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Shoulder - Coggle Diagram

- - - - Link between axial and appendicular
        skeleton
  - - - Convex medially
        • Concave laterally
    - - the axis thru the length of the bone thats oriented ~ 20° posterior to frontal plane
    - - 1st rib
    - - Convex laterally
        • Concave medially
  - - - what angles does it have (3)
        
        superior, inferior, lateral
        
        where is the lateral angle
        
        on the anterior surface next to the glenoid cavity and the coracoid process
        
        where is the coracoid process
        
        over the glenoid fossa (cavity)
      - what does the spine seperate
        
        superior and inferior fossas which holds supraspinatus and infraspinatus
    - - Upward and Downward Rotation
      - Anterior and Posterior Tilt
      - Internal and External Rotation
- - - - SC, AC, ST, GH joints
    - - flexion
        
        ~180 °
        
        when is it less
        
        if humerus is ER
        
        approximate flexion ROM c max ER
        
        ~ 30 °
      - hyperextension
        
        ~ 60°
    - - abduction
        
        ~180°
        
        when is it less
        
        if humerus is IR
        
        approximate abduction ROM c max ER
        
        ~ 60°
      - hyperadduction
        
        ~ 75°
        
        what occurs
        
        Arm adducts past anatomical position
    - - Total rotation (ER & IR)
        
        ER
        
        ~ 90°
        
        IR
        
        ~ 90°
        
        ROM at anatomical position
        
        ~ 180°
        
        ROM at 90 degree abduction
        
        ~ 90°
        
        why is this lower than in anatomical position
        
        bc rotation is limited in abduction
        
        is IR or ER force capacity greater
        
        IR
      - horizontal flexion or adduction
        
        ~ 135°
        
        Horizontal adduction increases the activity of which 2 mm.
        
        pec major and anterior deltoid
      - horizontal extension or abduction
        
        ~ 45°
        
        Horizontal abduction increases the activity of which 3 mm.
        
        infraspinatus, teres minor, and posterior deltoid
      - is horizontal adduction or abduction considered a planar motion
        
        no
  - - - ligaments and many supporting mm. are tight or loose
        
        Loose
      - what occurs with arm ER
        
        capsule tightens
      - what occurs with arm IR
        
        does not tighten capsule when shoulder in anatomical position
      - Inferior GH joint capsule
        
        Loose
        
        why is this
        
        to allow for full ABD and ER
    - - joint becomes more stable
        
        why
        
        2° tension from subscapularis and lower glenohumeral ligament
    - - Supraspinatus, Infraspinatus, and Teres minor
        
        what do they do to provide stability
        
        Compress the humeral head into glenoid fossa
        
        does their stability increase or decrease after 90 degrees
        
        decrease
  - - - scapular & clavicular motions which accompany any normal elevation of the arm
        
        by what ratio does the scapula and humerus move
        
        1:2 ratio (1: humerus ; 2: scapula)
        
        how is the degree ratio divided when the arm is abd to 180 degrees
        
        120 degrees by rotation of humerus; 60 degrees by rotation of the scapula
        
        Scapular motion during elevation
        
        what does the scapula do @ initiation of arm elevation
        
        small movement either towards or away from spinal column
        
        why does this occur
        
        to help stabilize the scapula on thorax
        
        1 more item...
        
        when is this movement most evident (2)
        
        in the 1st 30° of abduction and 1st
        45-60° of flexion
        
        by which ratio does the GH and ST joints move in abd and flex
        
        2:1 ratio
        
        how is the ratio divided
        
        • ~ 120° comes from GH motion
        • ~ 60° comes from ST motion
        
        Contributing joint actions to total UE
        elevation (3, degrees right after)
        
