Mod 4: Shoulder Flashcards by Alyssa Donley

shoulder joint (socket/plane/saddle) that’s responsible for elev/dep, prot/retract & rotation

sternoclavicular jt

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shoulder joint responsible elev/dep, prot/retract, up/down rotation, wing, tip

scapulothoracic jt (pseudo)

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synovial plane jt that rotates to accomodate humerus & scap

acromioclavicular joint (AC jt)

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ball & socket jt that’s responsible for flex/ext, abd/add, ER/IR, horizontal abd/add

glenohumeral joint (GH jt)

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upward rotation force couple mm (3)

serratus anterior, upper trap, lower trap

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downward rotation force couple mm (3)

levator scapula, rhomboids, pec minor

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which ligament if damaged causes separated shoulder?

coracoclavicular ligament

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which ligament creates an arch?

coracoacromial ligament

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location of 4 shoulder bursae

subacromial, subdeltoid, subscapular, subcoracoid

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capsular pattern of GH jt

ER, aBd, IR, flex

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effect of forward head/shoulder on scapular position
what is required for GH flexion?

elevation/protraction/med border tilts
thoracic extension

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Rotator Cuff/Impingement Special Tests (6)

Drop Arm Test (RTC tear)
Hawkins Kennedy Impingement Test (imp or RTC)
Infraspinatus Test (Imp or Infra tear)
Neer Impingement Test (imp or RTC)
Supraspinatus Test/Empty Can test
Painful Arc (in 60-100* aBd)
Internal/External Rotation Lag Sign

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Instability Special Tests (4)

Apprehension Test (ant. shoulder instability)
Relocation Test (post . force)
Load & Shift
O’Brien Test (for labral tear)
Sulcus Sign (dip between acromion & humeral head)- for inferior instability

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Biceps Special Tests (2)

Speed’s Test
Yergason’s Test
-long head of biceps for both

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AC Jt Special Tests (2)

Spring Sign (inf. force on clavicle)
Shear Test

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Gen. Shoulder Rehab: Phase 1/2

control inflamm/pain w/ modalities, activity mod.
improve postural awareness
up/down chain: cervical & elbow
pain free ROM w/ joint mobs, PROM to AAROM to AROM

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Gen. Shoulder Rehab Phase 3/4

strengthen: scapulohumeral rhythm & RTC (iso to conc to ecc, ADLs, transverse, speed, plyo)
proprioception: CKC
posture, ergonomics

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which glide for flexion & abduction

inferior

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which glide to improve ER

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which glide to improve flexion & IR
& ER** why?

posterior
ER: recenters humerus in glenoid fossa

Normal shoulder ROM:
flex
ext
IR
ER
abd
horiz abd
horiz add

flex: 180
ext: 60
IR: 70
ER: 90
abd: 180
add: NA
horiz abd: 45
horiz add:135

alteration in normal position OR motion of scapula during shoulder movement
types

scapular dyskinesis
prominent inferior medial border (tilt)
prominent whole medial border (winging)
prominent superior medial border

which space with which structures is responsible for shoulder impingement?

subacromial space
w/ humeral head, LH biceps tendon, superior jt capsule, supraspinatus
(& some subscap, infraspinatus & subacromial bursa)

painful arc degrees of impingement

60-100* abduction

mechanical compression of RTC tendon between acromion & coracoid process which causes degeneration (bone spurs) -or: dec. subacromial space d/t GH instability (movement based)

shoulder impingement

Tx for shoulder impingement

address posture- upper X syndrome scap stability upper thoracic mobility address capsular restrictions RTC strength

surgery: removal of a portion of acromion/CA ligament -can combo RTC repair or distal clavicular excision

subacromial decompression

causes of acute vs chronic RTC tear

acute: injury, trauma, fall, quick heavy lifting chronic: partial/degenerative tear d/t improver biomechanics

frequent locations of shoulder tendinopathy

bicipital RTC

abnormal symptomatic motion of GH jt that effects normal joint kinematics & causes pain/sublux/dislocation

Glenohumeral instability

Bankart lesion: location of damage, structure damages, caused by

avulsion of anterior glenoid rim: labral damage from 3-6 oclock" d/t traumatic anterior dislocation

compression fx of post/post-lat humeral head where humeral head impacted the inferior glenoid rim

Hill Sachs Lesion

s/s: loud clunk as shoulder moved from forward flex position to abd/ER position - pain w/ flex/add position

Posterior GH Instability

shoulder subluxation d/t RTC weakness/paralysis (ex: CVA)

Inferior GH Instability

SLAP lesion meaning & location -often d/t

test in superior labrum from ant to post 11-1oclock" d/t FOOSH, ecc biceps contract, "Peel back"

SLAP/GH instability rehab: limit activity of which mm? contraindicated? precaution: tx emphasis:

limit early biceps activity C: no extension P: abduction & ER emphasis: dynamic stability

s/s: pain in ___ jt, painful arch w/ shoulder elevation, pain w/ horiz abd/add, hyp/hyper mob -d/t FOOSH, MVA, sports

sternoclavicular joint sprain

avoid 2 motions when AC joint sprain?

shoulder depression humeral traction

s/s: point tenderness over AC jt, pain & ROM loss w/ EROM, piano sign of clavicle

AC joint separation/separated shoulder

proximal humerus fx: displaced location of fx? (2)

greater & lesser tuberosity anatomical & surgical neck fx

synovial inflammation w/ subsequent reactive capsular fibrosis -stiff capsule that's painful w/ loss of both PROM & AROM

adhesive capsulitis/frozen shoulder

frozen shoulder capsular pattern

ER, ABd, flex (most to least restricted)

3 phases of frozen shoulder

freezing/early painful frozen/stiffening- dec pain but dec ROM/fxn thawing/recovery- gradual inc ROM

frozen shoulder Tx conservative vs. medical

C: joint mob, PROM, A/AROm without compensation, return to fxn medical: manipulation, pain management, aggressive PT PROM/jt mob often

TSA motion precaution

no aggressive IR/ER stretching b/c subscap is detached/reattached

Reverse TSA motion precaution

don't force IR/Add -ROM expectations decreased

pediatric shoulder injury: overuse w/ epiphysiology of prox humerus -throwing injury

Little Leaguer's Shoulder