Test n measures combined

4 joints of shoulder

GH, AC, SC, ST

GH osteos

flexion, extension, abduction, adduction, med/lat rot

resting position of GH

55 deg abduction, 30 deg horizontal adduction, slight ER

Close packed position of GH

full abduction and ER

capsular pattern of GH joint

ER, abduction, IR, some flexion

order for capsular pattern of GH

ER>AB>F>IR

SC joint osteos

elevation/depression, retraction/protraction, rotation

Resting position of SC

arm at side

Close packed position of SC

full elevation

Capsular pattern of SC joint

none

AC joint osteos

angular movements of scapula on clavicle fine tuning

resting position of AC

arm at side

closed packed position of AC

90 abduction

Capsular pattern of AC

pain at extremes of ROM

ST joint osteos

Upward/downward rot, elevation/depression, protraction/retraction, ant/post tilts

plane of scapula degrees

30-40

Scapulohumeral rhytmn is used for

prevening impingements, allowing good length tension relationships

steps for Scapulohumeral rhytmn

during dirst 30 degrees of abduction, should be smooth and coordinated

Shoulder elevation is made from

60 degrees from ST, 120 degrees from GH

ratio for scapulohumeral rhythm

2:1 ratio

what arc of motion is clavicle moving the most

120-180

when the scapula upwardly rotates, what happens to the distal end of the clavicle

elevates to 30 deg

What then causes posterior rotation of clavicle

costoclavicular, coracoclavicular ligaments

what happens after posterior rotation of clavicle

rotates 45 to get to final 60 degrees of scapular ROM

From 0-30 what is scapular movement

no scapular movement, just scapular setting

from 30-60 degrees what is scapular movement

glenoid fossa upwardly rotates with GH joint, axis moves and is at the AC joint by 90-100 elevation

rotator cuff muscles

supraspinatus, infraspinatus, teres minor, subscapularis

Scapular elevation end feel

firm

scapular depression end feel

firm/hard

scapular abduction and adduction end feel

firm

shoulder MOTIONS end feel

firm

What things may effect shoulder complex ROM

age ( larger in children), gender (more in females), BMI, testing position/posture, right vs left, sports

end feel for pec major, pec minor, lats MLT

firm muscular

nerves that branch from posterior cord

axillary, subscapular, thoracodorsal

nerves that branch from proximal segments of brachialplexus

dorsal scapular, long thoracic, pectoral, suprascapular

Functional scaption rom

170

extension functional rom

to reach behind back

horizontal add/abd functional

wash opp side shoulder/axilla and open/close window

IR/ER functional

reach behind neck, button shirt, eat and drink

Scapular stabilizers in shoulder elevation

traps, rhomboids, serratus ant, levator scap

humeral stabilizers in shoulder elevation

subscap, supraspinatus, infraspinatus, upper half of teres minor

humeral flexors/abductors in shoulder elevation

deltoid, pec major, coracobrachialis

humeral rotators in shoulder elevation

deltoid, pec major, teres major, lat, teres minor, subscapularis

Adduction/Extension use for lats and teres major

tennis serve, closing a window

Closed chain lat use with adduction/extension

crutch walking, rising from sitting

Pec major flexion/adduction function

dressing, bathing, hygeine

subscap IR function

functional link with forearm pronation (with help from teres major, lats, pec major, ant deltoid)

Infrapinatus, teres minor, posterior delt with ER function

supination of forearm

-bowling, manipulating foot into shoe, inserting light bulb overhead

General scan for UE

start sitting/standing, arms at side. Place one hand behind neck and down, other hand on low back and up

During the general scan for UE, what movements are used for reaching arm behind the neck and down

scapular upward rotation, shoulder elevation and ER, elbow flexion, forearm supination, wrist radial deviation, finger extension

where should they get when reaching for neck and down?

around t4

During the general scan for UE, what movements are used for reaching arm on low back and reach up?

scapular downward rotation, shoulder extension and IR, elbow flexion, forearm pronation, wrist radial deviation, finger extension

where should they get when reaching for low back and reach up?

around t12

Scapular elevation AROM

ask patient to move shoulders up towards ears

Scapular depression AROM

ask patient to move shoulders toward waist

Scapular abduction AROM

patient flexes arm to 90, ask to reach forward

scapular adduction AROM

ask patient to squeeze shoulder blades together

Scapular downward rotation AROM

ask pt to place hand in small of back

scapular upward rotation AROM

ask pt to elevate arm overhead

scapular PROM

patient sidelying, move through motions (elevation, depression, abduction, adduction)

