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DPT 616 : MSK > Evidence Based Management of the Shoulder Joint Complex > Flashcards

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

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2
Q

how much ST jt motion makes up 120 deg of GH abd?

A

60 deg upward rot

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3
Q

how much GH jt ER makes up 120 deg of GH abd?

A

45 deg

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4
Q

how much SC jt motion makes up 120 deg of GH abd?

A

25 deg upward rot

25 deg elevation

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5
Q

what kind of jt is the SC jt?

A

a saddle jt

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6
Q

what is the articulation of the SC jt?

A

the clavicle articulates with a disc on the manubrium

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7
Q

t/f: the clavicle moves in an oblique plane that tilts into the sag plane when going into protraction/retraction

A

true

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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

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9
Q

elevation and depression of the clavicle is restricted by what lig?

A

the costoclavicular lig

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10
Q

protraction at the SC jt is accompanied by what other motion?

A

depression

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11
Q

retraction at the SC jt is accompanied by what other motion?

A

elevation

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12
Q

when the SC jt protracts and depresses, what is the direction of the glide?

A

anterior

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13
Q

when the SC jt retracts and elevates, what is the direction for the glide?

A

posterior

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14
Q

when the SC jt protracts/retracts, is it convex on concave motion or concave on convex motion?

A

concave on convex motion

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15
Q

what plane is rotation of the clavicle?

A

sagittal plane

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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

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17
Q

what is the roll and glide of elevation at the SC jt?

A

roll sup
glide inf

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18
Q

what is the roll and glide of depression at the SC jt?

A

roll inf
glide sup

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19
Q

what motions does the interclavicular lig restrict?

A

sup and lat motions

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20
Q

what motion does the costoclavicular lig restrict?

A

elevation

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21
Q

what plane does protraction/retraction occur in?

A

transverse plane

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22
Q

t/f: the AC jt is a pseudoarticulation

A

true

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23
Q

what kind of jt is that AC jt?

A

planar jt

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24
Q

what part of the scap defines upward/downward rotation?

A

the inf angle of the scap

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25
Q

when the inf angle of the scap moves medially, what motion is occurring?

A

downward rotation

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26
Q

how much downward rotation occurs at the scap?

A

20 deg

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27
Q

when the inf angle of the scap moves laterally, what motion is occurring?

A

upward rotation

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28
Q

how much upward rotation is there at the scap?

A

60 deg

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29
Q

t/f: the scap does upward/downward rotation, tilting, and IR/ER

A

true

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30
Q

when the scap tilts anteriorly, what muscle is working a lot?

A

pec minor

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31
Q

when the scap tilts posteriorly, what muscle is working a lot?

A

LT

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32
Q

what is the most mobile jt in the body?

A

the GH jt

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33
Q

why is the GH jt prone to instability?

A

bc only 25% of the humeral head is covered by the glenoid fossa

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34
Q

what provides dynamic stability at the shoulder?

A

SITS muscles (supraspinatus, infraspinatus, teres minor, subscapularis)

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35
Q

describe the setting phase of the shoulder

A

during the first 30 deg of shoulder and, there is very little scap motion

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36
Q

what the scapulohumeral rhythm?

A

2:1 GH to ST

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37
Q

what is the exception to the roll/glide rules at the shoulder?

A

IR/ER

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38
Q

when the GH jt ERs, what is the glide?

A

posterior

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39
Q

what is a theory as to why the humeral head glides posteriorly during ER?

A

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

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40
Q

when the GH jt IRs, what is the glide?

A

anterior

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41
Q

what is the theory as to why the humeral head glides anteriorly during IR?

A

the posterior lig complex catches the humeral head and pushes it forward as it becomes taught

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42
Q

what is the roll and glide of shoulder flexion?

A

roll sup

glide inf/ant

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43
Q

what is the roll and glide of shoulder abduction?

