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