Chapter 007 Deep-Tissue Techniques for the Shoulder Joint Muscles

Chapter 007 Deep-Tissue Techniques for the Shoulder Joint Muscles

True / False Questions

1.Active movement lengthens muscles, as it contracts and pulls on the engaged bone.
TrueFalse

2.Passive movement is action that does not shorten the soft tissues; there is no contraction and, therefore, no shortening.
TrueFalse

3.If pain is present during passive movement, probably some other structure around or within the joint is causing the complaint such as bursae, ligaments, joint capsules, cartilage, and nerves.
TrueFalse

4.Crepitus is any grinding, grating, or popping elicited during the movement of the joint.
TrueFalse

5.An arc of pain is a pain response during a portion of only active movement.
TrueFalse

6.The subdeltoid bursa is actually located anterior to the greater trochanter.
TrueFalse

7.The chronic stage of inflammation has all the signs and symptoms of the acute stage.
TrueFalse

8.Pain from muscles, skin, and joints is called somatic pain.
TrueFalse

9.The five signs and symptoms of the acute stage of the inflammatory response are redness, heat, swelling, nausea, and loss of function.
TrueFalse

10.A therapist would be able to massage a freshly sprained ankle.
TrueFalse

Multiple Choice Questions

11.For clients who do not have a diagnosis it is best to
A.take a complete medical history.
B.give the treatment to the client anyhow.
C.refuse to work with the client without further questioning.
D.refer the client immediately.

12.Active movement shortens muscles as it contracts and pulls on the bone; so it will most likely involve the structures of
A.bursae.
B.ligaments.
C.muscle and tendons; soft tissue.
D.joint capsules.

13.If there is pain in passive movement of the shoulder joint it might involve
A.the anterior deltoid muscle.
B.bursae, ligaments, or the joint capsule.
C.any muscle or tendons.
D.subscapularis only.

14.To determine active range-of-motion the practitioner must first
A.perform the action for the client.
B.ask the client to perform the action.
C.demonstrate the action.
D.perform the action for the client on the painful extremity.

15.The location of the subacromial bursae is below the
A.anterior deltoid.
B.posterior deltoid.
C.coracoid process.
D.acromion process.

16.In order to perform passive flexion of the shoulder joint the practitioner would lift the arm of the upper extremity directly
A.outward laterally to the client.
B.out anteriorly to the client.
C.out across the chest of the client.
D.out in a diagonal direction across the chest of the client.

17.In order to perform passive extension of the shoulder joint the practitioner would lift the arm of the upper extremity
A.from flexion straight posteriorly.
B.outward laterally to the client.
C.across the chest of the client.
D.out anteriorly to the client.

18.In order to demonstrate active abduction of the shoulder joint the practitioner would lift his arm of the upper extremity
A.from flexion straight posteriorly.
B.across the chest.
C.outward laterally.
D.out anteriorly.

19.In order to demonstrate active adduction of the shoulder joint the practitioner would lift his arm of the upper extremity
A.from flexion straight posteriorly.
B.across the chest.
C.outward laterally.
D.medially toward the side.

20.In order to demonstrate active horizontal adduction of the shoulder joint the practitioner would lift his arm of the upper extremity
A.from flexion straight posteriorly.
B.across the chest.
C.outward laterally.
D.medially toward the side.

21.In order to demonstrate active horizontal abduction of the shoulder joint the practitioner would lift his arm of the upper extremity
A.away from the chest.
B.across the chest.
C.outward laterally.
D.medially toward the side.

22.If the client experiences pain with passive range-of-motion then it is a good idea to
A.treat the client.
B.diagnose the condition.
C.refer the client to another health professional.
D.keep doing the passive range-of-motion.

23.Any grinding, grating, or popping elicited during the movement of the joint might be
A.annoying.
B.crepitus.
C.arc of pain.
D.a bursa.

24.Undiagnosed pain in and of itself is enough to constitute the need for
A.a treatment.
B.a medical history.
C.a referral.
D.deep-tissue techniques.

25.RICE stands for rest, ice, compression, and elevation and is used in
A.non-inflammatory situations.
B.acute stage only of the inflammatory response.
C.subacute stage only of the inflammatory response.
D.all stages of the inflammatory response, but usually always in the acute stage.

