Chapter 004 the Shoulder Girdle

Chapter 004 The Shoulder Girdle – Dynamic Stability for the Shoulder...

True / False Questions

1. The bones of the shoulder girdle include the scapula and the clavicle. True False

2. The two synovial joints in the shoulder girdle include the acromioclavicular joint and the glenohumeral joint. True False

3. The scapulothoracic joint is not a true synovial joint. True False

4. This synergistic movement of the scapulothoracic joint with the shoulder joint is known as the scapulohumeral rhythm. True False

5. The origin of the upper trapezius is the root of the spine of the scapula. True False

6. The upper trapezius and lower trapezius function as agonist and antagonist muscles. True False

7. The shoulder girdle muscles are innervated primarily from the nerves of the cervical plexus and lumbar plexus. True False

4-1 Chapter 004 The Shoulder Girdle – Dynamic Stability for the Shoulder...

8. Osteoarthritis can be a cause of nerve compression. True False

9. Active Isolated Stretching (AIS) involves the use of body's natural movements (flexion, extension, rotation, etc.) and physiology to achieve greater range of motion. True False

10. In the Active Isolate Stretching (AIS) protocol, the antagonist muscles help to stretch the agonist muscles. True False

Multiple Choice Questions

11. Some bony landmarks on the scapula include the coracoids process, A. greater tubercle, and lesser tubercle. B. spine, and superior angle. C. spine, and lesser tubercle. D. spine, and greater tubercle.

12. Abduction of the scapulae is provided by ______muscles. A. lower trapezius and pectoralis minor B. levator scapula and serratus anterior C. pectoralis minor and serratus anterior D. rhomboids and pectoralis minor

13. The muscles _____ and the ______work together to perform elevation of the scapulae. A. pectoralis minor; serratus anterior B. upper and middle trapezius; levator scapulae C. levator scapulae; lower trapezius D. lower trapezius; pectoralis minor

14. The subclavius is a(n) ______of the sternoclavicular joint. A. synergist B. agonist C. antagonist D. stabilizer

15. The trapezius is innervated by the ______nerve. A. accessory B. medial pectoral C. long thoracic D. sciatic

16. The muscles of the shoulder girdle that perform adduction of the scapulae are the A. pectoralis minor and rhomboids. B. rhomboids and levator scapulae. C. middle and lower trapezius and rhomboids. D. serratus anterior and rhomboids.

17. The muscles of shoulder girdle that perform depression of the scapulae are the A. levator scapulae and pectoralis minor. B. serratus Anterior and rhomboids. C. lower trapezius, pectoralis minor and subclavius. D. pectoralis minor and serratus anterior.

18. The muscles of the shoulder girdle that perform upward rotation of the scapulae are the A. serratus anterior and middle and lower trapezius. B. rhomboids and upper trapezius. C. lower trapezius and pectoralis minor. D. rhomboids and pectoralis minor.

19. The muscles of the shoulder girdle that perform downward rotation of the scapulae are the A. levator scapulae and pectoralis minor. B. rhomboids and pectoralis minor. C. lower trapezius and rhomboids. D. serratus anterior and pectoralis minor.

20. The muscles that insert on the clavicle and or scapula and have action on the shoulder girdle are the A. trapezius, deltoids, pectoralis minor, serratus anterior, and rhomboids. B. trapezius, levator scapulae, rhomboids, serratus anterior, and deltoids. C. trapezius, levator scapulae, rhomboids, serratus anterior, pectoralis minor, and subclavius. D. trapezius, supraspinatus, pectoralis minor, serratus anterior, and rhomboids.

21. The upper trapezius inserts on the A. spine of the scapula. B. inferior angle of the scapula. C. lateral clavicle. D. root of the spine of the scapula.

22. The middle trapezius inserts on the A. root of the spine of the scapula. B. deltoid tuberosity. C. lateral clavicle. D. spine of the scapula, acromium.

23. The lower trapezius inserts on the A. lateral clavicle. B. supraspinous fossa. C. root of the spine of the scapula. D. spine of the scapula.

24. The origin of the levator scapulae is A. spine of the scapula. B. superior angle of the scapula. C. C1-4 transverse processes. D. C1 spinous process.

25. The insertion of the levator scapulae is the A. vertebral border of the scapula (medial) from superior angle to root of the spine. B. spine of the scapula. C. root of the spine of the scapula. D. inferior angle of the scapula.

