Shoulder Flashcards
What is the DASH questionnaire?
patient asked about 30 functional tasks, scored 0-4 on the tasks. max score is 80
LOWER score= greater disability
what is the shoulder pain and disability index (SPADI)?
measurement of 13 items scored on VAS, 8 items physical function, 5 items pain related
Max score=100
HIGHER score= greater disability
What is the ASES questionare?
10 items scored on VAS
Max score=100
LOWER score= greater disability
What should you look at when observing a patient with shoulder pathology?
irritability of the condition
(Are they holding their arm close to them?)
posture
head position
scapular dumping?
Order of shoulder screen assessments?
AROM/PROM
repeated movement testing
joint play
muscle performance
functional testing
Provacation palpation
How do you assess movement patters of an individual with shoulder pathology?
observe if they are using their shoulder for movement.
Are they substituting with scapula, trunk, or head?
potential causes for Traumatic onset of shoulder pain?
fall onto lateral shoulder
forced external rotation
dislocation (dashboard/steering wheel during MVA)
FOOSH (posterior dilocation
Potential causes for insidious onset of shoulder pain?
overhead use
lifting and carrying
seated work life
Change in athletics, occupation, ADL’s
Change in health status
Complaints of popping/shifting can indicate potential injury to what?
general instability
weakness of RC/capsule
Complaints of clicking, snapping, grinding can indicate?
Clicking: labral issue
grinding: arthritic issue
Snapping: tendon/ bone issue
C/O aching can indicate?
muscle issue
C/O sharp pain, numbness, dead arm can indiciate?
nerve issue
C/O of shoulder stiffness can indicate?
arthritis issue
what degree range is the glenohumeral painful arc?
60-120*
what degree range is the acromioclavicular painful arc?
170-180*
Source of neuromuscular shoulder pain?
cervical radiculopathy
Brachial plexopathy
neurologic amytrophy
Focal mononeuropathy
Muscular dystrophy
Source of cardiovascular shoulder pain?
Cardiac ischemia, thoracic outlet syndrome, aortic disease, axillary thrombosis
Source of pulmonary shoulder pain?
pneumonia, pulmonary embolism, pneumothorax, pneumoperitoneum
Source of malignant shoulder pain?
metastatic cancer
source of abdominal shoulder pain?
billary disease, hepatic disease, pancreatitis, splenic injury, perforated viscuss
What is Ehlers-Danlos disorder?
defect in collagen synthesis, higher rates of hypermobility
higher incidence of dislocation
what is marfan’s syndrome?
Genetic disorder of connective tissue, disproportionately long limbs, fingers, statue, predisposal to CV disorders
Hyper mobile—> higher incidence of dislocation
Beighton index hypermobility score ranges?
0-3: normal
4-9: hypermobile
5 positions: 8 total components (tested on both sides)
What are some warning signs that shoulder pain may be visceral?
constant pain, no relief with rest
insidious onset
pain in throbbing
Fever, nausea, weight loss, dizziness
pain changes with eating, sneezing, breathing, walking
Warning signs that shoulder pathology may be a fracture?
traumatic onset
pain worse during sleep
Why is age >50 a red flag complaint?
they have increased risk of RC tear or other serious patholgies
why is night pain and weight loss a red flag complaint?
Sign of cancer
Where does an MI refer pain to?
left shoulder
why is pleurtic pain a red flag complaint?
increased risk for pancoast tumor
List the red flag complaints?
age>50
night pain, weight loss
fever
pain unrelated to activity, not relieved with rest
history of smoking
History of cancer
Pleuritic pain
What are you looking for in regards to skin characteristics?
vasculature
incisions/lesions
What are some potential defects you may see in the arm?
Popeyes sign
suprascapular atrophy
subscapular atrophy
axillary atrophy
Accessory
long thoracic
Signs that the shoulder complex has impaired smoothness?
clicking, popping, grating
What are you looking for during inspection of the shoulder?
Skeletal abnormalities (posture, prominence)
Skin characteristics
Defects (popeye or ludington sign)
Hypertrophy (upper trap)
Axillary n. issue would result in atrophy of which muscles?
delt and teres minor
accessory n issue would result in atrophy of which muscles?
trapezius, SCM
Suprascapular n. issue would result in atrophy of which muscles?
infraspinatus, supraspinatus
subscap nerve issue would result in atrophy to which muscles?
subscapularis (upper+ lower), teres major (lower)
Long thoracic n issue would result in atrophy to which muscles?
serratus ant. (scapular winging)
what does it mean if mid range AROM is unstable?
pathology not related to capsule
what does it mean if end range AROM is unstable?
pathology most likely related to joint capsule
Normal range of shoulder…
Flexion?
Abduction?
Extension
ER?
IR?
180
180
60
90
70
ER 90* scaption and abduction is associated with which capsular instability?
anterior dislocation
Horizontal Adduction and IR are associated with which capsular instability?
posterior dislocation
how do you assess movement patters of an individual with shoulder pathology?
observe if they are using their shoulder for movement.
Are they substituting with scapula, trunk, or head?
how do you assess glenohumeral active range of motion?
you dont its only done passively
what is a derangement in the shoulder?
internal distrubance in normal resting position of joint resulting in pain
How does shoulder derangement present?
rapid changes in symptoms
pain most likely intermittent
limitations depend on the day
Usually insidious onset
How does shoulder articular dysfunction present?
intermittent pain
pain at end range when structures are stretches
no rapid change in symptoms
How does shoulder contractile dysfunction present?
intermittent pain
pain with active contraction
no rapid changes of symptoms
How does postural syndrome present?