26.The chronic stage of the inflammatory response can last for
A.the first 24 hours.
B.the first 3 hours.
C.months or even years.
D.the first 4 hours.

27.Pregnancy after the first trimester and shoulder injuries present a good case for the ______position.
A.side-lying
B.supine
C.prone
D.seated

28.In a sequence for the side-lying position and techniques, the therapist would want to
A.perform deep-tissue techniques first.
B.perform trigger points before all other techniques.
C.palpate the soft tissue.
D.perform any range of motion before anything else.

29.In order to provide elliptical movement for the scapula the practitioner's hands should be placed on the ______and the ______.
A.infraspinatus; teres minor
B.supraspinatus; latissimus dorsi
C.supraspinatus; infraspinatus
D.latissimus dorsi; quadratus lumborum

30.Position the client's arm ______in order to apply deep transverse friction the supraspinatus tendon.
A.in front of the body
B.behind the back
C.across the chest
D.an external rotation

Fill in the Blank Questions

31.______is an acronym for rest, ice, compression, and elevation.
______

32.The three stages of the inflammatory response are ______, ______and ______.
______

33.The five signs and symptoms of the acute stage of the inflammatory response are ______, ______, ______, ______, and ______.
______

34.The therapist must apply caution using compression over the pectoralis major muscle so as to not compress the ______.
______

35.The structure that might become impinged by abduction of the humerus might be the ______.
______

36.When working with a client in a side-lying position, the therapist may have to ______the table.
______

37.In the side-lying position, place the client's arm ______the back to locate the subscapularis tendon.
______

38.Supportive structures for the client in the side-lying position might include ______.
______

39.When interviewing a client questions about the ______of pain should be asked.
______

40.Compressed nerve pain is often in the ______, ______or ______variety.
______

41.Somatic pain can range from a(n) ______to ______pain.
______

42.In the subacute stage of the inflammatory response, the one sign or symptom that does not progress is ______.
______

43.In positioning the client in the side-lying position, the head, neck, and spine should be in ______.
______

44.After palpating the soft-tissue use ______techniques first.
______

45.______shorten muscles whenever possible in a treatment.
______

46.Treat the healthy soft tissue ______; work on painful areas or those with restricted motion ______.
______

47.When applying pressure to the supraspinatus trigger point, bring the client's shoulder in a(n) ______direction.
______

48.In the side-lying position, to assist access to the serratus anterior, after you have located and pinned the tissue, gently ______towards you.
______

49.The structure that the therapist must be careful with when stripping the coracobrachialis is the ______.
______

50.For compression of the pectoralis major to be done without hurting the client, but utilizing enough pressure, the therapist should use a(n) ______palm and his ______and ______.
______

7-1

Chapter 007 Deep-Tissue Techniques for the Shoulder Joint Muscles Key

True / False Questions

1.Active movement lengthens muscles, as it contracts and pulls on the engaged bone.
FALSE

Active movement contracts muscles, therefore the above statement would be incorrect.

Bloom's: Application
Bloom's: Knowledge
Difficulty: Easy
Learning Outcome: 7-1
Learning Outcome: 7-4

2.Passive movement is action that does not shorten the soft tissues; there is no contraction and, therefore, no shortening.
TRUE

Bloom's: Application
Bloom's: Knowledge
Difficulty: Easy
Learning Outcome: 7-1
Learning Outcome: 7-4

3.If pain is present during passive movement, probably some other structure around or within the joint is causing the complaint such as bursae, ligaments, joint capsules, cartilage, and nerves.
TRUE

Bloom's: Knowledge
Difficulty: Easy
Learning Outcome: 7-1
Learning Outcome: 7-4

4.Crepitus is any grinding, grating, or popping elicited during the movement of the joint.
TRUE

Bloom's: Knowledge
Difficulty: Easy
Learning Outcome: 7-1
Learning Outcome: 7-4
Learning Outcome: 7-5

5.An arc of pain is a pain response during a portion of only active movement.
FALSE

An arc of pain may be present in passive movement as well.

Bloom's: Application
Bloom's: Comprehension
Bloom's: Knowledge
Difficulty: Medium
Learning Outcome: 7-1
Learning Outcome: 7-4

6.The subdeltoid bursa is actually located anterior to the greater trochanter.
FALSE

The subdeltoid bursa is located just beneath the anterior deltoid muscle.

