Test Bank for Joint Structure and Function: A Comprehensive Analysis, 5th Edition, Pamela K.

Test Bank for Joint Structure and Function: A

Comprehensive Analysis, 5th Edition, Pamela K.
Levangie Cynthia C. Norkin

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Chapter 7: The Shoulder Complex

Multiple Choice
Identify the choice that best completes the statement or answers the question.

____ 1. The ultimate function of motion at the scapulothoracic joint is to:

a. Orient the glenoid fossa for optimal contact with the humeral head when
maneuvering the arm.
b. Provide downward rotation during shoulder girdle elevation.
c. Decrease stability at the acromioclavicular (AC) and sternoclavicular (SC) joints.
d. Work independent of the glenohumeral (GH) motion.
____ 2. Which of the following best describes motion at the sternoclavicular (SC) joint?
a. During clavicular elevation and depression, the disc of the SC joint moves with the
medial end of the clavicle on the manubrial facet.
b. During clavicular protraction and retraction, the disc of the SC joint moves with
the medial end of the clavicle on the manubrial facet.
c. During clavicular elevation and depression, the lateral end and medial end of the
clavicle move in the same direction.
d. During clavicular protraction and retraction, the lateral end and medial end of the
clavicle move in opposite directions.
____ 3. The ____________________ ligament is the primary stabilizer of the sternoclavicular joint.
a. interclavicular
b. coracoclavicular
c. costoclavicular
d. sternoclavicular
____ 4. When a tennis player elevates her shoulder during a serve, the clavicle rolls in a(n)
____________________ direction and glides in a(n) ____________________ direction on the
clavicular notch at the sternoclavicular joint.
a. superior, superior
b. inferior, inferior
c. superior, inferior
d. inferior, superior
____ 5. Which of the following best describes the structure of the glenohumeral (GH) joint?
a. The joint surfaces of the GH joint are naturally congruent and stable.
b. The glenoid labrum enhances the depth of the glenoid fossa.
c. The glenoid fossa, by itself, is three times larger than the humeral with which it
articulates.
d. The glenoid labrum is a thin hyaline cartilage structure.
____ 6. Which of the supporting ligaments of the glenohumeral (GH) joint is considered to be a “ligament
complex”?
a. The inferior GH ligament
b. The middle GH ligament
c. The superior GH ligament
 d. The coracoacromial ligament
____ 7. The external rotation that occurs at the glenohumeral joint after 80° to 90° of abduction produces
a(n) ____________________ roll and a(n) ____________________ glide of the humeral head on
the glenoid fossa.
a. posterior, posterior
b. anterior, anterior
c. anterior, posterior
d. posterior, anterior
____ 8. The acromioclavicular (AC) joint contributes to shoulder elevation ____________________.
a. between 30° and 90° of abduction when tension on the trapezoid component of the
coracoclavicular ligament produces a posterior rotation of the clavicle
b. after 90° of shoulder abduction and until all scapulothoracic motion is taken up
c. between 30° and 90° of abduction when anterior rotation of the clavicle allows for
30° of scapular upward rotation
d. after 60° of abduction
____ 9. Which of the following is a function of the rotator cuff during shoulder girdle elevation?
a. Functions with the deltoid to produce a superior translation of the humeral head
during shoulder girdle elevation
b. Produces scapular upward rotation during shoulder girdle motion
c. Balances the deltoid activity by providing a slight inferior translatory force of the
humeral head during shoulder girdle elevation
d. Produces downward rotation of the scapula during shoulder girdle motion
____ 10. Which of the following muscles produce upward scapular rotation when the shoulder girdle is
elevated from 90° to 180°?
a. Deltoid and rotator cuff muscles
b. Upper trapezius, lower trapezius, and serratus anterior
c. Upper trapezius and serratus anterior
d. Teres major and teres minor
____ 11. Which structure directly produces the posterior rotation of the clavicle needed for normal shoulder
girdle elevation?
a. The conoid portion of the coracoclavicular ligament
b. The coracohumeral ligament
c. The subclavius muscle
d. The anterior fibers of the deltoid muscle
____ 12. Anterior scapular tipping is normally ____________________ from vertical and directly affects
motion at the ____________________ joint.
a. 10° to 15°, glenohumeral
b. 10° to 15°, acromioclavicular
c. 35° to 45°, glenohumeral
d. 35° to 45°, acromioclavicular
____ 13. Elevation of the clavicle at the sternoclavicular joint involves osteokinematic motion of the
clavicle in the ____________________ direction and arthrokinematic motion of the joint surface
in the ____________________ direction.
a. inferior, superior
b. inferior, inferior
c. superior, inferior
d. superior, superior
____ 14. Which of the following muscles assists in counteracting the upward translatory force caused by the
deltoid muscle at the glenohumeral joint?
a. Supraspinatus
b. Serratus anterior
c. Coracobrachialis
d. Teres minor
____ 15. Which muscle(s) stabilize(s) the scapula in order to allow normal function of the teres major
muscle?
a. Levator scapula
b. Supraspinatus
c. Rhomboids
d. Upper trapezius

Completion
Complete each statement.

