Shoulder Flashcards
Instability tests
Sulcus sign 0* - 2 or more fingers = abnormal
Sulcus sign 90* - 2 or more fingers = abnormal
Anterior load and shift
Posterior load and shift
Labrum enhances stability (5)
-Expands the overall size and depth of glenoid
-Increases the superior/inferior diameter by 75%
-increases the posterior diameter by 50%
-serves as primary attachment of capsule & GH ligaments
- superior is LHB attachment
Biceps important for what in GH joint?
Anterior stability
Positive on all 4 GH instability tests means what?
Multi-directional instability
SLAP lesion tests
Compression-rotation
Anterior slide
Posterior slide
Speeds test
O’Brien’s compression - not sensitive to specific structures, thumb down - AC, thumb up - SLAP
Yergason’s
Subacromial Pain Syndrome Tests
Neer impingement
Hawkins-Kennedy
Painful Arc test
Scapular assist test
AC joint tests
Cross-body adduction
AC shear
O’Briens active compression
Slap Lesion Grade 1
SLAP degenerative
Marked fraying w/degenerative appearance
Periphery attached
LHB firmly attached
Slap Lesion Grade 2
Degenerative & fraying
Superior labrum & biceps tendon stripped off underlying glenoid
Results in labral-biceps anchor being unstable & pulled away from glenoid
Most common tear
Slap Lesion Grade 3
Bucket handle type tear
Central portion displace into the joint while periphery firmly attached to glenoid
Slap Lesion Grade 4
-Bucket handle tear w/extension into biceps
-Labral flap tends to displace into joint
Slap Lesion Type 1 Treatment parameters
ROM
As tolerated, no restrictions
Protection phase: Biceps (7-10 days)
Return to sport
Dependent on strength & biomechanics of shoulder
Prognosis: 2-4 weeks
Slap lesion type 2 Treatment Parameters
Sling x 4 weeks at all times
Gentle PROM only for week 1.
Full ROM by 6 weeks w/combined ER and abduction the LAST motion achieved
Protection
Avoid biceps resistance ex for 10-12 weeks, no ER beyond neutral x 4 weeks, 40 degrees x 6 weeks
Gentle elbow/wrist/hand ex start day after surgery & continue throughout
After 7-10 days, PT focusing on gentle PROM w/in pain-free range; avoid ER beyond neutral & ext behind body x 4 weeks
Slap Lesion Type 3 Treatment Parameters
ROM: similar to type II BUT 1-2 weeks slower
Protection: same as type II
Return to activity: same as type II
Slap Lesion Type 4 Treatment Parameters
ROM: dependent of surgery. Excision sling for 3 weeks. Full ROM by 6 weeks
Protection: avoid biceps for 6 weeks if tenodesis or 10 weeks if repaired
Return to sport: 8-10 weeks
Return to throwing: 3-4 months
AC joint injuries
Grade 1: AC lig sprain
Grade 2: AC tear and CC ligament sprain
Grade 3: AC and CC ligament rupture
Sites of impingement
AC Joint
Undersurface of Acromion
CA Ligament
Coracoid Process
Subacromial pain syndrome signs
Limited AROM ABD and ER
Painful Arc 70-120
PROM full w/o pain
+ impingement tests
supraspinatus painful and weak
Primary impingement
Degenerative changes to acromion/coracoid
Capsular tightness
Faulty posture
Secondary impingement
Change in F couple/muscle
Abnormal movement patterns of GH/ Scapulothoracic joint
Instability of Scapula or GH joint
3 types of AC morphology
Type 1 Human hanging off a rock, 90% surgery success rate
Type 2: more hooked, 60-70%
Type 3: supah hooked, 50-60%
3 Stages of shoulder impingement
1: Bursitis/Tendonitis: Edema, hemorrhage
2: Partial tear and/or tissue fibrosis
3: Full Thickness Tears
Type 1 Shoulder impingement objective findings
Painful arc
RC and or Scapular Weakness
Positive tests
Stage 2 Shoulder impingement objective findings
Crepitus and Catching
Limited ROM
Stage 3 Shoulder impingement objective findings
Atrophy of supraspinatus/infraspinatus
More limited ROM and weakness
Obligate Translation
Tightness of posterior capsule forces anterior displacement of center of rotation
Internal Impingement Syndrome
Mechanical compression of RC insertion point
Internal vs External impingement
Internal is due to humerus (greater tuberosity) moving posteriorly and superiorly on glenoid
External is structures being compressed under AC joint
RCT tear - factors that significantly affect healing (2)
Age and tear size
Small = <1cm
Medium= 1-3cm
Large= 3-5cm
Massive= >5cm
Hallmark of RCT
Night time pain
98% chance of full thickness RCT w/ these 3-4 criteria met
Age >60
Shoulder abduction weakness
Positive (Neer’s or Hawkins-Kennedy)
Painful arc sign for RCT? Combined with what 2 things leads to 90% chance of RCT full thickness tear?
60-120*
Drop arm sign
ER weakness
