AT Chapter 22

Identify a true statement about the second group of muscles acting on the glenohumeral joint.

They include the coracobrachialis.

Identify a true statement about the first group of muscles acting on the glenohumeral joint.

They originate on the axial skeleton.

True or false: A fracture of the lesser tuberosity may occur as the subscapularis tendon avulses its attachment in posterior glenohumeral dislocation.

True

True or false: Older individuals may not require surgical repair in case of biceps brachii rupture because the brachialis muscle is the primary flexor of the elbow joint.

True

True or false: With all grades of acromioclavicular sprain, an aggressive rehabilitation program involving joint mobilization, flexibility exercises, and strengthening exercises should begin immediately after the recommended period of protection.

True

The coracoclavicular ligament helps maintain the position of the clavicle relative to the _____.

acromion

Susanna is a gymnast. While practicing a spinning move, she loses balance and injures her right shoulder. She experiences moderate pain and disability and is unable to touch the left shoulder with her right hand. She carries her right arm in external rotation and slight abduction. In this scenario, Susanna has _____.

an anterior glenohumeral dislocation

In the context of the humerus, the _____ is the attachment for the articular capsule of the glenohumeral joint.

anatomical neck

Ken injures his shoulder while playing soccer. He visits Selina, a physiotherapist. Before beginning the therapy, she checks Ken's clavicular shaft. She also examines the contour of his deltoid muscle. In this scenario, the method of assessment implemented by Selina is referred to as a(n) _____ observation.

anterior

Recurrent _____ instability may cause the athlete who throws to complain of pain or clicking or to experience what is described as a dead arm syndrome in the cocking phase of the overhead throwing motion.

anterior

In a(n) _____ dislocation, the head of the humerus is forced out of its articular capsule in an anterior direction past the glenoid labrum and then downward to rest under the coracoid process.

anterior/inferior glenohumeral

The scapular muscles attach the _____.

axial skeleton to the scapula

In the context of the humerus, the _____ lies between the two tubercles and retains the long tendon of the biceps brachii muscle.

bicipital groove

The biceps brachii rupture commonly occurs near the origin of the muscle in the _____.

bicipital groove

The spinal nerve roots from the fifth cervical vertebra through the first thoracic vertebra to create the complex nerve network called the ______ ______.

brachial plexus

Thoracic outlet compression syndromes involve compression of the _____.

brachial plexus

In the context of the sternoclavicular joint, the articular disk is placed so that the _____.

clavicle moves on the disk

The subacromial bursa is easily subjected to trauma when the humerus is in the overhead position because it becomes compressed under the _____.

coracoacromial arch

The _____ ligament joins the coracoid process and the clavicle.

coracoclavicular

In the context of the phases of throwing or pitching relative to the shoulder complex, the external rotators of the rotator cuff contract eccentrically in the _____ phase.

deceleration

The anterior glenohumeral ligament's greatest tension is in _____.

extension with external rotation

A _____ separates the two articulating surfaces of the acromioclavicular joint.

fibrocartilaginous disk

The middle glenohumeral ligament is in greatest tension when in _____.

flexion and external rotation

The most common mechanism in an anterior/inferior glenohumeral dislocation is _____.

forced abduction

With _____, there is excessive translation of the humeral head without complete separation of the joint surfaces.

glenohumeral subluxations

During initial inspection, shoulder pointers may be mistaken for a _____.

grade 1 acromioclavicular sprain

During the management of the sternoclavicular sprain, _____ is usually maintained for 3 to 5 weeks, followed by graded reconditioning exercises.

immobilization

Winging of the superior medial border of the scapula is likely due to _____.

impingement

A characteristic of the sternum is that it _____.

is a site of attachment for the ribs via costal cartilage

A characteristic of the recurrent anterior instability of the shoulder joint is that it may _____.

lead to a positive apprehension test

In the context of the shoulder complex, a soft tissue that is palpated posteriorly for determining pain sites and deformities is the _____.