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

7.The chronic stage of inflammation has all the signs and symptoms of the acute stage.
FALSE

In the chronic stage of inflammation, pain is usually less, swelling is maintained, and/or reduced so the signs and symptoms are not the same as the acute stage.

Bloom's: Comprehension
Bloom's: Knowledge
Difficulty: Medium
Learning Outcome: 7-2
Learning Outcome: 7-3

8.Pain from muscles, skin, and joints is called somatic pain.
TRUE

Bloom's: Knowledge
Difficulty: Easy
Learning Outcome: 7-1

9.The five signs and symptoms of the acute stage of the inflammatory response are redness, heat, swelling, nausea, and loss of function.
FALSE

The five signs and symptoms of the acute stage of the inflammatory response are redness, heat, swelling, pain, and loss of function.

Bloom's: Knowledge
Difficulty: Easy
Learning Outcome: 7-3

10.A therapist would be able to massage a freshly sprained ankle.
FALSE

An acute stage of a freshly sprained ankle is an example of a contraindication for massage. All the signs and symptoms of the acute stage of the inflammatory response are present.

Bloom's: Application
Bloom's: Comprehension
Bloom's: Knowledge
Difficulty: Medium
Learning Outcome: 7-10
Learning Outcome: 7-2
Learning Outcome: 7-3

Multiple Choice Questions

11.For clients who do not have a diagnosis it is best to
A.take a complete medical history.
B.give the treatment to the client anyhow.
C.refuse to work with the client without further questioning.
D.refer the client immediately.

A safe treatment protocol would be to take a complete medical history before determining whether or not to refer the client to another health professional.

Bloom's: Application
Bloom's: Knowledge
Difficulty: Easy
Learning Outcome: 7-10

12.Active movement shortens muscles as it contracts and pulls on the bone; so it will most likely involve the structures of
A.bursae.
B.ligaments.
C.muscle and tendons; soft tissue.
D.joint capsules.

Active movements pull on muscle and tendons; all soft tissue would be affected. Passive movement does not involve muscle and tendons, but if there was a pathological condition it might involve other structures in and around the joint.

Bloom's: Application
Bloom's: Comprehension
Bloom's: Knowledge
Difficulty: Medium
Learning Outcome: 7-1
Learning Outcome: 7-4

13.If there is pain in passive movement of the shoulder joint it might involve
A.the anterior deltoid muscle.
B.bursae, ligaments, or the joint capsule.
C.any muscle or tendons.
D.subscapularis only.

Passive movement does not involve muscle and tendons, but if there was a pathological condition it might involve other structures in and around the joint.

Bloom's: Application
Bloom's: Comprehension
Bloom's: Knowledge
Difficulty: Medium
Learning Outcome: 7-1
Learning Outcome: 7-4

14.To determine active range-of-motion the practitioner must first
A.perform the action for the client.
B.ask the client to perform the action.
C.demonstrate the action.
D.perform the action for the client on the painful extremity.

Clients are not likely to know the language of range-of-motion and must be guided through the actions by demonstration first.

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

15.The location of the subacromial bursae is below the
A.anterior deltoid.
B.posterior deltoid.
C.coracoid process.
D.acromion process.

Subacromion literally means below the acromion.

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

16.In order to perform passive flexion of the shoulder joint the practitioner would lift the arm of the upper extremity directly
A.outward laterally to the client.
B.out anteriorly to the client.
C.out across the chest of the client.
D.out in a diagonal direction across the chest of the client.

Flexion is movement of the humerus straight anteriorly.

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

17.In order to perform passive extension of the shoulder joint the practitioner would lift the arm of the upper extremity
A.from flexion straight posteriorly.
B.outward laterally to the client.
C.across the chest of the client.
D.out anteriorly to the client.

Extension is movement of the humerus straight posteriorly from any point in the sagittal plane.

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

18.In order to demonstrate active abduction of the shoulder joint the practitioner would lift his arm of the upper extremity
A.from flexion straight posteriorly.
B.across the chest.
C.outward laterally.
D.out anteriorly.

Abduction is upward lateral movement of the humerus out to the side of the client.

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

19.In order to demonstrate active adduction of the shoulder joint the practitioner would lift his arm of the upper extremity
A.from flexion straight posteriorly.
B.across the chest.
C.outward laterally.
D.medially toward the side.

