const {
  Document, Packer, Paragraph, TextRun, Table, TableRow, TableCell,
  HeadingLevel, AlignmentType, BorderStyle, WidthType, ShadingType,
  VerticalAlign, PageNumber, PageBreak, Header, Footer, ImageRun,
  UnderlineType, TabStopType, TabStopPosition
} = require('docx');
const fs = require('fs');
const https = require('https');
const http = require('http');

// ── helpers ──────────────────────────────────────────────────────────────────

function heading1(text) {
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    text,
    heading: HeadingLevel.HEADING_1,
    spacing: { before: 320, after: 120 },
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}

function heading2(text) {
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    heading: HeadingLevel.HEADING_2,
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}

function heading3(text) {
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}

function para(text, opts = {}) {
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}

function boldPara(text) {
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}

function bullet(text, bold_prefix = '') {
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function subbullet(text) {
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function numberedQ(num, text, marks = '') {
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}

function subQ(letter, text, marks = '') {
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function answerLine(lines = 3) {
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function pageBreak() {
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}

function noteBox(text) {
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            children: [new Paragraph({
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              spacing: { before: 80, after: 80 },
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    spacing: { after: 160 },
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}

function makeTable(headers, rows, shadeHeader = true) {
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    ),
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  const dataRows = rows.map((row, ri) =>
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      ),
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  );

  return new Table({
    width: { size: 100, type: WidthType.PERCENTAGE },
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}

function sectionBox(letter, title, marks) {
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    width: { size: 100, type: WidthType.PERCENTAGE },
    rows: [
      new TableRow({
        children: [
          new TableCell({
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                new TextRun({ text: `SECTION ${letter}: `, bold: true, color: 'FFFFFF', size: 28, font: 'Calibri' }),
                new TextRun({ text: title, bold: true, color: 'FFD700', size: 28, font: 'Calibri' }),
                new TextRun({ text: `   [${marks}]`, color: 'FFFFFF', size: 24, font: 'Calibri' }),
              ],
              alignment: AlignmentType.CENTER,
              spacing: { before: 100, after: 100 },
            })],
          }),
        ],
      }),
    ],
  });
}

// ── cover page ────────────────────────────────────────────────────────────────

function coverPage() {
  return [
    new Paragraph({ spacing: { after: 800 } }),
    new Paragraph({
      children: [new TextRun({ text: 'MUSCULOSKELETAL ANATOMY & BIOMECHANICS', bold: true, size: 36, font: 'Calibri', color: '1F3864' })],
      alignment: AlignmentType.CENTER,
      spacing: { after: 120 },
    }),
    new Paragraph({
      children: [new TextRun({ text: 'ASSIGNMENT', bold: true, size: 56, font: 'Calibri', color: '2E74B5' })],
      alignment: AlignmentType.CENTER,
      spacing: { after: 200 },
    }),
    new Table({
      width: { size: 80, type: WidthType.PERCENTAGE },
      rows: [
        new TableRow({ children: [
          new TableCell({
            shading: { type: ShadingType.CLEAR, fill: '2E74B5' },
            children: [new Paragraph({
              children: [new TextRun({ text: 'Glenohumeral & Scapulohumeral Rhythm', bold: true, color: 'FFFFFF', size: 32, font: 'Calibri' })],
              alignment: AlignmentType.CENTER,
              spacing: { before: 120, after: 120 },
            })],
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        ]}),
      ],
    }),
    new Paragraph({ spacing: { after: 400 } }),
    new Table({
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      rows: [
        ['Topic', 'Shoulder Complex Biomechanics – Scapulohumeral Rhythm'],
        ['Level', 'Undergraduate / Graduate Health Sciences'],
        ['Total Marks', '100 marks'],
        ['Sections', '6 Sections (A–F)'],
        ['Time Allowed', '2 Hours'],
        ['Instructions', 'Attempt ALL questions. Write legibly. Show all calculations.'],
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              indent: { left: 120 },
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            width: { size: 30, type: WidthType.PERCENTAGE },
          }),
          new TableCell({
            shading: { type: ShadingType.CLEAR, fill: i % 2 === 0 ? 'EBF3FB' : 'FFFFFF' },
            children: [new Paragraph({
              children: [new TextRun({ text: row[1], size: 22, font: 'Calibri' })],
              indent: { left: 120 },
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    new Paragraph({ spacing: { after: 300 } }),
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      rows: [
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              new Paragraph({ children: [new TextRun({ text: 'Student Name: ', bold: true, size: 24, font: 'Calibri' })], spacing: { after: 40 } }),
              new Paragraph({ border: { bottom: { style: BorderStyle.SINGLE, size: 4, color: '2E74B5' } }, spacing: { after: 160 } }),
              new Paragraph({ children: [new TextRun({ text: 'Student ID: ', bold: true, size: 24, font: 'Calibri' })], spacing: { after: 40 } }),
              new Paragraph({ border: { bottom: { style: BorderStyle.SINGLE, size: 4, color: '2E74B5' } }, spacing: { after: 160 } }),
              new Paragraph({ children: [new TextRun({ text: 'Date: ', bold: true, size: 24, font: 'Calibri' })], spacing: { after: 40 } }),
              new Paragraph({ border: { bottom: { style: BorderStyle.SINGLE, size: 4, color: '2E74B5' } }, spacing: { after: 100 } }),
            ],
            margins: { top: 200, bottom: 200, left: 200, right: 200 },
          }),
        ]}),
      ],
    }),
    pageBreak(),
  ];
}

