Shoulder Flashcards
Neer impingement stage 1
Less than 25 years old, minimal changes on diagnostic imaging. Characterized by edema and inflammation
Neer impingement stage 2
Between age 25 to 40 years old, show symptoms of tendonitis and fibrosis in supraspinatus tendon
Neer impingement stage 3
Imaging shows bone spurs, tendon degeneration, tend to be older than 40 years old
External rotation lag sign
94% specificity for ruling in full thickness. Rotator cuff tears of super spinatus and infraspinatus
Lateral scapula slide test
Can indicate weakness of scapular stabilizers.
Determine scapular position with arm abducted to zero, 45, 90°. Measure distance of scapula. Patients with suspected scapular weakness have increased measurements on involved side
Wright test
Highest sensitivity test for ruling out Thoracic outlet syndrome. Implicates axillary interval (space posterior to pec minor)
AKA hyperabduction test
Type 1 SLAP lesion
Isolated fraying of superior labrum. Degenerative in nature
Typically associated w RTC pathology
Type II SLAP lesion
Detachment of superior labrum and origin of LHB from supraglenoid tubercle
Type 3 slap lesion
Bucket handle tear of labrum with intact bicep insertion newly
Tend to be associated with traumatic instability
Type 4 SLAP lesion
Bucket handle tear of labrum that extends into the bicep tendon
Tends to be associated with dramatic instability
Type 5 slap lesion
Bankart lesion of anterior capsule extending into anterior superior labrum
Type 6 SLAP lesion
Anterior or posterior superior labral flap tear that disrupts bicep tendon anchor
Type 7 SLAP lesion
Legion that extends anteriorly to involve inferior or middle glenohumeral ligament
SLAP special tests for compressive injuries
Active compression test
Compression-rotation test
Clunk test
Anterior slide
SLAP special tests for traction injuries
Speeds test
Dynamic speeds test
Active compression test
SLAP special tests for OH injuries (peel back mechanism)
Pronated load test.
Resisted soup nation external rotation
Bicep load test 1 and 2
Pain provocation test
Crank test
Shoulder impingement special tests
Hawkins-Kennedy (most Sens)
Neers
Painful arc
Scapular retraction test (SRT)
PT manually repositions and stabilizes medial border of scapula.
+ if improved muscle strength in scapula with stabilized position or decreased pain and impingement during jobe relocation tests
Scapular assistance test( SAT)
PT manually facilitates scapular upward rotation as patient abducts arm
+ With relief of impingement, clicking, or rotator cuff weakness once assisted
Shoulder labral special tests
Generally, low sensitivity, limited value for ruling out label pathology
Yergason, bicep load, crank test have decent Sp.
Yergason Sp = 0.95 but low +LR
crank test Sp = 0.72
Shoulder (anterior) instability special testing
All tests have high specificity, good for rolling in instability
Surprise test has best Sn (Sn = 0.81, with low -LR)
Apprehension test had highest Sp
Relocation test also has strong Sp
TUBS
Traumatic, Unilateral shoulder dislocation, often results in Bankart lesion, requiring Surgery
Often results from anterior force to shoulder while it is abducted and externally rotated.
May also accompany bony abnormalities like hill sachs lesion
MDI or AMBRI
Multi-directional instability, or Atraumatic Multi-directional Bilateral shoulder dislocation that responds best to Rehab or Inferior capsular shift
Often require extensive rehab. If no favorable response is seen after 3 months, additional rehab will probably not be beneficial. May need inferior capsular shift
Anterior shoulder dislocation
MOI often involves traumatic nature, particularly from abducted and externally. Rotated position
Concomitant axillary nerve or labral injury
Posterior shoulder dislocation
MOI often involves discordinated muscle contraction like spasms or seizure
May have concomitant axillary nerve injury
Shoulder stabilization procedures
Capsulolabral repair:
Bankart repair
Modified bankart
Subscap shortening:
Putti-platt
Magnuson-stack
Coracoid transfer:
Laterjet
Bristow
Remplissage procédure
Arethoscopic stabilization procedure for moderate or large hill sachs lesion(> 25% of glenoid)
“Fills in” hill sachs lesion using infraspinatus tenodesis to reduce instability
Subacromial impingement
Bursal sided RTC impingement in OH positions or maximal IR
Internal shoulder impingement
Impingement of articular sided RTC tendon at maximal ER + abduction (late stage cocking)
Associated with PASTA lesion and SLAP tear. May see diffuse pain of posterior shoulder, IR ROM deficit
Adhesive capsulitis risk factors
*DM type ii
*Thyroid disease
*Female
*Age 40-65
*Prex hx adhesive capsulitis on contralateral side
Autoimmune conditions
Trauma
Stroke/heart attack
Prolonged immobilization
Lateral scapular slide test
Measures amount of protraction at zero, 45, 90° of shoulder abduction
Lateral excursion increased in cases of scapular weakness
