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KIN: Shoulder 1/2
| Question | Answer |
|---|---|
| Is the AC joint capsule strong? | No - needs reinforcement from ligaments |
| What are the AC joint ligaments? | Coracoclavicular ligament Trapezoid ligament Conoid ligament |
| What plane does the trapezoid ligament lie in? | Sagittal plane |
| What plane does the conoid ligament lie in? | Conoid |
| What movement do the coracoclavicular ligaments prevent? | Superior dislocation of the clavicle on the acromion |
| What is the coracoclavicular ligament's most critical role? | Producing rotation of the clavicle necessary for full UE ROM |
| What are the ACJ ligaments reinforced by? | Delt and trap fibers |
| What forces does the conoid primarily provide restraint against? | Superior/inferior forces |
| What forces does the trapezoid primarily provide resistance against? | Posterior translations along the clavicle |
| What are the motions of the ACJ? | IR ER Anterior tipping Posterior tipping Upward rotation Downward rotation |
| GHJ sacrafices ________ for _________? | Stability for mobility |
| Does the scapula lie in the frontal plane? | No - scapular plane (scaption) |
| Which directions does the head of the humerus face in relation to the shaft of the humerus? | Medially, superiorly, and posteriorly |
| What is the glenoid labrum? | Accessory structure used to increase the surface area of the glenoid fossa |
| How is the glenoid labrum attached inferiorly and superiorly? | Inferiorly - firmly attached Superiorly - loosely attached |
| What is the angle of inclination? | Angle formed by the axis through the humeral head and longitudinal axis of the shaft of the humerus (130-150 degrees) |
| What is the angle of torsion? | Angle that is formed by measuring axis through the humeral head and the axis through the humeral condyles (-30 degrees: posterior or retroversion) |
| What is a Bankhart lesion? | Inferior lesion of the labrum |
| In the resting position, where is the GHJ taut and where is it slack? | Taut - superiorly Slack - anteriorly and inferiorly |
| Where is the GHJ capsule and ligaments weakest? | Inferiorly |
| What would be a closed packed position of the GHJ? | Abduction and ER |
| What are the ligaments of the GHJ? | Coracohumeral ligament GH ligaments (Superior, middle, inferior) |
| When are all of the GHJ ligaments tight? | ER of humerus Motions involving anterior glide of humeral head |
| Between which GH ligaments is the most weakness and what is this area called? | Superior and middle GH ligament Foramen of Weibrecht |
| What is significant about the Foramen of Weighbrecht? | Common site of extrusion of humeral head with anterior dislocation of shoulder |
| What is the Foramen of Weighbrecht reinforced anteriorly by? | Subscapularis tendon |
| What is Rotator Interval Capsule? | Space between the supraspinatus and subscapularis |
| Where are the superior GH ligaments the least stable? | O degrees |
| At what angle does the middle GH ligament contribute to anterior stability the most? | 45 degrees abduction |
| Where is the inferior GH ligament most stable? | Abduction greater that 45 degrees |
| When the arm is abducted greater than 45 degrees and ER what is the inferior GH ligament working to restrict? | Anterior motion |
| When the arm is abducted greater than 45 degrees and IR what is the inferior GH ligament working to restrict? | Posterior motion |
| Where do the coracohumeral ligaments run? | Originate on lateral coracoid process and blend with superior capsule and supraspinatus tendon to insert on anterior side of greater tuberosity |
| What do the coracohumeral ligaments restrict? | ER Flexion Extension |
| What acts as the passive support for UE against gravity? | Coracohumeral ligaments |
| In what direction do the coracohumeral ligaments resist displacement | Inferiorly |
| What is another name for the coracoacromial arch? | Suprahumeral arch |
| What does the coracoacromial arch prevent? | Superior dislocation |
| What is the problem with the coracoacromial arch? | Irritates the RTC a lot since there is such a small space |
| What makes up the coracoacromial arch? | Coracoacromial ligament and acromion process of scapula |
| In healthy adults, how much space exists between the undersurface of the arch and the humeral head? | 1 cm |
| Do you have more IR/ER with the arm at 0 degrees or at 90 degrees? | 90 degrees |