// ── mark scheme summary table ─────────────────────────────────────────────────

function markScheme() {
  return [
    heading2('Mark Scheme Summary'),
    new Paragraph({ spacing: { after: 100 } }),
    makeTable(
      ['Section', 'Topic', 'Marks'],
      [
        ['A', 'Short Answer Questions', '14 marks'],
        ['B', 'Structured Questions', '21 marks'],
        ['C', 'Extended Response / Essays', '25 marks'],
        ['D', 'Clinical Case Studies', '20 marks'],
        ['E', 'Diagram Labeling', '10 marks'],
        ['F', 'True / False with Justification', '16 marks'],
        ['', 'TOTAL', '106 marks'],
      ]
    ),
    new Paragraph({ spacing: { after: 200 } }),
    divider(),
    pageBreak(),
  ];
}

// ── main document build ───────────────────────────────────────────────────────

async function buildDoc() {

  const children = [
    ...coverPage(),
    ...markScheme(),

    // ── SECTION A ──
    sectionBox('A', 'SHORT ANSWER QUESTIONS', '14 marks – 2 marks each'),
    new Paragraph({ spacing: { after: 120 } }),
    noteBox('Answer each question clearly and concisely. Full sentences are expected.'),

    numberedQ(1, 'Define scapulohumeral rhythm. State the exact numerical ratio that governs it during arm abduction and explain why this ratio has clinical importance.', '2 marks'),
    ...answerLine(4),

    numberedQ(2, 'Name the four articulations that make up the shoulder complex. For each joint, state whether it is a true synovial joint or a functional articulation.', '2 marks'),
    ...answerLine(4),

    numberedQ(3, 'At 90° of total arm abduction, calculate how many degrees of movement occur at (a) the glenohumeral joint and (b) the scapulothoracic articulation. Show your working.', '2 marks'),
    ...answerLine(4),

    numberedQ(4, 'Describe the "setting phase" of scapulohumeral rhythm. What happens during the first 30° of arm abduction and why is this phase important?', '2 marks'),
    ...answerLine(4),

    numberedQ(5, 'Define a "force couple" in the context of shoulder biomechanics. Provide one example of a force couple operating at the glenohumeral joint during abduction and name the muscles involved.', '2 marks'),
    ...answerLine(4),

    numberedQ(6, 'Why must the humerus externally rotate during abduction past 80–90°? Name the structure at risk if this rotation does not occur and explain the resulting clinical syndrome.', '2 marks'),
    ...answerLine(4),

    numberedQ(7, 'What is the approximate range of abduction still possible in a shoulder with complete glenohumeral ankylosis? Explain the biomechanical mechanism that permits this residual motion.', '2 marks'),
    ...answerLine(4),

    divider(),
    pageBreak(),

    // ── SECTION B ──
    sectionBox('B', 'STRUCTURED QUESTIONS', '21 marks'),
    new Paragraph({ spacing: { after: 120 } }),

