Sample Q&A Shoulder Flashcards
Positive finding for dawbarn’s
when pain over the subacromial bursa disappears on abduction of the arm
what if dawbarn’s is negative? (pain stays)
may be due to inferior humerus, sore pectoralis muscle
what is the indication of a positive dawbarn’s
subacromial bursitis
3 parts to drop arm test
- patient raises arm against gravity
- patient holds against doctor’s pressure
- patient holds up arm when doctor taps arm
indication of pain during part 1 of drop arm
grade 3 rotator cuff tear
what is a positive for part 1 of drop arm?
arm drops, or they cannot fight against gravity
indication of pain during part 2 of drop arm
grade 2 rotator tear
what is a positive for part 2 of drop arm?
can raise arm against gravity, but not hold against resistance
indication of pain during part 3 of drop arm
grade 1 rotator tear
what is a positive for part 3 of drop arm?
can raise arm against gravity, and against resistance, but there is pain
positive sign for dugas
when patient can’t touch chest wall with affected arm/elbow while holding the opposite shoulder
indication for a positive dugas
current shoulder dislocation/separation
what kind of test is dugas best for?
post check
shoulder apprehension test positive
a look of alarm on the face and/or the patient pulls away from the rpessure
indication of a positive shoulder apprehension test?
glenohumeral joint is unstable, or has a propensity to dislocate
yergason’s positive
click or pop that occurs when the bicipetal tendon pops out of the groove
indication for a positive yergason’s
bicipetal tendon instability
bicipetal tendon instability can be due to?
shallow groove or lax/tear/sprain of the transverse humeral ligament
differential diagnosis for bicipetal tendon instability?
inferior humerous
AC PS visualization
distal end of the clavicle sits higher possibly cauing a slight bump
compare trapezius muscles on each side to see if there is a smooth transition over the distal clavicle
GHI visualization
will see sulcus sign
STL visualization
more than 3 of the patient’s finger widths between the medial border of the scapula and the spine
STM visualization
less than 3 of the patient’s finger widths between the medial border of the scapula of the spine
St Cl S visualization
proimal end of the clavicle sits higher than the opposite side
fluid motion for AC PS
stabilize the humeral head into the glenoid fossa, then apply S-I pressure over the distal end of the clavicle
GH fluid motion
stabilize the AC joint and scapular spine with hand closest to the patient. the other hand will hold the elbow and draw the humerus I-S
STM fluid motion
place thumb at medial inferior angle of scapula and press M-L while prestressing the shoulder girdle in the same direction
STL fluid motion
doctor places their thumb at the lateral inferior angle of the scapula and press L-M while prestressing the shoulder girdle in the same direcction
St Cl fluid motion
doctor stands behind the patient and places their 2nd and 3rd digits at St-Cl joints and asks the patient to shrug their shoulders up and roll them backward/forward
which part of the adjustment takes care of the superiority in the AC PS?
pushing down on the distal end of the clavicle
which part of the adjustment takes care of the posteriority in the AC PS?
pushing slightly forward and eternally rotating arm
what is a “shoulder separation”?
dislocation/hypermobility of the AC joint
treatment for AC PS (with fixation)
ROM, not immobilize
treatment for AC separation?
immobilize with a brace or “reminder” tether, ice
move of choice for GH joint
GH traction supine because you can palpate the joint during this procedure
give at least 3 diagnoses that GH traction would work for
frozen shoulder GHI GHP GH dislocation osteoarthritis with fleion
what tests will help to differentially diagnose a GHI and GHP?
yergason’s
dawbarn’s
supraspinatus
what tests will help get extra information to diagnose a GHI or GHP?
apley
teres major
anterior deltoid
internal and external rotation
what is the most common shoulder misalignment?
GHI
indications of a GHI
sulcus sign point tenderness at anterior aspect of GH joint capsule fluid motion loss decrease external rotation anterior deltoid weakness
indications of a GHP
normal visual fluid motion loss point tenderness at posterior aspect of GH joint decrease internal rotation teres major
what part of the scapulo-humeral ratio would decrease with a GHP or GHI subluxation?
glenohumeral part
would appear as 1:1
is there a move of choice for GHI?
no, it is GH supine traction because you can feel the jint open up
what are at least 3 other diagnoses that GHI should be differentiated from?
GHP subacromial bursitis bicipetal tendonitis bicepital instability sprain or tear of rotator cuff dislocation heart attack gallbladder spleen
where is the patient’s shoulder placed for GHP prone?
supported on the table for stabilization
what is the thrusting move of coice for GHP?
prone
to stabilize the GH joint
what is important about the LOC of GHP?
straight P-A, drop the elbow so that it’s level or below the wrist
what ROM do you use to bring the arm to tension in a GHP?
abduction and extension
where is the pain point for GHP?
posterior aspect of glenohumeral joint
what is the most common shoulder dislocation and why?
anterior-inferior due to gravity pulling down and forward
carrying things pulls it down and forward
anterior glenoid labrum is shallow
anterior inferior aspect of the joint capsule is weaker
what motions do you take the patient’s arm through for the Kockher’s maneuver (in order)?
traction S-I external rotation adduction internal rotation support in dugas position
what motions do you take the patient’s arm thorough for Fare’s maneuver (in order)?
slight S-I traction
pump arm up and down 2-3 degrees while bringing the arm into 90 degree abduction
at 90 degrees externally rotate the arm, at about 120 degrees the humerus sets, then adduct arm and stailize on chest
what 3 systems do you want to post check after a shoulder dislocation maneuver?
vascular (pulse, color of nail beds, warmthe of hand)
neurological (pinwheel, sharp/dull, hot/cold, muscle test in hand, check muscle tone, decreased pain)
musculoskeletal (dugas is now negative, xray, visually shoulder appears rounded
3 parts to frozen shoulder
- patient arm over padded back of studry chair, traction S-I to patient tolerance, hold for 60-90 degrees, check ROM. if improved, go to step 2
- same position, treaction SI while taking through the newly gained ROM (to tolerance). Do once per day until progress stops.