levator scapulae

In the context of the causes of shoulder instabilities, increased laxity of the supportive capsular and tendinous structures leads to _____.

more instability

A feature of the subclavian artery is that it _____.

moves downward laterally behind the clavicle

Myositis ossificans is a condition in which calcifications, or bone fragments, occur in a(n) _____ adjacent to bone.

muscle

Repeated contusions to the lateral aspect of the upper arm can lead to _____.

myositis ossificans

In the context of functional progressions related to rehabilitation of the shoulder complex, strengthening activities should make use of the diagonal 2 upper-extremity proprioceptive neuromuscular facilitation pattern, which closely resembles _____ motions.

overhead throwing

Shoulder pointers cause a bone bruise and subsequent irritation to the _____.

periosteum

The _____ nerves stem from the brachial plexus and innervate the muscles of the upper extremity.

peripheral

Dan, a construction worker, injures his shoulder while working at a construction site. As soon as he is rushed to the hospital, a physician checks if his scapula is protracted. The physician also examines whether Dan has developed a distracted, or winged, scapula on either of his shoulders. In this scenario, the physician has implemented a(n) _____ observation to identify Dan's injury.

posterior

Sarah, a therapist, examines an athlete's injured shoulder. She checks the symmetry of the athlete's shoulder as well as the evenness of his scapulae. She also notes the normality of the athlete's scapulohumeral rhythm. In this scenario, Sarah implements a(n) _____ observation.

posterior

Jim falls from bicycle and lands on his left shoulder. After the injury, he is unable to externally rotate and elevate his left arm. X-ray of the shoulder reveals that the anterior deltoid muscle is flattened and the acromion and coracoid processes are prominent. These are symptoms of _____.

posterior glenohumeral dislocation

Management of stages I and II of shoulder impingement involves _____.

restoring normal biomechanics

In the context of posterior glenohumeral dislocation, a _____ defect can occur on the anteromedial portion of the humeral head following a posterior shoulder dislocation.

reverse Hill-Sachs lesion

The pathological process of a sprain to the glenohumeral joint often involves the _____ muscles.

rotator cuff

In the context of the muscles that produce movement of the scapula on the thorax, the _____ both abducts and upwardly rotates the scapula.

serratus anterior

A soccer player falls on the tip of his shoulder while tackling the ball. He experiences excruciating pain when he tries to move his shoulder. The pain enhances when he attempts to flex, adduct, or internally rotate his arm. He complains of tenderness in the affected area when the physician palpates the subacromial space. The impingement test conducted on him exhibits a positive result. In this scenario, the player probably has _____.

shoulder bursitis

During a baseball tournament, a player accidentally hits Paul's left shoulder. He is immediately rushed to the hospital where the physician conducts several preliminary tests on him. He has pain when he is asked to flex, adduct, and internally rotate his arms. He experiences tenderness when the physician palpates the subacromial space. Moreover, the impingement test exhibits a positive result. In this scenario, Paul has _____.

shoulder bursitis

A part of the shoulder complex, also referred to as the breastbone, is the _____.

sternum

A soft tissue of the shoulder complex that is palpated anteriorly for determining pain sites and deformities is the _____.

subacromial bursa

The _____ is located between the coracoacromial arch and the glenohumeral capsule.

subacromial bursa

A true statement about the clavicle is that it _____.

supports the anterior portion of the shoulder

In the context of the muscles of the rotator cuff, the _____ compresses the humeral head into the glenoid.

supraspinatus

The subacromial bursa is reinforced by the _____.

supraspinous tendon

A patient who wants to continue activity during stages III and IV of shoulder impingement may require _____.

surgical intervention

During the anterior observation of an injury to the shoulder complex, a therapist would check if _____.

the lateral end of the clavicle is prominent

A feature of the sternoclavicular joint is that it is _____.

the only direct connection between the upper extremity and the trunk

Leo is an athletic trainer. During a match, an athlete falls on her outstretched arm and sustains an injury. Leo can positively assert that the injured athlete has a clavicular fracture if she _____.

tilts her head toward the injured side

The scapular muscles include the _____.

trapezius

Winging of the entire medial border of the scapula at rest is caused by fatigue of the _____.

trapezius

Rhea, a basketball player, falls on the tip of her right shoulder and fractures her clavicle. In this scenario, she will _____.

turn her chin toward her left side

Identify the subacute and chronic conditions that result due to any traumatic injury to the shoulder joint. (Check all that apply.)

