Evidence Based Management of the Shoulder Joint Complex Flashcards
1
Q
how much AC jt motion makes up 120 deg of GH abd?
A
35 deg upward rot
2
Q
how much ST jt motion makes up 120 deg of GH abd?
A
60 deg upward rot
3
Q
how much GH jt ER makes up 120 deg of GH abd?
A
45 deg
4
Q
how much SC jt motion makes up 120 deg of GH abd?
A
25 deg upward rot
25 deg elevation
5
Q
what kind of jt is the SC jt?
A
a saddle jt
6
Q
what is the articulation of the SC jt?
A
the clavicle articulates with a disc on the manubrium
7
Q
t/f: the clavicle moves in an oblique plane that tilts into the sag plane when going into protraction/retraction
A
true
8
Q
what are the benefits of the disc articulation in the SC jt?
A
increased mobility, stability, and load acceptance in the SC jt
9
Q
elevation and depression of the clavicle is restricted by what lig?
A
the costoclavicular lig
10
Q
protraction at the SC jt is accompanied by what other motion?
A
depression
11
Q
retraction at the SC jt is accompanied by what other motion?
A
elevation
12
Q
when the SC jt protracts and depresses, what is the direction of the glide?
A
anterior
13
Q
when the SC jt retracts and elevates, what is the direction for the glide?
A
posterior
14
Q
when the SC jt protracts/retracts, is it convex on concave motion or concave on convex motion?
A
concave on convex motion
15
Q
what plane is rotation of the clavicle?
A
sagittal plane
16
Q
what ligament stops elevation of the clavicle at about 90 deg, then rotates the clavicle to allow for the scap to continue moving?
A
the coracoclavicular lig
17
Q
what is the roll and glide of elevation at the SC jt?
A
roll sup
glide inf
18
Q
what is the roll and glide of depression at the SC jt?
A
roll inf
glide sup
19
Q
what motions does the interclavicular lig restrict?
A
sup and lat motions
20
Q
what motion does the costoclavicular lig restrict?
A
elevation
21
Q
what plane does protraction/retraction occur in?
A
transverse plane
22
Q
t/f: the AC jt is a pseudoarticulation
A
true
23
Q
what kind of jt is that AC jt?
A
planar jt
24
Q
what part of the scap defines upward/downward rotation?
A
the inf angle of the scap
25
when the inf angle of the scap moves medially, what motion is occurring?
downward rotation
26
how much downward rotation occurs at the scap?
20 deg
27
when the inf angle of the scap moves laterally, what motion is occurring?
upward rotation
28
how much upward rotation is there at the scap?
60 deg
29
t/f: the scap does upward/downward rotation, tilting, and IR/ER
true
30
when the scap tilts anteriorly, what muscle is working a lot?
pec minor
31
when the scap tilts posteriorly, what muscle is working a lot?
LT
32
what is the most mobile jt in the body?
the GH jt
33
why is the GH jt prone to instability?
bc only 25% of the humeral head is covered by the glenoid fossa
34
what provides dynamic stability at the shoulder?
SITS muscles (supraspinatus, infraspinatus, teres minor, subscapularis)
35
describe the setting phase of the shoulder
during the first 30 deg of shoulder and, there is very little scap motion
36
what the scapulohumeral rhythm?
2:1 GH to ST
37
what is the exception to the roll/glide rules at the shoulder?
IR/ER
38
when the GH jt ERs, what is the glide?
posterior
39
what is a theory as to why the humeral head glides posteriorly during ER?
the anterior lig complex catches the humeral head and pushes it back as it becomes tight
ER muscles are posterior and therefore pull the humeral head back
40
when the GH jt IRs, what is the glide?
anterior
41
what is the theory as to why the humeral head glides anteriorly during IR?
the posterior lig complex catches the humeral head and pushes it forward as it becomes taught
42
what is the roll and glide of shoulder flexion?
roll sup
glide inf/ant
43
what is the roll and glide of shoulder abduction?
roll sup
glide inf/post
44
what is the roll and glide of shoulder IR?
roll/spine post
glide ant
45
what is the roll and glide of shoulder ER?
