Buckets For Shoulder Pain Flashcards
What are the buckets for shoulder pain?
Subacromial pain syndrome
Adhesive capsulitis
Glenohumoral instability
Other
What are impairments that are present in the subacromial pain syndrome bucket?
Subacromial pain syndrome (impingement)
Rotator cuff full thickness tear
Rotator cuff tendinopathy/partial thickness tear
SLAP/LHB tendinopathy
Bursitis
Articular surface rotator cuff tear
What would someone with rotator cuff tendinopathy present with?
Anterolateral shoulder pain
Pain with overhead motion
Painful arc with AROM abduction
Night pain
What would someone with a rotator cuff tear present with?
Anterolateral shoulder pain
Compensatory shoulder shrugging with overhead motion
Constant shoulder achiness
Night pain that wakes them up
Patient > 40 y/o
What are the special tests for shoulder impingement?
Hawkins Kennedy test
Painful arc (60-120°)
Infraspinatus muscle test
Neers test
Empty can
How can you rule in shoulder impingement using special tests?
If 3 out of 5 are positive
What are the special tests for a rotator cuff full thickness tear? (Ruling in)
Drop arm test
Painful arc (60-120°)
Infraspinatus muscle test
What are the special tests for rotator cuff tendinopathy?
Lift off test
Belly press test (both are testing Subscapularis)
What is the presentation in someone with long head bicep tendinopathy?
Anterior shoulder pain
Painful palpation at proximal LHB
Pain with eccentric deceleration (throwing or swinging)
Pain with muscular loading of bicep (shoulder flexion and arm supination)
What are the special test used for long head bicep tendinopathy?
Yergasons test (resisted elbow flexion, supination, and shoulder ER)
Speed test
What does someone with a SLAP lesion present with?
Deep shoulder pain
Complaints of clicking
Complaints of joint locking
Pain with eccentric deceleration (throwing or swinging)
Pain with muscular loading of bicep (shoulder flexion and arm supination)
What are the special tests for a SLAP lesion?
Biceps load 1 and 2
Crank test
What does someone with articular-sided rotator cuff internal impingement syndrome present with?
Specific posterior shoulder pain during abduction and ER
What is the special test used for articular sided rotator cuff internal impingement syndrome?
Posterior impingement sign test
What is the relevance of GH internal rotation deficit?
Pitchers have increased shoulder ER which limits their IR on pitching arm (as long as total arc is equal in both arms it is fine)
What are the impairments associated with the glenerohumeral instability bucket?
Anterior instability (most common)
Posterior instability/posterior labral injury
Multidirectional instability/global instability
Bankart/reverse bankart tear
What does someone with anterior instability present with?
Anterior pain
Pain in abduction and ER
Recurrent anterior subluxations
Joint clicking or locking
Dead arm syndrome
What are the special tests for anterior instability?
Apprehension test
Relocation test
Surprise test (must be done in this order)
How do we know if the relocation test is a positive test?
If symptoms get better
What is the special test for a bankart lesion?
Crank test
How does someone with posterior instability/posterior labral lesion present?
Deep posterior shoulder pain
Pain in horizontal adduction
Pain in activities that involve pushing
Pain in closed chain activities (plank)
Recurrent posterior subluxations
Joint clicking
What are the special tests for posterior instability/posterior labral tear?
Jerk test
Kim test
What are the special tests for multidirectional/global instability?
Load and shift
Sulcus
What are categories in the “other” bucket?
ACJ
GHJ arthritis
Fracture
Nerve entrapment
Post op
What does someone with an ACJ injury present with?
Superior joint pain
Pain with end range elevation
Pain with horizontal abduction and adduction
Pain with ACJ palpation
Notable AC joint step off
What is the MOI for the ACJ?
Fall on shoulder
What are the special tests for the ACJ?
Paxinos test
Crossover test
Painful arc (150-180°)
What does someone present with that has GHJ arthritis?
Joint pain
Crepitus
AM stiffness
Age > 65
Pain with end range
Where in the labrum do you see a SLAP tear?
Between 10 and 2
Where in the labrum do you see a bankart lesion?
Between 3 and 6
What muscles do you want to protect immediately following a full shoulder replacement?
Subscapularis (do not do resisted IR)
What is immediate post op recommendation?
Using sling in neutral position
What happens in a Hills-Sachs lesion?
Anterior glenoid impacts the posterior humeral head
