UQ MSI: Flashcards on Scapular and Humeral Diagnoses in Movement Impairments

resting alignment: SC joint clavicular retraction

20 degrees

Resting alignment: SC/clavicular elevation

6-29 degrees

resting alignment: scapular internal rotation

30-40 degrees

resting alignment: scapular upward rotation

0-15 degrees

resting alignment: scapular anterior tilt

10-15 degrees

resting alignment: abduction

3 inches

scapular diagnoses associated with long serratus

scapular IR with AT

scapular IR with insufficient UR

where does UR come from during arm elevation

primarily from SC joint posterior axial rotation of the clavicle on the sternum

secondarily from AC joint

where does posterior tilt of scapula come from during arm elevation?

primarily from AC joint

where does scapular external rotation come from during arm elevation

SC joint retraction

AC joint internal rotation

where does scapular elevation come from during arm elevation

primarily SC elevation/depression

where does scapular abduction come from during arm elevation

primarily SC protraction/retraction

end range position of scapula

acromion C6-7

vertebral border should be 55-60 degrees (UR)

abduction: 3 inches (no change)

posteriorly tilt 10 degrees

ER 10 degrees (so at end range 20-30 degrees of anterior tilt)

scapular diagnoses associated with a long upper trap

scapular depression

scapular IR with insufficient UR

scapular diagnoses associated with a long lower trap

scapular IR with AT

scapular IR with abduction

scapular IR with insufficient UR

resting alignment: scapular elevation/depression

root of spine of scap T3

scapular diagnoses associated with overactivation of scapulohumeral muscles

scapular IR with AT

scapular IR with abduction

scapular diagnoses associated with short pec minor

scapular depression

scapular IR with AT

scapular IR with abduction

scapular IR with insufficient UR

scapular diagnoses associated with short deltoid

scapular IR with insufficient UR

scapular diagnoses associated with overactivation of LA

scapular depression

scapular IR with AT

scapular diagnoses associated with weakness of serratus

scapular depression

scapular IR with AT

scapular IR with insufficient UR

scapular diagnoses associated with short levator scap

scapular IR with AT

scapular IR with insufficient UR

scapular diagnoses associated with long rhomboids

scapular IR with abduction

humeral diagnoses associated with long subscapularis

humeral anterior glide

humeral diagnoses associated with shortness of deltoid

humeral superior glide

glenohumeral hypomobility

humeral diagnoses associated with short/stiff posterior capsule

humeral anterior glide

humeral superior glide

glenohumeral hypomobility

humeral diagnoses associated with inferior glide

humeral anterior glide

humeral diagnoses associated with weakness of infraspinatus and supraspinatus

humeral superior glide

humeral diagnoses associated with decreased acromial crease

humeral superior glide

glenohumeral hypomobility

humeral diagnoses associated with stiffness of infraspinatus and subscapularis

humeral superior glide

glenohumeral hypomobility (more likely short)

scapular depression with insufficient UR: movement impairment

acromion depresses in the first 90 of should flexion or abd

acromion does not begin to elevate after about 30 of arm elevation

acromion below C6-7 at end range

scapula depresses when a load is placed on the arm or during prone tests

often occurs with insufficient UR

scapular depression with insufficient UR: symptoms

pain in upper trap region

headaches associated with neck pain

scapular depression with insufficient UR: alignment

horizontal clavicles

long sloping shoulder

scapula lower than T2-7

vertebral border not parallel to spine

humerus in abduction relative to scapula

scapular depression with insufficient UR: muscle impairments

lengthened or weak upper trap and serratus anterior

excessive activation of lats and lower trap

insufficient activation of upper trap

scapular depression with insufficient UR: primary focus of intervention

patient education regarding alignment impairments and how to modify during daily activities

arm support

scapular depression with insufficient UR: cues

avoid depression

gradually lift shoulders

avoid elbow hyperextension

lift armpit

push into wall

what muscles internally rotate the scap

posterior delt

teres major

teres minor

infraspinatus

pec minor

scapular internal rotation can occur with

anterior tilt

abduction

insufficient UR

scapular IR with anterior tilt: movement impairments

(AC joint)

insufficient ER and posterior tilt by end range arm elevation

scapular IR and ant tilt on the RETURN from arm elevation

balance between serratus anterior and traps is key

scapular IR with insufficient UR: movement impairments

during flexion and abd

scapular IR with insufficient UR:symptoms

may have pain in the area of the rhomboid

rhomboids are key here!!!

too much IR and abd is caused by

traps not performing well, too long, or not as stiff as the IR and abd

serratus not balanced by traps

scapulohumeral muscles pulling harder than serratus and traps

too much anterior is caused by

serratus anterior and lower trap not performing well or not as stiff as muscles that anterior tilt

pec minor too stiff or short

insufficient UR is caused by

serratus anterior balanced by traps not performing well

scapular DR dominant too short or stiff

humeral head relative to the acromion

1/3 of the humeral head anterior to acromion

GH LR should be about _______ by the end of arm elevation

60 degrees

treatment based on the principal movement impairment should

reduce stress all involved tissues

humeral anterior glide syndrome: movement impairment

excessive or abnormal anterior motion of the humeral head during shoulder motions

humeral anterior glide syndrome: relative flexibility

the anterior joint capsule is more flexible than the posterior joint capsule or the lateral rotators

short/stiff posterior capsule can contribute to anterior glide

humeral anterior glide syndrome: key tests

shoulder abduction

shoulder LR

humeral anterior glide syndrome: muscle activation impairments

dominance of posterior deltoid over infraspinatus and teres minor

dominance of pec major over subscapularis

posterior springs are more stiff than the anterior springs

humeral superior glide syndrome: movement impairments

insufficient inferior glide or relative superior glide of the humeral head during arm motion

normally the rotator cuff offsets the superior force of the deltoid

humeral superior glide syndrome: history

pain in the GHJ worse with over head activity or reaching out to the side

unable to sleep on the affected side

contraction of deltoid, if not offset but the rotator cuff will result in

superior glide

humeral superior glide syndrome: alignment

decreased subacromial space

humerus in abd

scapula depressed or DR

acromion drops over humeral head

glenohumeral hypomobility: movement impairments

limited glenohumeral motion is all direction

scapular movement substitutes for GH movement

glenohumeral hypomobility: impairments in muscle activation, length and strength

shortness in the rotator cuff and capsule

compensatory upper trap activity for lack of GH motion