roll/spine ant
glide post
46
what is the roll and glide of shoulder horizontal adduction?
roll med
glide lat
47
what is the roll and glide of shoulder horizontal abduction?
roll lat
glide med
48
what is the roll and glide of shoulder POS elevation?
roll sup
glide inf
49
what is the roll and glide of shoulder extension?
roll/spin ant
glide ant
50
what are the restraints to ER at 0 deg abd?
subscap
sup GH lig
coracohumeral lig
51
what are the restraints to ER at 45 deg abd?
subscap
mid GH lig
52
what are the restraints to ER at 90 deg abd?
inf GH lig
53
when the arm is higher up, where do the restraints come from?
further down
54
when the arm is lower down, where do the restraints come from?
further up
55
what is the shape of the inf GH lig?
pouch-like (axillary pouch)
56
what is the benefit of the shape of the inf GH lig?
the puhc allows for more flexibility in arm elevation
57
when the inf GH lig becomes inflammed and sticks to itself, what condition may be present?
adhesive capsulitis
58
what are the restraints to IR at 0 deg abd?
ing GH lig
teres minor
post capsule
59
what are the restraints to IR at 45 deg abd?
inf GH lig
60
what are the restraints to IR at 90 deg abd?
inf GH lig
post capsule
61
the inf GH lig and coracohumeral lig resist what motions?
ER and ext
62
the sup GH lig resists what?
inf translation of the humeral head
63
the middle GH lig resists what motions?
anterior translation from 0-45 deg in ER
64
how can we try to loosen ligs?
heat, stretching, US, cross/transverse friction massage
65
the inf GH lig restricts ____ and ____ in 90 deg abd?
IR, ER
66
when is the inf GH lig most taught?
at 90 abduction with full ER
67
t/f: the higher the arm gets, the more slack the mid and sup GH ligs get
true
68
what is the rotator interval?
a critical zone in the shoulder bw the subscap and supraspinatus where impingement frequently occurs
69
what structures run through the rotator interval?
the biceps tendon
subacromial bursa
suprascapularis tendon
70
t/f: the shape of the acromion can cause impingement at the rotator interval
true
71
the rotator interval space is typically _______mm
4-11
72
what can cause decreased acromial space in the rotator interval?
inflammation of the structures running through it, acromial shape differences
73
what questions should we ask about the chief complaint at the shoulder?
reproducible motions/positions
pain levels and location
74
what is a macrotrauma?
a single event causing the injury
75
what is a microtrauma?
cumulative events causing the injury
76
t/f: we can use US for feedback on muscle use
true
77
what diagnostic imaging can be used at the shoulder?
plain film radiograph
arthrography
CT scan
MRI
78
what are possible adjacent contributors to shoulder pain?
cervical spine
thoracic spine
79
how may the thoracic spine contribute to shoulder pain?
if someone lack motion at the thoracic spine, they may compensate for the lack of motion by overusing the shoulder
80
what are typical views used in radiographs of the shoulder?
AP in IR or ER
lat/scapular (Y view)
81
what shoulder pathology can be diagnosed with an MRI?
rotator cuff tears, Bankart lesions, SLAP lesions
82
what is a Bankart lesion?
a labral tear at 3-6 o clock
83
what is a SLAP tear?
a labral tear at 10-2 o clock
84
what does SLAP stand for?
sup labrum anterior or posterior to the biceps
85
a tight biceps could cause what at the shoulder?
SLAP tear
86
what disability questionnaires may be used for shoulder pathology?
SPADI
DASH/quick-DASH
UCLA Shoulder Rating Scale
Penn Shoulder Score
87
what are medical red flags in the shoulder?