26. The origin of the rhomboid major is on the A. transverse processes of C 1-4. B. spinous processes of T2-T5. C. spinous processes of C7, T1. D. transverse processes of C 1-3.

27. The origin of the rhomboid minor is on the A. transverse processes of T2-T5. B. spinous processes of T2-T5. C. spinous processes of C7-T1. D. root of the spine of the scapula.

28. The insertion of the rhomboid minor is on the A. coracoid process. B. humerus. C. root of the spine of the scapula. D. vertebral border of the scapula below the root of the spine.

29. The insertion of the rhomboid major is on the A. vertebral border of the scapula below the root of the spine. B. root of the spine of the scapula. C. acromion. D. spine of the scapula.

30. The origin of the serratus anterior is on the A. coracoid process. B. anterior surfaces of the third to fifth ribs. C. superior aspect of the first rib. D. surface of the upper nine ribs at the side of the chest.

31. The insertion of the serratus anterior is on the A. anterior aspect of the whole length of the medial border of the scapula. B. coracoid process. C. inferior groove in the mid-portion of the clavicle. D. humerus.

32. The origin of the pectoralis minor is on the A. clavicle. B. anterior surfaces of the third to fifth ribs. C. surfaces of the upper nine ribs at the side of the chest. D. first rib.

33. The insertion of the pectoralis minor is on the A. superior angle of the scapula. B. clavicle. C. coracoid process. D. acromion.

34. The origin of the subclavius is located on the A. coracoid process. B. clavicle. C. superior angle of the scapula. D. superior aspect of the first rib at its junction with its costal cartilage.

35. The insertion for the subclavius is located on the A. spine of the scapula. B. inferior groove in the mid-portion of the clavicle. C. coracoid process. D. first three ribs.

36. When strengthening the pectoralis major, what other muscle group should be strengthened with it to help shoulder balance? A. Biceps brachii, triceps B. Subclavius, pectoralis minor C. Rhomboids, trapezius D. Subclavius, brachialis

37. Increasing flexibility in the body helps A. reduce wear and tear on the joints. B. improve sleep. C. depression. D. resting heart rate.

38. Flexibility is defined as A. improvement in eccentric contractions. B. angle of two points. C. the end motion of a segment. D. lengthening of a synergist muscle.

39. Ligaments, in their supportive roles as joint protectors A. elongate to assist a stretch. B. restrict range of motion and flexibility at the end movement. C. heat up to allow stretching. D. cause the golgi tendon organ to fire.

40. Two of the main influences on flexibility are A. blood flow and oxygen. B. Pacinian and Meissner's corpuscles. C. physical length of the antagonist muscle and the neurologic innervation of the muscle being stretched. D. strength of agonist and temperature of muscle.

41. To protect a muscle from being overstretched, a primary afferent neuron initiates a(n) A. myotactic reflex arc. B. stretch organ. C. eccentric contraction. D. golgi tendon reflex.

42. When a muscle is in a stretch, and pressure is applied to the tendons, the golgi tendon response occurs, also known as A. myotactic reflex arc. B. inverse stretch reflex. C. golgi inversion response. D. GTO.

43. Clinical flexibility is best defined as A. stretching in a home gym. B. stretching performed by a physician. C. flexibility therapy after surgery. D. flexibility in a clinical setting and when injuries might exist.

44. Active Isolated Stretching (AIS) is best suited for a clinic because A. its number of safe components. B. athletes recommend it. C. it does not work in a home setting. D. a nurse should always be present.

45. Stretching the upper and middle trapezius fibers are important because A. it improves breathing. B. it improves blood flow to the pectoralis major. C. it improves cervical lesions. D. of the antigravity functions of these muscles and history of inflicting chronic tension.

46. To stretch the rhomboids, the scapula must be A. retracted. B. protracted. C. in downward rotation. D. neutral.

47. Winging of the scapulae is usually caused by what two muscles? A. Trapezius and pectoralis minor B. Levator scapulae and latissimus C. Serratus anterior and rhomboids D. Subscapularis and teres major

48. One way to strengthen the upper trapezius is A. shoulder shrugs with dumbbells. B. biceps curls with cables. C. front dumbbell raises. D. latissimus dorsi pull downs.

49. Levator scapulae can be strengthened with shoulder shrugs and A. serratus push ups. B. wall push ups. C. scapular retraction. D. lateral neck flexion against gravity.