A

roll sup

glide inf/post

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44
Q

what is the roll and glide of shoulder IR?

A

roll/spine post

glide ant

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45
Q

what is the roll and glide of shoulder ER?

A

roll/spine ant

glide post

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46
Q

what is the roll and glide of shoulder horizontal adduction?

A

roll med

glide lat

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47
Q

what is the roll and glide of shoulder horizontal abduction?

A

roll lat

glide med

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48
Q

what is the roll and glide of shoulder POS elevation?

A

roll sup

glide inf

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49
Q

what is the roll and glide of shoulder extension?

A

roll/spin ant

glide ant

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50
Q

what are the restraints to ER at 0 deg abd?

A

subscap

sup GH lig

coracohumeral lig

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51
Q

what are the restraints to ER at 45 deg abd?

A

subscap

mid GH lig

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52
Q

what are the restraints to ER at 90 deg abd?

A

inf GH lig

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53
Q

when the arm is higher up, where do the restraints come from?

A

further down

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54
Q

when the arm is lower down, where do the restraints come from?

A

further up

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55
Q

what is the shape of the inf GH lig?

A

pouch-like (axillary pouch)

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56
Q

what is the benefit of the shape of the inf GH lig?

A

the puhc allows for more flexibility in arm elevation

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57
Q

when the inf GH lig becomes inflammed and sticks to itself, what condition may be present?

A

adhesive capsulitis

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58
Q

what are the restraints to IR at 0 deg abd?

A

ing GH lig

teres minor

post capsule

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59
Q

what are the restraints to IR at 45 deg abd?

A

inf GH lig

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60
Q

what are the restraints to IR at 90 deg abd?

A

inf GH lig

post capsule

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61
Q

the inf GH lig and coracohumeral lig resist what motions?

A

ER and ext

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62
Q

the sup GH lig resists what?

A

inf translation of the humeral head

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63
Q

the middle GH lig resists what motions?

A

anterior translation from 0-45 deg in ER

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64
Q

how can we try to loosen ligs?

A

heat, stretching, US, cross/transverse friction massage

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65
Q

the inf GH lig restricts ____ and ____ in 90 deg abd?

A

IR, ER

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66
Q

when is the inf GH lig most taught?

A

at 90 abduction with full ER

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67
Q

t/f: the higher the arm gets, the more slack the mid and sup GH ligs get

A

true

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68
Q

what is the rotator interval?

A

a critical zone in the shoulder bw the subscap and supraspinatus where impingement frequently occurs

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69
Q

what structures run through the rotator interval?

A

the biceps tendon

subacromial bursa

suprascapularis tendon

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70
Q

t/f: the shape of the acromion can cause impingement at the rotator interval

A

true

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71
Q

the rotator interval space is typically _______mm

A

4-11

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72
Q

what can cause decreased acromial space in the rotator interval?

A

inflammation of the structures running through it, acromial shape differences

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73
Q

what questions should we ask about the chief complaint at the shoulder?

A

reproducible motions/positions

pain levels and location

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74
Q

what is a macrotrauma?

A

a single event causing the injury

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75
Q

what is a microtrauma?

A

cumulative events causing the injury

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76
Q

t/f: we can use US for feedback on muscle use

A

true

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77
Q

what diagnostic imaging can be used at the shoulder?

A

plain film radiograph

arthrography

CT scan

MRI

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78
Q

what are possible adjacent contributors to shoulder pain?

A

cervical spine

thoracic spine

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79
Q

how may the thoracic spine contribute to shoulder pain?

A

if someone lack motion at the thoracic spine, they may compensate for the lack of motion by overusing the shoulder

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80
Q

what are typical views used in radiographs of the shoulder?

A

AP in IR or ER

lat/scapular (Y view)

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81
Q

what shoulder pathology can be diagnosed with an MRI?

A

rotator cuff tears, Bankart lesions, SLAP lesions

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82
Q

what is a Bankart lesion?

