 151 -- Unit 5 Lab \#1A -- UE Joints:** [Reference]: Clinical Mechanics and Kinesiology Chapter 10 pg. 173-211; Muscle Manual pg. 188-225 Learner Objectives: **7D24:** Demonstrate competence in performing components of data collectio...

TIDEWATER COMMUNITY COLLEGE PTA PROGRAM VA BEACH CAMPUS **PTH 151 -- Unit 5 Lab \#1A -- UE Joints:** [Reference]: Clinical Mechanics and Kinesiology Chapter 10 pg. 173-211; Muscle Manual pg. 188-225 Learner Objectives: **7D24:** Demonstrate competence in performing components of data collection skills essential for carrying out the plan of care by administering appropriate tests and measures (before, during and after interventions) for the following areas: G: Joint Integrity and Mobility: detect normal and abnormal joint movement A1. Identify all joint structures and muscles of the shoulder, elbow, wrist and hand. A2. Identify and label the bony and ligamentous structure of the shoulder, elbow, wrist and hand. A3. Recognize and describe the normal motions available at the shoulder, elbow, wrist and hand [Shoulder Joint Complex:] Loudon pg. 173-181; Vizniak pg. 188 1. [Bones:] - Humerus - Scapula - Clavicle 2. [Joints] 1. **[Glenohumeral joint:]** (GH jt aka shoulder joint) Loudon pg. 182-183 - **Superior Glenohumeral ligament**: thickening of anterior joint capsule - **Middle Glenohumeral ligament**: thickening of anterior joint capsule - **Inferior Glenohumeral ligament**: thickening of anterior and inferior joint capsule - **Coracohumeral ligament**: runs between coracoid process of scapula and greater tubercle of humerus - Flexion/Extension - sagittal plane, mediolateral axis of rotation - Abduction/Adduction - frontal plane, anteroposterior axis - IR/ER - transverse plane, superoinferior axis - **Glenoid labrum**: forms a cartilaginous lip around the glenoid fossa to deepen the fossa. Loudon pg. 182-183, Clinical Correlation 10.4 pg. 182 - **Subacromial bursa** (aka subdeltoid bursa): located between the acromion process of the scapula and the supraspinatus tendon. Loudon pg. 188 - **Coracoacromial ligament**: runs between the coracoid process of the scapula and the acromion process of the scapula. Vizniak pg. 190 - **Coracoacromial arch**: roof of GH joint; comprised of coracoacromial ligament and acromion process of scapula 2. **[Scapulothoracic joint:]** (ST joint) (aka scapulocostal joint) Loudon pg. 185; Vizniak pg. 188 - Anterior aspect of the scapula - Posterior aspect of the rib cage - Elevation/Depression - gliding along the frontal plane - Upward and Downward Rotation - gliding along the frontal plane - Anterior/Posterior tipping - around a mediolateral axis in the sagittal plane - IR/ER - around a vertical axis along the transverse plane - Adduction/Abduction (Protraction/Retraction) - gliding along the frontal plane - Considered a pseudojoint because it does not have the characteristics of a synovial joint. - ST motion does not occur in isolation but it occurs simultaneously with motion occurring at the acromioclavicular (AC) or sternoclavicular (SC) joints. - If the ST joint does not move, you will not achieve full motion of the GH joint. - The relationship between ST and GH motion is known as **[scapulohumeral rhythm]**: - For every 2 degrees of GH Abd or flexion a corresponding 1 degree of upward rotation will occur at the ST joint. - Therefore - for every 3 degrees of shoulder elevation (flexion or Abd) ⅔ comes from the humerus and ⅓ comes from the scapula. - Ie. to achieve 180 degrees of flexion or Abd, 120 degrees will come from the humeral elevation and another 60 degrees will come from the ST joint. - This 2:1 ratio is not always consistent during the early or setting phase. - After 30 - 60 degrees of shoulder elevation, the scapula finds a position of stability and the 2:1 ratio is closely maintained. - Superior angle of the scapula located at T2 - Inferior angle of the scapula located at T7 - SC & AC contributions to the Scapulohumeral Rhythm - see below 3. **[Sternoclavicular joint]** (SC joint) Loudon pg. 184-185; Vizniak pg. 188 - **Anterior sternoclavicular ligament**: reinforces joint capsule anteriorly - **Posterior sternoclavicular ligament**: reinforces joint capsule posteriorly - **Interclavicular ligament**: runs between medial ends of right and left clavicle - **Costoclavicular ligament**: runs from 1^st^ rib to medial inferior clavicle - Elevation/Depression - Posterior/ Anterior Rotation - Protraction/Retraction - **\*\*The only osseous joint that connects the UE to the axial skeleton\*\*** - Fibrocartilaginous disc is located within the joint to improve joint congruence 4. **[Acromioclavicular joint]** (AC joint) Loudon pg. 183-184; Vizniak pg. 188 - **Acromioclavicular ligament**: runs between the acromion process of the scapula and lateral end of the clavicle ([FYI]: sometimes divided into superior and inferior AC ligaments) - **Coracoclavicular ligament**: runs between coracoid process of the scapula and lateral, inferior aspect of the clavicle. Divided into two parts: - **Trapezoid**: slightly more anterior and lateral in its location - **Conoid**: slightly more posterior and medial in its location - scapular IR/ER, scapular anterior/posterior tipping and scapular upward/downward rotation. - [Older sources] indicated the clavicle moved at this joint: clavicular posterior and anterior rotation. CLINICALLY: Many would argue that both scapular and clavicular motion probably occur. - Fibrocartilaginous disc is often located within the joint to improve joint congruence - AC joint separation injuries are common due to fall onto outstretched arm 5\. **[SC & AC Joint Contributions to Scapulohumeral Rhythm:]** - Neumann (2022) has divided the full 180 degrees of shoulder elevation into an early phase and late phase - each consisting of 90 degrees of elevation. - Early phase: - 60 degrees from the humerus - 30 degrees from scapular rotation - 20-25 degrees occurs due to clavicular elevation at the SC joint - About 10 degrees of upward rotation at the AC joint - Late phase: - 60 degrees from the humerus - 30 degrees from scapular rotation - Only another 5 degrees is possible at the SC joint - Rotation at the AC joint can go through another 20-25 degrees - As the clavicle elevates tension slowly increases in the coracoclavicular ligament. - Elevation continues -\> tension increases and pulls the coracoid process inferiorly. - The coracoclavicular ligament is very stiff and therefore does not significantly elongate resulting in tension on the conoid ligament at the conoid tubercle. - Due to its location this creates a posterior rotation around the long axis of the clavicle of 30 to 55 degrees.