SHLD 4

Question 1

GIRD

Answer 1

= posterior capsule works to slow down in follow through

• causes tightness in posterior muscles
• assoicated with acquired instability - overhead overuse

Stretching, once day everyday to prevent injury
3 reps of 30 secs sleeper stretch for 6 weeks
+ foam roller
+ progressive ER strengthening when symptoms subside
- in clinic do some mobilisation with movement

Question 2

Increase GHJ flexion

Answer 2

PNF
• Contract-relax
• Progress:

Joint mobilisation
• Traction/distraction: because there is an element of spin in GHJ flexion (joint mechanics)
• Progress: duration, grade, position, MWM

Improve thoracic mobility
• Greater GHJ available with trunk flexion
Increase mobility by sitting, rotating trunk to one side and then holding for 30-60 seconds. Do this for 5 sets.

Question 3

GHJ EXT.

Answer 3

Joint mobilisation
• Traction/distraction
• Biomechanics:

Question 4

Increase GHJ abduction

Answer 4

Joint mobilisation
• Inferior glide
• biomechanics

Question 5

Increase GHJ external rotation

Answer 5

Joint mobilisation
• anterior glide
• biomechanics

Question 6

Increase GHJ internal rotation

Answer 6

Joint mobilisation
• posterior glide
• biomechanics

Question 7

not to be missed

Answer 7

1. Somatic referred pain (cervical spine, thoracic spine,
   myofascial structures)
2. Tumour (bone tumours in proximal humerus)
3. Visceral referred pain (e.g. diaphragm, gall bladder, heart, spleen, apex of lungs)

Question 8

special tests - GH instability, capsule, labral

Answer 8

GH instability tests:
Sulcus sign (MDI)
Load and Shift (AP/PA instability)
Subluxation/relocation (anterior instability)

Labral Integrity
O’Brien’s active compression
Biceps load test
Crank test

Capsule
Anterior capsule length test
Posterior capsule length test

Question 9

special tests - impingement and specific

Answer 9

Impingement Tests
Neer’s impingement test
Hawkins Kennedy impingement test (more commonly used)

Specific Tests
Empty can test (supraspinatus)
Gerber’s lift off test (subscapularis)
Speeds test (long head of biceps)
Yergason’s test (LHB and transverse lig.)
Horizontal adduction (AC joint)

Question 10

capsule tightness

Answer 10

posterior = restricted IR, horizontal add. & flx - MOVING FWD

• restricted posterior glide
• humeral head may sit ant.

anterior capsule = restricted ER, abduction, ext - MVING BACK AND OUT

• restricted posterior OR ANT glide
• humeral head may sit ant. or superior if anteroinferior tight.

inferior = restricted abd - MOVING UPWARD AND OUTWARD
Restricted inferior glide
- humeral head may sit superiorly