| Why do you not have as much abduction when the humerus is IR? | Impingement on the greater tubercle (can't pass under or behind the acromion) |
| What does full shoulder abduction require? | Simultaneous 60 degrees of upward rotation of the scapula |
| Approximately what degrees is scaption? | 45 degrees horizontal abduction |
| What are the arthrokinematics of the GHJ? | Roll and slide in the opposite direction |
| What does abduction of the shoulder WITHOUT a concurrent inferior slide cause? | Humeral impingement against acromion |
| What are the prime movers during abduction? | Anterior and middle delt, supraspinatus |
| What are the prime movers during flexion? | Anterior delt, coracobrachialis, long head of biceps |
| What muscle in the shoulder is almost always active? | Supraspinatus |
| Where is the painful arc usually seen and why? | 60-120 degrees abduction Because this is where MA is the largest (90 degrees) and RTC is working the hardest |
| Does the supraspinatus have a large or small MA and what does this mean? | Large - can be a strong abductor |
| What ligament does the biceps tendon slide through? | Transverse humeral ligament |
| What is the approximate scapulohumeral rhythm ratio? | 2:1 (GH:scap) |
| What muscles produce upward rotary force on the scapula during Phase one of scapulohumeral rhythm? | Trap and portions of SA |
| What is the clavicle responsible for during phase one of scapulohumeral rhythm? | Gets elevated and carries scapula through 30 degrees of upward rotation |
| Is there any upward rotation of the ACJ during phase one of scapulohumeral rhythm? | NO |
| What ligament permits some tipping and winging of the scapula during phase one of the scapulohumeral rhythm? | Coracoclavicular |
| What happens in phase one of scapulohumeral rhythm when the CC ligament becomes taugh and clavicular elevation ends? | Scapula with have to upwardly rotate 30 degrees |
| What is the total motion at the end of phase on of scapulohumeral rhythm? | (90 degrees) - 60 degrees GH + 30 degrees ST |
| Describe phase one of scapulohumeral rhythm | Elevation of clavicle at SCJ swings the scapula through an arc of motion that has an axis at the base of the spine of the scapula |
| Where is the axis of rotation in phase one of scapulohumeral rhythm? | Medial |
| What is the action of traps and SA during phase two of scapulohumeral rhythm? What is this restricted by? | Continue to upwardly rotate scap Conoid and trapezoid ligaments |
| What axis does the clavicle rotate along during phase two of scapulohumeral rhythm? | longitudinal |
| Where do the coracohumeral ligaments run? | Originate on lateral coracoid process and blend with superior capsule and supraspinatus tendon to insert on anterior side of greater tuberosity |
| What do the coracohumeral ligaments restrict? | ER Flexion Extension |
| What acts as the passive support for UE against gravity? | Coracohumeral ligaments |
| In what direction do the coracohumeral ligaments resist displacement | Inferiorly |
| What is another name for the coracoacromial arch? | Suprahumeral arch |
| What does the coracoacromial arch prevent? | Superior dislocation |
| What is the problem with the coracoacromial arch? | Irritates the RTC a lot since there is such a small space |
| What makes up the coracoacromial arch? | Coracoacromial ligament and acromion process of scapula |
| In healthy adults, how much space exists between the undersurface of the arch and the humeral head? | 1 cm |
| Do you have more IR/ER with the arm at 0 degrees or at 90 degrees? | 90 degrees |
| Why do you not have as much abduction when the humerus is IR? | Impingement on the greater tubercle (can't pass under or behind the acromion) |
| What does full shoulder abduction require? | Simultaneous 60 degrees of upward rotation of the scapula |
| Approximately what degrees is scaption? | 45 degrees horizontal abduction |
| What are the arthrokinematics of the GHJ? | Roll and slide in the opposite direction |
| What does abduction of the shoulder WITHOUT a concurrent inferior slide cause? | Humeral impingement against acromion |
| What are the prime movers during abduction? | Anterior and middle delt, supraspinatus |
| What are the prime movers during flexion? | Anterior delt, coracobrachialis, long head of biceps |
| What muscle in the shoulder is almost always active? | Supraspinatus |
| Where is the painful arc usually seen and why? | 60-120 degrees abduction Because this is where MA is the largest (90 degrees) and RTC is working the hardest |