R shoulder-lung, GB
L shoulder-heart, spleen, diaphragm
cardiac (MI)
Pancost's tumor (superior sulcus0
gall bladder
liver
spleen
peripheral nerve entrapment
88
what organs can refer pain to the R shoulder?
lung
gall bladder
89
what organs can refer pain to the L shoulder?
heart
spleen
diaphragm
90
a peripheral nerve entrapment of what nerves could cause shoulder pathology?
spinal accessory
axillary
long thoracic
suprascpaular
91
a peripheral nerve entrapment of the spinal accessory nerve could cause weakness of what muscle?
traps
92
a peripheral nerve entrapment of the axillary nerve could cause weakness of what muscle?
delts
93
a peripheral nerve entrapment of the long thoracic nerve could cause weakness of what muscle?
serratus anterior
94
a peripheral nerve entrapment of the suprascapular nerve could cause weakness of what muscles?
supraspinatus
infraspinatus
95
what should we observe at the shoulder during an exam?
head, neck position
thoracic kyphosis
scap position
shoulder position
muscles contours
upper crossed
96
what is normal thoracic kyphosis?
40 deg
97
what is normal scap position?
2 in from spine
sup angle at T2
inf angle at T7
98
what spinal level should the sup angle of the scap be at?
T2
99
what spinal level should the inf angle of the scap be at?
T7
100
what is weak in upper crossed syndrome?
deep cervical flexors
scap stabilizers (rhomboids, MT, LT, SA)
101
what is tight in upper crossed syndrome?
suboccipital
UT
LS
pecs
102
how do we know if the head is properly aligned?
the tragus should be in line with the acromion
103
if we observe scapular winging, what muscle should we MMT?
the SA
104
what is the purpose of observation?
to help us dial in on the specific things we want to check in the exam
105
what may cause one shoulder to be more elevated than the other?
UT tightness
scoliosis
spinal accessory nerve injury on the dropped side
poor ergononics
higher pelvis on one side
106
what does QQR mean when testing ROM?
assess for Quality, Quantity, and Reproduction of symptoms
107
where might we note pain in ROM?
at end range
through range
in a painful arc
108
why is the time to baseline pain important to us?
bc it tells us the reactivity of the problem
109
t/f: we should assess just uniplanar motions when testing ROM?
false, we should be test uni and multiplanar motions
110
why should we test motions single and multiple times?
to see if pain is reproduced after one time or multiple times and how many times if multiple
111
where is the painful range for the AC jt?
170-180 deg shoulder abd
112
where is the painful range for the GH jt?
45/60 deg to 120 deg shoulder abd
113
what does it mean when a pt has to lean over to flexion their shoulder?
possible RC weakness, so they try to get a better advantage for the delts
114
during the first 30 deg shoulder flexion, what is the RC doing?
stabilizing and depressing the humeral head to prevent it jamming into the acromion
115
why is it a problem if the delts work unopposed?
bc it jams the humeral head straight up into the acromion
116
what motions make up functional ER?
abduction
ER
overpressure
117
what motions make up function IR?
extension
adduction
IR
overpressure
118
how do we measure functional ER and IR?
by how far up or down the thumb can go
119
in normal functional IR range, where should the thumb get to?
about T7 at the inferior angle of the scap
120
what muscles are involved in resisted abduction?
delts
supraspinatus
121
if resisted abduction causes pain with horizontal abduction, what muscle may be involved?
posterior delts
122
if resisted abduction causes pain with horizontal adduction, what muscle may be involved?
anterior delts
123
if resisted abduction causes pain, but there is no pain with resisted horizontal adb or add, what muscle may be involved?
supraspinatus
124
what muscles are involved in resisted adduction?
pec major
teres minor
lats
teres major
125
if resisted adduction and flexion causes pain, what muscle may be involved?
pec major
126
if resisted adduction and ER causes pain, what muscle may be involved?
teres minor
127
if resisted adduction and extension cause pain, what muscle may be involved?
lats (or could be teres major)
128
if resisted adduction and IR cause pain, what muscle may be involved?
teres major (or could be lats)
129
what muscles are involved with resisted ER?
teres minor
infraspinatus
supraspinatus
130
if resisted ER and adduction causes pain, what muscle may be involved?
teres minor
131
if resisted ER and abduction causes pain, what muscle may be involved?
supraspinatus
132
if resisted ER causes pain, but not adduction or abduction, what muscle may be involved?
infraspinatus
133
what muscles are involved in resisted IR?
subscap
pec major, lats, and teres major
134
if resisted IR and adduction causes pain, what muscles may be involved?
pec major
lats
teres major
135
if resisted IR causes pain but not adduction, what muscle may be involved?
