L3 The Shoulder Exam Flashcards by Hannah P Erickson

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

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GH Joint Symptoms

reproduced by rotation and compression of joint
PT reports S/S deep in joint, may radiate

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Subacromial Symptoms

s/s at upper arm
may radiate down arm
pts may use entire hand to grasp the shoulder

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Stiffness and GHJ

either frozen shoulder or arthritis, depending on capsular pattern

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Intrinsic Factors for RCD

symptoms are caused by properties in the tendon itself

result of tension overload, tendon degeneration, etc

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Extrinsic factors for RCD

Symptoms caused by properites outside of the tendon

Primary: angle of acromion, humeral head, AC joint deformity

Secondary: Instability

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Posterior Impingement

occurs during ABD/ER

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M vs F Shoulder Pathologies

M: trauma, osteolysis, OA
F: instability, frozen shoulder, arthritis

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Calcific Tendonitis

Subacromial pathology
pain on ascending
usually no traumatic MOI
hot, burning pain

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Adhesive Capsulitis

also known as frozen shoulder
GHJ impairment
presents with decreased abduction and ER
more common in females

has three stages of acuity

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Thoracic Outlet Syndrome

deep, boring, pain in the neck or shoulder

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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

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Things to observe

sulcus deformity
anterior dislocation
step deformity
ruptures or tears
lymphomas
cellulitis
winging
atrophy

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Hands on hips position

allows you to see possible atrophy of muscles

may be due to a nerve injury

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Inferior angle scapular dysfunction

inferior medial border is prominent at rest

results from anterior tipping of scapula

commonly seen in impingement

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Medial border scapular dysfunction

entire medial border is posteriorly displaced

occurs from IR of scapula in transverse plane

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Scapular True Winging

occurs with injury to long thoracic
penetrating force
stretch injury
compression
repetitive overhead use

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Superior scapular dysfunction

early and excessive superior scapular elevation during arm elevation

results from RC weakness and force couple imbalances

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Painful arc

pain from 45° to 120° of abduction

high spin, present in all impingements

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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