| Does the supraspinatus have a large or small MA and what does this mean? | Large - can be a strong abductor |
| What ligament does the biceps tendon slide through? | Transverse humeral ligament |
| What is the approximate scapulohumeral rhythm ratio? | 2:1 (GH:scap) |
| What muscles produce upward rotary force on the scapula during Phase one of scapulohumeral rhythm? | Trap and portions of SA |
| What is the clavicle responsible for during phase one of scapulohumeral rhythm? | Gets elevated and carries scapula through 30 degrees of upward rotation |
| Is there any upward rotation of the ACJ during phase one of scapulohumeral rhythm? | NO |
| What ligament permits some tipping and winging of the scapula during phase one of the scapulohumeral rhythm? | Coracoclavicular |
| What happens in phase one of scapulohumeral rhythm when the CC ligament becomes taugh and clavicular elevation ends? | Scapula with have to upwardly rotate 30 degrees |
| What is the total motion at the end of phase on of scapulohumeral rhythm? | (90 degrees) - 60 degrees GH + 30 degrees ST |
| Describe phase one of scapulohumeral rhythm | Elevation of clavicle at SCJ swings the scapula through an arc of motion that has an axis at the base of the spine of the scapula |
| Where is the axis of rotation in phase one of scapulohumeral rhythm? | Medial |
| What is the action of traps and SA during phase two of scapulohumeral rhythm? What is this restricted by? | Continue to upwardly rotate scap Conoid and trapezoid ligaments |
| What axis does the clavicle rotate along during phase two of scapulohumeral rhythm? | longitudinal |
| What does clavicular rotation eventually cause during phase two of scapulohumeral rhythm? | Will cause crank shaped clavicle to flip over lateral end superior |
| What happens in phase two of scapulohumeral rhythm after the clavicle flips over? | Scap is then carried through 30 more degrees of upward rotation around an AP axis through ACJ which undergoes tipping and winging |
| What is the axis of rotation during phase two of scapulohumeral rhythm? | Lateral on spine of scap |
| What action does the delt have on the humerus with arm at side? | Primarily superior translatory pull |
| When humerus elevates what action does delt have on humerus? | Compression |
| What is deltoid activity dependent on? | Functioning RTC |
| With a RTC, is the pain an inhibitor or a facilitator? | Inhibitor |
| If the scapula is not upwardly rotating what will the middle and posterior fibers of the delt do? | Act to downwardly rotate scapula |
| If you have paralyzed delt can you get full abduction of GHJ? | Yes, but torque is reduced |
| If you have a paralyzed supraspinatus can you get full abduction of GHJ? | Often difficult or impossible due to altered arthrokinematics |
| Is activity of the infraspinatus, teres minor and subscapular greater in flexion or abduction? | Flexion |
| Does the trap rise more linearly during abduction or flexion? Why? | Abduction because it sits more in the frontal plane and muscles tend to work better in the plane they are in |
| Does the SA rise more linearly during abduction or flexion? Why? | Flexion because it sits more in the sagittal plane |
| When, during abduction, does the upper trap start to fire? | Pretty much right away |
| When, during abduction, does the lower trap start to fire? | Not until about 150 degrees |
| What are the actions of the lats? | Adduction IR Extension Adducts and depresses scap |
| What are the actions of lats in a CKC? | Pull caudal attachment superior toward cephalad attachment on scap unweighting body |
| Action of clavicular part of pec major? | Flexion |
| Action of teres major and rhomboids | Adduct IR Extension |
| What would an unopposed teres major do? | Upwardly rotate scapula |
| What are the rhomboids responsible for? | Downward rotation of scapula |
| What are the IR of shoulder complex? | Subscapularis Anterior deltoid Pectoralis major Lats Teres major |
| Which is stronger: IR or ER? | IR |
| What are the ER of the shoulder complex? | Infraspinatus Teres minor Posterior deltoid |
| What are the ER of arm very important for? | Decelerating IR of arm during throwing motion |
| What is a progression of impingement? | RTC problems |
| What are AC injuries caused by? | Overuse |
| What are SC injuries caused by? | Instability, subluxation |
| What is another name for adhesive capsulitis? | Frozen shoulder |
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