A

a labral tear at 3-6 o clock

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83
Q

what is a SLAP tear?

A

a labral tear at 10-2 o clock

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84
Q

what does SLAP stand for?

A

sup labrum anterior or posterior to the biceps

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85
Q

a tight biceps could cause what at the shoulder?

A

SLAP tear

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86
Q

what disability questionnaires may be used for shoulder pathology?

A

SPADI

DASH/quick-DASH

UCLA Shoulder Rating Scale

Penn Shoulder Score

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87
Q

what are medical red flags in the shoulder?

A

R shoulder-lung, GB

L shoulder-heart, spleen, diaphragm

cardiac (MI)

Pancost’s tumor (superior sulcus0

gall bladder

liver

spleen

peripheral nerve entrapment

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88
Q

what organs can refer pain to the R shoulder?

A

lung

gall bladder

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89
Q

what organs can refer pain to the L shoulder?

A

heart

spleen

diaphragm

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90
Q

a peripheral nerve entrapment of what nerves could cause shoulder pathology?

A

spinal accessory

axillary

long thoracic

suprascpaular

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91
Q

a peripheral nerve entrapment of the spinal accessory nerve could cause weakness of what muscle?

A

traps

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92
Q

a peripheral nerve entrapment of the axillary nerve could cause weakness of what muscle?

A

delts

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93
Q

a peripheral nerve entrapment of the long thoracic nerve could cause weakness of what muscle?

A

serratus anterior

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94
Q

a peripheral nerve entrapment of the suprascapular nerve could cause weakness of what muscles?

A

supraspinatus

infraspinatus

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95
Q

what should we observe at the shoulder during an exam?

A

head, neck position

thoracic kyphosis

scap position

shoulder position

muscles contours

upper crossed

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96
Q

what is normal thoracic kyphosis?

A

40 deg

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97
Q

what is normal scap position?

A

2 in from spine

sup angle at T2

inf angle at T7

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98
Q

what spinal level should the sup angle of the scap be at?

A

T2

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99
Q

what spinal level should the inf angle of the scap be at?

A

T7

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100
Q

what is weak in upper crossed syndrome?

A

deep cervical flexors

scap stabilizers (rhomboids, MT, LT, SA)

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101
Q

what is tight in upper crossed syndrome?

A

suboccipital

UT

LS

pecs

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102
Q

how do we know if the head is properly aligned?

A

the tragus should be in line with the acromion

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103
Q

if we observe scapular winging, what muscle should we MMT?

A

the SA

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104
Q

what is the purpose of observation?

A

to help us dial in on the specific things we want to check in the exam

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105
Q

what may cause one shoulder to be more elevated than the other?

A

UT tightness

scoliosis

spinal accessory nerve injury on the dropped side

poor ergononics

higher pelvis on one side

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106
Q

what does QQR mean when testing ROM?

A

assess for Quality, Quantity, and Reproduction of symptoms

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107
Q

where might we note pain in ROM?

A

at end range

through range

in a painful arc

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108
Q

why is the time to baseline pain important to us?

A

bc it tells us the reactivity of the problem

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109
Q

t/f: we should assess just uniplanar motions when testing ROM?

A

false, we should be test uni and multiplanar motions

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110
Q

why should we test motions single and multiple times?

A

to see if pain is reproduced after one time or multiple times and how many times if multiple

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111
Q

where is the painful range for the AC jt?

A

170-180 deg shoulder abd

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112
Q

where is the painful range for the GH jt?

A

45/60 deg to 120 deg shoulder abd

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113
Q

what does it mean when a pt has to lean over to flexion their shoulder?

A

possible RC weakness, so they try to get a better advantage for the delts

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114
Q

during the first 30 deg shoulder flexion, what is the RC doing?

A

stabilizing and depressing the humeral head to prevent it jamming into the acromion

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115
Q

why is it a problem if the delts work unopposed?