Substitute movement of shoulder flexion AROM

trunk extension, shoulder abduction

how to measure shoulder flexion/extension

supine

goni for shoulder flexion

axis: lateral greater tubercle

proximal arm: midaxillary line

distal arm: lateral midline of humerus

shoulder extension AROM substitute movements

scapular ant tilt, scapular elevation, shoulder abduction, trunk flexion and ipsilateral rotation

Shoulder extension goni

axis: lateral greater tubercle

proximal arm: midaxillary line

distal arm: lateral midline of humerus (towards lateral epicondyle)

Alternate position for shoulder extension

prone or sitting

Shoulder abduction substitutions for AROM

contralateral trunk lateral flexion, scapular elevation, shoulder flexion

Shoulder abduction goni

axis: acromion

proximal arm: parallel to anterior sternum

distal arm: anterior midline of humerus

shoulder horizontal abduction/adduction substitutions AROM

scapular retraction, scapular protraction, trunk rotation

Shoulder horizontal abduction/adduction PROM

patient sitting, shoulder in 90 abduction and neutral, elbow flexed.

Shoulder IR AROM substitutions (in both prone and supine)

prone: scapular elevation, shoulder abduction, elbow extension

supine: scapular elevation, protraction and ant tilt, shoulder abduction, elbow extension

Shoulder IR goni

axis: olecranon process

proximal arm: perp to floor

distal arm: along ulna using olecranon and ulnar styloid process for reference

Shoulder IR position

supine, elbow flexed to 90

shoulder IR alternate position

prone or supine, shoulder in 90 abduction, elbow flexed to 90, towel under elbow

Shoulder ER AROM substitutions ( in supine with shoulder in 90 abduction)

elbow extension, scapular depression, shoulder adduction

shoulder ER AROM substitutions ( in sitting with arm at side)

scapular depression, shoulder adduction, trunk rotation

Shoulder ER prom position

supine

shoulder ER goni

axis: olecranon process

proximal arm: perp to floor

distal arm: along ulna using olecranon and ulnar styloid process for reference

alternate position for IR and ER

sitting

IR: abduction shoulder 15 degrees, elbow flexed to 90

ER: arm at side, elbow flexed to 90

Reliability of universal gonis

reliability varies depending on motion being tested, intratester reliability is larger than intertester, recommended to repeat measurements

Reliability of inclinometers and other devices

universal gonis are recommended and are less expensive

MLT on pect major

supine with shoulder in ER and elbow flexed to 90

contraindication to testing pec major length

anterior dislocation history

MLT for pec minor

supine with arms at side, palm up

-observe for decreased scapular retraction

-measure the distance between posterior corner of acromion and plinth

contraindication for MLT of pec minor

posterior dislocation

Lats MLT

supine, shoulders in anatomical position, legs flexed at hips and knees

-asses for restrictions

compensation for lat MLT

increased thoracolumbar extension

shoulder flexion MMT

anterior deltoid

sitting, flex to 90 ( some adduction and IR)

gravity minimized shoulder flexion MMT

sidelying on non-test side, flex/adduct/ir

shoulder extension MMT

lats, teres major

-prone,arm at side, shoulder in IR

shoulder extension gravity minimized MMT

patient sidelying on non-test side with arm at side

Scapular depression MMT

reverse action against gravity for lats

-seated with hands flat and push off table

Shoulder abduction MMT

middle deltoid and supraspinatus

-patient sitting, test arm at side with elbow extension

gravity minimized shoulder abduction mmt

supine, test arm at side

shoulder horizontal abduction MMT

posterior deltoid

-prone, shoulder abducted to 75, elbow at 90

shoulder horizontal abduction mmt gravity miinimized

patient sitting, shoulder abduction to 75, elbow at 90 supported by table

shoulder horizontal adduction MMT

pec major

-supine, shoulder abducted to 90, elbow flexed to 90

shoulder horizontal adduction mmt gravity minimized

patient sitting, shoulder abducted to 90 and elbow at 90 suppported by table or therapist

Shoulder ER MMT

infraspinatus and teres minor

-prone, shoulder abducted to 90, elbow at 90, upper arm resting on plinth

shoulder ER mmt gravity minimized

sitting, houlder abducted to 90, elbow at 90, forearm midposition