subscap
136
what muscle is involved in resisted flexion?
corocobrachialis
137
if there is pain with flexion and horizontal abduction and adduction, what muscle may be involved?
delts
138
how do we perform scapulothoracic and scapulohumeral resistance testing (flip sign)?
have pt perform scapular adduction w/ER resistance
139
what would result in a positive flip sign?
weak MT/UT
140
why would weak MT/UT result in a positive flip sign?
bc the tension of the supra, infra, and teres minor without the tension of the MT/UT holding the scap down against the chest wall will cause the scap to flip
141
how do we perform lats testing?
have PT in ext, IR, and add
resist pt arm going towards the ceiling in prone
142
how do we perform rhomboid resistance testing?
in prone, have the pt put their hand behind their back and lift their hand off their back while you push on their scap
143
how do we perform UT resistance testing?
in sitting or supine, try to bend ear to shoulder or elevate shoulders with resistance down
144
how do we perform MT resistance testing?
in prone with elbow bent to 90 deg and shoulder abducted 90 deg, resist the pt pushing up towards the ceiling at the elbow
145
how do we perform LT resistance testing?
in prone with the arm over the head, resist the arm going up to the ceiling
146
how do we perform SA resistance testing?
in sitting or standing with the arm overhead to 130 deg, push down and back into retraction while feeling the medial border of the scap
147
if the pt can't hold the SA resistance test and there is scap winging, what may this indicate?
SA weakness or long thoracic nerve injury
148
what are the special tests for impingement syndromes?
Hawkins Kennedy
Neer
Yergason
149
if you do all contractile tissue tests and they are negative, but all impingement tests are positive, what is likely going on?
bursitis
150
how do we perform the Hawkins Kennedy test?
have PT in flex, IR, add (can increase add) and push down at their wrist and up at their elbow
151
what is the sensitivity and specificity of the Hawkins Kennedy test?
sn=72-92%
sp=25-66%
152
is the HK better to rule in or out?
out
153
what is the crossover test?
test for impingement or AC jt like HW
bring arm across body
154
how do we perform the Neer test?
have PT flex, IR as you stabilize the scap
155
t/f: the Neer and HK test will test us that something is wrong, but not what is wrong
true
156
what is the sensitivity and specificity of the Neer test?
sn=68-95%
sp=25-68%
157
is the Neer test better to rule in or out?
out
158
how do we perform the Yergason test?
have the pt's elbow at 90 deg flexion and pronated
resist supination and/or elbow flexion while palpating the bicipital groove
159
what can the Yergason test test for?
impingement and biceps
160
t/f: in the Yergason test, we may also bring them out into ER to see if it will flip out the bicipital groove
true
161
what is the sensitivity and specificity of the Yergason test?
sn=9-37%
sp=86-96%
162
is the Yergason test better to rule in or out?
in
163
what are the special tests for the RC?
ER Lag (dropping) sign
Hornblower sign
drop arm test
lift off test
full/empty can test
164
what are the indications for the ER Lag (dropoff) sign?
R/O infraspinatus tear
165
how do we perform the ER Lag (dropoff) sign?
put the pt's arm into 90 deg elbow flexion and have them hold it then apply resistance to ER
166
if a pt can hold their arm in a position (strong), but it's painful, what may we suspect?
tendinopathy
167
if a pt cant hold the position, what may we suspect?
a full tear
168
if a pt has pain with active motion and resistance, what may we suspect?
partial tear
169
what is the sensitivity/specificity and +/- LR of the ER Lag (dropoff) sign?
sn=20-100%
sp=69-100%
(-) LR=0-.64
(+)LR=NA
170
is the ER Lag (dropoff) sign better to rule in or out?
in
171
what are the indications for Hornblower test?
R/O teres minor tears
172
how do we perform the Hornblower sign?
bring the shoulder into elevation and ER with slight elbow flexion
173
what will we see with a teres minor tear in the Hornblower test?
the arm will drop
174
what is the sensitivity/specificity and +/- LR of the Hornblower test?
sn=92-100%
sp=30-93%
(+)LR=14.3
(-)LR=0
175
in the Hornblower test better to rule in or out?
out
176
what are the indications for the drop arm test?