A

bc it jams the humeral head straight up into the acromion

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116
Q

what motions make up functional ER?

A

abduction

ER

overpressure

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117
Q

what motions make up function IR?

A

extension

adduction

IR

overpressure

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118
Q

how do we measure functional ER and IR?

A

by how far up or down the thumb can go

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119
Q

in normal functional IR range, where should the thumb get to?

A

about T7 at the inferior angle of the scap

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120
Q

what muscles are involved in resisted abduction?

A

delts

supraspinatus

121
Q

if resisted abduction causes pain with horizontal abduction, what muscle may be involved?

A

posterior delts

122
Q

if resisted abduction causes pain with horizontal adduction, what muscle may be involved?

A

anterior delts

123
Q

if resisted abduction causes pain, but there is no pain with resisted horizontal adb or add, what muscle may be involved?

A

supraspinatus

124
Q

what muscles are involved in resisted adduction?

A

pec major

teres minor

lats

teres major

125
Q

if resisted adduction and flexion causes pain, what muscle may be involved?

A

pec major

126
Q

if resisted adduction and ER causes pain, what muscle may be involved?

A

teres minor

127
Q

if resisted adduction and extension cause pain, what muscle may be involved?

A

lats (or could be teres major)

128
Q

if resisted adduction and IR cause pain, what muscle may be involved?

A

teres major (or could be lats)

129
Q

what muscles are involved with resisted ER?

A

teres minor

infraspinatus

supraspinatus

130
Q

if resisted ER and adduction causes pain, what muscle may be involved?

A

teres minor

131
Q

if resisted ER and abduction causes pain, what muscle may be involved?

A

supraspinatus

132
Q

if resisted ER causes pain, but not adduction or abduction, what muscle may be involved?

A

infraspinatus

133
Q

what muscles are involved in resisted IR?

A

subscap

pec major, lats, and teres major

134
Q

if resisted IR and adduction causes pain, what muscles may be involved?

A

pec major

lats

teres major

135
Q

if resisted IR causes pain but not adduction, what muscle may be involved?

A

subscap

136
Q

what muscle is involved in resisted flexion?

A

corocobrachialis

137
Q

if there is pain with flexion and horizontal abduction and adduction, what muscle may be involved?

A

delts

138
Q

how do we perform scapulothoracic and scapulohumeral resistance testing (flip sign)?

A

have pt perform scapular adduction w/ER resistance

139
Q

what would result in a positive flip sign?

A

weak MT/UT

140
Q

why would weak MT/UT result in a positive flip sign?

A

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
Q

how do we perform lats testing?

A

have PT in ext, IR, and add

resist pt arm going towards the ceiling in prone

142
Q

how do we perform rhomboid resistance testing?

A

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
Q

how do we perform UT resistance testing?

A

in sitting or supine, try to bend ear to shoulder or elevate shoulders with resistance down

144
Q

how do we perform MT resistance testing?

A

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
Q

how do we perform LT resistance testing?

A

in prone with the arm over the head, resist the arm going up to the ceiling

146
Q

how do we perform SA resistance testing?

A

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
Q

if the pt can’t hold the SA resistance test and there is scap winging, what may this indicate?

A

SA weakness or long thoracic nerve injury

148
Q

what are the special tests for impingement syndromes?

A

Hawkins Kennedy

Neer

Yergason

149
Q

if you do all contractile tissue tests and they are negative, but all impingement tests are positive, what is likely going on?

A

bursitis

150
Q

how do we perform the Hawkins Kennedy test?

A

have PT in flex, IR, add (can increase add) and push down at their wrist and up at their elbow

151
Q

what is the sensitivity and specificity of the Hawkins Kennedy test?

A

sn=72-92%
sp=25-66%

152
Q

is the HK better to rule in or out?

A

out

153
Q

what is the crossover test?

A

test for impingement or AC jt like HW

bring arm across body

154
Q

how do we perform the Neer test?