    numberedQ(8, 'Describe the muscular force couple responsible for scapular upward rotation.', '8 marks'),
    new Paragraph({
      children: [new TextRun({ text: 'Your answer must include:', italics: true, size: 22, font: 'Calibri' })],
      spacing: { after: 60 }, indent: { left: 360 },
    }),
    subbullet('The names of the three muscles involved'),
    subbullet('The individual mechanical action of each muscle'),
    subbullet('How their combined actions produce upward rotation of the glenoid fossa'),
    subbullet('The clinical consequence if any one of these three muscles is paralysed'),
    ...answerLine(8),

    numberedQ(9, 'Using the 2:1 ratio, complete the table below showing glenohumeral (GH) and scapulothoracic (ST) contributions at each degree of total arm elevation. Show your calculations in the space provided.', '5 marks'),
    new Paragraph({ spacing: { after: 100 } }),
    makeTable(
      ['Total Arm Elevation', 'GH Contribution (°)', 'ST Contribution (°)', 'Calculation'],
      [
        ['30°', '', '', ''],
        ['60°', '', '', ''],
        ['90°', '', '', ''],
        ['150°', '', '', ''],
        ['180°', '', '', ''],
      ]
    ),
    new Paragraph({ spacing: { after: 200 } }),

    numberedQ(10, 'A 55-year-old woman presents with right shoulder pain. On observation, her right scapula elevates markedly very early during arm abduction, well before the arm reaches 60°. She has limited glenohumeral abduction.', '8 marks'),
    subQ('a', 'What clinical term describes the abnormal scapular movement pattern you observe?', '1 mark'),
    ...answerLine(2),
    subQ('b', 'Name two shoulder pathologies that most commonly produce this finding.', '2 marks'),
    ...answerLine(2),
    subQ('c', 'Explain the biomechanical reason why the scapula compensates in this way. Refer to the 2:1 ratio in your answer.', '3 marks'),
    ...answerLine(4),
    subQ('d', 'How does this altered rhythm affect the subacromial space and what clinical syndrome may result?', '2 marks'),
    ...answerLine(3),

    divider(),
    pageBreak(),

    // ── SECTION C ──
    sectionBox('C', 'EXTENDED RESPONSE', '25 marks'),
    new Paragraph({ spacing: { after: 120 } }),
    noteBox('Write in continuous prose. Use subheadings where appropriate. Diagrams are encouraged and will be credited.'),

    numberedQ(11, 'Write a detailed essay on the role of the rotator cuff in maintaining glenohumeral rhythm during shoulder abduction.', '15 marks'),
    new Paragraph({
      children: [new TextRun({ text: 'Your essay must address all of the following:', italics: true, size: 22, font: 'Calibri' })],
      spacing: { after: 60 }, indent: { left: 360 },
    }),
    subbullet('Anatomy of the rotator cuff – the four muscles, their origins, insertions, and primary actions'),
    subbullet('The concept of concavity-compression and how it centres the humeral head in the glenoid'),
    subbullet('The inferior force couple between the deltoid and the rotator cuff – why this is essential to abduction'),
    subbullet('How supraspinatus initiates abduction and its relationship to the first 15–30°'),
    subbullet('The role of infraspinatus/teres minor in clearing the greater tubercle from the acromion'),
    subbullet('Consequences of a full-thickness supraspinatus tear on scapulohumeral rhythm (superior humeral migration, impingement arc, loss of rhythm)'),
    subbullet('Clinical and physiotherapy management strategies to restore rhythm in rotator cuff pathology'),
    new Paragraph({ spacing: { after: 120 } }),
    ...answerLine(16),
    pageBreak(),

    numberedQ(12, 'Compare the movement contributions of the sternoclavicular (SC) and acromioclavicular (AC) joints during full arm elevation to 180°.', '10 marks'),
    new Paragraph({
      children: [new TextRun({ text: 'Your answer must cover:', italics: true, size: 22, font: 'Calibri' })],
      spacing: { after: 60 }, indent: { left: 360 },
    }),
    subbullet('Type of each joint and its axes of movement'),
    subbullet('The degrees of clavicular elevation and posterior rotation at the SC joint during full elevation'),
    subbullet('Why posterior rotation of the clavicle at the SC joint is essential for scapular upward rotation beyond 90°'),
    subbullet('The contribution of the AC joint to independent scapular rotation (~20°)'),
    subbullet('What happens to scapulohumeral rhythm when the AC joint is disrupted (e.g., Grade III AC dislocation) – discuss both mechanical and muscular consequences'),
    new Paragraph({ spacing: { after: 120 } }),
    ...answerLine(16),