50. To isolate rhomboids more specifically for strengthening in a prone position, the head should be A. rotated. B. extended. C. at an oblique angle. D. completely relaxed in a flexed position.

Fill in the Blank Questions

51. ______is another name for the movement adduction of the scapulae. ______

52. ______is another name for the movement abduction of the scapulae. ______

53. The brachial plexus is vulnerable to ______or "pinched" nerves from several perspectives. ______

54. Soft-tissue structures can apply pressure to nerves and cause ______. ______

55. Osteoarthritis, a pathological condition causing abnormal bony growth, can press on the nerves and cause ______. ______

56. Clinical Flexibility and Therapeutic Exercise (CFTE) is a(n) ______composed of stretching and strengthening the muscles of the body. ______

57. Flexibility is defined as the end motion of a segment, and it can occur by ______contraction of the agonist (active range of motion), or by motion of an external force (passive range of motion). ______

58. Stretching is taking a muscle in its resting length and ______it. ______

59. Proprioceptive Neuromuscular Facilitation (PNF) stretching utilizes the components of muscle physiology to obtain a(n) ______amount of flexibility in muscles. ______

60. Active Isolated Stretching (AIS) involves the use of body's natural movements (flexion, extension, rotation, etc.) and physiology to achieve ______range of motion. ______

61. Clinical flexibility is defined as stretching used in a(n) ______setting, and it is usually assisted by a therapist. ______

62. The middle trapezius can be palpated from C7 to T3 and laterally to acromion process and scapula spine, particularly during ______. ______

63. The trapezius can act as its own agonist and ______. ______

64. The rhomboid major is palpable and superficial near the ______angle of the scapula. ______

65. The serratus anterior is named for its ______. ______

66. Rhomboids are muscles that literally mean ______. ______

67. Serratus anterior and pectoralis minor perform ______of the scapulae and together are ______. ______

68. The upper and middle trapezius and levator scapulae perform ______of the scapulae. ______

69. The lower trapezius and the upper and middle trapezius act as agonist and ______. ______

70. The trapezius is located mostly ______to the rhomboids. ______

71. The pectoralis minor and the serratus anterior both originate on ______. ______

72. When the rhomboids perform adduction of the scapulae ______act as antagonist to perform abduction of the scapulae. ______

73. The rhomboids perform downward rotation with its synergist ______. ______

74. Upward rotation is performed by the synergists of the middle and lower trapezius and ______. ______

75. The acromioclavicular joint is made up of the ______and the ______. ______

4-13 Chapter 004 The Shoulder Girdle – Dynamic Stability for the Shoulder... Key

True / False Questions

1. The bones of the shoulder girdle include the scapula and the clavicle. TRUE

Bloom's: Application Bloom's: Knowledge Difficulty: Easy Learning Outcome: 4-2 Learning Outcome: 4-3 Learning Outcome: 4-6

2. The two synovial joints in the shoulder girdle include the acromioclavicular joint and the glenohumeral joint. FALSE

The glenohumeral joint is the shoulder joint. The other synovial joint in the shoulder girdle is the sternoclavicular joint.

3. The scapulothoracic joint is not a true synovial joint. TRUE

Bloom's: Comprehension Bloom's: Knowledge Difficulty: Medium Learning Outcome: 4-2 Learning Outcome: 4-3 Learning Outcome: 4-5

4. This synergistic movement of the scapulothoracic joint with the shoulder joint is known as the scapulohumeral rhythm. TRUE

Bloom's: Comprehension Difficulty: Hard Learning Outcome: 4-4 Learning Outcome: 4-5

5. The origin of the upper trapezius is the root of the spine of the scapula. FALSE

The root of the spine of the scapula is the insertion for the lower trapezius.

Bloom's: Application Bloom's: Knowledge Difficulty: Medium Learning Outcome: 4-4 Learning Outcome: 4-8

6. The upper trapezius and lower trapezius function as agonist and antagonist muscles. TRUE

Bloom's: Comprehension Bloom's: Knowledge Difficulty: Medium Learning Outcome: 4-7

7. The shoulder girdle muscles are innervated primarily from the nerves of the cervical plexus and lumbar plexus. FALSE

The lumbar plexus does not innervate the shoulder girdle muscles.