A

have PT flex, IR as you stabilize the scap

155
Q

t/f: the Neer and HK test will test us that something is wrong, but not what is wrong

A

true

156
Q

what is the sensitivity and specificity of the Neer test?

A

sn=68-95%
sp=25-68%

157
Q

is the Neer test better to rule in or out?

A

out

158
Q

how do we perform the Yergason test?

A

have the pt’s elbow at 90 deg flexion and pronated

resist supination and/or elbow flexion while palpating the bicipital groove

159
Q

what can the Yergason test test for?

A

impingement and biceps

160
Q

t/f: in the Yergason test, we may also bring them out into ER to see if it will flip out the bicipital groove

A

true

161
Q

what is the sensitivity and specificity of the Yergason test?

A

sn=9-37%
sp=86-96%

162
Q

is the Yergason test better to rule in or out?

A

in

163
Q

what are the special tests for the RC?

A

ER Lag (dropping) sign

Hornblower sign

drop arm test

lift off test

full/empty can test

164
Q

what are the indications for the ER Lag (dropoff) sign?

A

R/O infraspinatus tear

165
Q

how do we perform the ER Lag (dropoff) sign?

A

put the pt’s arm into 90 deg elbow flexion and have them hold it then apply resistance to ER

166
Q

if a pt can hold their arm in a position (strong), but it’s painful, what may we suspect?

A

tendinopathy

167
Q

if a pt cant hold the position, what may we suspect?

A

a full tear

168
Q

if a pt has pain with active motion and resistance, what may we suspect?

A

partial tear

169
Q

what is the sensitivity/specificity and +/- LR of the ER Lag (dropoff) sign?

A

sn=20-100%
sp=69-100%
(-) LR=0-.64
(+)LR=NA

170
Q

is the ER Lag (dropoff) sign better to rule in or out?

A

in

171
Q

what are the indications for Hornblower test?

A

R/O teres minor tears

172
Q

how do we perform the Hornblower sign?

A

bring the shoulder into elevation and ER with slight elbow flexion

173
Q

what will we see with a teres minor tear in the Hornblower test?

A

the arm will drop

174
Q

what is the sensitivity/specificity and +/- LR of the Hornblower test?

A

sn=92-100%
sp=30-93%
(+)LR=14.3
(-)LR=0

175
Q

in the Hornblower test better to rule in or out?

A

out

176
Q

what are the indications for the drop arm test?

A

R/O RC tears (supra, infra)

177
Q

how do we perform the drop arm test?

A

bring the patient’s arm into about 90 deg abduction and add resistance if they can hold the position

178
Q

what is the sensitivity/specificity and +/- LR of the drop arm test?

A

sn=15%
sp=100%
(+)LR=NA
(-)LR=NA

179
Q

is the drop arm test better to rule in or out?

A

in

180
Q

what are the indications for the lift off test?

A

R/O subscap tear

181
Q

how do we perform the lift off test?

A

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
Q

what is the sensitivity/specificity of the lift off test?

A

sn=62-89%
sp=98-100%

183
Q

what are the indications for the full/empty can test?

A

R/O supraspinatus tear

184
Q

how do we perform the full/empty can test?

A

resist shoulder flexion in ER (thumbs up, full can) then in IR (thumbs down, empty can) in scaption

185
Q

if the pt can’t do the full can test, should we do the empty can test?

A

no!

186
Q

what is the sensitivity/specificity of the full/empty can test?

A

sn=62-89%
sp=98-100%

187
Q

is the lift off test better to rule in or out?

A

in

188
Q

is the full/empty can test better to rule in or out?

A

in

189
Q

what are the special tests for instability in the shoulder?

A

apprehension and relocation test

Jerk test

sulcus sign

190
Q

what are the indications for the apprehension and relocation test?

A

R/O anterior instability of the shoulder

191
Q

how do we perform the apprehension and relocation test?

