EEO:Lecture 6 Flashcards
what shoulder actions make up shoulder elevation?
flexion, abduction, scaption
Shoulder questions to ask?
Which hand do you write with?
Activities you are having difficulty with?
Have you ever had a history of neck pain, upper back pain, or headaches?
Other shoulder?
Shoulder Questionnaires
Quick DASH
UCLA shoulder scale
UEFS
Patient Specific Functional Scale
Shoulder performance measures
Hand Grip Dynamometry
Time Weighted Overhead Test
Upper Quarter Y Balance
UE Endurance
Apely Scratch
UE CKC Stability Test
from the front the clavicle is elevated __ degrees
20
From the side,
the ________ is in line with the ear
___________ kyphosis
transition at ____
elbow is directly below __________ head
the acromion in line with the ear
thoracic kyphosis
transition at cervical-thoracic
elbow directly below humeral head
an elevated clavicle leads to a lengthened ________ &
a short _________
lengthened pec major (clavicular head)
shorted upper trap
a depressed clavicle leads to a lengthened ___________ and a short ___________
lengthened upper trap, short pec major (clavicular)
T or F: cubital fossa should face primarily anteriorly and slightly lateral with arms at side
F
Correct answer: cubital fossa should face primarily anteriorly and slightly medial with arms at side
Increased thoracic kyphosis:
gravity has a _________ moment arm for flexion
correlated with scapular _________ and cervical __________
gravity has stronger moment arm for flexion
correlated with scapular protraction and cervical extension
decreased thoracic kyphosis:
gravity _____ through vertebral bodies
possibly __________ work on muscles that attach to scapular
Gravity more through vertebral bodies
Possible increased work on
muscles that attach to scapula
T or F: the CT junction should have some kyphosis
T
in excessive kyphosis, what is the breakdown point for the CT junction?
hinge in the lower cervical spine
excessive kyphosis increased the work for what muscles?
scapular stabilizer muscles
excessive kyphosis is possibly associate with scapular __________ & _________
scapular depression and abduction
T or F: decreased kyphosis is common
F!
decreases kyphosis is rare
Scapulae positioned
between which vertebral levels
T2-T7
at which vertebral level is the superior angle of the scapula?
T2
at which vertebral level is the inferior angle of the scapula?
T7
scapulae is about __ inches from spinous processes
3
what to look for with overhead reach test
- symmetry
- single versus multiple reps
- muscles that are dominant
- muscles that are weak
what specific movements to look for when screening an overhead reach
does the scapula upwardly rotate?
does the scapula wing?
does the humerus remain internally rotated?
causes of AC joint sprain
FOOSH
downward force on acromion
upward force on clavicle
AC joint sprain pt presentation
- “pop”
- WEAKNESS at end range arm
- pain at 90 degrees shoulder flex
- pain with horizontal adduction
- pain at joint
- piano key sign
Piano key sign
if you press down on the raised end of the clavicle, it depresses, but when you release it springs back up
causes of AC joint arthritis
repetitive overhead
prior related injury
Prior scapular dyskinesia
scapular dyskinesia
shoulder blades do not move the way the are supposed to
AC joint arthritis pt presentation
pain at end range
pain with shoulder flexion, Hor. adduction
pain at joint
palpable bony growth
shoulder impingement causes
bony growth
poor mechanics
prior injury
FOOSH
shoulder impingement pt presentation
pain at 60-120 abduction (painful arch)
pain irritated with overhead reach
click/pop
do shoulder impingement patients have pain at rest?
no
why is it important to clear the spine with shoulder impingement?
the older you get, the more likely the shoulder pain is coming from the cervical (C5) spine
causes of rotator cuff tendinopathy
repeated micro trauma
rotator cuff tendinopathy is a progression of what condition
shoulder impingement
rotator cuff tendinopathy pt presentation
pain with contraction or stretching, overhead reach, repetitive load, lying on shoulder
atrophy in muscle belly
NO PAINNFUL ARCH
do patients with rotator cuff tendinopathy have pain at rest?
yes
cause of rotator cuff tear
FOOSH, repetitive microtrauma
pt presentation of rotator cuff tear
weakness and pain based on degree of tear, muscle atrophy, scapular malpositioning
what motions are limited after rotator cuff surgery?
PROM flexion, abduction, ER, IR
no shoulder AROM (4-6 weeks)
What will be the difference between the AROM and PROM of a patient with a rotator cuff tear post surgery?
AROM will be significantly lower than PROM due to muscle weakness from being in a sling for 6 weeks
what is another name for a labral tear?
bankart lesion
causes of labral tears
FOOSH, direct trauma, violent pull of shoulder, loaded lifting
pt presentation labral tear
pop, click, clunk
arm feels heavy
pain with overhead reach
weakness
type 1 SLAP lesion
frayed
not detached or bucket handle
type 2 SLAP lesion
detached
type 3 SLAP
frayed and bucket handle
type 4 SLAP
detached and bucket handle
pt presentation of SLAP lesion
pop, click, clunk
arm feels heavy,
arm feels about to dislocate
pain with flexion and/or IR
weakness in shoulder/scapular stabilizers
difficulty lying on side
frozen shoulder (adhesive capsulitis) causes
insidious, may correlate with middle age, T2 DM, or hypothyroidism
“freezing” frozen shoulder stage
losing ROM, painful
“frozen” frozen shoulder stage
minimal ROM, less painful
“thawing” frozen shoulder stage
regaining ROM, pain varies
What is the capsular pattern for adhesive capsulitis?
MIDTERM QUESTION
1: Greatest loss of external rotation (most restricted movement).
2: Moderate loss of abduction.
3: Least loss of internal rotation (though still restricted).
ShouldER = ER
How will AROM and PROM compare in patients with frozen shoulder?
they will be similar
shoulder end feels
FIRM
subacromial bursitis end feel
empty
frozen shoulder end feel
hard capsular
for shoulder MMT, how would you test functionality?
you resist at a longer lever arm location
normal shoulder flexion range
180
normal shoulder extension range
AAOS- 60
AMA- 50
shoulder abduction norm range
180
AMA- 170
shoulder IR range
AAOS- 70
AMA- 80
ext < IR < ER < abd < flexion
shoulder ER range
AAOS- 90
AMA- 60
ext < IR < ER < abd < flexion
decreased kyphosis leads to possible _________ weight bearing though vertebral bodies and ________ movement through vertebral bodies
possible increased weight bearing though vertebral bodies and increased movement through vertebral bodies (NOT facets)