Adduction is a downward movement of the humerus in the frontal plane from abduction.

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

20.In order to demonstrate active horizontal adduction of the shoulder joint the practitioner would lift his arm of the upper extremity
A.from flexion straight posteriorly.
B.across the chest.
C.outward laterally.
D.medially toward the side.

Horizontal adduction is movement of the humerus across the chest of the client.

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

21.In order to demonstrate active horizontal abduction of the shoulder joint the practitioner would lift his arm of the upper extremity
A.away from the chest.
B.across the chest.
C.outward laterally.
D.medially toward the side.

Horizontal abduction is movement of the humerus in a horizontal plane away from the chest.

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

22.If the client experiences pain with passive range-of-motion then it is a good idea to
A.treat the client.
B.diagnose the condition.
C.refer the client to another health professional.
D.keep doing the passive range-of-motion.

It is likely that if the client has pain with passive range-of-motion it is a structure that is not soft tissue and therefore out of the scope of practice of the therapist and may need a diagnosis.

Bloom's: Application
Bloom's: Comprehension
Bloom's: Knowledge
Difficulty: Medium
Learning Outcome: 7-1
Learning Outcome: 7-10
Learning Outcome: 7-4

23.Any grinding, grating, or popping elicited during the movement of the joint might be
A.annoying.
B.crepitus.
C.arc of pain.
D.a bursa.

Crepitus is described as any grinding, grating, or popping elicited during the movement of the joint.

Bloom's: Knowledge
Difficulty: Easy
Learning Outcome: 7-1

24.Undiagnosed pain in and of itself is enough to constitute the need for
A.a treatment.
B.a medical history.
C.a referral.
D.deep-tissue techniques.

Pain that is undiagnosed is a warning sign to be taken very seriously by manual therapists. Diagnosis is outside of the scope of practice of the manual therapist.

Bloom's: Knowledge
Difficulty: Easy
Learning Outcome: 7-3

25.RICE stands for rest, ice, compression, and elevation and is used in
A.non-inflammatory situations.
B.acute stage only of the inflammatory response.
C.subacute stage only of the inflammatory response.
D.all stages of the inflammatory response, but usually always in the acute stage.

Rest, ice, compression, and elevation is useful in all stages of the inflammatory process, but is a first aid measure to decrease swelling in the acute

Bloom's: Knowledge
Difficulty: Easy
Learning Outcome: 7-10
Learning Outcome: 7-3

26.The chronic stage of the inflammatory response can last for
A.the first 24 hours.
B.the first 3 hours.
C.months or even years.
D.the first 4 hours.

The chronic stage of the inflammatory response follows acute and subacute and develops after the swelling or edema has subsided. A chronic sprained ankle with significant ligament damage can last months or even years with signs and symptoms of the chronic stage.

Bloom's: Comprehension
Bloom's: Knowledge
Difficulty: Medium
Learning Outcome: 7-2

27.Pregnancy after the first trimester and shoulder injuries present a good case for the ______position.
A.side-lying
B.supine
C.prone
D.seated

The side-lying position provides a unique opportunity to work with individuals that may not respond in supine or prone positions.

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

28.In a sequence for the side-lying position and techniques, the therapist would want to
A.perform deep-tissue techniques first.
B.perform trigger points before all other techniques.
C.palpate the soft tissue.
D.perform any range of motion before anything else.

It would not matter what position the client is in, the therapist should palpate the tissues before other techniques of range of motion.

Bloom's: Application
Bloom's: Knowledge
Difficulty: Medium
Learning Outcome: 7-10

29.In order to provide elliptical movement for the scapula the practitioner's hands should be placed on the ______and the ______.
A.infraspinatus; teres minor
B.supraspinatus; latissimus dorsi
C.supraspinatus; infraspinatus
D.latissimus dorsi; quadratus lumborum

In order to mobilize the scapula in a clockwise and counterclockwise direction the hands have to be place superior to the scapula and laterally to the scapula. The supraspinatus is located superiorly and the latissimus dorsi/teres major are located laterally.

Bloom's: Application
Bloom's: Comprehension
Bloom's: Knowledge
Difficulty: Hard
Difficulty: Medium
Learning Outcome: 7-9