Shoulder

Question 1

15-35 y/o usually present with which kind of shoulder injury?

Answer 1

Rotator cuff dysfunction

Question 2

> 40 y/o usually present with which kind of shoulder injury?

Answer 2

Degenerative change

Question 3

40-60 y/o usually present with which kind of shoulder injury?

Answer 3

Frozen shoulder

Question 4

Does frozen shoulder generally affect men or women more?

Answer 4

70% more women

Question 5

FOOSH injury can cause

Answer 5

a SLAP lesion

Question 6

A fall where the person lands on their elbow can cause

Answer 6

an AC separation- it drives the humeral head up against the acromion

Question 7

Night pain, pain at rest generally means

Answer 7

Rotator cuff injuries

Question 8

Lifting the arm over the head by a patient with instability or inflammation usually

Answer 8

exacerbates shoulder problems

Question 9

Deep, boring, achy, pain in the neck or shoulder could possibly indicate

Answer 9

Thoracic outlet syndrome with or without radiculopathy

Question 10

If the limb becomes tired after movement, this could indicate

Answer 10

vascular involvement

Question 11

Usually the dominant shoulder

Answer 11

is often lower and shows greater muscularity and a decrease in ROM

Question 12

Inspection of the Anterior view of the shoulder: “Step deformity”

Answer 12

AC dislocation, clavical lying superior to the acromion. It also indicates a tear of the acromioclavicular and possibly the coracoclavicular ligaments

Question 13

Inspection of the Anterior view of the shoulder: “Sulcus Sign”

Answer 13

Appears with distal humeral traction, indicating multidirectional instability and a loss of muscle control due to a nerve injury

Question 14

Inspection of the posterior view of the shoulder: “Classic Scapular winging”

Answer 14

the vertebral border of the scapula moves away from the chest wall, may be seen in weak or paralyzed serratus anterior or long thoracic nerve injury which is innervated by the C5, C6, C7, nerve roots.

Question 15

Classic winging can be caused by which radiculopathies?

Answer 15

C3, C4 (trapezius)
C5 (rhomboids)
C7 (serratus anterior, rhomboids)

Question 16

Inspection of the posterior view of the shoulder: “scapular tilt”

Answer 16

Also called “inferior border” winging ( the most common winging- the inferior border is tilted away from the chest wall) may occur due to weakness of the lower trapezius, latissimus dorsi, serratus anterior, or most likely a tight pectorals minor pulling on the coracoid process

Question 17

AROM

Answer 17

Performed in a sitting position with painful movements last

Question 18

Apley’s scratch test

Answer 18

Combines a bunch of movements to see where the problems is, medial rotation, extension and adduction, lateral rotation, flexion and abduction. Dominant shoulder may show restrictions, unless the activity the patient performs (pitching) happens to increase the ROM of the dominant shoulder

Question 19

AROM: Shoulder flexion

Answer 19

180

Question 20

AROM: Shoulder extension

Answer 20

60

Question 21

AROM: Abduction

Answer 21

170-180

Question 22

AROM: Adduction

Answer 22

50-75

Question 23

AROM: Internal rotation

Answer 23

60-100

Question 24

AROM: External rotation

Answer 24

80-90

Question 25

IZ needed for Shoulder balancing treatment at the JOINT level of dysfunction

Answer 25

Infraspinatus Teres Minor Supraspinatus Subscapularis

Question 26

IZ needed for Shoulder balancing treatment at the GIRDLE level of dysfunction

Answer 26

Rhomboids (Major/Minor) Pectoralis (Major/Minor) Lower Trapezius Serratus Anterior

Question 27

The types of conditions often seen with improper glenohumeral arthrokinematics are:

