CHIR12006

Week 5 Study Guide Questions

Question 1. In scapula humeral rhythm how does the scapula maintain a stable
position on the rib cage during the first 30 degrees of abduction?

The movement only happens at the glenohumeral joint, the scapula remains in a
fixed position. The main muscles for holding the scapula in position are the Serratus
posterior, rhomboids, levator scapula and trapezius.

Question 2. How does the scapula improve mechanical stability in the scapula
humeral rhythm?

The bone shape of the scapular provides a mobile socket for the proximal humorous
to articulate with.

Question 3. What is the capsular pattern of restriction in the glenohumeral

joint?

External rotation > abduction > Internal rotation

Question 4. What is the name of the ligament that resists upward humeral head
movement and external rotation?

Coracohumeral ligament

Question 5. Scapular winging in due to a weakness of what muscle?

Serratus Anterior

Question 6. What specific movement restrictions of the shoulder does the

Apley’s scratch test screen for?

Cephalic arm - Abduction, External rotation, Flexion.

Caudal – Adduction, Internal rotation, Extension
Question 7. Complete the table below

Shoulder Movement
Flexion 120 degrees (160- 180 for shoulder
girdle)
Extension 55 degrees (increases with scapular
elevation)
Abduction 170 - 180
Adduction 35
Internal Rotation 60 - 100
External rotation 90 degrees when abducted to 90
degrees

Question 8. Name all the structures of the shoulder in the diagram below.

A – Acromioclavicular ligament
B – Acromion process
C – Coracoacromial ligament
D – Coracohumeral ligament
E – Bicep tendon
F – Lesser tuberosity
G – Capsular ligament
H – Coracoid process
I – Coracoclavicular ligament
J – Clavicular
Question 9. The acromioclavicular ligament strengthens the superior aspect of
the joint capsule. Why is it intrinsically weak?

It is a small ligament that has to deal with a lot of stress.

Question 10. The SC joint capsule is reinforced by what structure shown in

Bergmann Fig 6.32?

The sternoclavicular ligament.

Question 11. The coracoclavicular ligament is made up of what two ligaments?

Trapezoid & Conoid

Question 12. What does the costoclavicular ligament do?

Attaches the first rib to the clavicle

Question 13. What is the close packed position of the glenohumeral joint?

Maximal abduction and lateral rotation.

Question 14. Read and summarise the paper (found in Moodle)

Cultural Health Attributions, Beliefs, and Practices: Effects on Healthcare and
Medical Education Lisa M. Vaughn*,1, Farrah Jacquez2 and Raymond C. Baker3

a) What is ethnocentrism and how can we minimise its effects with our
patient interactions?
Ethnocentrism is our evaluation of other cultures according to preconceptions of our
own cultures.

b) Identify six (6) ways to enhance patient communication from culturally

different background.
Verbal communication:
• High/low context
• Concept of face
• Language barriers
• Naming
Non-verbal communication
• Eye contact
• Gestures and colloquialism

c) What are four (4) cultural examples of barriers to accessing health care?

• Perceptions of health when we are sick is influences by our cultural heritage.

• Many migrants worry that a doctor will not recognise their specific cultural
needs.
• Different culture groups have specific expectations.
• Some cultural groups place a greater emphasis on the independence of the
elderly when they become ill than western cultures do.

d) In a culturally competent practice what does the acronym LEARN model

stand for?

Listen with sympathy and understanding to patient’s/family perception

Explain your perception
Acknowledge and discuss differences and similarities
Recommend treatment
Negotiate treatment
Question 15. What may be indicated if there is a decrease in the acromio-
humeral joint space?

A) rotator cuff tear

B) stroke
C) glenohumeral joint effusion
D) brachial plexus lesion

Question 16A.The acromio-clavicular joint space should not exceed what

difference bilaterally.

A) 2 mm
B) 3 mm
C) 5 mm
D) 7 mm
16B. A decrease or an increase may indicate what?
Increase may indicate resorption or separation
Decrease may indicate arthritis
Question 17. What is the radiographical feature in the image below showing?
Ununited Apophysis of the acromion
Question 18. How do we measure the coraco-clavicular joint space?
And what is the normal maximal range?

By measuring from the bottom of the clavicle to the top of the acromion process
A) 2-4 mm
B) 4- 6 mm
C) 8-10 mm
D) 11-13 mm

B) Using the image below measure the coraco-clavicular space

Question 19. List three (3) of the normal variants that can appear in the
shoulder complex?

• Ununited apophyses
• Rhomboid fossa
• Upper humeral notch

Question 20. The scapulohumeral rhythm serves what two (2) purposes?

Allows full abduction of the shoulder girdle