        3 more items...
    - - Rotates posteriorly, elevates, and protracts
      - what 2 motions are considered elevation
        
        flex and abd
  - - - do they mostly stabilize or mobilize
        
        stabilize
      - where do they originate (3 areas)
        
        spine, ribs, or cranium
      - where do they attach
        
        at the scapula
      - 2 examples
        
        Trapezius, serratus anterior
    - - do they mostly stabilize or mobilize
        
        mobilize
      - where do they originate
        
        on the scapula
      - where do they attach
        
        at the humerus
      - 2 examples
        
        Deltoid, supraspinatus
    - - Elevation of scapula mm. (3)
        
        Upper trap, levator, and rhomboids
      - Depression of scapula mm. (4)
        
        lower trap, lats, pec minor, subclavius
      - Protraction of scapula m.
        
        serratus ant.
      - Retraction of scapula mm. (3)
        
        Rhomboids, middle trap, lower trap
    - - Elevator mm. (flexion and abd) (5)
        
        deltoid, supraspinatus, coracobracialis, biceps brachii (long head), remaining RC mm.
        
        how do the remaining rotator cuff mm. contribute to the elevation of GH joint
        
        indirectly by stabilizing the humeral head
        
        the RC mm. contribute approx how much % of force to shoulder flex or abd
        
        ~ 50%
        
        when is force production decreased
        
        1 more item...
        
        which muscle produces ~50% force for both motions
        
        deltoid
        
        when is it most active
        
        between 90-180°
        
        1 more item...
        
        when is it most fatigue resistant
        
        between 45-90°
        
        1 more item...
        
        what does the other 50% come from
        
        force provided by RC mm. from stabilizing joint
      - Adductors/Extensors mm. (7)
        
        lats, sternal head of pect major, teres major, triceps long head, post deltoid, infraspinatus, teres minor
        
        what are these motions also called (2)
        
        shoulder lowering or "De-elevation"
        
        when do these motions occur (4)
        
        when arm is forcefully lowered, lowered against resistance, or with hyperextension/ hyperadduction
        
        what do these events involve
        
        concentric muscular action
        
        2 real world examples
        
        1 more item...
        
        primary m. movers in concentric adduction or extension against resistance (3)
        
        3 more items...
        
        motions of the scapula during arm ext or add (3)
        
        retracts, depresses, and
        downwardly rotates
        
        what 2 things occur during this
        
        Rhomboid works in force couple with
        teres major and lat dorsi to control this motion
        
        what mm. help rhomboids retract the scapula during this (2)
        
        1 more item...
        
        Pec minor also depresses and
        downwardly rotates
      - IR mm. (5)
        
        subscapularis, anterior deltoid, pect major, lats, teres major
        
        teres major only helps with IR during what
        
        against resistance
      - ER mm. (4)
        
        infraspinatus, teres minor, posterior deltoid, supraspinatus (in some positions)
  - - - ADD > EXT > FLEX > ABD > IR > ER
        
        why is Greatest force possible during shoulder
        adduction (3)
        
        contribution of l dorsi, teres major, and pec
        major
        
        theres about how much more strength in add than abd
        
        2x (why is this ironic)
        
        bc abd is used much more
        
        why is there more force in ext than flex (3)
        
        relies heavily upon lats dorsi,
        teres major, and pec major
        
        ER & IR
        
        when is IR strength the greatest
        
        at neutral position
        
        when is ER strength the greatest
        
        at 90° of shoulder flexion
        
        what strength is more ( IR & ER @ 45° abduction or IR & ER @ 45° flexion)
        
        IR & ER @ 45° abduction
    - - what exercise can cause subacromial impingement
        
        Resisted abduction
        
        when is this magnified
        
        if humerus IR
        
        what modification to prevent this
        
        humerus ER
      - If there anterior and/or posterior instability, this can create challenges in what type of exercises (5)
        
        Bench press, push ups, behind the neck pull-
        downs, horizontal adduction/adduction, end-range rowing
        
        what does this do on the joint capsule
        
        increase strain
        
        2 ways these type of excersises can be modified
        
        perform with less IR or ER, decrease ROM
- - - - • SC joint sprain or dislocation
        