Bloom's: Knowledge Difficulty: Medium Learning Outcome: 4-1

8. Osteoarthritis can be a cause of nerve compression. TRUE

9. Active Isolated Stretching (AIS) involves the use of body's natural movements (flexion, extension, rotation, etc.) and physiology to achieve greater range of motion. TRUE

10. In the Active Isolate Stretching (AIS) protocol, the antagonist muscles help to stretch the agonist muscles. FALSE

In order to stretch the antagonist muscles, the agonist muscles must be used.

Bloom's: Application Bloom's: Comprehension Bloom's: Knowledge Difficulty: Hard Difficulty: Medium Learning Outcome: 4-10 Learning Outcome: 4-9

Multiple Choice Questions

11. Some bony landmarks on the scapula include the coracoids process, A. greater tubercle, and lesser tubercle. B. spine, and superior angle. C. spine, and lesser tubercle. D. spine, and greater tubercle.

The greater tubercle and lesser tubercle are on the head of the humerus not the scapula.

12. Abduction of the scapulae is provided by ______muscles. A. lower trapezius and pectoralis minor B. levator scapula and serratus anterior C. pectoralis minor and serratus anterior D. rhomboids and pectoralis minor

Only the serratus anterior and pectoralis minor work together to provide abduction of the scapulae. Other muscles are not located in a position to perform abduction of the scapulae or are not matched with the right synergist.

Bloom's: Application Bloom's: Knowledge Difficulty: Medium Learning Outcome: 4-4 Learning Outcome: 4-5 Learning Outcome: 4-7

13. The muscles _____ and the ______work together to perform elevation of the scapulae. A. pectoralis minor; serratus anterior B. upper and middle trapezius; levator scapulae C. levator scapulae; lower trapezius D. lower trapezius; pectoralis minor

Only the upper and middle trapezius and levator scapulae perform the function of elevation of the scapulae and are synergists. Other muscles are not located in a position to perform elevation of the scapulae or are not matched with the right synergist.

Bloom's: Application Bloom's: Comprehension Bloom's: Knowledge Difficulty: Medium Learning Outcome: 4-4 Learning Outcome: 4-5 Learning Outcome: 4-7

14. The subclavius is a(n) ______of the sternoclavicular joint. A. synergist B. agonist C. antagonist D. stabilizer

The location of the muscles lends to its stabilizing function. It is not considered to be a prime mover of the shoulder girdle.

Bloom's: Application Bloom's: Comprehension Bloom's: Knowledge Difficulty: Medium Learning Outcome: 4-7

15. The trapezius is innervated by the ______nerve. A. accessory B. medial pectoral C. long thoracic D. sciatic

Only the accessory nerve innervates the trapezius.

16. The muscles of the shoulder girdle that perform adduction of the scapulae are the A. pectoralis minor and rhomboids. B. rhomboids and levator scapulae. C. middle and lower trapezius and rhomboids. D. serratus anterior and rhomboids.

Middle and lower trapezius and rhomboids are located positively to perform adduction of the scapulae and are synergists. The other muscles cannot perform adduction of the scapulae as they are not located in a direct line of pull for adduction to occur or are not matched with the right synergist.

Bloom's: Application Bloom's: Comprehension Bloom's: Knowledge Difficulty: Medium Learning Outcome: 4-5 Learning Outcome: 4-7

17. The muscles of shoulder girdle that perform depression of the scapulae are the A. levator scapulae and pectoralis minor. B. serratus Anterior and rhomboids. C. lower trapezius, pectoralis minor and subclavius. D. pectoralis minor and serratus anterior.

Lower trapezius, pectoralis minor, and subclavius are located positively to perform depression of the scapulae and are synergists. The other muscles cannot perform depression of the scapulae as they're not located in a direct line of pull for depression to occur or are not matched with the right synergist.

18. The muscles of the shoulder girdle that perform upward rotation of the scapulae are the A. serratus anterior and middle and lower trapezius. B. rhomboids and upper trapezius. C. lower trapezius and pectoralis minor. D. rhomboids and pectoralis minor.

The serratus anterior and the middle and lower trapezius are located positively to perform upward rotation of the scapulae and are synergists. The other muscles cannot perform upward rotation of the scapulae as they are not located in a direct line of pull for upward rotation to occur or are not matched with the right synergist.

19. The muscles of the shoulder girdle that perform downward rotation of the scapulae are the A. levator scapulae and pectoralis minor. B. rhomboids and pectoralis minor. C. lower trapezius and rhomboids. D. serratus anterior and pectoralis minor.

