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ortho 3 > Shoulder MSI > Flashcards

Shoulder MSI Flashcards

1
Q

Scapular movement coordination deficits

A 
Depression
Abduction
Downward rotation 
Winging 
Tipping
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2
Q

Humeral movement coordination deficits

A

Anterior glide

Internal rotation

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3
Q

Scapular movement faults

A

Insufficient elevation/upward rotation
Excessive internal rotation/ winging
Insufficient posterior tilt

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4
Q

What is most likely to demonstrate altered kinematic?

A

Scapular plane

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5
Q

Scapular resting position

A

30-45 deg internal rotation 2-3 inches of abduction from spine Sits Superior angle of spine at T2, inferior angle of spine at T7 Scapula Upward rotation Neutral to 3 degrees Anterior tilt of scapula 10-20 degrees

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6
Q

Scapular elevation norm

A

Inferior angle to SC joint elevates 25 degrees
SC joint rotates posterior 25 degrees
SC joint retracts 15 degrees
AC joint upward rotates 35 degrees
Scapula posterior tilts 20 degrees
Glenohumeral must ER 45 degrees (more needed for abduction than flexion)
Glenohumeral motion is 120 degrees
Scapulothoracic motion is 60 degrees of upward rotation

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7
Q

Normal scapulohumeral rhythm

A

2:1
120 GH
60 scap

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8
Q

Shoulder elevation setting phase

A

60 deg flex, 30 deg abduction

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9
Q

Shoulder elevation scapular movement

A

Upward rotation
ER
Post tilt
Elevation

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10
Q

Two faults during setting phase of elevation

A

Downward rotation - rhomboids over active

Adduction - rhomboids plus everything else on

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11
Q

Upper traps in impingement/pain

A

Work too hard/early

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12
Q

SA in impingement/pain

A

Decreased LT to SA ratio

SA is delayed, decreased, or deactivates too early

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13
Q

Mid and low trap in impingement/pain

A

Decreased/delayed
Middle during ER
Lower during abduction

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14
Q

Thoracic kyphosis

A

Associated w/ abducted and downward rotated scap

Reducing it facilitates greater shoulder range

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15
Q

Scapular depression movement fault

A

Lower than normal scapular position
Lower than normal clavicle upward 20 deg angle
Lacks elevation to C6-7 during shoulder motion
Increased tension from lats/pecs pull downward
Lengthened U trap or levator, increased stress on Cspine

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16
Q

Movement faults associated w/ scapular depression

A

Scap down rotation or abduction
Humeral IR; cspine ext/rotation
Long arms/neck, heavy arms/chest

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17
Q

Scapular depression movement tests

A 
Shoulder flexion/abduction
Lat/pec length 
SA MMT
Cervical rotation
Scapular-thoracic movement
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18
Q

Scapular depression tax

A 
Tape to elevate
Unload/elevate on objects
Tape bra straps together
Normalize pec and lat length
B/L shoulder flexion w/ elevation
Improve M trap/SA strength
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19
Q

Scapular downward rotation movement fault

A

Downward rotated at rest
Lacks 60 deg upward rotation during elevation
GH may be moving too much for compensation

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20
Q

Scapular foward rotation movement fault - muscle imbalance

A

Levator scap and rhomboids
SA and L trap
LT best up rotator > 90 deg
UT and SA better when < 90

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21
Q

Scapular downward rotation associated faults

A

Scapular depression, abduction, Cervical ext/rotation

Long/heavy arms, increased T kyphosis

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22
Q

Scapular downward rotation movement tests

A 
Shoulder flexion/abduction
Lat/pec length test
SA MMT
Quadruped
C/s rotation
Scapulothoracic mobility
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23
Q

Scap downward rotation tx

A

Improve posture/alignment - tape
SA, L trap strength/activation
Rhomb, levator flex/inhibition
Retrain coordination w/ upward rotation

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24
Q

Scapular abduction movement fault

A

> 3” from spine at rest
1/2’ past MAL during shoulder elevation
Stabilizers lack strength against scapular-humeral muscles
(Pecs + SA dominant, short/strong RC, weak M and L trap, weak rhomb)
Excessive thoracic flexion

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25
Q

Scap abduction associated movement faults

A

Scapular depression and down rotation
Anterior humeral glide
Thoracic flexion, large breasts, obesity

26
Q

Scap abduction movement tests

A

Shoulder elevation and return
Pec major/ teres length
B/E ER by side
Horizontal adduction length test

27
Q

Scap abduction tx

A

Improve scap position at rest (tape, hands on hip, tape bra straps)
Improve MT, LT, Rhob strength
Decreased pec/teres major stiffness
Improve TSpine extension
Improve GH motion (post capsule or post cuff)

