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KIN: Shoulder 1/2

QuestionAnswer
Is the AC joint capsule strong? No - needs reinforcement from ligaments
What are the AC joint ligaments? Coracoclavicular ligament Trapezoid ligament Conoid ligament
What plane does the trapezoid ligament lie in? Sagittal plane
What plane does the conoid ligament lie in? Conoid
What movement do the coracoclavicular ligaments prevent? Superior dislocation of the clavicle on the acromion
What is the coracoclavicular ligament's most critical role? Producing rotation of the clavicle necessary for full UE ROM
What are the ACJ ligaments reinforced by? Delt and trap fibers
What forces does the conoid primarily provide restraint against? Superior/inferior forces
What forces does the trapezoid primarily provide resistance against? Posterior translations along the clavicle
What are the motions of the ACJ? IR ER Anterior tipping Posterior tipping Upward rotation Downward rotation
GHJ sacrafices ________ for _________? Stability for mobility
Does the scapula lie in the frontal plane? No - scapular plane (scaption)
Which directions does the head of the humerus face in relation to the shaft of the humerus? Medially, superiorly, and posteriorly
What is the glenoid labrum? Accessory structure used to increase the surface area of the glenoid fossa
How is the glenoid labrum attached inferiorly and superiorly? Inferiorly - firmly attached Superiorly - loosely attached
What is the angle of inclination? Angle formed by the axis through the humeral head and longitudinal axis of the shaft of the humerus (130-150 degrees)
What is the angle of torsion? Angle that is formed by measuring axis through the humeral head and the axis through the humeral condyles (-30 degrees: posterior or retroversion)
What is a Bankhart lesion? Inferior lesion of the labrum
In the resting position, where is the GHJ taut and where is it slack? Taut - superiorly Slack - anteriorly and inferiorly
Where is the GHJ capsule and ligaments weakest? Inferiorly
What would be a closed packed position of the GHJ? Abduction and ER
What are the ligaments of the GHJ? Coracohumeral ligament GH ligaments (Superior, middle, inferior)
When are all of the GHJ ligaments tight? ER of humerus Motions involving anterior glide of humeral head
Between which GH ligaments is the most weakness and what is this area called? Superior and middle GH ligament Foramen of Weibrecht
What is significant about the Foramen of Weighbrecht? Common site of extrusion of humeral head with anterior dislocation of shoulder
What is the Foramen of Weighbrecht reinforced anteriorly by? Subscapularis tendon
What is Rotator Interval Capsule? Space between the supraspinatus and subscapularis
Where are the superior GH ligaments the least stable? O degrees
At what angle does the middle GH ligament contribute to anterior stability the most? 45 degrees abduction
Where is the inferior GH ligament most stable? Abduction greater that 45 degrees
When the arm is abducted greater than 45 degrees and ER what is the inferior GH ligament working to restrict? Anterior motion
When the arm is abducted greater than 45 degrees and IR what is the inferior GH ligament working to restrict? Posterior motion
Where do the coracohumeral ligaments run? Originate on lateral coracoid process and blend with superior capsule and supraspinatus tendon to insert on anterior side of greater tuberosity
What do the coracohumeral ligaments restrict? ER Flexion Extension
What acts as the passive support for UE against gravity? Coracohumeral ligaments
In what direction do the coracohumeral ligaments resist displacement Inferiorly
What is another name for the coracoacromial arch? Suprahumeral arch
What does the coracoacromial arch prevent? Superior dislocation
What is the problem with the coracoacromial arch? Irritates the RTC a lot since there is such a small space
What makes up the coracoacromial arch? Coracoacromial ligament and acromion process of scapula
In healthy adults, how much space exists between the undersurface of the arch and the humeral head? 1 cm
Do you have more IR/ER with the arm at 0 degrees or at 90 degrees? 90 degrees
