CP 2 Midterm

What is the purpose of movement patterns?

to assess the firing pattern of muscles during a particular motion and the quality of their performance

What are the kinds of muscles evaluated during these movement patterns?

Agonists, synergists, and stabilizers

What is the goal when assessing movement?

to note the activation and firing sequence of the prime movers and synergists

Should verbal cues be used with patients during movement patterns?

Minimal cues

Should you touch the muscles involved during movements?

No

Which muscle should you pay the most attention to during the movement?

The initiator

When should you test length and strength of a muscle?

After assessing movement patterns

If there is a faulty muscle pattern, which muscles should you treat first?

Any short or tight muscles

Which muscles should you address last if a pattern is faulty?

Weak muscles

What are hypertonic muscles?

shortened and have a lower firing threshold

What are hypotonic muscles?

long and have a higher firing threshold

Can there be exceptions with the hypo and hypertonic muscles rules?

Yes

What muscles are primarily being assessed during a push up movement

Scapular stabilizers

Scapula signs to look for during push up movement

winging, flaring, tipping, adduction, abduction, or elevation

Spine signs to look for during push up movement

excessive lordosis or kyphosis, flexion or extension of the neck

What are the main stabilizers of the scapula?

SERRATUS ANTERIOR, trapezius (U,M,L), rhomboids, and levator scapulae

What is the reason for an over-active levator scapula?

Other muscles are not functioning

What is the cause of winging of the scapula?

Weakness or inhibition of the serratus anterior (primarily), middle and lower traps, rhomboids

What is the cause of tipping of the scapula?

Weakness or inhibition of the serratus anterior and lower traps

Hyperactivity and/or shortening of the pec minor and/or major

What is the cause of adduction (kissing) of the scapula?

Weakness or inhibition of the rhomboids and/or middle trap

What is the cause of abduction of the scapula?

Weakness or inhibition of the upper/middle/lower traps and potentially rhomboids

What is the cause of elevation of the scapula?

Weakness or inhibition of the lower traps

Hyperactivity of the upper trap and/or levator scap

What is the primary assessment for shoulder abduction?

To assess scapulohumeral rhythm

What muscle initiates the first 15 degrees of shoulder abduction?

Supraspinatus

During shoulder abduction, up till what point should the scapula remain still?

30 degrees of abduction

After 30 degrees, what moves concurrently?

Scapula and glenohumeral joint

What is the ratio of glenohumeral joint movement to scapula movement?

2:1

Up till what point should there be no elevation or “hiking” of the shoulder?

60 degrees of abduction

What degrees does humeral abduction take place?

0-60

What degrees does scapular rotation occur?

60-90

Scapular rotation is accompanied by clavicular elevation of how many degrees?

30

Phase one of full 180 shoulder abduction is how many degrees and uses what muscles?

0-90, and involves the middle deltoid and supraspinatus muscle

Phase two of full shoulder abduction is how many degrees and uses what muscles?

90-180, serratus anterior, upper trap, and lower trap pull inferior angle laterally and acromion elevates

What are the four joints of the shoulder girdle?

sternoclavicular, acromioclavicular, glenohumeral, and scapulothoracic

What kind of joint is the sternoclavicular joint?

Complex saddle joint

What is the purpose of the articular cartilage of the sternoclavicular joint?

increases congruity of the highly irregular joint surfaces

What are the ligaments of the sternoclavicular joint?

SC ligament, interclavicular, costoclavicular (rhomboid)

What is the loose-packed position of the sternoclavicular joint?

Arm down by their side

What is the close-packed position of the sternoclavicular joint?

Maximum shoulder elevation

What are the conditions of the sternoclavicular joint?

Osteoarthritis, sprain, and dislocation

What direction of dislocation is the most common in the sternoclavicular joint?

Anterior with superior medial displacement

What kind of dislocation of the sternoclavicular joint can be very serious?

Posterior

What kind of joint is the acromioclavicular joint?

Planar joint with incongruent surfaces

What is unique about the articular disc of the acromioclavicular joint?

High degree of variability between individuals and within individuals

What are the ligaments of the acromioclavicular joint?

Coracoclavicular ligament and acromioclavicular ligament

What are the two ligaments that make up the coracoclavicular ligament?

conoid and trapezoid

What is the loose-packed position for the acromioclavicular joint?

Debatable

What is the closed packed position of the acromioclavicular joint?

