Straight Anatomy
Rotator Cuff Specific
Biomechanics
Jay
Manny
100
What joints make up the shoulder and what bones articulate in each joint?
Glenohumeral joint: Humerus, scapula
Scapulothoracic joint: Functional joint between scapula and thorax
Acromioclavicular joint: Scapula, clavicle
Sternoclavicular joint: Sternum, clavicle
100
Name the muscles in the rotator cuff
Subscapularis, infraspinatus, teres minor, supraspinatus
100
Describe the arthrokinematics of GHJ flexion and extension
Flexion: Anterior roll, posterior glide
Extension: Posterior roll, anterior glide
100
Demonstrate shoulder flexion/extension goniometry
Flexion: Patient supine with knees flexed
- Fulcrum: Over lateral aspect of greater tubercle
- Proximal arm: Parallel to midaxillary line of trunk
- Distal arm: Align with the lateral midline of the humerus
Extension: Patient prone with face turned away from involved shoulder
- Fulcrum: Lateral aspect of greater tubercle
- Proximal arm: Parallel to midaxillary line of trunk
- Distal arm: Align with lateral midline of humerus
100
What are the ICF classifications for the shoulder?
1. Shoulder pain with radiating pain
2. Shoulder pain with mobility deficits
3. Shoulder pain with muscle power deficits
4. Shoulder pain with movement coordination impairments
200
Describe the structure and function of the glenoid labrum
Structure: Fibrocartilage, thinner in the middle and thicker peripherally, variations in size/thickness/morphology, larger superior > inferior
Function: Deepens the socket, attachment site for GHLs and LHBT, provides lubrication of the joint, provides proprioceptive input to the CNS
200
Name the actions of each rotator cuff muscle
Supraspinatus: ABD, stabilize GHJ
Teres minor: ER, stabilize GHJ
Infraspinatus: ER, stabilize GHJ
Subscapularis: IR, stabilize GHJ
200
Describe the arthrokinematics for GHJ ABD, ADD, ER and IR
ABD: Superior roll, inferior glide
ADD: Inferior roll, superior glide
ER: Posterior roll, anterior glide
IR: Anterior roll, posterior glide
200
What is the cluster for subacromial pain syndrome? Demo the tests :)
(+) Hawkins-Kennedy, painful arc, and infraspinatus resisted test
200
Demonstrate a first rib mobilization and teach your patient how to self-mobilize this at home
Patient sitting with ipsilateral arm on your leg and head side bent ipsilateral. Aim your force towards their contralateral hip. Self-mob with a tennis ball in a towel.
300
Draw the brachial plexus :)
300
What is the cluster for rotator cuff pathology? (there's a few just name 1)
1. (+) Painful arc, drop arm and infraspinatus resisted test
2. (+) Painful arc, drop arm, infraspinatus resisted test and age ≥ 60
3. Age > 65, weak ER and night pain
300
Describe the arthrokinematics at the SC and AC joints during scapular upward rotation
SC: Elevation, posterior rotation
AC: Upward rotation
300
What is the cluster for AC joint pathology? Demo the tests :)
(+) Cross arm ADD, resisted extension and active compression
300
Name 2 early and late phase interventions that you could give a patient to increase shoulder mobility and demo :)
Early: Pendulums, PROM, STM
Late: Cane AAROM, pulleys, AROM, stretching, STM
400
Describe the functions of the superior, middle, and inferior glenohumeral ligaments
Superior: Limits ER and inferior translation of the humeral head at 0 degrees GHJ ABD
Middle: Limits ER and anterior translation of the humeral head at 45 degrees GHJ ABD
Inferior: Limits ER and superior/anterior translation of the humeral head (anterior portion) at 90 degrees GHJ ABD/ER; limits IR and anterior translation of the humeral head (posterior portion) at 90 degrees GHJ ABD/IR
400
Demonstrate MMTs for the rotator cuff muscles
Supraspinatus: Standing, 20 degrees scaption, resist elevation
Subscapularis: Prone, arm in 90/90 with towel roll, resist IR
Infraspinatus/teres minor: Prone, arm in 90/90 with towel roll, resist ER
400
Describe the arthrokinematics at the GH, AC, SC, and ST joints during arm depression
GHJ: Posterior roll, anterior glide
AC: Downward rotation
SC: Elevation
ST: Downward rotation, posterior tilt
400
Demonstrate 2 special tests that can be used to confirm that a pt has limited scapular mobility or scapular dyskinesia that's causing pain
Scapular assistance: Assist posterior tilt and upward rotation while they move in scaption; (+) = pain relief
Scapular reposition: Grab on the front of AC joint, posteriorly tilt and ADD the scapula and have them repeat the painful motion; (+) = pain relief
400
What are the stages of subacromial pain syndrome?
Stage I- acute inflammation (tendinitis/bursitis)
Stage II- degeneration (tendinosis)
Stage III- rupture and arthritis (RCT)
500
Name the scapulothoracic, thoracohumeral, and scapulohumeral muscles
Scapulothoracic: Trapezius, rhomboids, serratus anterior, levator scapulae
Thoracohumeral: Pectoralis major, latissimus dorsi, teres major
Scapulohumeral: Supraspinatus, infraspinatus, teres minor, teres major, subscapularis, deltoid, coracobrachialis
500
What are the origins and insertions of the rotator cuff muscles?
Subscapularis: Subscapular fossa --> lesser tubercle
Supraspinatus: Supraspinous fossa --> superior greater tubercle
Infraspinatus: Infraspinous fossa --> posterior greater tubercle
Teres minor: Upper posterior scapula --> posterior greater tubercle
500
Describe the arthrokinematics at the GH, SC, AC, and ST joints during arm elevation
GHJ: Anterior roll, posterior glide
SC: Posterior rotation and elevation
AC: Upward rotation
ST: Upward rotation, posterior tilt
500
Demonstrate MMTs for deltoid (all parts), trapezius (all parts), rhomboids, latissimus dorsi and serratus anterior
I'm not writing this all out
500
Observe someone's scapular mobility and make corrections if there is pain, coordination impairments, or you see something you just don't like
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