Answer 27

``` Rotator cuff injury Bicipital tendinopathy Subacromial Bursitis Impingement Syndrome (secondary leading to primary) Degenerative changes ```

Question 28

Glenohumeral Artrokinematics

Answer 28

Major reasoning behind most shoulder issues, both the shoulder girdle and the joint should be addressed during treatment because rarely is it purely one or the other

Question 29

Tears involving tendons, ligaments, and cartilage

Answer 29

They do not receive a good blood supply so they will either not heal completely or contribute to instability of the joint involved. Acupuncture can only increase the circulation of Qi to the structures and help with the body's response to the pain.

Question 30

Main distal points for the shoulder

Answer 30

LI-4: relieves pain and opens the channel Linggu, Dabai: Master Tung points, great for pain anywhere on the body, but also great shoulder points TW-5: Luo pt. activates the channel and alleviates pain, expels wind and releases the exterior LU-5: He-Sea point, relaxes sinews and alleviates pain, especially for anterior shoulder pain and Qi stagnation SI-3: Good channel point, for posterior pain, infra, trees minor, upper back SI-6: Xi-cleft point, good channel point for acute posterior shoulder pain LI-10: Any shoulder problem, especially supraspinatus issues

Question 31

significant distal points

Answer 31

ST38- Shoulder pain along the LI channel, Yang Ming connection GB34- Shoulder pain along the TW channel, Shao Yang connection, He Sea point BL58- shoulder pain along the SI channel, Tai Yang connection, Luo point *palpate bilaterally to find the most tender point. Can be needled when local points are not indicated and to improve ROM by decreasing acute pain.

Question 32

May present with a history of shoulder injury wroth pain located over the anterior/lateral glenohumeral head, typically LI15. Pain also presents at night, difficult to find a comfortable position. Possible painful areas are between 60-120 degrees of abdunction, worse with RROM. If PROM produces pain, it is usually with the shoulder flexion and abduction at end range where the insertion of the tendon may be impinged. Often the shoulder will show an upper crossed pattern

Answer 32

Supraspinatus Tendinopathy/Injury HIPS

Question 33

Test to confirm Supraspinatus tendinopathy

Answer 33

Empty Can Test | MMT PROM ABD first 20 degrees

Question 34

TCM DX of Supraspinatus tendiopathy

Answer 34

Qi and Blood Stagnation of the LI, SI meridians

Question 35

TX of Supraspinatus tendinopathy

Answer 35

Disperse stagnation in effected meridians, address any underlying imbalance such as LV blood deficiency, SP Blood deficiency etc.

Question 36

Acute: rest with ice 24-48 hours after injury Local: EA 4 hz LI15-SI12, or LI15-LI10, depending on pain referral: 40 min., SI12 Distal: Xi Cleft LI7, LU6, SI6, TW7 as needed, LI10, LI4, TW5 threaded to TW8, ST38 (same side), ST42 Chronic: local: LI15, TW14, LI16, SI12 distal: TW5 threaded to TW8, LI10. LI4, ST38 (ss), IZ: infra, supra, teres minor, subscap

Answer 36

Supraspinatus TX points

Question 37

Indicates further progression of muscular imbalance in the rotator cuff resulting in repetitive stress injury, subacromial thickening or swollen supraspinatus tendon attachment

Answer 37

Impingement Syndrome: HIPS

Question 38

populations >40 y/o is usually d/t degenerative changes in the rotator cuff, acromion process, the corticoid process and anterior tissue. This type of impingement may involve an acromion spur. In these patient poor muscle dynamics also exist.

Answer 38

Primary Impingement

Question 39

in young patients (15-35) anterior shoulder pain is usually due to problems with muscle dynamics involving the glenohumeral and scapulothoracic articulations.

Answer 39

Secondary Impingement

Question 40

Posterior impingement may occur in…

Answer 40

throwing overhead but it is not seen in the general population

Question 41

Tests performed with diagnosing impingement syndrome

Answer 41

Neer impingement test | Hawkins-Kennedy Impingement test

Question 42

TCM DX of Impingement syndrome

Answer 42

Q/B stagnation of the LI, SI meridians, Bi syndrome in Primary (usually cold or bone bi), LV Qi stag, possibly SP blood def.

Question 43

TX of Impingement Syndrome

Answer 43

Dispel Bi, Move Qi and Blood, Smooth LV Qi, Build SP blood, relax sinew channel

Question 44

"Shoulder balancing treatment-joint level": IZ of the Infra, Supra, SubScap, and Teres minor SI3, SI9, SI11, GB21, SI14, TW14, LI4, LU7, LI10, LI16, LI15

Answer 44

TX point for secondary Impingement

Question 45

Mechanism of Injury can be falling and bracing arm which drives the humeral head up into the AC joint. Pain with PROM elevation, especially when they cross their arm and touch the opposite shoulder. Point tenderness over distal end of the clavicle, directly over the AC joint is a great way to determine this pathology as the pain tends to be specific. Possibly over coraco-clavicular ligaments as well if its involved. Step deformity of the clavicle, on the acromion sign may be seen

Answer 45

AC Sprain/Arthritis

Question 46

TCM Diagnosis of AC Sprain/Arthritis

Answer 46

Qi and Blood stagnation of the LI and TW meridians

Question 47

TX of AC Sprain/arthritis

Answer 47

Move Qi and Blood in LI and Tw * when acute do not needle into the joint * when chronic, osteoacupuncture is indicated Local: LI16, LI15, LI10, TW14 Distal: SI12, Gb34, LI1, TW1

Question 48

Commonly idiopathic (without known cause). Decrease in PROM of arm into abduction and external/lateral rotation. Can follow a period of pain in the shoulder with muscle guarding but can also be considered to be an unknown cause. It about 1/3 of cases, frozen shoulder can occur in both arms. Women are more affected than men and its unusual onset begins between ages of 40 and 65. This condition affects approximately 10% to 20% of diabetics. The process itself is when the capsule becomes fibrous tirruse causing the inferior olds of the capsule to become adhered to each other

Answer 48

Frozen shoulder HIPS

Question 49

4 stages of Frozen shoulder

Answer 49

``` initial (most pain 0-3 mo) freezing stage (3-9 mo) frozen stage (decease in pain, 9-15 mo) thawing stage (15-24 mo) ```

Question 50

TCM DX of frozen shoulder

Answer 50

wind cold invasion with progression from cold bi to fixed bi

Question 51

Dispel fixed or painful bi, move Qi and Blood, relax the sinew channel Local: LI15, GB21, TW14, sticky needle subscap Distal: LI10, LI4, LU7, GB34, ST38

Answer 51

Treatment of Frozen shoulder