Normal tissues under sustained loads
Resolves with position changes
which joint play movements can be do in glenohumeral joint?
anterior, posterior, inferior glides
what joint play movements can be done at scapula?
elevation
depression
upward/downward rotation
protraction
retraction
what joint play movements can be done at AC joint?
anterior
posterior glide
What joint play movements can be done at sternoclavicular joint?
superior, inferior
anterior, posterior
What joint play movements can be done at thoracic spine?
CVP
IVP
what glides occur during flexion?
posterior and inferior glide
what glides occur during extension?
anterior
what glides occur during abduction?
inferior glide @ humerus
Inferior glide @ clavicle
What glides occur during IR?
posterior glide
What glides occur during ER?
technically anterior glide but since many people have bad posture (posterior glide)
Should u do shoulder or scapular MMT first?
scapula
will affect where you place support during shoulder assessment
Rule IN rotator cuff syndrome if?
symptoms worsen with overhead activity
midrange catching sensation
MMT to RC flexion and abduction= pain
RC weakness
Rule OUT RC syndrome if?
MMT is pain free
RC and biceps have normal strength
Loss of passive ROM
Diagnostic cluster for RC tear?
Age>65
Night pain
ER weakness
also
Age>60
painful arc
drop arm
infraspinatus
> _____* loss of force at 10*abduction is indicative of?
50%
RC tear
What tests help to confirm full thickness supraspinatus tear?
empty/full can
External rotation lag sign
what tests help to confirm full thickness infraspinatus tear?
external rotation lag sign
what tests help to confirm full thickness subscap tear?
lift off + belly press or
bear hug + belly press
What tests help to confirm rotator cuff partial tear?
painful arc
What does speeds test help to diagnose?
long head of biceps tendinopathy
What does ludingtons test help to diagnose?
long head of biceps tendon rupture
What test cluster should you use for impingement syndrome?
painful arc
infraspinatus test
hawkins Kennedy
what is the scapular assistance test?
assisting upward rotation
Should decrease pain
what is scapular resistance test?
stabilization of medial border of scap
improves painful arc
What does the internal rotation resisted strength test help differentiate between?
RC tendinopathy v.s intra-articular pathology
Internal rotation resisted strength test…
if IR>ER strength then what is the pathology?
If ER> IR what is the pathology?
RC tendinopathy
intra-articular pathology
What is a hill sachs lesion?
anterior labral tear and posterior humeral head fracture
What is a bankart lesion?
anterior inferior labrum tear
Issue with instability
what is a reverse hill sachs fracture?
anterior medial humeral head fracture
What two special tests assess for superior labral tear?
Active compression test
biceps tendon II test
What two special tests assess for posterior dislocation?
jerk test
kims test
what two special tests assess for AC pathology?
AC resisted extension
active compression test
cross body adduction test
Rule IN adhesive capsulitis if?
patient is 40-65
gradual onset of worsening stiffness/pain
pain + stiffness limit sleeping
PROM limited in multiple directions
Rule OUT adhesive capsulitis if?
PROM is normal
radiographic arthritis is present
ER and IR PROM increases with 45* abduction
what tendons can you palpate in the shoulder?
supraspinatus
infraspinatus
teres minor
subscap
LHB
High irritability is characterized by?
high pain levels (7/10)
consistent night/resting pain
high levels of disability
pain before end range
AROM < PROM
Moderate irritability is characterized by?
moderate pain (4-6/10)
intermittent night/resting pain
moderate disability
pain at end range
AROM=PROM
Low irritability is characterized by?
pain 3/10
no night/resting pain
minimal disability
pain with overpressure
AROM =PROM
Pain control interventions
Pt education
PROM in pain free range
AROM in pain free range
Submax isometrics
manual scap stabilization
non-thrust
Soft tissue techniques
Modalites
how are submax isometrics prescribed?
5 second hold, no pain, 10 reps, throughout day
5-50% MVIC
What are types of soft tissue techniques?
Strain counter strain, AR, PNF, tooling
Priority impairments for someone in the mobility group?
pain with motion
decreased joint play
decreased ROM
poor posture
Decreased MMT
substitution of GH motion with scapulohumeral
Intervention strategies for mobility group?
PROM/AAROM/AROM
Stretching: PNF, contract relax
Non-thrust: III, IV
MWM
Motor control (sequencing of scap movement)
How do you decreased capsule, ligament, fascia extensibility?
creep, stress relaxation
how do you stretch a tight muscle?
3-5 sets of 30-60s hold
how do you stretch a spasming muscle?
PNF, active release
What does the cross-body stretch help?
posterior capsule movement
What is a grade V non-thrust?
trust manipulation
which direction joint mob increases ER?
posterior glid
How do you perform repeated movements for the shoulder joint?
extension with cane
sets of 10
What exercises can be used for scapula?
I,Y,T
what are rhythmic stabilization exercises good for?
multidirectional instability, dislocation, RC tear
Give an example of a rhythmic stabilization exercise?
ball on the wall RC and scap exercise with pertubation
Bosu ball plank
what percent stronger is dominant arm compared to non-dominant?
15-30%
Training of what movement will improve all other shoulder movements?
IR/ER training
Is training ER /IR in side lying vs standing easier Or harder
harder, adding gravity
How do you program RC strength exercises?
starts with 3-5 sets light weight
15-20 reps
at what point of rehab do you want to include speed training?
at the end
speed increases injury risk
Your doing great! Keep up the good work
💕💕💕💕
