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Ortho Tx 700 > Shoulder > Flashcards

Shoulder Flashcards

1
Q

Function of the shoulder

A

Position/move arm for purpose of hand function

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2
Q

The spine of the scapula is usually at the level of what SP?

A

T3

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3
Q

Palpate Greater Tubercle

A

Just posterior to bicipital groove

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4
Q

Palpate Lesser Tubercle

A

Just anterior to bicipital groove

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5
Q

Palpate bicipital groove

A

Anterior to greater tubercle; internal/external rotation, bicep contraction to double check.

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6
Q

Deltoids

A

Origin:

(anterior) lateral 1/3 clavicle
(middle) acromion process
(posterior) spine of the scapula

Insertion: deltoid tuberosity

Action: (all) abduction

(anterior) flexion, medial rotation, horizontal adduction
(posterior) extension, external rotation, horizontal abduction

Nerve: Axillary (C5,6)
Artery: anterior and posterior circumflex

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7
Q

Supraspinatus

A

Origin: supraspinous fossa
Insertion: greater tubercle (superior facet)

Action: abduction

Suprascapular nerve
Suprascapular artery

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8
Q

Infraspinatus

A

Origin: infraspinous fossa
Insertion: greater tubercle (middle facet)

Action: external rotation

Suprascapular nerve
Suprascapular artery

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9
Q

Biceps Brachii

A

Origin:

(long) supraglenoid tubercle
(short) coracoid process

Insertion: radial tuberosity and bicipital aponeurosis

Action: GH flexion, elbow flexion, forearm supination

Musculocutaneous nerve
Brachial artery

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10
Q

Teres Minor

A

Origin: lateral scapula (superior/middle)
Insertion: greater tubercle (inferior facet)

Action: external rotation

[Can blend in with infraspinatus]

Axillary nerve
Circumflex scapular and circumflex humeral artieries

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11
Q

Teres Major

A

Origin: Lateral scapula (inferior portion)
Insertion: Bicipital groove (medial lip)

Actions: internal rotation, adduction, extension

[can blend in with lats]

Lower subscapular nerve
Circumflex scapular artery

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12
Q

Subscapularis

A

Origin: subscapular fossa
Insertion: lesser tubercle

Action: medial rotation

Upper and lower subscapular nerves
Circumflex scapular, dorsal, and suprascapular arteries

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13
Q

Subclavius

A

First rib to clavicle (middle of inferior surface)

Action: depresses clavicle at sternoclavicular joint; elevates 1st rib at sternocostal and costalspinal joints (during inspiration)

Intercostal nerves
Anterior and posterior intercostal arteries

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14
Q

Latissimus Dorsi

A

Origin: SPs of T7-L5, posterior iliac crest, sacrum, R8-12. Occasionally inferior scapula

Insertion: Medial lip of bicipital groove

Action: extension, medial rotation, adduction, anterior pelvic tilt

Thoracodorsal nerve
Thoracodorsal and posterior intercostal artery,

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15
Q

Pectoralis Major

A

Origin: medial 1/2 of clavicle; sternum and costal cartilage 1-7

Insertion: lateral lip of bicipital groove

Action: flexion, adduction, medial rotation, horizontal adduction

Medial and lateral pectoral nerves
Thoracoacromial artery (branch of axillary)
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16
Q

Pectoralis Minor

A

Origin: R 3-5
Insertion: corocoid process

Action: protraction and depression of scapula; elevation of ribs 3-5

Medial and lateral pectoral nerves
Thoracoacromial artery (branch of axillary)
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17
Q

Serratus Anterior

A

Origin: Anterolateral portion of R1-9
Insertion: Anterior surface of medial border of scapula

Action: protraction and upwards rotation of scapula

Long thoracic nerve
Dorsal scapular (subclavian) and lateral throracic (axillary) arteriesi
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18
Q

Upper Trapezius

A

Origin: EOP and medial 1/3 of superior nuchal line, nuchal ligament, SP of C7

Insertion: acromion and lateral 1/3 clavicle

Action: scapular retraction and elevation

Spinal Accessory Nerve (CN XI)
Transverse cervical and dorsal scapular arteries

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19
Q

Middle Trapezius

A

Origin: SPs of T1-5
Insertion: Acromion and spine of scapula

Action: scapular retraction

Spinal Accessory Nerve (CN XI)
Transverse cervical and dorsal scapular arteries

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20
Q

Lower Trapezius

A

Origin: SPs of T6-12
Insertion: root of the spine of the scapula

Action: scapular retraction and depression

Spinal Accessory Nerve (CN XI)
Transverse cervical and dorsal scapular arteries

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21
Q

Rhomboids

A

Origin:

