Lecture 9: Shoulder parts Flashcards
Functions of the rotator cuff
- move shoulder through ROM
- abductoin-supraspinatus
- IR - subscapularis
- ER- infraspinatus (teres minor)
- acts as humeral head stabilizers (prevents it sliding along glenoid)
rotator cuff strains and tears in the young athlete
- sudden onset
- usually some type of acute overload
- twing felt in shoulder
- some limitation in function
- graded 1-3
- responds quickly to rest and rehab
Drop arm test
- tear of cuff - emphasis on supraspinatus
- just know that the rotators cuff leads to dropping of the arm test
rotator cuff strains and tears in the older athlete (35+)
- shoulder pain during activity above shoulder
- usually slower onset
- inability to sleep on shoulder or with arm above head
- usually weak rotator cuff
- position impingement signs
- really a tendinosis (no inflammation, theres a change in structure and poor vascularity)
shoulder impingement
- primary - due to the shape of the acromion
- secondary - cause by one or both of the following
1: often weakness of scapular stabilizers which affects scapular position (tips forward)
2: poor centralization of the humeral head due to weakness or imbalance of rotator cuff muscles - with impingement, the humerus is pulled too far up and pinches the supraspinatus or sub-acromial bursa
- this causes pain during ROM between 70-120 degrees
muscular imbalance explained
1: deltoid cannot initiate abduction because line of pull is parallel to humerus
2: supraspinatus can initiate abduction as it is perpendicular
3: once started deltoid has a strong superior pull on the humerus within the gelnoid
impingement causing RC tendinitis/tendinopathy (symptoms)
symptoms:
- diffuse pain around acromion and over deltiod
- overhead activities increase pain
- feels ok below shoulder height
- difficulty sleeping on shoulder (impinged motion)
sings of impingement causing RC tendinitis/tendinopathy
- painful arc (70 - 120) degrees (okay below 90 degrees)
- weak external rotators with scapula stabilized
- poor scapulohumeral rhythm
- poor joint stability (can have an anterior humeral head)
- positive hawkins-kennedy and neer test
hawkins-kennedy impingement test
- supraspinatus pinches beneath Coraco-acromial arch
neer impingement test
- supraspinatus pinches beneath Croaco-acromial arch
treatment for impingement causing RC tendinitis/tendinopathy
1: palliate pain (POLICE or Peace & love
2: idealize/maintain ROM
3: strength scapular stabilizers
4: strengthen RC
5: Reinforce proper movement patterns
apprehension test
1: tell (tell you to stop)
2: roll ( roll their body towards the arm)
3: fight (fight what you are doing)
4: pull (pull the arm to the body)
what is the apprehension test designed for?
- to see if there is laxity, especially on the anterior capsule of the shoulder
(could mean someone dislocated)
( could also mean someone has a multi-directional instability)
when is the apprehension test used?
- when we think there is some type of anterior instability of the shoulder
fowler reduction/relocation test
1: A-P pressure on the GH joint (take hand and push on the head of the humerus)
2: centralizes the humeral head
3: takes pressure of anterior capsule
4: feels better
- used in combination with the apprehension test
what is a positive test for fowler reduction/relocation test?
- the person will not have pain because of the pressure on the humeral head.
- for anterior stability of the humeral head
special tests for shoulder parts
- MMT 4/5 for internal rotation
- positive apprehension
(significant anterior movement) - positive Fowler’s reduction/relocation
(less pain, more ROM - pain over front of shoulder on palpation
what does selective tissue consist of?
1: AROM
2: PROM
3: resistance testing
diagnosis/clinical impression of shoulder injuries
1: subcapularairs strain
2: anterior inferior glenohumeral ligament sprain
subscapularis strain diagnosis and clinical impression
grade 1
anterior inferior glenohumeral ligament sprain
grade 2/ AMBRI
- no dislocation reported
- significant instability and pain
what can you do for shoulder injuries?
1: inflammatory/destructive
2: repair/fibroblastic
3: remodelling
inflammatory/destructive part of shoulder injuries: what can we do?
- it will feel/look like: red, hot, swollen, painful
- what do you do to help?
- POLICE/ PEACE & LOVE
-Scap stabilizer strengthening - palliate pain
- POLICE/ PEACE & LOVE
repair/fibroblastic: part of shoulder injuries: what can we do?
- maintain/idealize ROM
- strengthen
-Rotator cuff and scap. stabilizers - proprioception
remodelling: part of shoulder injuries: what can we do?
where we get them to return to sport
- functional training for return to play
- idealize strength through range
- add in power component, if needed
- bracing/taping?