R/O RC tears (supra, infra)
177
how do we perform the drop arm test?
bring the patient's arm into about 90 deg abduction and add resistance if they can hold the position
178
what is the sensitivity/specificity and +/- LR of the drop arm test?
sn=15%
sp=100%
(+)LR=NA
(-)LR=NA
179
is the drop arm test better to rule in or out?
in
180
what are the indications for the lift off test?
R/O subscap tear
181
how do we perform the lift off test?
have the pt put their arm behind their back into functional IR and lift their arm off their back
if they can't put their arm behind their back, have them push their arm into their belly and if they can do that, try to pull their arm away from their belly
182
what is the sensitivity/specificity of the lift off test?
sn=62-89%
sp=98-100%
183
what are the indications for the full/empty can test?
R/O supraspinatus tear
184
how do we perform the full/empty can test?
resist shoulder flexion in ER (thumbs up, full can) then in IR (thumbs down, empty can) in scaption
185
if the pt can't do the full can test, should we do the empty can test?
no!
186
what is the sensitivity/specificity of the full/empty can test?
sn=62-89%
sp=98-100%
187
is the lift off test better to rule in or out?
in
188
is the full/empty can test better to rule in or out?
in
189
what are the special tests for instability in the shoulder?
apprehension and relocation test
Jerk test
sulcus sign
190
what are the indications for the apprehension and relocation test?
R/O anterior instability of the shoulder
191
how do we perform the apprehension and relocation test?
put the pt in abd and bring them into ER in supine
for relocation provide anterior pressure at the humeral head
192
what is a key consideration with the apprehension and relocation test?
BE VERY CAREFUL AND LOOK AT THE PT'S FACE
193
what is the sensitivity/specificity and +/- LR of the apprehension and relocation test?
sn=30-63%
sp=61-99%
(+)LR=.53-3.08
(-)LR=.47-1.11
194
is the apprehension and relocation test better to rule in or out?
in
195
what are the indications for the Jerk test?
R/O posterior instability
196
how do we perform the Jerk test?
have the pt in shoulder flexion to about 90 deg and IR and horizontal adduction with their elbow bent
in sitting, give posterior pressure to push the humeral head back to check the integrity of the posterior capsule
197
what a common mechanism of injury where the Jerk test would be positive?
FOOSH
198
what is a common population we see positive Jerk tests in?
football linesmen
199
what is the sensitivity/specificity and +/- LR of the Jerk test?
sn, sp, LR=NA
200
what are the indications for the sulcus sign?
R/O inferior instability
201
how do we perform the sulcus sign?
inferiorly glide the humeral head while palpating the subacromial area and gripping the epicondyles
202
if there is more than __ finger space with the sulcus sign, it is indicative of instability in the GH jt
1
203
what is the sensitivity/specificity and +/- LR of the sulcus sign?
sn=17%
sp=93%
(+)LR=2.43
(-)LR=.89
204
is the sulcus sign better to rule in or out?
in
205
what are the special tests for glenoid labrum dysfunction?
speed test
biceps load test
O'Brian test
Crank test
Kim test
SLAP prehension test
anterior slide test (Kibler)
206
t/f: a SLAP lesion is often a dx of exclusion from ruling out everything else
true
207
where is a SLAP lesion?
10-2 o'clock
208
if a pt describes the pain as achey, clicks sometimes, doesn't other times, and is a vague pain, what are we suspecting?
a labrum problem
209
how do we perform the speeds test?
flex the shoulder to 90 deg, extend the elbow, and supinate the forearm
resist shoulder flexion at the forearm
210
what is a positive speeds test?
pain
211
pain with the speeds test indicates what?
biceps tendinopathy or labral tear
212
what is the sensitivity/specificity and +/- LR of the speeds test?
sn=17%
sp=93%
(+)LR=2.43
(-)LR=.89
213
is the speeds test better to rule in or out?
in
214
how do we perform the biceps load test?
abduct the shoulder to 90 deg, ER, and supinate with the palm facing the head in supine
resist elbow flexion
215
bc of the relationship bw the biceps and the labrum, the biceps load test may also indicate what?
the labrum
216
what is the sensitivity/specificity and +/- LR of the biceps load test?
sn=78-91%
sp=97%
(+)LR=26.38-30
(-)LR=.11
217
how do we perform the O'Brian test?
flex 90 deg and IR the arm then flex 90 deg and ER the arm with 10 deg hor add
resist shoulder flexion
218
what is a positive O'Brian test?