    divider(),
    pageBreak(),

    // ── SECTION D ──
    sectionBox('D', 'CLINICAL CASE STUDIES', '20 marks – 10 marks each'),
    new Paragraph({ spacing: { after: 120 } }),

    heading2('Case Study 1'),
    noteBox('A 40-year-old cricket bowler presents unable to lift his right arm above shoulder height. On examination there is winging of the right scapula – the medial border lifts away from the thorax on forward flexion against resistance. He has no pain. Passive range of motion at the glenohumeral joint is completely full and pain-free.'),

    numberedQ(13, '', ''),
    subQ('a', 'Which nerve, if damaged, would produce this clinical picture? Name the primary muscle it supplies and describe where this nerve is vulnerable to injury.', '2 marks'),
    ...answerLine(3),
    subQ('b', 'Explain in detail how denervation of this muscle disrupts scapulohumeral rhythm. Refer specifically to the scapular force couple and the 2:1 ratio.', '4 marks'),
    ...answerLine(5),
    subQ('c', 'Why is full passive range of motion preserved despite the patient being unable to actively elevate the arm fully? What does this tell you about where the lesion is?', '2 marks'),
    ...answerLine(3),
    subQ('d', 'Outline a physiotherapy rehabilitation programme for this patient. State the goals and key exercises in the correct sequence.', '2 marks'),
    ...answerLine(4),

    new Paragraph({ spacing: { after: 200 } }),
    heading2('Case Study 2'),
    noteBox('A physiotherapist is treating a 62-year-old patient post-total shoulder arthroplasty. At 8 weeks post-op, the patient can only actively abduct to 70°. Observation reveals the scapula is elevating (shrugging) instead of rotating upward. Pain is minimal. There is marked atrophy of the posterior shoulder musculature.'),

    numberedQ(14, '', ''),
    subQ('a', 'Based on the 2:1 ratio, what is the expected glenohumeral contribution and scapulothoracic contribution at 70° total elevation? Show your calculation.', '2 marks'),
    ...answerLine(3),
    subQ('b', 'The patient is substituting with upper trapezius dominance instead of proper scapular upward rotation. Name the THREE muscles that form the correct scapular upward rotation force couple, and describe the specific exercise for each.', '4 marks'),
    ...answerLine(6),
    subQ('c', 'List four muscles the therapist should prioritise assessing and strengthening to restore normal scapulohumeral rhythm. For each muscle, state the test used to assess it clinically.', '4 marks'),
    makeTable(
      ['Muscle', 'Clinical Assessment Test', 'Significance to Rhythm'],
      [
        ['1.', '', ''],
        ['2.', '', ''],
        ['3.', '', ''],
        ['4.', '', ''],
      ]
    ),
    new Paragraph({ spacing: { after: 200 } }),

    divider(),
    pageBreak(),

    // ── SECTION E ──
    sectionBox('E', 'DIAGRAM LABELING', '10 marks – 2 marks each label'),
    new Paragraph({ spacing: { after: 120 } }),
    para('Study the diagram of scapulohumeral rhythm below and answer the questions that follow. The diagram shows the right shoulder at 90° of total arm abduction.'),
    new Paragraph({ spacing: { after: 160 } }),

    // Embed textbook image
    new Paragraph({
      children: [
        new ImageRun({
          data: fs.readFileSync('/home/daytona/workspace/glenohumeral-assignment/rhythm_diagram.png'),
          transformation: { width: 400, height: 450 },
        }),
      ],
      alignment: AlignmentType.CENTER,
      spacing: { after: 60 },
    }),
    new Paragraph({
      children: [new TextRun({ text: 'Figure: Scapulohumeral rhythm at 90° arm abduction. (Source: THIEME Atlas of General Anatomy and Musculoskeletal System)', italics: true, size: 20, font: 'Calibri', color: '595959' })],
      alignment: AlignmentType.CENTER,
      spacing: { after: 200 },
    }),