        MOI typically what
        
        blunt trauma to area of middle deltoid
        
        2 common examples
        
        landing from fall, MVA
        
        when is pain usually onseted
        
        upon horizontal abduction
        
        2 examples
        
        Golf swing, backstroke
        
        Is anterior or posterior dislocations more serious
        
        posterior
        
        why
        
        bc Threat to trachea, esophagus, veins, & arteries in area
        
        when does it typically occur
        
        from anterior blow
        
        symptoms (3)
        
        coughing, SOB, difficulty swallowing
      - • Clavicular fracture
        
        MOI typically what
        
        direct trauma like from football or MVA
        
        where on the clavicle is it most commonly fx
        
        middle 1/3
      - • AC joint sprain or dislocation
        
        MOI typically what
        
        Blunt trauma to lateral shoulder
        
        what specific injury can cause this
        
        Falling On an Outstretched Hand (FOOSH)
        
        AC Grades
        
        Type 1
        
        description
        
        sprain injury of the AC ligament with no complete tear
        
        Type II
        
        description
        
        tear of the AC ligament but not of the CC ligaments
        
        Type III
        
        description
        
        involves tears of both the AC and CC ligaments, with 25%
        to 100% displacement of the clavicle compared with that on the contralateral side
        
        Type IV
        
        description
        
        both the AC and CC ligaments are torn and there is posterior displacement of the distal clavicle into the trapezius fascia
        
        Type V
        
        aka
        
        Rockwood type V
        
        description
        
        the AC and CC ligaments and both the origin of the deltoid and
        insertion of the trapezius are torn
        
        what does this cause
        
        1 more item...
        
        how much is the CC ligament distance increased
        
        1 more item...
        
        what fascia is stripped from its attachment
        
        deltotrapezial fascia
        
        how much is the clavicle displaced
        
        more than three times the diameter of its distal part.
        
        Type VI
        
        description
        
        inferior displacement of the distal clavicle into the sub coracoid position
      - • GH joint sprain or dislocation
        
        MOI is usually what (2)
        
        trauma or repeated overuse
        
        which dislocations are the most common (2)
        
        anterior and inferior dislocation
        
        usual causes is when force is applied to arm in what position
        
        abducted and externally rotated overhead
        
        which dislocations are rare
        
        Posterior
        
        usual causes is when force is applied to arm in what position
        
        adducted and internally rotated below shoulder level
  - - - • Subacromial Pain Syndrome
        
        MOI is usually what
        
        stress to tissues between humeral head and acromion
        
        what structures are in that area (3)
        
        Supraspinatus, supraspinatus tendon, bursa
        
        Typically accelerated with what
        
        prolonged or repetitive internal rotation
        
        Typically marked by a painful arc thru what
        
        ~ 60-120° elevation
        
        what is a painful arc
        
        specific area of movement that causes pain
      - • RC strain or tear
        
        MOI typically (2)
        
        repetitive or overhead
        activities
      - • Subacromial bursitis
        
        description
        
        Irritation of the bursa above supraspinatus muscle and beneath acromion
        
        MOI is usually what
        
        repetitive activity above shoulder height
        
        can develop in what specific example
        
        WC propulsion
      - • Bicipital tendonopathy
        
        description
        
        Typically irritated in area of bicipital
        groove
        
        what tear can also typically occur
        
        anterosuperior portion of labrum
        
        what is often present
        
        with painful arc similar to
        RC injury (think he meant subacromial pain syndrome) :red_cross:
- - - - where is this joint
        
        where the anterior surface of scapula is against the posterior surface of the ribs
        
        what mm. does the scapula rest on (2)
        
        subscapularis & serratus anterior
        
        what is under these 2 mm.
        