- check for ristricted parts fo ROM, then give a small impulse. make sure patient is performing at home exercise before doing this
what can the doctor have the patient do for home treatment?
part 2 with a family member
arm over padded back of a chair wile swinging a weight or plastic jug filled with sand
perform apley scratch exercises
pulley over door or basement beam
what is the most important component for frozen shoulder treatment?
find out what cause the patient to stop using their shoulder thus allowing it to freez, then address the problem
could be due to scar tissue buildup, DJD, arthritis
why is 3 part treaction procedure preferred over surgery for rozen shoulder
less risk of fracturing the humerus
dislocating the GH joint
neurovascular damage
pain point for STL and STM
anterior to the scapula in the subscapularis muscle
what position is the arm placed in for STL?
behind patient’s back while side-lying
help to pre-stress teh scapula from lateral to medial
doctor will each thier arm through the axillary arm opening
where is the stabilization hand for STL?
over AC joint
where are fingers of SH?
over GH joint
in what direction does the doctor push with the SH to help bring the ST articulation to ttension?
S-I
what position is the patient’s arm placed in for ST-M?
in front of patient’s body while side lying. This is to help pre-stress the scapula from M-L
where is #11 of the SH for STM side lying?
over the GH joint
where are the fingers of the SH for STM?
over the AC joint
in what direction does the doctor push with the SH to help bring the ST articulation to tension?
I-S
What are some common mistakes for the STM prone?
patient’s shoulder should be off the table
doctor should stand opposite the side of contact
doctor should use an inferior CH
in what direction does the clavicle most commonly subluxate?
superior
is traction a post check for St-Cl S?
no
it is actually a procedure and should be done before St-Cl S
How should the patient be placed for St-Cl S traction supine?
supine with the scapula off the table
What do we do with the arm opposite the side of contact in St-Cl traction seated?
we hold back the shoulder opposite the side the contact
why do we hold back the shoulder in St-Cl traction seated?
to isolate St-Cl joint and not rotate the thoracics
How do you bring the St-Cl joint to tension before the thrust (superior)
by bringing the arm into abduction and extension
describe the thrust for St-Cl S
straight S-I with maybe a littel torque (fingers with torque up toward the axilla, radial deviation of the wrist.
which rib levels may commonly need St-Co thrusting adjusting procedure?
ribs 2-5
where is the pain point for St-Co joint?
right over the joint of the involved rib. if it’s a superior rib the pain may be located over the top of the rib head
if it is inferior rib the pain may be located over the bottom of the rib head
what is the best way to check the St-Co joint?
fluid motion. palpate the involved ribs while seated, have the patient take a very deep breath in while bringing the shoulders up, then exhale all the way out feeling the excursion of the ribs
differential diagnoses for pain that runs along hte rib all the way around the thoracic cage?
thoracic subluxation, shingles, intercostal neuralgia, rib fracture, tumor, heart attack if on left side
how far up and back do we go with the patient’s shoulder for St-Co traction seated?
to the patient’s tolerance or until you fee the joint open up
how far up and back would you go or a rib 2 compared to rib 5?
not as far, it won’t take as much rotation/extension for rib 2
how should the patient be placed for St-Co upine?
supine with scapula off the table, even further for lower ribs
which way should the doctor’s finger point for St-Co traction supine?
M-L, some I-S for ribs 2-3, M-L some S-I for ribs 4-5
follow the angle of the rib, remember it changes the lower you go in teh rib cage
what is the limiting factor for bringing the arm posteiror and superior?
patient tolerance or until you feel the joint open up
patient placement for St-Co I, St-Co S?
supine on the center of the table
what is the doctor’s stance for St-Co I, St-Co S?
side of involvement, straight away so you don’t add a body drop
what do you do for patient safety for St-Co I, St-Co S?
turn their face away so you don’t hit them with your elbow or fingers
breathing instructions for St-Co I?
take a deep breath in and hold
which phase of breathing should you see improvement on inspiration or expiration?
inspiration
what type of breathing would show aberrant motion with St-CoS?
on expiration, the rib doesn’t comes down
how do you get your LOC S-I for St-Co S?
drop your elbow donw close to the chest wall
what breathing instrucitons do you give the patient to hlep prestress the rib for St-Co S?
take a deep breath in, blow it out al the way and hold
why do you give breathing instructions for St-Co S?
take a deep breath in to oxygenate the lungs
blow out the air so the musculature is pulling down on the rib and opens up the joint space below the rib
hold to keep from forcing residual air out of the patient’s lung. it also stop patient form starting to take a breath in