The rhomboids and pectoralis minor are located positively to perform downward rotation of the scapulae and are synergists. The other muscles are not either located in a direct line of pull for downward rotation to occur or are not matched with the right synergist.

20. The muscles that insert on the clavicle and or scapula and have action on the shoulder girdle are the A. trapezius, deltoids, pectoralis minor, serratus anterior, and rhomboids. B. trapezius, levator scapulae, rhomboids, serratus anterior, and deltoids. C. trapezius, levator scapulae, rhomboids, serratus anterior, pectoralis minor, and subclavius. D. trapezius, supraspinatus, pectoralis minor, serratus anterior, and rhomboids.

Deltoids and supraspinatus insert on the humerus and are not shoulder girdle muscles.

Bloom's: Application Bloom's: Comprehension Bloom's: Knowledge Difficulty: Medium Learning Outcome: 4-4 Learning Outcome: 4-7 Learning Outcome: 4-8

21. The upper trapezius inserts on the A. spine of the scapula. B. inferior angle of the scapula. C. lateral clavicle. D. root of the spine of the scapula.

The inferior angle of the scapula is not a part of the attachment sites of the trapezius. The other attachment sites are for the middle and lower trapezius.

22. The middle trapezius inserts on the A. root of the spine of the scapula. B. deltoid tuberosity. C. lateral clavicle. D. spine of the scapula, acromium.

The deltoid tuberosity is the insertion for the deltoids. The other attachment sites are for the upper and lower trapezius.

23. The lower trapezius inserts on the A. lateral clavicle. B. supraspinous fossa. C. root of the spine of the scapula. D. spine of the scapula.

The supraspinous fossa is the origin of the supraspinatus. The other attachment sites are for the upper and middle trapezius.

24. The origin of the levator scapulae is A. spine of the scapula. B. superior angle of the scapula. C. C1-4 transverse processes. D. C1 spinous process.

In order to lift the scapula, the levator scapulae must come from the neck for the appropriate line of pull. Only C1-4 transverse processes work in this arrangement.

25. The insertion of the levator scapulae is the A. vertebral border of the scapula (medial) from superior angle to root of the spine. B. spine of the scapula. C. root of the spine of the scapula. D. inferior angle of the scapula.

In order for the levator scapulae to lift the scapula in elevation, it must have a line of pull from the neck to the superior angle of the scapula. Other attachments might affect a different action.

26. The origin of the rhomboid major is on the A. transverse processes of C 1-4. B. spinous processes of T2-T5. C. spinous processes of C7, T1. D. transverse processes of C 1-3.

Transverse processes of C 1-4 is the origin of levator scapulae, spinous processes of C7; T1 is the origin for rhomboid minor; D is outside the line of pull for the muscle to perform.

27. The origin of the rhomboid minor is on the A. transverse processes of T2-T5. B. spinous processes of T2-T5. C. spinous processes of C7-T1. D. root of the spine of the scapula.

Since the rhomboid minor is smaller than the major and it is superior to the major, it is logical from the angle of pull that is come from the spinous processes of C7-T1. The root of the spine could not be an origin or fixed attachment as it moves the scapula.

28. The insertion of the rhomboid minor is on the A. coracoid process. B. humerus. C. root of the spine of the scapula. D. vertebral border of the scapula below the root of the spine.

The coracoid process is in the wrong location for the angle of pull; the humerus is not a shoulder girdle bone; and the vertebral border of the scapula below the root of the spine is the insertion for rhomboid major.

29. The insertion of the rhomboid major is on the A. vertebral border of the scapula below the root of the spine. B. root of the spine of the scapula. C. acromion. D. spine of the scapula.

In order for the larger rhomboid major to have its correct actions, it must have a broad attachment on the vertebral border of the scapula below the insertion of rhomboid minor. The other attachments would not work from a perspective of line of pull.

30. The origin of the serratus anterior is on the A. coracoid process. B. anterior surfaces of the third to fifth ribs. C. superior aspect of the first rib. D. surface of the upper nine ribs at the side of the chest.

Anterior surface of the third to fifth ribs is the origin of the pectoralis minor; coracoid process is the insertion of pectoralis minor; superior aspect of the first rib is impossible from a line of pull; only the surface of the upper nine ribs at the side of the chest works from a line of pull.

