Shoulder Review

Straight Anatomy

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

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

300

Draw the brachial plexus :) 

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

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

Rotator Cuff Specific

100

Name the muscles in the rotator cuff

Subscapularis, infraspinatus, teres minor, supraspinatus

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

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

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

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

Biomechanics

100

Describe the arthrokinematics of GHJ flexion and extension

Flexion: Anterior roll, posterior glide

Extension: Posterior roll, anterior glide

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

300

Describe the arthrokinematics at the SC and AC joints during scapular upward rotation

SC: Elevation, posterior rotation

AC: Upward rotation

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

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

Jay

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

200

What is the cluster for subacromial pain syndrome? Demo the tests :)

(+) Hawkins-Kennedy, painful arc, and infraspinatus resisted test

300

What is the cluster for AC joint pathology? Demo the tests :) 

(+) Cross arm ADD, resisted extension and active compression

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

500

Demonstrate MMTs for deltoid (all parts), trapezius (all parts), rhomboids, latissimus dorsi and serratus anterior

I'm not writing this all out

Manny

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

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

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

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

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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