A

put the pt in abd and bring them into ER in supine

for relocation provide anterior pressure at the humeral head

192
Q

what is a key consideration with the apprehension and relocation test?

A

BE VERY CAREFUL AND LOOK AT THE PT’S FACE

193
Q

what is the sensitivity/specificity and +/- LR of the apprehension and relocation test?

A

sn=30-63%
sp=61-99%
(+)LR=.53-3.08
(-)LR=.47-1.11

194
Q

is the apprehension and relocation test better to rule in or out?

A

in

195
Q

what are the indications for the Jerk test?

A

R/O posterior instability

196
Q

how do we perform the Jerk test?

A

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
Q

what a common mechanism of injury where the Jerk test would be positive?

A

FOOSH

198
Q

what is a common population we see positive Jerk tests in?

A

football linesmen

199
Q

what is the sensitivity/specificity and +/- LR of the Jerk test?

A

sn, sp, LR=NA

200
Q

what are the indications for the sulcus sign?

A

R/O inferior instability

201
Q

how do we perform the sulcus sign?

A

inferiorly glide the humeral head while palpating the subacromial area and gripping the epicondyles

202
Q

if there is more than __ finger space with the sulcus sign, it is indicative of instability in the GH jt

A

1

203
Q

what is the sensitivity/specificity and +/- LR of the sulcus sign?

A

sn=17%
sp=93%
(+)LR=2.43
(-)LR=.89

204
Q

is the sulcus sign better to rule in or out?

A

in

205
Q

what are the special tests for glenoid labrum dysfunction?

A

speed test

biceps load test

O’Brian test

Crank test

Kim test

SLAP prehension test

anterior slide test (Kibler)

206
Q

t/f: a SLAP lesion is often a dx of exclusion from ruling out everything else

A

true

207
Q

where is a SLAP lesion?

A

10-2 o’clock

208
Q

if a pt describes the pain as achey, clicks sometimes, doesn’t other times, and is a vague pain, what are we suspecting?

A

a labrum problem

209
Q

how do we perform the speeds test?

A

flex the shoulder to 90 deg, extend the elbow, and supinate the forearm

resist shoulder flexion at the forearm

210
Q

what is a positive speeds test?

A

pain

211
Q

pain with the speeds test indicates what?

A

biceps tendinopathy or labral tear

212
Q

what is the sensitivity/specificity and +/- LR of the speeds test?

A

sn=17%
sp=93%
(+)LR=2.43
(-)LR=.89

213
Q

is the speeds test better to rule in or out?

A

in

214
Q

how do we perform the biceps load test?

A

abduct the shoulder to 90 deg, ER, and supinate with the palm facing the head in supine

resist elbow flexion

215
Q

bc of the relationship bw the biceps and the labrum, the biceps load test may also indicate what?

A

the labrum

216
Q

what is the sensitivity/specificity and +/- LR of the biceps load test?

A

sn=78-91%
sp=97%
(+)LR=26.38-30
(-)LR=.11

217
Q

how do we perform the O’Brian test?

A

flex 90 deg and IR the arm then flex 90 deg and ER the arm with 10 deg hor add

resist shoulder flexion

218
Q

what is a positive O’Brian test?

A

IR>ER pain and weakness

219
Q

pain “inside” the shoulder with an O’Brian test indicates what?

A

SLAP

220
Q

pain on “top” of the shoulder with the O’Brian test indicates what?

A

AC jt

221
Q

what test looks like a speeds test with hor add?

A

O’Brian test

222
Q

how do we perform the Crank test?

A

160 deg elevation w/elbow flexion

some deg of shoulder stabilization w/other hand

compression with ER/IR

223
Q

what is the Crank test for?

A

biceps or labrum (SLAP)

224
Q

t/f: the Crank test is a good test to trust on its own

A

false

225
Q

what is the sensitivity/specificity and +/- LR of the crank test?

