AC joint, GH joint mobs, Scapula

Question 1

How does one perform an active compression test and what is a positive test?

Answer 1

• Forward flexion to 90°
• Cross body adduct 10 to 15°
• Maximally IR
• Downward force
• Do same in ER
• Positive if pain localized to AC joint with IR and relieved in ER

Question 2

How does one perform a cross body adduction test? What is a positive test?

Answer 2

• flexion to 90° with horizontal adduction across body.

- Positive if localized pain to the AC joint

Question 3

How do you perform an Acromioclavicular Resisted Extension Test? What is a positive test?

Answer 3

• Test position of Hawkins Kennedy
• Resist horizontal abduction
• Positive if localized pain to the AC joint.

Question 4

How do you look for the Paxinos sign? What is a positive test?

Answer 4

• pt sits relaxed
• therapist thumb on post acromion, fingers on distal and middle clavicle
• push acromion sup. and ant. and clavicle in opposite direction.
• Positive if pain over AC joint and/or too much movement.

Question 5

How do you mobilize the GH joint for loss of flexion?

Answer 5

• flex to endrange
• laterally distract humerus with both hands
• do contract/relax technique during treatment by having patient try to flex against your resistance while maintaining lateral distraction.

Question 6

How do you mobilize the GH joint for loss of abduction?

Answer 6

• abduct to endrange
• grab glenoid in armpit with thumb & index fingers
• stabilize the humerus, then glide glenoid superomedially.
• Do contract/relax technique

Question 7

How do you mobilize the GH joint for loss of internal rotation?

Answer 7

• Abduct pt’s arm, standing between body and their arm
• IR to endrange
• posterior glide the humerus (have joint line on edge of table).
• Do contract/relax technique

Question 8

How do you mobilize the GH joint for loss of external rotation?

Answer 8

• Abduct pt’s arm
• ER to endrange
• Grasp humerus and pull up producing anterior glide.
• Do contract/relax technique

Question 9

Scapular dyskinesis happens in what % of people with GH instability? those with GH impingement syndrome?

Answer 9

64% in GH instability. 100% in GH impingement syndrome.

Question 10

When assessing the scapula with pt. relaxed, at what vertebrae levels should the acromion and superior angle be at? How should the medial border of the scapula be oriented and how far from the spine should it be?

Answer 10

Acromion at height of T1
Superior angle at height of T2
Vertebral border should be vertical and 3 inches from the spine.

Question 11

How should the medial border of the scapula be oriented during full elevation? What 5 things about the scapula should you not see at all when relaxed or elevated?

Answer 11

upwardly rotated 60°.
You should not see:
1.winging
2. tipping
3. downward or upward rotation in relaxed position
4. Atrophy in scapular musculature
5. Any dynamic winging

Question 12

What are 5 reasons for scapular dyskinesis?

Answer 12

1. GH pathology
2. Neuropathy
3. Muscle weakness
4. Muscle tightness (be concerned about cervical spine facilitation)
5. Loss of neuromuscular control (may be related to posture)

Question 13

1. What direction should you glide the scapula to test Latissimus dorsi?
2. Serratus Anterior?
3. Levator Scapulae & Rhomboids?
4. Pec Major and Serratus upper fibers?

Answer 13

1. Elevation and Protraction
2. Elevation and Retraction
3. Depression and Protraction
4. Depression and Retraction

Question 14

Take a look at the exercises in the last part of the shoulder. Did that? Good. Now, can pullies be used early on in treatment of serious shoulder issues?

Answer 14

Though don’t use pullies early in treatment because it is hard to know if pt. is moving passively or not.