Approach to Shoulder Complaint Flashcards
shoulder flexion ROM
180°
shoulder extension ROM
60°
shoulder abduction ROM
180°
shoulder internal/external ROM
90°
shoulder horizontal abduction ROM
40-55°
shoulder horizonal adduction ROM
130-140°
dermatome over the AC joint
C4
dermatome over the lateral aspect of the lower edge of the deltoid muscle moving into the anterior middle portion of arm and forearm
C5
dermatome of radial side of forearm and thumb
C6
dermatome of palmar side of middle finger and posterior middle portion of arm and forearm
C7
dermatome of the 5th digit and medial portion of arm and forearm
C8
dermatome of the medial aspect of antecubital fossa, proximal to the medial epicondyle of the humerus
T1
dermatomes of the biceps and brachioradialis Ms.
C5-6
dermatomes of the triceps M.
C6-7
- patient: shoulder abducted to 90° and elbow flexed to 90°
- stabalize shoulder and force arm into external rotation
- (+) test: patient apprehension
- indicates: glenohumeral instability
apprehension test
- patient: flex shoulder to 90° and abduct to 45°
- internally rotate arms so thumbs are pointed down, press down on forearms while patient resists
- (+) test: pain or weakness
- indicates: supraspinatus pathology
empty can test
- patient: abducts arm to 90°, then slowly drops arm to neutral, can also be down w/ gentle tap on the wrist
- (+) test: uncontrolled arm drop
- indicates: supraspinatus pathology
drop arm test
- patient: abducts arm starting at neutral
- (+) test: pain between 60-120° of abduction
- indicates: subacromial bursa impingement and/or rotator cuff injury
painful arc test
- stabalize shoulder and pronate forearm outward, passively flex shoulder into full flexion
- (+) test: pain
- indicates: subacromial bursa impingement or rotator cuff impingement
Neer’s Test or Neer’s Impingement
(“Neer to the Ear”)
- patient: flex shoulder to 90° and elbow to 90°
- passively internally rotate shoulder
- (+) test: pain
- indicates: subacromial bursa impingement or rotator cuff impingement
Hawkin’s Test
- passively adduct arm across patient’s chest and rest patient’s hand on their opposite shoulder
- monitor posterior aspect of AC joint
- (+) test: AC joint pain or increased TTA’s
- indicates: AC joint pathology
Cross Arm Test
Most common type of shoulder dislocation:
anterior dislocation (95-97% of cases)
Most common rotator cuff tendon to be injured:
supraspinatus
Most common causes of shoulder pain:
rotator cuff injuries (acute) and myofascial injuries (acute)
scapular depression causes distal clavicle (AC joint) to ______ ______ and proximal clavicle (SC joint) to ______ ______
scapular depression causes distal clavicle (AC joint) to inferior glide (clavicle inferior to acromion) and proximal clavicle (SC joint) to superior glide (clavicle superior to sternum)
*vice versa for scapular elevation*
- GH joint motion: adduction
- scapular motion:
- clavicle AC joint:
- clavicle SC joint:
- GH joint motion: adduction
- scapular motion: depression
- clavicle AC joint: inferior glide
- clavicle SC joint: superior glide
- GH joint motion: abduction
- scapular motion:
- clavicle AC joint:
- clavicle SC joint:
- GH joint motion: abduction
- scapular motion: elevation
- clavicle AC joint: superior glide
- clavicle SC joint: inferior glide
- GH joint motion: flexion
- scapular motion:
- clavicle AC joint:
- clavicle SC joint:
- GH joint motion: flexion
- scapular motion: protraction
- clavicle AC joint: anterior glide
- clavicle SC joint: posterior glide
- GH joint motion: extension
- scapular motion:
- clavicle AC joint:
- clavicle SC joint:
- GH joint motion: extension
- scapular motion: retraction
- clavicle AC joint: posterior glide
- clavicle SC joint: anterior glide
- GH joint motion: internal rotation
- scapular motion:
- clavicle AC joint:
- clavicle SC joint:
- GH joint motion: internal rotation
- scapular motion: n/a
- clavicle AC joint: internal rotation
- clavicle SC joint: n/a
- GH joint motion: external rotation
- scapular motion:
- clavicle AC joint:
- clavicle SC joint:
- GH joint motion: external rotation
- scapular motion: n/a
- clavicle AC joint: external rotation
- clavicle SC joint: n/a
- glenohumeral joint tx
- patient lays prone w/ arm off table
- grasp humeral head and assess ease and restriction by using distraction, compression, twist, and shear
- engage either direct or indirect barrier until release is felt
shoulder myofascial release
- GH joint tx
- engage 7 stages of articulatory movement of shoulder: ext/flex, compression circumduction, traction circumduction, abduction w/ ext rot, adduction, internal rot, traction w/ inferior glide
- patient lays lateral recumbent w/ involved shoulder up
- MET can be included once restrictive barrier has been engaged
Spencer’s Technique
- AC tx
- doc: ipsilateral side or behind patient
- grasp elbow or forearm and monitor clavicle between thumb and fingers
- apply anterior/inferior pressure w/ thumb on lateral clavicle while flexing patient’s elbow; extending and adducting humerus (to gap AC joint)
- shoulder is moved into a circulatory sweep, posterior, superior, then anteromedial
superior clavicle articulatory technique
- patient: supine w/ neck fully flexed by physician
- doc: thumb over sternal end of clavicle, exerting a downward/caudal pressure on the clavicle
- patient instructed to inhale and exhale fully, during exhalation, physician springs the clavicle inferiorly/caudally
- tx: elevated SC joint = adducted SC joint
adducted SD articulatory technique
- patient: supine
- doc: ipsilateral side
- monitor at clavicular head and place other hand behind scapula, patient holds physician’s shoulder
- physician flexes the clavicle toward the manubrium pulling scapula anteriorly
- posterior force simultaneously applied to proximal clavicle from anterior to posterior to engage restrictive barrier
- apply principles of MET
- tx: anterior SC joint = extension SC joint
extension SD MET
- patient: supine
- doc: ipsilateral side
- monitor on the sternal clavicular head, place arm into extension and internal rotation
- patient is instructed to raise arm against physician’s hand toward ceiling applying principles of MET
- tx: elevated SC joint = adducted SC joint
adducted SD MET
- patient: supine
- doc: contralateral side
- patient gaps the SC joint by adducting th ipsilateral arm (using their contralateral hand to aid in the motion)
- articulatory springing is applied laterally, posteriorly, and inferiorly over medial end of clavicle
- tx: anterior SC joint = extension SC
extension SD articulatory technique