1. Scapular movements that take place at the acromioclavicular joint include

____________________ tipping that occurs around a ____________________ axis and
____________________ that occurs around a ____________________ axis.

Short Answer

1. What is the most frequent direction of glenohumeral (GH) dislocation? What position of the
humerus puts the joint at greatest risk for dislocation?

2. What are the advantages to the coracoacromial arch? What are the disadvantages?

3. Why is the supraspinatus able to abduct the shoulder without additional muscular synergy?

4. What accounts for the static stability of the glenohumeral (GH) joint when the arm is at the side?
What happens if you excessively load the hanging (dependent) limb?

5. How would range and strength of abduction of the upper extremity be affected if the
sternoclavicular joint were fused?

6. How would range and strength of abduction of the upper extremity be affected if there were a
rupture of the coracoclavicular ligament?
7. How would range and strength of abduction of the upper extremity be affected if there were
paralysis of the infraspinatus, teres minor, and subscapularis muscles?

8. How would range and strength of abduction of the upper extremity be affected if there were
paralysis of the deltoid muscle?

9. What muscular synergy does the teres major require to perform its function?
Chapter 7: The Shoulder Complex
Answer Section

MULTIPLE CHOICE

1. ANS: A
The scapulothoracic joint, although not a “true” joint, plays a significant role in the mobility and
stability of general shoulder girdle motion. Its primary function is to provide optimal positioning of
the glenoid fossa in order to add range to elevation of the arm and provide a stable base for
controlled motion of the GH joint.

PTS: 1
2. ANS: B
The articular disc of the SC joint separates the joint into two separate cavities. During
elevation/depression, the medial end of the clavicle moves on the rather stationary disc. However,
during protraction/retraction, the disc and clavicle move on the manubrium as one unit. This adds
to the ability to use convex/concave rules to this unusual saddle joint.

PTS: 1
3. ANS: C
The costoclavicular ligament is the strongest of the three sternoclavicular ligaments and limits
upward translation of the clavicle on the sternum. This ligament also counters many of the upward
forces exerted at this joint by the muscles of the head and neck.

PTS: 1
4. ANS: C
As a person raises his or her arm overhead, the lateral end of the clavicle will raise in a superior
direction. Given the convex nature of the sternal end of the clavicle and the concave nature of the
articular surface of the manubrium and the first costal cartilage, this will lead to sliding of the
clavicle in the sternoclavicular joint in the opposite direction of the lateral end of the clavicle.

PTS: 1
5. ANS: B
A general anatomy overview provides the answer to this question. The large humeral head is very
incongruent with the shallow glenoid fossa. The dense fibrous glenoid labrum attaches to the
periphery of the fossa, enhancing the depth of the fossa.

PTS: 1
6. ANS: A
The sling-like inferior GH ligament has three components to it and therefore has been termed a
“ligament complex.” These three components have been shown to make different contributions to
GH stability and have independent viscoelastic properties.

PTS: 1
 7. ANS: D
General rules of arthrokinematics suggest that when a convex surface moves on a concave surface,
the role and glide occur in opposite directions. This is true and can easily be seen with movement
of the large, convex humeral head on the rather shallow concave glenoid fossa. Without this
arthrokinematic gliding, motion at the GH joint would be severely impaired.

PTS: 1
8. ANS: B
The AC joint remains retrained well into the second phase of elevation due to the force of the
coracoclavicular ligament. As the scapula continues to upwardly rotate, it places a great deal of
tension on the conoid portion of the coracoclavicular ligament. During the second 30° of scapular
upward rotation (after 90° osteokinematic motion), the conoid portion of the coracoclavicular
ligament pulls the clavicle in a posteroinferior direction. At this point, the AC joint absorbs various
amounts of force via anterior/posterior and medial/lateral scapular tipping.

PTS: 1
9. ANS: C
The muscles of the rotator cuff primarily work to produce an inferior pull on the head of the
humerus. This balances the primarily superior translation of the deltoid muscle.

PTS: 1
10. ANS: B
This force couple is indicated as the primary muscles that contribute to upward rotation of the
scapula. The muscles play various roles during different points of shoulder girdle elevation, but all
contribute to full upward rotation of the scapula.

PTS: 1
11. ANS: A
During scapular upward rotation, the coracoid process moves inferiorly, causing tension on the
coracoclavicular ligament (particularly the conoid portion). The tight ligament pulls on the
posteroinferior portion of the clavicle, causing it to rotate posteriorly.

PTS: 1
12. ANS: B
The scapula displays a normal amount of anterior tipping of 10° to 15° which positions the
acromion at the acromioclavicular joint.

PTS: 1
13. ANS: C
The sternoclavicular joint is a saddle joint with both concave and convex surfaces on each joint
surface. In clavicular elevation, the convex surface of the clavicle moves on the concave surface of
the manubrium, causing the osteokinematic and arthrokinematic motions to be in the opposite
directions.

PTS: 1
14. ANS: D
 The subscapularis, teres minor, and infraspinatus muscle of the rotator cuff serve to balance the
superior translation caused by the passive tension of the deltoid and supraspinatus muscle.

