shoulder 3 - tests and injuries Flashcards
what are the two presenation of a hypermobile shoulder
TUBS and AMBRI
what is the TIBS hypermobile shoulder presentation
traumatic
unidirectional
bankart lesion
surgical repair
EX: I did this activity and my shoulder fell apart
TUBS - unidiretional
anterior
posterior - more traumatic
inferior
TIBS- bankart lesion
A tear that happens in the lower rim of the labrum.
The rim of the glenoid being torn off as the humeral head slides forward with friction, boney – tear off a portion of the bone as well
what leads to a anterior instability
post directed force with arm in ER and abd
what leas to a post instability
post directed force with the arm flexed and internally rot
what leads to an inf instability
inf force with the arm in abd
what is the AMBRI presentation
Atraumatic
multidirectional
bilateral
rehab
inferior capsule shift
beightons scale
what is the general presentation of someone with shoulder instability
instability and apprehension
weakness with overhead activities
loss of power and coordination
may have some clicking snapping and popping
what is the test for multidirectional instability
sulcus sign
what are the test for anterior instability
anterior apprehension
anterior drawer
what a is a general test for shoulder instability
load and shift test
what are the test for posterior instability
posterior drawer test
postierior apprehension, jerk, kim
what is the intervention for instability
strengthing of the RC and scapular
side lying ER
prone I, Y, T
other exercises to target specific musculature
what is the positive load and shift
clicking, popping, pain provocation
Evaluating the glide of the humeral head in the glenoid
what is a apprehension test
: apprehension that is reduced/ eliminated with relocation maneuver
what is a positive anterior drawer test
humeral head slides past coracoid
what is a positive posterior drawer test
the thumb is felt to slide past the coracoid.
a little pain but the pt may be apprehensive
what is a positive for the posterior apphrehension test
Looking for apprehension and pain
what is a positive test for the Jerk test and kim test
sudden onset of sharp posterior shoulder pain indicates a positive test result, with or
without a clunk
what is a positive sulcus sign test
too much inf translocation
o-deg sulcus sign is test
the superior capsule
90-deg sulcus sign is testing what
the inferior capsule
what is the MOI of a SLAP lesion
fall on a outstretched arm
traction on the long head of the biceps associated with overhead throwing activities
internal impingement
peel back of the labrum due to towist of the biceps tendon during abd and ER
what are the symptoms of a slap lesion
pain and mechanical catching and grinding - LHB
clicking
instability
what are the test for a slap lesion
O’brein’s
anterior slide test
crank test
biceps load one and two
what is the procedure for O’breins test
arm flexed to 90, 10-deg of abd
downward force is applied to the arm in full supination and pronation
what is a positive O’briens test
pain with the hand is in supination (IR) that reduced when the arm is in pronation (ER)
O’brein’s pain felt inside of the shoulder
labral lesion
O’brein’s pain felt up top of the shoulder
AC joint lesion
what is a postive anteiror slide test
pain of click in the front of the shoulder
what is the procedure for cranks test
pt sitting or supine
arm abd 160
passivly IR and ER the arm while applying an axial load
what is a positve cranks test
click or pop
what is the procedure for the biceps load test
- Arm position: 900 of abduction, extreme ER, supinated
- Try to pull the pt elbow into flexion
what is a positive biceps load test
is pain with contraction of biceps
what is the difference between biceps load 1 and 2
- Arm position: 1200 of abduction
what is a the best diagnostic test for the slap lesion
biceps load 1 and 2
what are speed and yergason test for
Labral tears and Evaluation of Biceps Tendon Long Head
what is the procedure for speeds test
stand (liked) or sitting
- arm is flexed to 90°, elbow extended, and the forearm fully supinated.