        thorax
      - movement
        
        how does it move across thorax (2)
        
        from motion at SC and AC joints
        
        how many degrees does the scapula move c 180° of arm elevation
        
        ~ 60° ROM
        
        Percentage contributed from SC joint & AC Joint
        
        ~ 65% occurs at SC joint
        ~ 35% occurs at AC joint
        
        6 motions
        
        elevation
        
        depression
        
        protraction
        
        retraction
        
        upward rotation
        
        what occurs
        
        Inferior angle rotates supero-
        laterally
        
        downward rotation
        
        what occurs
        
        Inferior angle rotates
        infero-medially
      - Osteokinematics
        
        scapular plane
        
        location
        
        in line c the scapula position
        
        location relative from the frontal plane
        
        ~ 35° anterior to frontal plane
        
        what is motion in this plane called
        
        scaption
      - Arthrokinematics
        
        what is the concave joint surface
        
        scapula
        
        does it have a loose-pack or close pack position
        
        no (why)
        
        bc it is not a synovial joint
        
        Joint orientation
        
        thorax (3 orientations)
        
        posterior, lateral, superior
        
        scapula (3 orientations)
        
        anterior, medial, inferior
    - - Characteristics
        
        what is special about it
        
        has greatest ROM in the body
        
        why is this (3 reasons)
        
        • Lax joint capsule
        
        • Limited ligamentous support
        
        • Shallow ball and socket joint
        
        1 more item...
        
        what type of joint is it
        
        synovial joint
        
        Labrum
        
        what does it do
        
        deepen the socket
        
        what is it made from
        
        fibrocartilage
        
        what supports it (2)
        
        surrounding ligaments and tendons
      - Ligaments (3)
        
        what part of the joint does it support
        
        anterior portion
        
        Inferior glenohumeral lig (AIGHL and PIGHL)
        
        what connects them
        
        the anterior band (there is also a post. band in the posterior portion)
        
        what happens during ER
        
        post. band gets shorter
        
        Middle glenohumeral lig (MGHL)
        
        Superior glenohumeral lig (SGHL)
        
        what is not a GH lig but still anterior to the joint
        
        coracohumeral lig
        
        what does it form c the acromion process
        
        coracoacromial arch
        
        function
        
        1 more item...
        
        what does it contain
        
        1 more item...
      - Additional Stability
        
        anatomical support (3)
        
        Glenoid labrum
        
        • Long head of biceps brachii
        
        • Rotator cuff
        
        static stability (4)
        
        gravity, capsular ligs, supraspinatus, post. deltoid
      - Osteokinematics (6 motions c degrees)
        
        Flexion ROM ~120°
        
        • Extension ROM ~45-55 °
        
        • ABD ROM ~120 °
        
        • ADD ROM ~120 °
        
        • IR ROM ~75-85 °
        
        • ER ROM ~60-70 °
      - Arthrokinematics
        
        Joint orientation
        
        glenoid (3 orientations)
        
        Lateral, anterior, inferior
        
        humerus (3 orientations)
        
        Medial, posterior, superior
        
        what is the concave surface
        
        glenoid
        
        Loose-pack position (2 ways)
        
        55 ° of ABD and 30 ° of horizontal ADD (55
        ° of scaption), slight ER
        
        30-40 ° of ABD, no FLEX, neutral rotation
        
        close-pack position
        
        full elevation (full abduction and ER)
        
        motions (6) (explanation of arthrokinematics right after)
        
        Flexion/Extension
        
        Spinning, Little or no roll or
        glide occurs
        
        Abduction
        
        Upward roll, Downward glide
        
        Adduction
        
        Downward roll, Upward glide
        
        IR
        
        Humeral head rolls anteriorly, Humeral
        head glides posteriorly
        
        ER
        
        Rolls posteriorly, Glides anteriorly
    - - Characteristics
        
        what type of joint is it
        
        plane synovial joint often possessing a
        fibrocartilage disc
        
        function
        
        bony restriction to elevation of UE
        
        what is it reinforced by
        
        dense capsule and AC ligaments
        above and below the joint
        
        nearby what ligament that is not an AC ligament
        
        coracoclavicular ligament
        
        function
        
        Assists scapular motion by serving as an axis of
        rotation
        
        how many degrees of freedom
        
        3
      - Osteokinematics
        
        Motions (6)
        