Why do you not have as much abduction when the humerus is IR? Impingement on the greater tubercle (can't pass under or behind the acromion)
What does full shoulder abduction require? Simultaneous 60 degrees of upward rotation of the scapula
Approximately what degrees is scaption? 45 degrees horizontal abduction
What are the arthrokinematics of the GHJ? Roll and slide in the opposite direction
What does abduction of the shoulder WITHOUT a concurrent inferior slide cause? Humeral impingement against acromion
What are the prime movers during abduction? Anterior and middle delt, supraspinatus
What are the prime movers during flexion? Anterior delt, coracobrachialis, long head of biceps
What muscle in the shoulder is almost always active? Supraspinatus
Where is the painful arc usually seen and why? 60-120 degrees abduction Because this is where MA is the largest (90 degrees) and RTC is working the hardest
Does the supraspinatus have a large or small MA and what does this mean? Large - can be a strong abductor
What ligament does the biceps tendon slide through? Transverse humeral ligament
What is the approximate scapulohumeral rhythm ratio? 2:1 (GH:scap)
What muscles produce upward rotary force on the scapula during Phase one of scapulohumeral rhythm? Trap and portions of SA
What is the clavicle responsible for during phase one of scapulohumeral rhythm? Gets elevated and carries scapula through 30 degrees of upward rotation
Is there any upward rotation of the ACJ during phase one of scapulohumeral rhythm? NO
What ligament permits some tipping and winging of the scapula during phase one of the scapulohumeral rhythm? Coracoclavicular
What happens in phase one of scapulohumeral rhythm when the CC ligament becomes taugh and clavicular elevation ends? Scapula with have to upwardly rotate 30 degrees
What is the total motion at the end of phase on of scapulohumeral rhythm? (90 degrees) - 60 degrees GH + 30 degrees ST
Describe phase one of scapulohumeral rhythm Elevation of clavicle at SCJ swings the scapula through an arc of motion that has an axis at the base of the spine of the scapula
Where is the axis of rotation in phase one of scapulohumeral rhythm? Medial
What is the action of traps and SA during phase two of scapulohumeral rhythm? What is this restricted by? Continue to upwardly rotate scap Conoid and trapezoid ligaments
What axis does the clavicle rotate along during phase two of scapulohumeral rhythm? longitudinal
Where do the coracohumeral ligaments run? Originate on lateral coracoid process and blend with superior capsule and supraspinatus tendon to insert on anterior side of greater tuberosity
What do the coracohumeral ligaments restrict? ER Flexion Extension
What acts as the passive support for UE against gravity? Coracohumeral ligaments
In what direction do the coracohumeral ligaments resist displacement Inferiorly
What is another name for the coracoacromial arch? Suprahumeral arch
What does the coracoacromial arch prevent? Superior dislocation
What is the problem with the coracoacromial arch? Irritates the RTC a lot since there is such a small space
What makes up the coracoacromial arch? Coracoacromial ligament and acromion process of scapula
In healthy adults, how much space exists between the undersurface of the arch and the humeral head? 1 cm
Do you have more IR/ER with the arm at 0 degrees or at 90 degrees? 90 degrees
Why do you not have as much abduction when the humerus is IR? Impingement on the greater tubercle (can't pass under or behind the acromion)
What does full shoulder abduction require? Simultaneous 60 degrees of upward rotation of the scapula
Approximately what degrees is scaption? 45 degrees horizontal abduction
What are the arthrokinematics of the GHJ? Roll and slide in the opposite direction
What does abduction of the shoulder WITHOUT a concurrent inferior slide cause? Humeral impingement against acromion
What are the prime movers during abduction? Anterior and middle delt, supraspinatus
What are the prime movers during flexion? Anterior delt, coracobrachialis, long head of biceps
What muscle in the shoulder is almost always active? Supraspinatus
Where is the painful arc usually seen and why? 60-120 degrees abduction Because this is where MA is the largest (90 degrees) and RTC is working the hardest