31. The insertion of the serratus anterior is on the A. anterior aspect of the whole length of the medial border of the scapula. B. coracoid process. C. inferior groove in the mid-portion of the clavicle. D. humerus.

Only the anterior aspect of the medial border of the scapula makes sense according to these muscles actions.

32. The origin of the pectoralis minor is on the A. clavicle. B. anterior surfaces of the third to fifth ribs. C. surfaces of the upper nine ribs at the side of the chest. D. first rib.

In order to have action on the scapula, the pectoralis minor must originate on the ribs.

33. The insertion of the pectoralis minor is on the A. superior angle of the scapula. B. clavicle. C. coracoid process. D. acromion.

Line of pull requires the coracoid process as a logical choice. It is located on the anterior chest, so the superior angle of the scapula is impossible.

34. The origin of the subclavius is located on the A. coracoid process. B. clavicle. C. superior angle of the scapula. D. superior aspect of the first rib at its junction with its costal cartilage.

Only the superior aspect of the first rib at its junction with its costal cartilage fits the actions and line of pull for the muscle.

35. The insertion for the subclavius is located on the A. spine of the scapula. B. inferior groove in the mid-portion of the clavicle. C. coracoid process. D. first three ribs.

The location of the muscle and the muscle's name give away the insertion on the clavicle.

36. When strengthening the pectoralis major, what other muscle group should be strengthened with it to help shoulder balance? A. Biceps brachii, triceps B. Subclavius, pectoralis minor C. Rhomboids, trapezius D. Subclavius, brachialis

Since the pectoralis major is an anterior muscle, it pulls the shoulders forward. Strengthening the posterior upper shoulders helps keep the shoulders back.

37. Increasing flexibility in the body helps A. reduce wear and tear on the joints. B. improve sleep. C. depression. D. resting heart rate.

Improving flexibility means a better range of motion in joint, which overall helps improve body movement.

38. Flexibility is defined as A. improvement in eccentric contractions. B. angle of two points. C. the end motion of a segment. D. lengthening of a synergist muscle.

Stretching is defined as taking a muscle in its resting length and expanding it.

39. Ligaments, in their supportive roles as joint protectors A. elongate to assist a stretch. B. restrict range of motion and flexibility at the end movement. C. heat up to allow stretching. D. cause the golgi tendon organ to fire.

Ligaments help provide overall stability to the joints.

40. Two of the main influences on flexibility are A. blood flow and oxygen. B. Pacinian and Meissner's corpuscles. C. physical length of the antagonist muscle and the neurologic innervation of the muscle being stretched. D. strength of agonist and temperature of muscle.

Without neurological innervation, stretching cannot take place.

41. To protect a muscle from being overstretched, a primary afferent neuron initiates a(n) A. myotactic reflex arc. B. stretch organ. C. eccentric contraction. D. golgi tendon reflex.

The myotactic reflex arc is also known as a stretch reflex.

42. When a muscle is in a stretch, and pressure is applied to the tendons, the golgi tendon response occurs, also known as A. myotactic reflex arc. B. inverse stretch reflex. C. golgi inversion response. D. GTO.

The inverse stretch reflex helps protect a muscle from overstretching by relaxing the muscle being stretched.

43. Clinical flexibility is best defined as A. stretching in a home gym. B. stretching performed by a physician. C. flexibility therapy after surgery. D. flexibility in a clinical setting and when injuries might exist.

Clinical flexibility is usually performed as a set of exercises to one that has existing injuries.

44. Active Isolated Stretching (AIS) is best suited for a clinic because A. its number of safe components. B. athletes recommend it. C. it does not work in a home setting. D. a nurse should always be present.

AIS used short holds, full range of motion, and is easy to teach patients.

45. Stretching the upper and middle trapezius fibers are important because A. it improves breathing. B. it improves blood flow to the pectoralis major. C. it improves cervical lesions. D. of the antigravity functions of these muscles and history of inflicting chronic tension.

Stretching the antigravity muscles helps forward shoulder postures.

46. To stretch the rhomboids, the scapula must be A. retracted. B. protracted. C. in downward rotation. D. neutral.

Protraction of the scapula causes tension on the medial attachments of the rhomboids.

