L3 The Shoulder Exam Flashcards
AC Joint Symptoms
located over the joint itself
patient typically uses 1-2 fingers to point to joint
pain will be localized to the joint, ADD might hurt
GH Joint Symptoms
reproduced by rotation and compression of joint
PT reports S/S deep in joint, may radiate
Subacromial Symptoms
s/s at upper arm
may radiate down arm
pts may use entire hand to grasp the shoulder
Stiffness and GHJ
either frozen shoulder or arthritis, depending on capsular pattern
Intrinsic Factors for RCD
symptoms are caused by properties in the tendon itself
result of tension overload, tendon degeneration, etc
Extrinsic factors for RCD
Symptoms caused by properites outside of the tendon
Primary: angle of acromion, humeral head, AC joint deformity
Secondary: Instability
Posterior Impingement
occurs during ABD/ER
M vs F Shoulder Pathologies
M: trauma, osteolysis, OA
F: instability, frozen shoulder, arthritis
Calcific Tendonitis
Subacromial pathology
pain on ascending
usually no traumatic MOI
hot, burning pain
Adhesive Capsulitis
also known as frozen shoulder
GHJ impairment
presents with decreased abduction and ER
more common in females
has three stages of acuity
Thoracic Outlet Syndrome
deep, boring, pain in the neck or shoulder
Nerve injury
weakness, numbness, parethesia
placing arm above head provides relief
atrophy of muscles may indicate nerve palsy
MOI to long thoracic can cause winging
Things to observe
sulcus deformity
anterior dislocation
step deformity
ruptures or tears
lymphomas
cellulitis
winging
atrophy
Hands on hips position
allows you to see possible atrophy of muscles
may be due to a nerve injury
Inferior angle scapular dysfunction
inferior medial border is prominent at rest
results from anterior tipping of scapula
commonly seen in impingement
Medial border scapular dysfunction
entire medial border is posteriorly displaced
occurs from IR of scapula in transverse plane
Scapular True Winging
occurs with injury to long thoracic
penetrating force
stretch injury
compression
repetitive overhead use
Superior scapular dysfunction
early and excessive superior scapular elevation during arm elevation
results from RC weakness and force couple imbalances
Painful arc
pain from 45° to 120° of abduction
high spin, present in all impingements
Reverse scpulohumeral rhythm
scapula moves more than humerus
present in RCT, frozen shoulder, OA
During elevation of arm, the scapula, clavicle, and humerus should do what?
Scapula: upwardly rotate and posteriorly tilt
Clavicle: elevates, retracts, posteriorly rotates
Humerus: elevates and ER
Observation during arm elevation in symptomatic subjects
decreased scapular upward rotation
decreased posterior tilt
increased scapular IR
increased clavicular elevation/retraction
ant/sup translation of humeral head
IR Loss and Pathologies
IR relates to GH jt posterior capsule tightness
relates to anterior and superior translation of head
increased subacromial contact of RC
decreased subacromial space
Apley’s scratch test
lower shoulder is ext, add, ir
upper shoulder is flex, abd, er
Decreased humeral head ER is b/c of
short pec major or lats
adhesive capsulitis
Increased protraction of scapular is caused by
tight pect
weak lower trap
weak searratus anterior
Increased depression on scap is caused by
weak upper trap
Increased anterior tilting of scapula is caused by
tight pec minor, weak lower trap
Motor patterns are produced by
learning
choice
adaptation
avoidance
Levator scapulae referral
over muscle to posterior shoulder, along medial border of scapula
Lats dorsi referral
inferior angle of scapula up to posterior and anterior shoulder into posterior arm. May refer to area above iliac crest
Rhomboids referral of pain
medial border of scapula
Supraspinatus referral of pain
over shoulder cap and above spine of scapula, sometimes down lateral aspect of arm to proximal forearm
Infraspinatus referral of pain
anterolateral shoulder and medial border of scapula. may go to lateral aspect of arm
Teres minor referral of pain
near deltoid insertion, up to shoulder cap, down lateral arm to elbow
Subscapularis referral of pain
posterior shoulder to scapula and down posteromedial and anteromedial aspects of arm to elbow
Teres major referral of pain
shoulder cap down lateral aspect of arm to elbow
Deltoid referral of pain
over muscle and posterior GHJ
Coracobrachialis referral of pain
anterior shoulder and down posterior arm
Diagnostic Imaging
should be used in conjunction with a physical exam to determine a diagnosis
should not be used as sole method
Scapula Dyskinesis and Pain
usually with scapular dyskinesis, athletes have a higher chance of developing shoulder pathologies
Better outcome for shoulder pain
high expectation of recovery from PT interventions
higher pain self-efficacy
lower pain severity at rest
being employed or in education
Poorer outcome for shoulder pain
resting shoulder pain not responding to meds
not currently employed or in education
FOOSH
fracture or dislocation of the GHJ, possible RCT
Fall onto tip of shoulder
can cause dislocation or subluxation of AC joint
Calcium deposits
happen at 20 to 40
Chondrosarcomas
occur for people older than 30
Physical test values
clinical tests have limited use in informing diagnosis
emphasis on the management of dysfunction may be more appropriate
Pain and Imaging
majority of studies report conflicting results between imaging and the detection of symptoms/pathologies/pain
structures and pain relationships are complex