IR>ER pain and weakness
219
pain "inside" the shoulder with an O'Brian test indicates what?
SLAP
220
pain on "top" of the shoulder with the O'Brian test indicates what?
AC jt
221
what test looks like a speeds test with hor add?
O'Brian test
222
how do we perform the Crank test?
160 deg elevation w/elbow flexion
some deg of shoulder stabilization w/other hand
compression with ER/IR
223
what is the Crank test for?
biceps or labrum (SLAP)
224
t/f: the Crank test is a good test to trust on its own
false
225
what is the sensitivity/specificity and +/- LR of the crank test?
sn=9-91%
sp=56-100%
(+)LR=1.04-13
(-)LR=.10-2
226
how do we perform the Kim test?
130 deg in POS (plane of scap) with elbow flexion
apply compression
227
what does a (+) Kim test indicate?
SLAP lesion
228
what is the sensitivity/specificity of the Kim test?
sn=80-82%
sp=86-94%
229
is the biceps load test better to rule in or out?
in
230
is the O'Brian test better to rule in or out?
out
231
what is the sensitivity/specificity and +/- LR of the O'Brian test?
sn=47-100%
sp=11-98%
(+)LR=.78-2.33
(-)LR=.51-1.48
232
is the crank test better to rule in or out?
in
233
is the Kim test better to rule in or out?
in
234
how do we perform the SLAP prehension test?
hor add w/the arm in IR then ER with no resistance
235
what is a (+) SLAP prehension test?
pain with IR that diminishes with ER
236
what is the sensitivity of the SLAP prehension test?
50-87.5%
237
how do we perform the anterior slide test (Kibler)?
have PT put hand on hip
provide ant/sup force through the elbow w/ one hand and other hand stabilizing the shoulder stressing the ant capsule
238
what does the anterior slide test (Kibler) sniff out?
Bankart lesion
239
where is a Bankhart lesion?
3-6 o'clock
240
what is the sensitivity/specificity and +/- LR of the anterior slide test (Kibler)?
sn=8-78%
sp=84-92%
(+)LR=.56-9.75
(-)LR=.24-1.1
241
is the anterior slide test (Kibler) better to rule in or out?
in
242
is the shoulder more mobile or more stable?
mobile
243
why does the shoulder lean towards more mobility than stability?
bc there is not a lot of coverage of the humeral head (gold ball on golf tee)
244
what is the association bw labral tears and GH instability?
mobc the jt is more unstable it is more prone to injury
245
what are some factors that contribute to GH instability?
ligament laxity (EDS), age, gender, hypermobile athletes, Marphan's
246
what is a common MOI of a SLAP lesion?
winding up to throw a ball
247
why does shoulder ER and abd cause SLAP lesion?
it winds up the biceps tendon and it pulls on the labrum
248
what are the special tests for AC jt dysfunction?
AC shear test
cross body adduction test
249
how do we perform the AC shear test?
compression over the AC jt w/ant and post shearing forces
250
what is the sensitivity/specificity of the AC shear test?
sn=100%
sp=97%
251
is the AC shear test better to rule in or out?
out
252
if the HK test is positive which of these other tests may also be positive: Speeds, apprehension, Kim, AC shear tests?
Speeds bc it also create subacromial irritation and is the only resistive test
253
how do we perform the cross body adduction test?
flex the shoulder to 90 deg and horizontally adduct the arm across the chest
254
the cross body adduction test is similar to what test, except without the IR?
HK
255
there is likely more ____ pain with the cross body adduction test
superior
256
what are the special tests for thoracic outlet syndrome?