A

sn=9-91%
sp=56-100%
(+)LR=1.04-13
(-)LR=.10-2

226
Q

how do we perform the Kim test?

A

130 deg in POS (plane of scap) with elbow flexion

apply compression

227
Q

what does a (+) Kim test indicate?

A

SLAP lesion

228
Q

what is the sensitivity/specificity of the Kim test?

A

sn=80-82%
sp=86-94%

229
Q

is the biceps load test better to rule in or out?

A

in

230
Q

is the O’Brian test better to rule in or out?

A

out

231
Q

what is the sensitivity/specificity and +/- LR of the O’Brian test?

A

sn=47-100%
sp=11-98%
(+)LR=.78-2.33
(-)LR=.51-1.48

232
Q

is the crank test better to rule in or out?

A

in

233
Q

is the Kim test better to rule in or out?

A

in

234
Q

how do we perform the SLAP prehension test?

A

hor add w/the arm in IR then ER with no resistance

235
Q

what is a (+) SLAP prehension test?

A

pain with IR that diminishes with ER

236
Q

what is the sensitivity of the SLAP prehension test?

A

50-87.5%

237
Q

how do we perform the anterior slide test (Kibler)?

A

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
Q

what does the anterior slide test (Kibler) sniff out?

A

Bankart lesion

239
Q

where is a Bankhart lesion?

A

3-6 o’clock

240
Q

what is the sensitivity/specificity and +/- LR of the anterior slide test (Kibler)?

A

sn=8-78%
sp=84-92%
(+)LR=.56-9.75
(-)LR=.24-1.1

241
Q

is the anterior slide test (Kibler) better to rule in or out?

A

in

242
Q

is the shoulder more mobile or more stable?

A

mobile

243
Q

why does the shoulder lean towards more mobility than stability?

A

bc there is not a lot of coverage of the humeral head (gold ball on golf tee)

244
Q

what is the association bw labral tears and GH instability?

A

mobc the jt is more unstable it is more prone to injury

245
Q

what are some factors that contribute to GH instability?

A

ligament laxity (EDS), age, gender, hypermobile athletes, Marphan’s

246
Q

what is a common MOI of a SLAP lesion?

A

winding up to throw a ball

247
Q

why does shoulder ER and abd cause SLAP lesion?

A

it winds up the biceps tendon and it pulls on the labrum

248
Q

what are the special tests for AC jt dysfunction?

A

AC shear test

cross body adduction test

249
Q

how do we perform the AC shear test?

A

compression over the AC jt w/ant and post shearing forces

250
Q

what is the sensitivity/specificity of the AC shear test?

A

sn=100%
sp=97%

251
Q

is the AC shear test better to rule in or out?

A

out

252
Q

if the HK test is positive which of these other tests may also be positive: Speeds, apprehension, Kim, AC shear tests?

A

Speeds bc it also create subacromial irritation and is the only resistive test

253
Q

how do we perform the cross body adduction test?

A

flex the shoulder to 90 deg and horizontally adduct the arm across the chest

254
Q

the cross body adduction test is similar to what test, except without the IR?

A

HK

255
Q

there is likely more ____ pain with the cross body adduction test

A

superior

256
Q

what are the special tests for thoracic outlet syndrome?

A

Adson test

Allen test

ROOS test

Wright test

Military press test

257
Q

what kinds of s/s are we looking for with the special tests for thoracic outlet syndrome?

A

nerve and vascular symptoms (skin discoloration, occluded pulses, paresthesias, pain)

258
Q

what causes compression in thoracic outlet syndrome?

A

compression of the nerve or vessel through the clavicle and 1st rib/accessory rib

259
Q

how do we perform the Adson test?

A

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
Q

what is the sensitivity/specificity of the Adson test?

A

sn=32-87%
sp=74-100%

261
Q

is the Adson test better to rule in or out?

A

out

262
Q

how do we perform the Allen test?

