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57 Cards in this Set
- Front
- Back
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explain the actual connections of the scapulothoracic joint
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not a true anatomical joint, but an interface where ventral surface of scap slides on convex thoracic cage
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what is the movement of the upper extremity dependent on
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the scapula being stabilized on the thorax by the musculature joining the scapula to the thoracic cage (serratus anterior)
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the scap can be thought of as the ____ of the UE
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anchor for the UE
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what is the role of the scap
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dual: mobility and stability
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what are the dysfunctions of the scap/thoracic joint
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any number of muscle dysfunctions including: atrophy, hypertrophy, muscle imbalance, abnormal muscle tone
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what are the S and S of dysfunction of scap/thoracic joint
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1) pain of the posterior shoulder region
2) impingement of the RC 3) abnormal scapulohumeral rhythm |
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what is the treatment for scap/thoracic joint dysfunction
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based on findings of examination: ROM, Strengthening, posture reeducation, movement reeducation, and fux the scapular movement to decrease pain in GH
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what are the 4 basic elements to consider when discussing the scap/thoracic joint
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1) consider action of each muscle that attaches to the scap (and their upward and downward rotatory roles)
2) proper scapular position is one of relative adduction and depression (prayer stretch) 3) proper scapular position in sitting starts with proper seat height and lumbar position 4) proper position, movmemnt, and control of the scap is needed for proper glenohumeral motion |
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what is resting position for the GH joint
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55 degrees ABD and 35 degrees horizontal ADD
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what is the close packed position for the GH
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full abduction and ER
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what is the capsular pattern for GH
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ER, ABD, IR
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what is the arthrology of the GH
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synovial joint between the large convex humreal head and small concave glenoid fossa
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the design of the GH favors ____ and the expense of ____
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favors movement at the expense of stability
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what are the passive stabilizers of the GH joint
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1) Bony (labrum) congruency
(poor) 2) gh ligaments (only provide stability at end of range of motion 3) negative joint pressure (small contribution) 4) upwared orientation of the glenoid (small contribution) |
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what are the active stabilizers of the GH
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muscles!!!! rotator cuffs--- mid and end range stability
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what are the two most common orthopedic problems associated with the GH joint
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1) rotator cuff injuries
2) GH instability/dislocation |
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wha tare hte rotator cup muscles
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supraspinatus, terries minor, infraspinatus, subscapularis, long head of biceps
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what is the action of the supraspinatus
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abduction and ER
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what is the action of the infraspinatus
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horizontal abduction and ER
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what is the action of the teres minor
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horizontal abduction and ER
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what is the action of the subscap
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IR
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what is the action of the long head of the biceps
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forward flexion
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what is the #1 role of the rotatot cuff muscles
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primary mover (concentric action)
ER: infraspinatus, teres minor, supraspinatus IR: subscap Abduction: supraspinatus Flexion: long head of biceps |
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what is the #2 role of the rotator cuff muscles
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control (deceleration) of movement (eccentric action)
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give an example of the importance of the RC muscles in decelerating movement through eccentric action
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max velocity for IR of the shoulder in a professional pitcher is >7000degrees/sec which must be stpped in a very small amount of time by the External rotators
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what is the #3 role of the rotator cuff muscles
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humeral head depressor
- RC counteracts the deltoid action which can cause an upward migration of the humerus |
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what is the #4 role of the RC
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dynamic stabilizer of the GH joint
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how is dynamic stability achieved at the GH joint (by RC muscles)
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by creating compressive forces across the GH joint --> keeps head of humerus in the center of the glenoid fossa during movement so it doesnt "slip" or "distract"
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what is the #4 role of the RC
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dynamic stabilizer of the GH joint
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the dynamic stability of the GH by the RC requires resisting extreme forces of .....
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distraction and shear (as in throwers)
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how is dynamic stability achieved at the GH joint (by RC muscles)
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by creating compressive forces across the GH joint --> keeps head of humerus in the center of the glenoid fossa during movement so it doesnt "slip" or "distract"
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describe the forces in throwing
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anterior shear force of humeral head on glenoid at extreme of cocking phase = 40% BW
Distractino force of GHJ during follow-through is 80% BW (in prof. pitchers) |
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the dynamic stability of the GH by the RC requires resisting extreme forces of .....
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distraction and shear (as in throwers)
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what are the two inherent problems of the RC
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impingement syndrome and tension overload of the RC
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describe the forces in throwing
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anterior shear force of humeral head on glenoid at extreme of cocking phase = 40% BW
Distractino force of GHJ during follow-through is 80% BW (in prof. pitchers) |
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explain RC involvement in impingement syndrome
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RC located in subacromial space and can therefore be impinged between acromion/coracoacromial arch and greater tuberosity
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what are the two inherent problems of the RC
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impingement syndrome and tension overload of the RC
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what leads to tension overload of the RC
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the GH joint is relatively unstable and relies heavily on dynamic stabilizers for its stability
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explain RC involvement in impingement syndrome
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RC located in subacromial space and can therefore be impinged between acromion/coracoacromial arch and greater tuberosity
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where does the supraspinatus become impinged
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between the greater tubercle and undersurface of the acromion and coracoacromial ligament
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what leads to tension overload of the RC
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the GH joint is relatively unstable and relies heavily on dynamic stabilizers for its stability
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when is supraspinatus impingement especially detrimental
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where there is repetitive overhead movement of the shoulder
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where does the supraspinatus become impinged
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between the greater tubercle and undersurface of the acromion and coracoacromial ligament
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what are the borders of the "canal" that the supraspinatus runs through
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posteior = spine of scap
anterior = coracoid process superior = coracoacromial lig. and acromion |
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when is supraspinatus impingement especially detrimental
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where there is repetitive overhead movement of the shoulder
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what are the borders of the "canal" that the supraspinatus runs through
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posteior = spine of scap
anterior = coracoid process superior = coracoacromial lig. and acromion |
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what action is the most liekly to impinge the supraspinatus
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abduction performed while the humerus is internally rotated
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any disfunction in the RC role in what two motions will cause impingement
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initiation of Abduction and downward displacement of the humeral head`
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what are the three anatomical predisposing factors leading to rotator cuff tear/impingement
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1) anatomical configuration of the region
2) abnormal shape of the acromion 3) realative avascular area exits in the RC |
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what are the 3 different types of acromions that have been defined
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1: flat acromion
2: curved acromion 3: hooked acromion |
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what type of acromion has been shown to have the greatest incidence of tendinitis and RC tears
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hooked acromion (note: conservative treatment is less effective!)
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when is a radiograph for the acrmioin indicated
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when conservative treatment is not resulting in improvement of the condition- to determine the shape of the acromion --- most likely a hooked acromion because least likely to respond to conservative tx
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what is the critical zone
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area where avascular area and area of impingement are located
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what physiological changes are caused by the avascularity
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1)the tendon of the RC has tendency to degenerate over time
2)decreased potential for healing |
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where is the most impaired vascular supply in the RC
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supraspinatus and subscap when they are activated (creating tension) and weight of arm causes traction on tendons
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what occurs when the shoulder is held adducted along our side
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passive traction in the tendon --> ischemic region (note active tension can do this too)
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what do we recommend to prevent the ischemia due to arm adducted to our side
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hand in pocket--- slightly abducts the arm and decreases the tension on the tendons
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