        anterior-posterior rotation about a vertical axis
        
        where does this motion occur
        
        between acromion process and labrum
        
        degrees of ROM
        
        ~ 30-50°
        
        rotates about what axis
        
        axis of coracoclavicular ligament
        
        aka
        
        protration and retraction
        
        Upward and downward rotation
        
        explain movement
        
        rotates lateral + medial in the
        frontal plane c clavicle moving on the labrum
        
        what does the scapula rotate on
        
        trapezoid portion of
        the lateral coracoclavicular ligament
        
        degrees of ROM
        
        ~ 60°
        
        Elevation and depression
        
        where does movement occur
        
        AC joint
        
        degrees of ROM
        
        ~ 30°
        
        what movements are opposite for AC and SC joints
        
        elevation, depression, protraction, and
        retraction
        
        what does elevation at AC joint lead to
        
        Depression at the
        SC joint and vice versa
        
        what does protraction at SC joint lead to
        
        Retraction at AC
        joint and vice versa
        
        rotation of what structure occurs in the same direction for both AC and SC joints
        
        clavicle :red_cross:
        
        when does it rotate anteriorly
        
        with depression and protraction
        
        when does it rotate posteriorly
        
        with elevation and
        retraction
      - Arthrokinematics
        
        Joint Orientation
        
        Acromion (3 orientations)
        
        Superior, medial, anterior
        
        clavicle (3 orientations)
        
        Inferior, lateral, posterior
        
        what is the concave surface
        
        acromion
        
        Loose-pack position
        
        not cited in literature
        
        Close-pack position
        
        90° of abduction
        
        motions
        
        what glide occurs if you push acromion down
        
        inferior glide
        
        what glide occurs if you push clavicle down
        
        superior glide
        
        why
        
        bc acromion is above it
    - - what is special about this joint
        
        Only direct contact of the UE to the
        axial skeleton
      - Ligaments (3)
        
        Interclavicular ligament
        
        Costoclavicular ligament
        
        function
        
        main support for the SC joint
        
        what does costo mean
        
        ribs
        
        Sternoclavicular ligament (2)
        
        Posterior SC ligament
        
        Anterior SC ligament
        
        what else supports this joint other than ligaments and the joint capsule
        
        muscles
        
        what is the important one in this area
        
        subclavius
        
        where is it located
        
        1 more item...
      - what does the strong joint capsule do
        
        resist dislocation
      - Osteokinematics
        
        how many degrees of freedom
        
        3
        
        what are those motions (5)
        
        Elevation and Depression
        
        where does this motion occur
        
        1 more item...
        
        approximate ROM degrees
        
        1 more item...
        
        Protraction & Retraction
        
        where does this motion occur
        
        1 more item...
        
        approximate ROM degrees
        
        1 more item...
        
        Clavicle rotation
        
        what axis does clavicle rotation occur
        
        1 more item...
        
        approximate ROM degrees
        
        1 more item...
        
        Joint orientation & Concave joint surfaces areas
        
        Manubrium (2)
        
        lateral, superior
        
        Clavicle (2)
        
        medial, inferior
        
        Loose-pack position
        
        not cited in literature
        
        Close-pack position
        
        arm fully elevated
      - Athrokinematics
        
        which surface is convex and which is concave
        
        clavicle: convex; sternum; concave
        
        5 different motion
        
        elevation
        
        what 2 movement occur
        
        upward roll; dowward glide
        
        depression
        
        what 2 movement occur
        
        downward roll; upward glide
        
        Protraction/retraction
        
        in what direction are the movements
        
        Rolls and glides in same direction
        
        why
        
        1 more item...
        
        clavicular rotation
        
        what movement occurs
        
        spin