    numberedQ(15, 'Using the diagram above, answer the following:'),
    subQ('a', 'Identify and label the angle of glenohumeral abduction shown in the diagram. What is this value?', '2 marks'),
    ...answerLine(2),
    subQ('b', 'Identify and label the angle of scapular rotation shown. What is this value and how does it relate to the GH movement?', '2 marks'),
    ...answerLine(2),
    subQ('c', 'Draw an arrow on the diagram (or describe in words) indicating the direction of scapular upward rotation. Which muscles produce this movement?', '2 marks'),
    ...answerLine(2),
    subQ('d', 'The diagram represents 90° of total elevation. If the arm were raised to 120° total, predict the new GH and ST values using the 2:1 ratio.', '2 marks'),
    ...answerLine(2),
    subQ('e', 'Explain what would happen to the diagram if the patient had adhesive capsulitis (frozen shoulder). How would the angles change?', '2 marks'),
    ...answerLine(3),

    divider(),
    pageBreak(),

    // ── SECTION F ──
    sectionBox('F', 'TRUE / FALSE WITH JUSTIFICATION', '16 marks – 2 marks each'),
    new Paragraph({ spacing: { after: 120 } }),
    noteBox('Circle TRUE or FALSE. A correct T/F answer earns 1 mark. A correct one-sentence justification earns the second mark. No justification = maximum 1 mark.'),
    new Paragraph({ spacing: { after: 100 } }),

    ...[
      ['During arm abduction, the scapula and humerus begin moving simultaneously from 0° onward, with no initial setting phase.', 'FALSE'],
      ['In a patient with complete glenohumeral fusion (ankylosis), no shoulder abduction whatsoever is possible.', 'FALSE'],
      ['The serratus anterior is essential for scapular upward rotation and loss of its function produces medial scapular winging.', 'TRUE'],
      ['The 2:1 ratio means that for every 1° of scapular rotation, the glenohumeral joint moves 2°.', 'TRUE'],
      ['External rotation of the humerus during abduction beyond 80° is necessary to prevent impingement of the greater tubercle against the acromion.', 'TRUE'],
      ['The clavicle rotates posteriorly around its long axis during arm elevation above 90°, and this motion is essential to allow full scapular upward rotation.', 'TRUE'],
      ['A full-thickness supraspinatus tear does not affect scapulohumeral rhythm because the deltoid can fully compensate for supraspinatus function.', 'FALSE'],
      ['The subacromial space normally measures approximately 9–10 mm at rest and must be actively maintained during abduction by the rotator cuff and scapular rotators.', 'TRUE'],
    ].flatMap(([statement, answer], i) => [
      new Paragraph({
        children: [
          new TextRun({ text: `${i + 1}. `, bold: true, size: 24, font: 'Calibri' }),
          new TextRun({ text: statement, size: 24, font: 'Calibri' }),
        ],
        spacing: { before: 140, after: 60 },
      }),
      new Paragraph({
        children: [
          new TextRun({ text: '    Circle one:   ', size: 22, font: 'Calibri' }),
          new TextRun({ text: '  TRUE  ', bold: true, size: 22, font: 'Calibri', highlight: answer === 'TRUE' ? undefined : undefined }),
          new TextRun({ text: '          ', size: 22, font: 'Calibri' }),
          new TextRun({ text: '  FALSE  ', bold: true, size: 22, font: 'Calibri' }),
        ],
        spacing: { after: 40 },
        indent: { left: 360 },
      }),
      new Paragraph({
        children: [new TextRun({ text: 'Justification: ', bold: true, size: 22, font: 'Calibri' })],
        spacing: { after: 20 }, indent: { left: 360 },
      }),
      new Paragraph({
        border: { bottom: { style: BorderStyle.SINGLE, size: 4, color: 'AAAAAA' } },
        spacing: { after: 120 },
        indent: { left: 360 },
      }),
    ]),

    divider(),
    pageBreak(),

    // ── ANSWER KEY ──
    sectionBox('', 'ANSWER KEY (Instructor Use Only)', ''),
    new Paragraph({ spacing: { after: 120 } }),
    noteBox('This section is for instructor / examiner use only. Do not distribute to students before the assessment.'),