47. Winging of the scapulae is usually caused by what two muscles? A. Trapezius and pectoralis minor B. Levator scapulae and latissimus C. Serratus anterior and rhomboids D. Subscapularis and teres major

Serratus anterior weakness may result from an injury to the long thoracic nerve.

48. One way to strengthen the upper trapezius is A. shoulder shrugs with dumbbells. B. biceps curls with cables. C. front dumbbell raises. D. latissimus dorsi pull downs.

Shrugs that move forward, up, and back help strengthen the anti-gravity muscles of the shoulder.

49. Levator scapulae can be strengthened with shoulder shrugs and A. serratus push ups. B. wall push ups. C. scapular retraction. D. lateral neck flexion against gravity.

Neck extensions against gravity also help strengthen this muscle.

50. To isolate rhomboids more specifically for strengthening in a prone position, the head should be A. rotated. B. extended. C. at an oblique angle. D. completely relaxed in a flexed position.

Keeping the head relaxed and down during this exercise keeps the upper trapezius from helping.

Fill in the Blank Questions

51. ______is another name for the movement adduction of the scapulae. Retraction

Bloom's: Application Bloom's: Knowledge Difficulty: Easy Learning Outcome: 4-5

52. ______is another name for the movement abduction of the scapulae. Protraction

53. The brachial plexus is vulnerable to ______or "pinched" nerves from several perspectives. nerve impingements

54. Soft-tissue structures can apply pressure to nerves and cause ______. nerve entrapment

55. Osteoarthritis, a pathological condition causing abnormal bony growth, can press on the nerves and cause ______. nerve compression

56. Clinical Flexibility and Therapeutic Exercise (CFTE) is a(n) ______composed of stretching and strengthening the muscles of the body. modality

Bloom's: Application Bloom's: Knowledge Difficulty: Easy Learning Outcome: 4-1 Learning Outcome: 4-9

57. Flexibility is defined as the end motion of a segment, and it can occur by ______contraction of the agonist (active range of motion), or by motion of an external force (passive range of motion). active

58. Stretching is taking a muscle in its resting length and ______it. expanding

59. Proprioceptive Neuromuscular Facilitation (PNF) stretching utilizes the components of muscle physiology to obtain a(n) ______amount of flexibility in muscles. increased

60. Active Isolated Stretching (AIS) involves the use of body's natural movements (flexion, extension, rotation, etc.) and physiology to achieve ______range of motion. greater

61. Clinical flexibility is defined as stretching used in a(n) ______setting, and it is usually assisted by a therapist. clinical

62. The middle trapezius can be palpated from C7 to T3 and laterally to acromion process and scapula spine, particularly during ______. adduction

63. The trapezius can act as its own agonist and ______. antagonist

Bloom's: Application Bloom's: Comprehension Bloom's: Knowledge Difficulty: Medium Learning Outcome: 4-7

64. The rhomboid major is palpable and superficial near the ______angle of the scapula. inferior

65. The serratus anterior is named for its ______. shape

66. Rhomboids are muscles that literally mean ______. diamond-shaped

Bloom's: Knowledge Difficulty: Easy Learning Outcome: 4-1 Learning Outcome: 4-8

67. Serratus anterior and pectoralis minor perform ______of the scapulae and together are ______. abduction; synergists

68. The upper and middle trapezius and levator scapulae perform ______of the scapulae. elevation

69. The lower trapezius and the upper and middle trapezius act as agonist and ______. antagonist

70. The trapezius is located mostly ______to the rhomboids. superficial

Bloom's: Application Bloom's: Knowledge Difficulty: Easy Difficulty: Medium Learning Outcome: 4-4 Learning Outcome: 4-8

71. The pectoralis minor and the serratus anterior both originate on ______. ribs

Bloom's: Application Bloom's: Knowledge Difficulty: Easy Difficulty: Medium Learning Outcome: 4-4 Learning Outcome: 4-8

72. When the rhomboids perform adduction of the scapulae ______act as antagonist to perform abduction of the scapulae. pectoralis minor and serratus anterior

Bloom's: Application Bloom's: Knowledge Difficulty: Easy Difficulty: Medium Learning Outcome: 4-4 Learning Outcome: 4-7 Learning Outcome: 4-8

73. The rhomboids perform downward rotation with its synergist ______. pectoralis minor

74. Upward rotation is performed by the synergists of the middle and lower trapezius and ______. serratus anterior

75. The acromioclavicular joint is made up of the ______and the ______. clavicle; scapula