Bringing the glenohumeral joint into 90 degrees abduction

What are the conditions of the acromioclavicular joint?

Osteoarthritis, osteolysis, AC joint dislocation/ “shoulder separation”

What is osteolysis?

Resorption of the subchondral bone of the distal clavicle, can be from trauma or repetitive stress

What is the common MOI of AC joint dislocation?

impact to lateral aspect of shoulder or fall with outstretched hand (FOOSH)

How many grades of a shoulder dislocation are there?

There are 6 grades; 4-6 are variations of 3

What kind of joint is the glenohumeral joint?

Ball and socket, diarthrodial

What are the ligaments of the glenohumeral joint?

Superior, middle, inferior, and posterior GH ligaments

What are the rotator cuff muscles?

SITS

What is the loose-packed position of the glenohumeral joint?

In plane line of scapula with 55 degrees of abduction

What is the close-packed position of the glenohumeral joint?

Full abduction with external rotation

What is the role of the superior GH ligament?

Prevents inferior displacement of humerus along with supraspinatus

What is the role of the middle GH ligament?

Resists anterior translation and external rotation of GH joint; continuous with subscapularis tendon

What is the role of the inferior GH ligament?

Prevents anterior translation of head of humerus in external rotation; taught at 90 degrees abduction and stabilizes internal rotation; acts as sling for humeral head

What is the role of the posterior GH ligament?

Prevents posterior translation of humeral head

Is the scapulothoracic articulation a true joint?

No

What conditions involve the ST articulation?

SICK scapula, GIRD, Upper crossed syndrome, and impingement syndrome

What does sick stand for?

Scapular malposition, Inferior medial border winging, Coracoid tenderness, dysKinesis

What does GIRD stand for?

Glenohumeral internal rotation deficiency

What is a sign for GIRD?

Loss of internal rotation at 90/90, posterior capsule tightness

In whom is GIRD most common?

Overhead athletes, especially throwers

What are the 3 elbow joints?

Glenohumeral, humeroradial, radioulnar

What kind of joint is the humeroulnar joint?

Hinge (ginglymus) joint

What is the closed packed position of the humeroulnar joint?

Full extension and supination

What is the loose packed position of the humeroulnar joint?

Undeclared

What kind of joint is the humeroradial joint?

Plane joint

What motion does the humeroradial joint allow?

Glide of the radius on humerous during flexion and extension

What is the closed packed position of the humeroradial joint?

90 deg of elbow flexion + 5 deg supination

What kind of joint is the radioulnar joint?

Pivot (trochoid) joint

What motions does the radioulnar notch allow for?

Pronation and supination

What is the closed packed position for the radioulnar joint?

Full elbow extension with 5 deg supination

What is the approximate carrying angle?

5-15 degrees

On which arm is the carrying angle typically greater?

Dominant arm

What presents as redness and swelling at the tip of the olecranon?

Bursitis

What can bursitis form?

Single, direct trauma or repetitive stress/ infection

What is another name for lateral epicondylitis?

Tennis elbow

What is another name for medial epicondylitis?

Golfers elbow

What condition is often associated with repetitive or resisted extension of the wrist?

Lateral epicondylitis

What condition is often associated with repetive or resisted flexion of the wrist?

Medial epidondylitis

What is the child’s version of golfers elbow?

Little leaguers elbow

What can present with pain and swelling at radial head area with difficulty to probate or supinate forearm?

Proximal radius neck fracture

What can present with pain and swelling at the epicondyle, may result in ulnar nerve palsy?

Epicondyle fracture

What can present with pain and swelling at distal humerus?

Supracondylar fracture

What can present with pain and diffuse swelling over the entire elbow?

Proximal ulnar fracture

What is the second most common type of joint dislocation?

Elbow joint dislocation

What is the most common directions for an elbow dislocation

Posterior or posterior lateral

What is also known as nurse maids elbow?

Subluxated radial head

What causes a subluxation of the radial head?

Forearm being twisted and distracted

How do you reduce a subluxated radial head?

Elbow flexion to 90 deg and supination

What are the carpal bones in the proximal row?

Scaphoid, lunate, triquetral, and pisiform

What are the carpal bones in the distal row?

Trapezium, trapezoid, capitate, hamate

What is total wrist flexion deg?

80 deg

Where does most wrist flexion occur?

Intercarpal joint (60%)

What is total wrist extension?

70 deg