A

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
Q

what is the specificity of the Allen test?

A

sp=18-43%

264
Q

how do we perform the ROOS test?

A

raise the BL shoulder to 90 deg abduction, ER, and flex the elbows

open and close hands for 3 minutes

265
Q

what is the sensitivity/specificity of the ROOS test?

A

sn=82-84%
sp=30-100%

266
Q

is the ROOS test better to rule in or out?

A

in

267
Q

how do we perform the Wright test?

A

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
Q

what is the sensitivity/specificity of the Wright test?

A

sn=70-90%
sp=29-53%

269
Q

is the Wright test better to rule in or out?

A

in

270
Q

how do we perform the Military press test?

A

palpate the radial pulse and retract the shoulders in exaggerated military posture with palms facing out

271
Q

what is the specificity of the military press test?

A

53-100%

272
Q

what are the key (+) findings that rule in RC/impingement?

A

impingement sign

painful arc

pain with isometric resistance

weakness

atrophy

273
Q

what are key (-) findings that rule out RC/impingement?

A

significant loss of motion

instability sign

274
Q

what are key (+) findings to rule in adhesive capsulitis?

A

spontaneous progressive pain

loss of motion in multiple planes

pain at end range

275
Q

what are key (-) findings to rule out adhesive capsulitis?

A

normal motion

age >40 y/o

276
Q

what are key (+) findings to rule in GH instability?

A

age <40 y/o

hx of dislocation/subluxation

apprehension

generalized laxity

277
Q

what are key (-) findings to rule out GH instability?

A

no hx of dislocation

no apprehension

278
Q

what level of tissue irritability is 7/10 or greater pain

A

high

279
Q

what level of tissue irritability is 4-6/10 pain?

A

moderate

280
Q

what level of tissue irritability is 3/10 pain or less?

A

low

281
Q

what level of tissue irritability has night/resting pain (constant)?

A

high

282
Q

what level of tissue irritability has intermittent pain?

A

moderate

283
Q

what level of tissue irritability has no night or rest pain?

A

low

284
Q

if there is pain b4 end range, what level of tissue irritability is it?

A

high

285
Q

if there is pain at end range, what level of tissue irritability is it?

A

moderate

286
Q

if there is minimal pain with overpressure, what level of tissue irritability is it?

A

low

287
Q

if AROM is less than PROM, what level of tissue irritability is it?

A

high

288
Q

if AROM and PROM are about equal, what level of tissue irritability is it?

A

moderate

289
Q

if AROM=PROM, what level of tissue irritability is it?

A

low

290
Q

what are the intervention guidelines for high tissue irritability?

A

minimize physical stress through activity modification

monitor impairments

291
Q

what are the intervention guidelines for moderate tissue irritability?

A

mild to moderate physical stress

restore impairments

basic level fxnal activity restoration

292
Q

what are the intervention guidelines for low tissue irritability?

A

restore impairments

high demand for fxnal activity restoration

mod to high physical stress

293
Q

if there are no active mobility impairments, what should we do?

A

medical screening

294
Q

if there are active mobility impairments, passive mobility impairments, and passive accessory mobility impairments, what are we thinking the issue is?

A

GH capsular issue of some kind

295
Q

if there are active mobility impairments, but no passive mobility impairments or muscle weakness, what are we thinking the issue is?

A

NM coordination

296
Q

if there are active mobility impairments, passive mobility impairments, muscle weakness <2/5 and atrophy, what are we thinking the issue is?

A

peripheral neuropathy

297
Q

if there is active mobility impairments, passive mobility impairments, and muscle weakness not <2/5 or atrophy, what are we thinking the issue is?

A

NM coordination issue, pain dominant, or force production issue

298
Q

if there are active mobility impairments and passive mobility impairments, but no passive accessory impairments, what are we thinking the issue is?

A

myofascial restriction

DPT 616 : MSK (23 decks)

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