OMM MSK 1 Flashcards
Ligaments and Tendons of the shoulder
- 3 GLENOHUMERAL : SGHL, MGHL, IGHL
- CoracoAcromial
- CoracoClavicular
- CoracoHumeral
- Bicipital
Tendons:
- Supraspinatus
- Long head of the bicep
Thoracic Outlet Syndrome
Adson’s Test
-Compression at the superior thoracic outlet from excess pressure placed on a neurovascular bundle
-Between the anterior scalene and middle scalene muscles.
-sites of compression: Inter-scalene triangle, costoclavicular space, Rectopectoralis minor space
- affects Brachial Plexus, Subclavian artery the subclavian vein (rarely! the vein normally does not pass through the scalene hiatus)
Sxs) neck pain and or/pain that radiates down the arm, diminished pulses in the upper extremities
Adson’s Test: Evaluates for thoracic outlet compression
– Monitor the patient’s radial pulse while extending, externally rotating, and slightly abduction their arm.
– Ask the patient to rotate and extend their head towards the ipsilateral arm
- One hand on the shoulder
Variations: Tell the pt. to turn to the opposite of the radial pulse, or tell the pt. to lift the chin on the same side to create more compression
-test is only 50% accurate
Positive test:
– Decrease or absence of the pulse
Apprehension Test
Evaluates Instability of the anterior shoulder
-Physician abducts the arm to 90 degrees, then externally rotates the arm while applying anterior force to the humerus
Positive test:
Patient has pain or apprehension
Drop Arm Test
Evaluates Tear in a rotator cuff muscle
- Ask the patient to abduct their arm to shoulder level and lower slowly, Done bilaterally
- Or all the way
- Bring the arm down in a controllled fashion
- Light tapping can also mean the pt. has a positive test
-Positive test:
Unable to hold their arm abducted or to slowly lower arm to their side
Neer Sign
Hawkins Test
Evaluates: Impingement of the rotator cuff or the subacromial bursa within the Supra Humeral space
How it is performed:
Stabilize the shoulder, Internally rotate the patient’s arm (pronation) then passively flex the arm until the hand is above the head
Positive test: Pain with flexion
Hawkins Test:
Evaluates for: Impingement of the rotator cuff
- Flex the patients elbow to 90 degrees, then internally rotate the shoulder
- Quicj motion to cause the head of the humerus to go deeper in the glenoid fossa and impinge on soft tissue
Positive test:
Pain at the end of the range of motion
Adhesive Capsulitis
Apley’s Scratch test
Adhesive Capsulitis (frozen shoulder)
- —inflammatory process that leads to disuse and immobilization
e. g. pt. is in a sling for a prolonged period of time - —Diabetic pt.’s have an increased risk, significant effect on ADL , prevention is key
Special test: Active ROM, and Apley’s scratch test
Apley’s Scratch test
—evaluates ROM of the shoulder!
How it is performed:
-Ask patient to do these 3 steps
–Reach across chest, over the shoulder and touch the opposite scapula
-Reach behind their back and touch the opposite scapula “bottom up”
-Reach behind their head and touch the opposite scapula “top down”
WATCH for trick movements!
ALSO Supraspinatous test, when pt. has hand behind the back ask them to lift the arm off of their back. If they can’t there is a Supraspinatous pathology.
Positive test:
– Inability to reach equal levels on each side
Biceps Tendonitis
- -Inflammation or degenerative changes of the tendon of the long head of the biceps
- -Usually due to overuse or repetitive trauma
- -Special test: Yergason’s test
- –Medical Management: Rest, Ice, Lidocaine, steroids
–OMM: free up restrictions in the Glenohumeral area, Myofascial release, Counterstrain techniques
Yergason’s Test:
—Evaluate’s biceps tendon instability or tendinitis
How it is performed:
- –Pt.’s arm is placed at their side with the elbow flexed to 90 degrees. Physician monitors the tendon. Pt. is asked to externally rotate (supinate the forearm against resistance
- —bilaterally performed
- –one hand monitors the bicipital groove, one hand on wrist (pronate his wrist)
Positive test:
- -increase pain at the bicipital groove
- –Physician feels the tendon slipping out of the groove “popping out” under the monitoring thumb
Cervical Radiculopathy
Spurling’s test
Cervical Radiculopathy
Impingement of cervical roots
Causes: bulging or herniated discs, narrowing of exit foramina, degenerative hypertrophy of posterior joints
TEST: Spurling’s Test
Management: Anti-inflammatory
OMM: improve blood and lymph flow, decrease cervical spine dysfunction, decrease muscle spasm in cervical region that contributes to compression and pain
Spurlings Test:
Evaluates: cervical root disorder due to narrowing of the neuronal foramina
How it is performed:
—Stabilize one shoulder
—Physician extends and rotates the pt.’s head at C-spine to the ipsilateral side of the affected shoulder
—Axial compressive force is placed on the spine
Positive Test:
—Pain is reproduced, if pain is elicited during condition there is no need for further compression
ROM for shoulder
- Flexion
- Extension
- Abduction
- Adduction
- Internal Rotation
- External Rotation
Flexion – 180 degrees Extension – 45 degrees Abduction – 180 degrees Adduction – 45 degrees Internal rotation – 55 degrees External rotation – 45 degrees
Cubitus Valgus
Cubitus Valgus Carrying angle
5 degrees Males
10-15 degrees FEMales
ROM elbow Extension: Flexion: Pronation: Supination: Active flexion Passive
Extension: 0-5 °
Flexion: 135 ° +
Pronation: Average normal is 75 °
Supination: Average normal is 85 °
Active flexion: limited to 145°
Passive flexion: limited to 160°
Muscles of Ulnohumeral flexion
- Brachialis
- Brachioradialis
- Biceps Brachii
Brachialis - single function, main muscle during slow flexion
Brachioradialis - elbow flexor
Biceps brachii - main elbow flexor, supinator
biarticular muscle - stabilizer at the shoulder
- Remember biotensegrity model looking at the upper extremity as a unit
During rapid and forceful flexion all three muscles are brought into action assisted by the superficial forearm flexors
Muscles of Ulnohumeral Extension
-Triceps Brachii
Supination and Pronation
Triceps brachii - with a negligible assistance from anconeus.
Triceps’ long head is biarticular
efficiency is also dependent on shoulder position
Remember biotensegrity model looking at the upper extremity as a unit
Forced hyperextension results in a rupture in one of the limiting structures:
olecranon fracture,
torn capsule and ligaments,
a bruised brachial artery.
SUPINATION Radius and ULNA are Straight!
PRONATION Radius and Ulna cross
Radial head motion and Somatic Dysfunction
Supination Dysfunction
Pronation Dysfunction
Somatic Dysfunctions involving the radial head
Supination dysfunction – Radial head has freedom of motion in anterior glide
Pronation dysfunction
Radial head has freedom of motion in posterior glide
Epicondylitis (provocative tests)
Lateral Epicondylitis
Medial Epicondylitis
1) Lateral epicondylitis (aka Tennis elbow):
Pain during resisted wrist extension or with wrist flexion (to stretch)
2) Medial epicondylitis (aka Golfer’s elbow)
Pain during resisted wrist flexion or with passive wrist extension (to stretch)