-Bursitis -Synovitis

Identify the parts that have to be surgically removed if conservative treatment for thoracic outlet compression syndromes fails. (Check all that apply.)

-The first rib -The anterior scalene muscle

Identify the functions of the muscles of the rotator cuff in the shoulder complex. (Check all that apply.)

-They provide dynamic stability. -They control position.

Match the grades of sprain (in the left column) to their characteristics (in the right column). Instructions

1. Grade 1 sprain - Little pain and disability, with some point tenderness but no joint deformity 2. Grade 2 sprain - Subluxation of the sternoclavicular joint with visible deformity, pain, swelling, and point tenderness 3. Grade 3 sprain - Complete dislocation with gross displacement of the clavicle at its sternal junction, swelling, and disability

Match the main ligaments of the sternoclavicular joint (in the left column) to their roles (in the right column). Instructions

1. The anterior sternoclavicular ligament - It prevents upward displacement of the clavicle. 2. The interclavicular ligament - It prevents lateral displacement of the clavicle. 3. The costoclavicular ligament - It prevents lateral and upward displacement of the clavicle.

Match the types of muscles (in the left column) to their roles in the movement of the scapula (in the right column). Instructions

1. The levator scapulae and upper trapezius - Elevate the scapula 2. The middle trapezius and rhomboids - Adduct the scapula 3. The lower trapezius - Adducts and depresses the scapula

Match the phases of throwing or pitching relative to the shoulder complex (in the left column) with their descriptions (in the right column). Instructions

1. The windup phase - This phase lasts from the first movement until the ball leaves the gloved opposite hand. 2. The cocking phase - This phase begins when the hands separate and ends when maximum external rotation of the humerus has occurred. 3. The acceleration phase - This phase lasts from maximum external rotation until ball release. 4. The deceleration phase -This phase lasts from ball release until maximum shoulder internal rotation. 5. The follow-through phase - This phase lasts from maximum shoulder internal rotation until the end of the motion, when an athlete is in a balanced position.

Match the episodes of shoulder instabilities (in the left column) to their causes (in the right column). Instructions

1. Traumatic episodes - They occur from one or more situations that cause a complete or partial joint displacement. 2. Atraumatic episodes - They occur in patients who voluntarily or involuntarily displace the shoulder joint because of inherent ligamentous laxity. 3. Microtraumatic episodes - They are created by repetitive use of the shoulder, usually involving some faulty biomechanics, that leads to soft-tissue laxity.

After the setting phase of the scapulohumeral rhythm, there is a _____ ratio of glenohumeral to scapulothoracic movement.

2:1

A grade 1 acromioclavicular sprain requires use of a sling for _____.

3 or 4 days

Where does the subclavian artery become the axillary artery?

At the outer border of the first rib

True or false: Functional progressions usually incorporate some activity-specific skill that excludes overhead motions.

False

True or false: In the context of the trauma resulting in a sprain to the sternoclavicular joint, the complete rupture of the sternoclavicular and costoclavicular ligaments is a characteristic of grade 2 stage.

False

True or false: The posterior sternoclavicular ligament prevents lateral displacement of the clavicle.

False

How is the clavicle shaped?

It is a slender, S-shaped bone.

What should be done immediately after a sternoclavicular sprain?

POLICE should be used.

______ rhythm describes the movement of the scapula relative to the movement of the humerus throughout a full range of abduction.

Scapulohumeral

_____ is a brief, transient occurrence in which the humeral head quickly returns to its normal position relative to the glenoid.

Subluxation

Which of the following joints is a gliding articulation of the lateral end of the clavicle with the acromion process?

The acromioclavicular joint