PTS: 1
15. ANS: C
The rhomboids stabilize the scapula against the force of the teres major muscle.

PTS: 1

COMPLETION

1. ANS: anterior/posterior, coronal, medial lateral rotation, vertical

PTS: 1

SHORT ANSWER

1. ANS:
Anterior between the superior and middle GH ligaments. Because of the orientation of the head
and fossa, the most common dislocation of the humeral head occurs anteriorly. Bringing the
humerus into abduction and external rotation puts the humeral head in a position where it can most
readily be thrust forward through the capsule. Although the inferior axilla is least protected,
inferior dislocations generally would occur from a force from above, an area protected by the
coracoacromial arch. The posterior axilla is well protected by musculature. The anterior joint has
neither bony protection nor the muscular mass of the posterior axilla. There is also a common area
of marked weakness in the anterior joint capsule that will fail with sufficient imposition of force.

PTS: 1
2. ANS:
The advantage of the coracoacromial arch is that the arch checks upward dislocation of the
humeral head. The arch also prevents forces from above from traumatizing the soft tissue
structures lying between the acromion and the humeral head (primarily the supraspinatus tendon
and the subacromial/subdeltoid bursae). The disadvantage of the coracoacromial arch is that the
structures that lie in the limited suprahumeral space are likely to be impinged between the humeral
head and the osseoligamentous arch. The risk of impingement is increased by sustained elevation
of the humerus (e.g., overhead work), by failure of the infraspinatus, teres minor and subscapularis
muscles to prevent upward migration of the humeral head during elevation, or by inflammation of
the supraspinatus from overuse. Chronic impingement can lead to diminished nutrition and
eventual necrosis of the tissues in the suprahumeral space. The supraspinatus and other rotator cuff
muscle tendons are particularly vulnerable to such degenerative changes.

PTS: 1
3. ANS:
 Mostly, the effectiveness of the supraspinatus lies in its rather large moment arm compared to the
deltoid muscle. Although the supraspinatus has a small upward translatory component, this upward
force can be offset by the downward pull of gravity on the humerus. If the force of the
supraspinatus and gravity on the humerus are composed into a single resultant vector, the resultant
force creates approximately equal rotation and downward translation of the humeral head. This
makes the supraspinatus an effective, although not very forceful, abductor of the glenohumeral
(GH) joint.

PTS: 1
4. ANS:
Static stability of the humerus when the arm is hanging at the side appears to be a function of the
superior capsule, superior glenohumeral ligament, and the coracohumeral ligament—known
collectively as the rotator interval capsule. When a large load is placed in the hand, the
supraspinatus becomes active to reinforce the rotator interval capsule. The importance of the
supplementary support of the supraspinatus can best be seen in its absence; when the supraspinatus
muscle is paralyzed, the structures of the rotator interval capsule stretch out and become plastic
over time. As the rotator interval capsule becomes plastic, gradual subluxation of the GH joint may
occur.

PTS: 1
5. ANS:
All 120° of glenohumeral (GH) range would be available passively, although none of the
scapulothoracic motion would occur. Only 90° of GH motion could be accomplished actively,
because when the scapula is fixed or will not upwardly rotate, the deltoid becomes actively
insufficient after 90° of GH motion.

PTS: 1
6. ANS:
Without the coracoclavicular ligaments, the only force causing elevation of the clavicle would be
the direct action of the upper trapezius. That is, the indirect force for clavicular elevation would be
lost because the scapula would immediately upwardly rotate around the acromioclavicular (AC)
joint. Further, there would be no force to create clavicular rotation, because this motion occurs
only through the mediation of these ligaments. Given that some clavicular elevation would occur
through the direct action of the upper trapezius, and at least some s-t upward rotation would occur
directly at the AC joint, an approximation of 30° to 40° of scapular rotation would appear feasible.
The total range available actively and passively is 150° to 160°.

PTS: 1
7. ANS:
One would lose synergy with the deltoid such that an active contraction of the deltoid would
produce upward translation of the humeral head into the coracoacromial arch, rather than
abduction. Because scapular motion would still occur, the net effect would be slightly greater than
60° of elevation. Full passive range of motion would be available at the glenohumeral (GH) joint.

PTS: 1
8. ANS:
Test Bank for Joint Structure and Function: A Comprehensive Analysis, 5th Edition, Pamela K.

The supraspinatus could replace the force of the deltoid in abduction, although the motion would
be weak. That is, one could abduct fully (or nearly so depending on the strength of the muscle), but
the muscle could not take any significant resistance. Flexion could be accomplished by the
coracobrachialis, the clavicular portion of the pectoralis major, and the long head of the biceps.
Some weakness would be evident.

PTS: 1
9. ANS:
The teres major, like the deltoid, originates from the scapula but is intended to work on its heavier
distal end (humerus). If the scapula is not stabilized, the teres major will upwardly rotate the
scapula rather than extend the humerus. The teres major requires the synergy of the rhomboids to
stabilize its proximal segment and permit appropriate action on the humerus.

PTS: 1

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