- Examiner applies a downward force
what is a positive speeds test
is reproduction of pain in the proximal shoulder during internal rotation
what is a positive yergusons test
reproduction of pain in the proximal shoulder specifically the bicepetal groove
what is the procedure for yerguson test
- The elbow is flexed to 90°
- PT force into pronation and elbow extension (down) while palpating the long head of the biceps at the bicepetal groove.
what is the other name for a hypomobile shoulder
adhesive capsulitis
what is the general presentation of adhesive capsulitis
painful loss of shoulder motion of unknown orgin - rest, night,
age > 40
insidious
inability to sleep through the night
ROM limitation
what is the main feature of adhesive capsulitis
pain is the predominant initial feature followed by progressive loss of motion
what ROM limitation do we see with adhesive capsulitis
ER - 30-deg, usally greater then 50%
elevation - less then 120
IR less limited
look at the pre freezing chart and stuff
please
what is the intervention of choice for adhesive capsulitis
mobs - indicated if ROM is limited
how do we know when to progress from the resting poistion for mobs of the shoulder
start in the resting position and progress into the restricted ranges of motion based on the pain presentation of the patient and their tolerance
what is the procedure for GH distraction
70-deg of abd in the capsular plain
how do we improve flexion
Glenohumeral Posterior Inferior Glide
how do we improve abd
inferior glide
how do we improve ER
anterior glide
how do we improve IR
posterior glide
what is the resting and restricted position for - Glenohumeral Inferior Glide
resting - arm at you side
restricted - end range ABD
what is the resting and restricted position for - Anterior Glide
resting - side lying arm at pt side
restricted - pt prone with arm on PT’s leg at end range ER
what is the resting and restricted position for - Posterior Glide
resting - pt prone arm at side
restricted - pt prone with arm at end range IR against PT leg
what is the resting and restricted position for - Glenohumeral Posterior Inferior Glide
resting
restricted - pt supine, arm at end range flexion
what are some stretching exercise that the pt can do at home or in clinic
cane movement
what are the spectrum of RC injuries
sprain
tendionopathy
artial tear
full tear
the patient is strong and painful
contractile tissue - tendon or muscle
the patient is strong and painless
no issues
the patient is weak and painful
acute or serious pathology
the patient is weak and painless
nerve lesion
or
complete rupture or the muscle/tendon
what kind of athletes are RC injuries seen
throwing athletes
acute RC tears presentation
tarumatic event - FOOSH
acute pain and weakness
AROM more limited then PROM
pain and weakness with resisted test
attritional RC tears
age > 50
lateral shoulder and arm pain
visable atrophy
pain at night
weakness
PROM good
AROM limited
abd weakness
what is the cluster for a full thickness tear
drop arm sign
painful arc
infraspinatus lag sign
what are special test for RC tear
supraspinatus - full can, empty can
infraspinatus - lag sign
teres major - lag sign
subscapularis - belly push and lift off
for the full RC tear cluster what number is needed
3/3 or 2/3
there is an increase in the liklihood ratio
weak shoulder what is a another name for it
SAPS
Primary SAPS - what is it
structural narrowing of the acromion space
changes to the underside of the acromion
maybe - soft tissue swelling
secondary SAPs - what is it
functional narrowing of the SAP due to abnormal arthro
normal anatomy at rest with an impigment that occurs with movement
what can funtional SAPs be due to
loss of dynamic stablizer - RC and long head of the biceps
posterior capsule tightness
glenohumeral instability
altered scapular upward rotation
what is the common complaints with SAPs
lateral or anterior shoulder pain with overhead activities
pain with reaching across
hard time sleeping
what are the test for SAPs
hawkins kennedy
neer
painful arc
relocation test
empty can test
ER test
what is the procedure for neer’s test
the pt is sitting or standing
place the pt arm in the scapular plane with the palm facing away from the body
PT behind the pt and applies an inferior force at the shoulder - stablizing the scapula
bring the arm into flexion
what is a positive neer’s test
reproduction of pain
what is the procedure for hawkins kennedy
pt standing or sitting
Passively place pt arm into 90° of shoulder flexion and 90° of elbow flexion
Forcefully moves the arm into internal rotation
Passive
what is a positive hawkins kennedy
reproduction of pain with IR
what is hk looking at
eval of impingment
Posterior relocation is looking at what
Internal impingement
what is the procedure for the posterior relocation test
Pt supine, towel under shoulder, arm 90-90
Put the pt into ER until we have apprehension
Then apply posterior force to the humeral head – there should be less apprehension
Slowly lift hand away to see if they are apprehensive again
what is a positive posterior relocation test
posterior pain that is reduced/ eliminated with relocation maneuver
how do we treat SAPs
we want to work on the shoulder depressor (infra, teres minor, and subscap), these keep the acromion out from under itself