    heading2('Section A – Model Answers'),
    boldPara('Q1.'), para('Scapulohumeral rhythm is the coordinated, synchronised movement between the glenohumeral joint and the scapulothoracic articulation during arm elevation. The ratio is 2:1 (GH:ST). Clinically important because disruption of this ratio indicates shoulder pathology and can cause pain, impingement, or loss of function.'),
    boldPara('Q2.'), para('Glenohumeral (synovial ball-and-socket), Scapulothoracic (functional articulation – not true synovial), Sternoclavicular (synovial saddle joint), Acromioclavicular (synovial plane joint).'),
    boldPara('Q3.'), para('At 90° total: GH = 60°, ST = 30°. Using 2:1 ratio: 90° × (2/3) = 60° GH; 90° × (1/3) = 30° ST.'),
    boldPara('Q4.'), para('The setting phase (0–30°) is when the scapula finds its stable position against the thorax. During this phase, most movement occurs at the GH joint and the scapula moves variably or minimally. This phase is important as it establishes a stable base for subsequent scapular rotation.'),
    boldPara('Q5.'), para('A force couple is when two equal and opposite forces act on an object to produce rotation without translation. Example: The rotator cuff (inferior cuff – infraspinatus, teres minor, subscapularis) pulls the humeral head inferiorly and centrally while the deltoid pulls it superiorly – together they produce pure abduction without superior humeral migration.'),
    boldPara('Q6.'), para('External rotation swings the greater tubercle posteriorly, clearing it from the coracoacromial arch. Muscles: infraspinatus, teres minor. Without this rotation, the greater tubercle impinges on the acromion – causing subacromial impingement syndrome (painful arc).'),
    boldPara('Q7.'), para('40–60° of abduction is still possible via scapulothoracic motion alone. The scapula rotates upward via the trapezius and serratus anterior, elevating the glenoid fossa and producing apparent arm elevation even with a fused GH joint.'),

    heading2('Section B – Key Points'),
    boldPara('Q8 (8 marks):'), para('Three muscles: Upper trapezius (elevates/retracts clavicular end), Lower trapezius (depresses/retracts inferior scapular spine), Serratus anterior (protracts and pulls inferior angle forward). Combined: UT and LT/SA form a rotatory couple. Loss of serratus → winging, failure of overhead elevation. Loss of trapezius → scapular drop and tilt.'),
    boldPara('Q9 Table:'),
    makeTable(
      ['Total Elevation', 'GH (°)', 'ST (°)', 'Calculation'],
      [
        ['30°', '20°', '10°', '30 × 2/3 = 20; 30 × 1/3 = 10'],
        ['60°', '40°', '20°', '60 × 2/3 = 40; 60 × 1/3 = 20'],
        ['90°', '60°', '30°', '90 × 2/3 = 60; 90 × 1/3 = 30'],
        ['150°', '100°', '50°', '150 × 2/3 = 100; 150 × 1/3 = 50'],
        ['180°', '120°', '60°', '180 × 2/3 = 120; 180 × 1/3 = 60'],
      ]
    ),
    new Paragraph({ spacing: { after: 120 } }),
    boldPara('Q10: (a)'), para('Scapular dyskinesis (excessive early scapular elevation / abnormal scapulohumeral rhythm).'),
    boldPara('Q10: (b)'), para('Adhesive capsulitis (frozen shoulder) / rotator cuff pathology.'),
    boldPara('Q10: (c)'), para('With restricted GH joint, the 2:1 ratio is lost. To achieve any arm elevation, the scapula is forced to rotate earlier and more extensively than normal, substituting for the lost GH range.'),
    boldPara('Q10: (d)'), para('The acromion does not elevate adequately relative to the humeral head; the subacromial space narrows dynamically, predisposing to subacromial impingement.'),

    heading2('Section F – True / False Answers'),
    makeTable(
      ['Statement', 'Answer', 'Key Justification'],
      [
        ['1', 'FALSE', 'A setting phase (0–30°) exists where the scapula settles before the 2:1 rhythm begins.'],
        ['2', 'FALSE', '40–60° abduction is still possible via scapulothoracic motion alone.'],
        ['3', 'TRUE', 'Serratus anterior is a key component of the scapular upward rotation force couple.'],
        ['4', 'TRUE', 'For every 1° ST rotation, there are 2° GH movement – correct expression of 2:1.'],
        ['5', 'TRUE', 'External rotation swings greater tubercle away from the coracoacromial arch.'],
        ['6', 'TRUE', 'Posterior clavicular rotation at SC joint is essential for full scapular upward rotation.'],
        ['7', 'FALSE', 'Supraspinatus tear → loss of inferior force couple → superior humeral migration, impingement, loss of rhythm.'],
        ['8', 'TRUE', 'Normal subacromial space is 9–10 mm; maintained by rotator cuff centering and scapular rotation.'],
      ]
    ),
    new Paragraph({ spacing: { after: 200 } }),

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