CHIR12006

Week 5 Study Guide Answers

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?

Answer 1. The scapula maintains a stable position on the rib cage during the first 30
degrees of abduction by the contraction of the trapezius, serratus anterior and
rhomboid muscles.

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

Answer 2. The scapula improves mechanical stability in the SHR by bringing the
glenoid fossa under the humeral head.

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

joint?

Answer 3. The capsular pattern of restriction in the GH joint is external rotation,

abduction, internal rotation

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

Answer 4. The name of the ligament that resists upward humeral head movement
and external rotation is the coracohumeral ligament

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

Answer 5. Scapula winging is due to a weakness in the serratus anterior muscle.

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

Apley’s scratch test screen for?

Answer 6. Combination Flexion /External Rotation/ Abduction or

External Internal Rotation / Adduction
Question 7. Complete the table below

Shoulder Movement
Flexion 120 degrees (160- 180 for shoulder
girdle)
Extension 55 degrees (increases with scapular
elevation)
Abduction 120 degrees (180 for shoulder girdle
including SC and AC
Adduction 45 degrees
Internal Rotation 90 degrees when abducted to 90
degrees
External Rotation 90 degrees when abducted to 90
degrees

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

A. Acromioclavicular ligament G. Glenohumeral ligament

B. Acromion H. Coracoid process
C. Coraco-acromio ligament I. Coraco-clavicular ligament (trapezoid,
and conoid ligaments)
D. Coraco- humeral ligament J. clavicle
E. Biceps tendon (long head) K. Greater tuberosity
F. Lessor tuberosity
Question 9. The acromioclavicular ligament strengthens the superior aspect of
the joint capsule. Why is it intrinsically weak?

Answer 9. It gives way when force is applied to the acromion process or the
glenohumeral joint from above.

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

(Fig 6.29)?

Answer 10. The SC joint capsule is reinforced anteriorly and posteriorly by the
anterior and posterior sternoclavicular ligaments. The interclavicular ligaments
reinforce the capsule superiorly.

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

Answer 11. The coracoclavicular ligament is made up of conoid and trapezoid

ligaments.

Question 12. What does the costoclavicular ligament do?

Answer 12. The costoclavicular ligament acts as a fulcrum so that all but axial
rotatory movements of the lateral end of the clavicle are mirrored by the opposite
direction of movement at the medial end. Its key function is to limit excessive
superior, anterior or posterior movement of the medial end of the clavicle.

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

Answer 13. The closed packed position of the glenohumeral, acromioclavicular and
sternoclavicular joints?

Glenohumeral joint = Full abduction with external rotation.

Other closed packed positions include the following.

Acromioclvicular Joint = 90 degrees of abduction

Sternoclvicular Joint = full arm elevation
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?

Answer A. A belief in that the people, customs, traditions of your own race or
nationality are better than those of other races.

We can minimise its effects by following the HEARTS model. The HEARTS model is
not linear and should be adjusted according to client’s needs.
The steps include:
(Listening to History) - providing the opportunity for client to safely communicate their
story; compassionate connection necessary keeping in mind the honor of a
survivor’s willingness to relay their story to you
E (Focus on Emotions and Reactions) - focusing on the emotions experienced
throughout their experience; allowing survivor to put words to his/her feelings about
what took place; increasing “feeling vocabulary”
A (Asking Questions about Symptoms) - discussing behaviours and physical
symptoms
R (Explaining the Reasons for Symptoms) - helping survivor make sense of
symptoms; discussing physical and psychological symptoms as related to
experience of trauma; normalizing; helping establish sense of control; symptoms as
method employed by body for protection
T (Teaching Relaxation and Coping Strategies) - increasing sense of mastery and
reducing symptoms; imagery and focused breathing; identifying coping skills used
during times of trauma, stress
S (Helping with Self-Change) - identify ways in which survivor is the same and
different after trauma; positive changes; river example

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

different background.

1. Be humble, humanistic and hopeful. We are all more similar than we are different
especially when it comes to basic human needs and rights. Admit to what you do not know
and be open to learning from those of different backgrounds than your own. (e.g., patients,
students, parents, local leaders)

2. Cultural competency is a lifelong endeavor. Because culture is fluid and constantly

developing, it is impossible for even the most dedicated medical professional to know
everything about every culture for every person.

3. If you have questions about someone’s cultural background and beliefs, ASK. Most people
welcome the opportunity to talk about themselves and their background and appreciate your
interest.
4. Seek information to help your understanding of traditional health beliefs and practices
including religious practices that impact health and wellbeing.

5. Recognise that culture is multi-faceted, complex and pervasive. Culture encompasses more
than nationality, race or ethnicity and is intimately related to beliefs and practices.

6. Bi-lingual does not mean bi-cultural and multilingual does not mean multicultural.
Language is one aspect of culture, but for many people it is not the most important. Do not
make assumptions about an individual’s cultural experience based on the language they speak
on initial presentation

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

1. there any topics in your culture that are impolite to discuss with people you don’t
know very well?
2. Different cultures have different expectations regarding healthcare and what is
appropriate eg mammograms, physical examination by practitioners of the opposite
sex.
3. Distrust as clinicians have not been given the approval of community elders.
4. language barriers result in an inability to communicate effectively and respectfully.

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

stand for?

• L = Listen with sympathy and understanding to patient's / family’s

perception
• E = Explain your perception
• A = Acknowledge and discuss differences and similarities
• R = Recommend treatment
• N = 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 in the acromio-clavicular space may indicate

what?

Answer B.
An increase may indicate A- C separation or resorption and a decrease may indicate
A-C arthritis.
Question 17. What is the radiographical feature in the image below showing?

Answer 17. An ununited apophysis of the acromion

Question 18. How do we measure the coraco-clavicular joint space?
And what is the normal maximal range?

Answer 18.

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

Answer 18. 9 mm

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

1. Ununited Apophyses
2. Rhomboid Fossa
3. Upper Humeral Notch

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

Answer 20. The scapulohumeral rhythm preserves length- tension relationship of the
glenohumeral muscles; the muscles do not shorten as much as they would without
the scapula’s upward rotation, so they can sustain their force production through a
larger range of motion.
Secondly the scapulohumeral rhythm prevents impingement between the humerus
and acromion. Because of the difference in size between the glenoid fossa and the
humeral head, subacromial impingement can occur unless relative movement
between the humerus and the scapular is limited. Simultaneous movement of the
humerus and scapular during shoulder elevation limits relative arthrokinematics
movements between the two bones.