Does the supraspinatus have a large or small MA and what does this mean? Large - can be a strong abductor
What ligament does the biceps tendon slide through? Transverse humeral ligament
What is the approximate scapulohumeral rhythm ratio? 2:1 (GH:scap)
What muscles produce upward rotary force on the scapula during Phase one of scapulohumeral rhythm? Trap and portions of SA
What is the clavicle responsible for during phase one of scapulohumeral rhythm? Gets elevated and carries scapula through 30 degrees of upward rotation
Is there any upward rotation of the ACJ during phase one of scapulohumeral rhythm? NO
What ligament permits some tipping and winging of the scapula during phase one of the scapulohumeral rhythm? Coracoclavicular
What happens in phase one of scapulohumeral rhythm when the CC ligament becomes taugh and clavicular elevation ends? Scapula with have to upwardly rotate 30 degrees
What is the total motion at the end of phase on of scapulohumeral rhythm? (90 degrees) - 60 degrees GH + 30 degrees ST
Describe phase one of scapulohumeral rhythm Elevation of clavicle at SCJ swings the scapula through an arc of motion that has an axis at the base of the spine of the scapula
Where is the axis of rotation in phase one of scapulohumeral rhythm? Medial
What is the action of traps and SA during phase two of scapulohumeral rhythm? What is this restricted by? Continue to upwardly rotate scap Conoid and trapezoid ligaments
What axis does the clavicle rotate along during phase two of scapulohumeral rhythm? longitudinal
What does clavicular rotation eventually cause during phase two of scapulohumeral rhythm? Will cause crank shaped clavicle to flip over lateral end superior
What happens in phase two of scapulohumeral rhythm after the clavicle flips over? Scap is then carried through 30 more degrees of upward rotation around an AP axis through ACJ which undergoes tipping and winging
What is the axis of rotation during phase two of scapulohumeral rhythm? Lateral on spine of scap
What action does the delt have on the humerus with arm at side? Primarily superior translatory pull
When humerus elevates what action does delt have on humerus? Compression
What is deltoid activity dependent on? Functioning RTC
With a RTC, is the pain an inhibitor or a facilitator? Inhibitor
If the scapula is not upwardly rotating what will the middle and posterior fibers of the delt do? Act to downwardly rotate scapula
If you have paralyzed delt can you get full abduction of GHJ? Yes, but torque is reduced
If you have a paralyzed supraspinatus can you get full abduction of GHJ? Often difficult or impossible due to altered arthrokinematics
Is activity of the infraspinatus, teres minor and subscapular greater in flexion or abduction? Flexion
Does the trap rise more linearly during abduction or flexion? Why? Abduction because it sits more in the frontal plane and muscles tend to work better in the plane they are in
Does the SA rise more linearly during abduction or flexion? Why? Flexion because it sits more in the sagittal plane
When, during abduction, does the upper trap start to fire? Pretty much right away
When, during abduction, does the lower trap start to fire? Not until about 150 degrees
What are the actions of the lats? Adduction IR Extension Adducts and depresses scap
What are the actions of lats in a CKC? Pull caudal attachment superior toward cephalad attachment on scap unweighting body
Action of clavicular part of pec major? Flexion
Action of teres major and rhomboids Adduct IR Extension
What would an unopposed teres major do? Upwardly rotate scapula
What are the rhomboids responsible for? Downward rotation of scapula
What are the IR of shoulder complex? Subscapularis Anterior deltoid Pectoralis major Lats Teres major
Which is stronger: IR or ER? IR
What are the ER of the shoulder complex? Infraspinatus Teres minor Posterior deltoid
What are the ER of arm very important for? Decelerating IR of arm during throwing motion
What is a progression of impingement? RTC problems
What are AC injuries caused by? Overuse
What are SC injuries caused by? Instability, subluxation
What is another name for adhesive capsulitis? Frozen shoulder
Created by: 1185240090