Adson test
Allen test
ROOS test
Wright test
Military press test
257
what kinds of s/s are we looking for with the special tests for thoracic outlet syndrome?
nerve and vascular symptoms (skin discoloration, occluded pulses, paresthesias, pain)
258
what causes compression in thoracic outlet syndrome?
compression of the nerve or vessel through the clavicle and 1st rib/accessory rib
259
how do we perform the Adson test?
stabilize the scap
palpate the radial pulse
move the arm into abd, ER, ext
have PT look at the arm and hold their breath
feel if pulse changes
260
what is the sensitivity/specificity of the Adson test?
sn=32-87%
sp=74-100%
261
is the Adson test better to rule in or out?
out
262
how do we perform the Allen test?
palpate the radial pulse
bring the arm into 90 deg abd, elbow flex
tell pt to look away from the arm and hold their breath
feel for changes in pulse
263
what is the specificity of the Allen test?
sp=18-43%
264
how do we perform the ROOS test?
raise the BL shoulder to 90 deg abduction, ER, and flex the elbows
open and close hands for 3 minutes
265
what is the sensitivity/specificity of the ROOS test?
sn=82-84%
sp=30-100%
266
is the ROOS test better to rule in or out?
in
267
how do we perform the Wright test?
palpate the radial pulse and bring the arm into 180 deg ER and take a deep breath
hold the position for 20-30 sec to see if there's change to the pulse
268
what is the sensitivity/specificity of the Wright test?
sn=70-90%
sp=29-53%
269
is the Wright test better to rule in or out?
in
270
how do we perform the Military press test?
palpate the radial pulse and retract the shoulders in exaggerated military posture with palms facing out
271
what is the specificity of the military press test?
53-100%
272
what are the key (+) findings that rule in RC/impingement?
impingement sign
painful arc
pain with isometric resistance
weakness
atrophy
273
what are key (-) findings that rule out RC/impingement?
significant loss of motion
instability sign
274
what are key (+) findings to rule in adhesive capsulitis?
spontaneous progressive pain
loss of motion in multiple planes
pain at end range
275
what are key (-) findings to rule out adhesive capsulitis?
normal motion
age >40 y/o
276
what are key (+) findings to rule in GH instability?
age <40 y/o
hx of dislocation/subluxation
apprehension
generalized laxity
277
what are key (-) findings to rule out GH instability?
no hx of dislocation
no apprehension
278
what level of tissue irritability is 7/10 or greater pain
high
279
what level of tissue irritability is 4-6/10 pain?
moderate
280
what level of tissue irritability is 3/10 pain or less?
low
281
what level of tissue irritability has night/resting pain (constant)?
high
282
what level of tissue irritability has intermittent pain?
moderate
283
what level of tissue irritability has no night or rest pain?
low
284
if there is pain b4 end range, what level of tissue irritability is it?
high
285
if there is pain at end range, what level of tissue irritability is it?
moderate
286
if there is minimal pain with overpressure, what level of tissue irritability is it?
low
287
if AROM is less than PROM, what level of tissue irritability is it?
high
288
if AROM and PROM are about equal, what level of tissue irritability is it?
moderate
289
if AROM=PROM, what level of tissue irritability is it?
low
290
what are the intervention guidelines for high tissue irritability?
minimize physical stress through activity modification
monitor impairments
291
what are the intervention guidelines for moderate tissue irritability?
mild to moderate physical stress
restore impairments
basic level fxnal activity restoration
292
what are the intervention guidelines for low tissue irritability?
restore impairments
high demand for fxnal activity restoration
mod to high physical stress
293
if there are no active mobility impairments, what should we do?
medical screening
294
if there are active mobility impairments, passive mobility impairments, and passive accessory mobility impairments, what are we thinking the issue is?
GH capsular issue of some kind
295
if there are active mobility impairments, but no passive mobility impairments or muscle weakness, what are we thinking the issue is?
NM coordination
296
if there are active mobility impairments, passive mobility impairments, muscle weakness <2/5 and atrophy, what are we thinking the issue is?
peripheral neuropathy
297
if there is active mobility impairments, passive mobility impairments, and muscle weakness not <2/5 or atrophy, what are we thinking the issue is?
NM coordination issue, pain dominant, or force production issue
298
if there are active mobility impairments and passive mobility impairments, but no passive accessory impairments, what are we thinking the issue is?
myofascial restriction