28
Q

Scapular tilting movement fault

A

Anterior tilted at rest/lack of post tilt during elevation
Inferior angle protruding off thorax
Secondary to tightness in pec major/minor
Weakness in Ltrap
Associated w/ excessive thoracic flexion, humeral ant glide

29
Q

Scapular tipping movement test

A

Shoulder abduction
Pec length
Lower trap MMT

30
Q

Scapular tipping movement to

A

Improve pec inhibition/tightness
Improve lower trap strength
Taping into post tilt
Improve thoracic position

31
Q

Scapular winging movement fault

A

Scap IR
SA weak/control (M trap and rhomb also weak)
Concentric or eccentric winging

32
Q

Scapular winging movement tests

A

Shoulder elevation and lowering
HBB
SA and LT MMT
Quadruped rocking foward

33
Q

Scapular wining tax

A

Strengthen scapulothoraic muscles
Stretch scapular-humeral muscles
Concentric control of SA
Eccentric control

34
Q

Humeral anterior glide

A

Anterior translation of humeral head compared to acromion hood (norm >1/3)
Laxity in anterior capsule
Stiffness in posterior capsule/ER
Poor GH PICR

35
Q

Most common humeral movement fault

A

Anterior glide

36
Q

anterior glide associated med dx

A

impingements
instabilities
rotator cuff pathologies

37
Q

anterior glide movement tests

A

shoulder elevation: retest w/ post glide
pec and biceps length
horizontal adduction length
shoulder IR/ER at 90 deg: retest w/ post glide

38
Q

ant glide tx

A

normalize scap posting
improve GH rotation PICR
improve rotator cuff strength and control
decrease stiffness: post capsule, post delt/rotator cuff, biceps and pecs

39
Q

humeral IR fault

A

excessive IR at rest
insufficient ER during shoulder elevation
tightness in IR muscles
weakness in ER muscles

40
Q

humeral IR associated movement faults

A

thoracic flexion

scapular abduction/tipping

41
Q

humeral IR movement tests

A

shoulder flex/ab
humeral ER by side
shoulder IR/ER supine and prone
muscle length tests

42
Q

humeral IR tx

A

improve coordination (emphasize ER during movements)
improve length/stiffness (pecs, lats, subscap, T major)
improve strength/endurance (infra spin, T minor)

43
Q

shoulder specific posture assessment - lateral

A

thoracic spine excessive flexion
arms IR, elbow flexion
humeral head ant glide

44
Q

shoulder specific posture assessment - anterior

A

clavicle angle 20 deg
pec muscle bulk
cubital fossa Ir, abduction

45
Q

shoulder elevation abnormal

A 
asymmetrical
cervical movement
scapular faults
lack post GH creasing
humeral IR
excess/early UT activation
CT junction ext at end range
46
Q

early shrug w/ shoulder activation

A

adhesive capsulitis

full rotator cuff tear

47
Q

corrected shoulder elvation

A

scapular reposition/assistance
change humeral position
change/improve muscle timing w/ cueing

48
Q

normal return from shoulder elevation

A

symmetrical scapular downward rotation, controlled speed

49
Q

abnormal return from shoulder elevation

A

winging
retraction
very fast/slow

50
Q

B/L shoulder ER by side - normal

A

60 deg ER

no scap movement first 50%

51
Q

B/L shoulder ER by side - abnormal

A

limited ROM
excessive scap retraction
excessive Tspine extension

52
Q

supine BL shoulder flexion- normal

A

to 120 deg
maintained humeral ER
stable Lspine and rib cage

53
Q

supine BL shoulder flexion - abnormal

A

C or L spine ext
rib flare
humeral IR

54
Q

wall slides

A 
w/ humeral ER
w/ scap elevation
SA activation w/ TB
resisted ER
lift off for LT activation
55
Q

mid and lower trap progression

A 
wrist
forearm
arms
y lift offs standing
side lying
56
Q

best exercise for SA

A

serratus punch 120 deg
upward rotation, post tilt external rotation
scapular protraction and upward rotation movement

57
Q

lower trap activation

A

upward rotation, post tilt, ER

best lower to upper w/ prone horizontal abduction at 90 deg w/ ER

58
Q

best middle trap activation

A

prone row and prone horizontal abduction at 90 ab w/ ER have high EMG activity

59
Q

greatest lower-upper trap ratio

A

B/L ER at 0 deg abduction

60
Q

other things to look at

A

muscle length
MMT
STM
therex slides

ortho 3 (12 decks)

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