Shoulder Flashcards
abduction ROM
180
flexion ROM
180
scaption
170-180
ER
80-90
IR
60-100
extension
50-60
adduction
50-75
CPP of shoulder (glenohumeral joint)
abduction to 90 and ER
OPP of shoulder?
55 degrees of abduction, 30 deg. of horizontal adduction and ER
diagnose external primary impingement stage 1
intermittent mild pain with OH activities
>over age 35
diagnose external primary impingement stage 2
mild to moderate pain w/ OH activities, over age 35
diagnose external primary impingement stage 3
pain at rest or with activities, night pain, scapular or rc weakness is noted
diagnose full thickness rc tear
classic night pain
most weakness in abduction and lateral rotation
loss of motion
diagnose adhesive capulitis (idopathic frozen shoulder)
inability to perform ADLs secondary to loss of motion
rotator cuff mm
supraspinatus
infraspinatus
teres minor
subscapularis
Neer’s classification of rotator cuff disease:
stage 1: edema and hemmorrhage of the tendon and/or bursa
stage 2: tendinitis and fibrosis of the rc
stage 3: tear of rc (full or partial)
rc tear MOI
traumatic: usually falling onto an abducted and extended arm
atraumatic: overuse, degeneration
S&S of rc tear
weak and painful mmt
tests for rc tear
empty can neers painful arc drop arm hawkins kennedy
tx of rc tear
prom only for awhile after sx
aarom
arom
blackburn exercises
adhesive capsulitis
inflammation and fibrosis of the glenohumeral capsule and ligaments causing severe limitation of mobility
causes of primary adhesive capsulitis
idiopathic
causes of systemic secondary adhesive capsulitis
associated with DM, thyroid dysfunction, adrenal dysfunction
causes of intrinsic secondary adhesive capsulitis
rc disorders, biceps tendonitis, calcific tendons
causes of extrinsic secondary adhesive capsulitis
associated with a known abnormality of the shoulder or surrounding tissues, mastectomy, cervical ridiculopathy, tumors, CVA, humeral shaft or clavicular fractures, scapulothoracic abnormalities, acromioclavicular arthritis
how do u diagnose adhesive capsulitis?
u simply have to rule everything else out!, also they will have deep burning pain all around the shoulder girdle, and pain that wakes them up at night and positive shrug sign.
hallmark of adhesive capsulitis?
shrug sign! and … loss of PROM AND AROM following the CPR for the shoulder (ER> abduction > IR)–ER MOST effected!
ad. cap. stage 1
less than 3 mo.
achy pain at rest, sharp pain at end range
often misdiagnosed as rc tear
ad. cap. stage 2
freezing
lasts about 6 months
very painful with any motion
ad. cap. stage 3
frozen
lasts about 5 mo
no more pain but shoulder is beyond stiff
ad. cap stage 4
thawing
lasts up to 14 mo
painless stiffness begins to improve with tx
SLAP lesion
superior labral tear, labrum and biceps tendon anchor tear away. horizontal abduciton and ER= pain
Bankart lesion
ligament tears during shoulder dislocation, the inferior glenohumeral ligament pulls the inferior labrum away from the glenoid rim (called a bony bankart if a piece of bone is pulled away as well)
MOI of bankart lesions
repetitive OH throwing (pitchers and QBs)
foosh
violent OH reach (sliding into home)
sudden pull (wt. lifters)
catching a heavy object
hx of shoulder instability eventually leads to a tear
S&S of labral tear
pain with OH movement catching, locking, popping, grinding weakness instability loss of ROM difficult to pin point the pain night pain NO SWELLING
special tests for labral tears
SLAPrehension test biceps load test speeds test load and shift test active compression test clunk test crank test
how to perform an active compression test
have pt put arm in 90 deg. flexion and 10 deg. horizontal adduction and full IR, place a downward force through the arm like a MMT. Positive for labral tear when pain present in IR but relieved by putting arm in full ER.
Shoulder instability
the body’s inability to keep the humeral head in the glenoid fossa
static stabilizers
ligaments, tendons, capsule, articular surfaces, coracoacromial arch
dynamic stabilizers
mm–> rc + deltiod & biceps, negative pressure
anterior instability MOI
abduction+extension+ER+posterior force
S&S ant. instability
clicking, pain, dead arm feeling when throwing, inc. joint motion in ant. direction
posterior instability MOI
axial loading when arm is adducted and IR (seizure or electric shock)
S&S of post instabliity
impingement signs, IR deficit, pain and clicking, inc joint motion in the post. direction
multidirectional instability
instability in 3 areas, anterior, posterior, inferior
tests for shoulder instability
load and shift
anterior drawer
apprehension relocation test
what do u NEVER do in the same plane of instability?
mobs/manual therpay