(minor) SPs of C7-T1
(major) SPs of T2-5

Insertion: medial scapula (superior/inferior respectively)

Action: retraction and elevation

Dorsal scapular nerve
Dorsal scapular artery

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22
Q

Sternocleidomastoid

A

Origin:

(sternal) manubrium
(clavicular) medial 1/3 clavicle

Insertion: mastoid process (temporal), lateral 1/2 of superior nuchal line (occipital)

Actions: 
Flexion of lower neck
C0-C1 extension
Lateral flexion
CL rotation
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23
Q

Suprascapular Nerve

A 
C4,5,6
Brachial plexus
Lateral beneath traps and omohyoid
Suprascapular notch
Swoops laterally around spine of scapula

Suprapinatus
Infraspinatus

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24
Q

Axillary Nerve

A 
C5,6
Brachial plexus
Under clavicle
Through axillary space
Exits out quadrangular space
(three swoops)

Deltoids, T. minor, triceps (long head)

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25
Q

Lateral Pectoral Nerve

A

C5,6,7
Brachial plexus
Under clavicle, emerging just before Pec Minor
Veers medially

Pec major, minor

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26
Q

Musculocutaneous Nerve

A 
C5,6,7
Brachial plexus
Under clavicle
Straight down arm  Under bicep
Enters forearm lateral to bicep tendon
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27
Q

Subacromial/Subdeltoid Bursa

A

Extends over supraspinatous muscle and tendon, under acromion and deltoids

Bunches up during elevation of the arm

Easily impinged

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28
Q

Subscapular Bursa

A

Overlies anterior joint capsule
Beneath subscapularis

Articular effusion will manifest with swelling of subscapular bursa

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29
Q

GH Joint

A

Synovial
Ball & Socket

Capsular strength: weak and lax (inferiorly)

Head of the humerus (convex) on Glenoid fossa (concave)

Capsular pattern: ER –> Ab –> IR
Closed Pack: full abduction and ER
Resting: 55-70º abduction; 30º horizonal adduction

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30
Q

Glenoid labrum

A

Surrounds and deepens the glenoid cavity; stabilizes and allows for better articulation

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31
Q

Glenohumeral ligaments

A

Reinforce anterior capsule
Check external rotation (especially middle fibres, which twists)
Inferior fibres thickest

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32
Q

Coracohumeral ligament

A

Fights gravity; strengthens superior capsule

Similar attachment as supraspiantus

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33
Q

Transverse humeral ligament

A

Holds biceps tendon in place

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34
Q

Acromialclavicular joint

A

Synovial
Modified gliding

Lateral clavicle (concave) on acromion (convex)

Capsular strength: weak and lax

Resting position: arm by side with pillow support
Closed pack: Abduction to 90º
Capsular pattern: Full elevation with pain

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35
Q

The AC joint has a(n) __________ articular disc.

A

incomplete

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36
Q

GH Osteokinematics

A

3 degrees:

flexion/extension
abduction/adduction/
internal/external rotation

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37
Q

AC Osteokinematics

A

3 degrees:
elevation/depression
protraction/retraction
anterior/posterior rotation

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38
Q

SC Osteokinematics

A

3 degrees:
elevation/depression
protraction/retraction
anterior/posterior rotation

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39
Q

Convex on concave

A

Rolls and glides opposite

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40
Q

Concave on convex

A

Rolls and glides in same direction

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41
Q

Superior/inferior acromioclavicular ligament

A

Prevents AC separation

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42
Q

Coracoclavicular complex is made up of:

A 
Trapezoid ligament
Conoid ligament (posterior/medial)
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43
Q

Trapezoid ligament

A

Prevents excessive lateral movement in AC joint

Part of coracoclavicular complex

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44
Q

Conoid ligament

A

Attaches posteriorly on clavicle and contributes to posterior rotation of clavicle during abduction

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45
Q

Locate axillary pulse

A

midpoint of the axilla

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46
Q

Locate bicipital pulse (prox.)

A

Under mid 1/3 of the belly of the muscle

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47
Q

Locate bicipital pulse (distal)

A

Medial to tendon, in cubital fossa, superior to where you think it is (idiot)

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48
Q

Sternoclavicular joint

A

Synovial
Modified gliding

Resting position: arm by side with pillow for support
Closed pack: Maximal elevation of arm
Capsular pattern: full elevation with pain

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49
Q

The only joint that attaches shoulder to thorax

A

Sternoclavicular

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50
Q

Arthrokinematics of sternoclavicular joint

A

Facet on clavicle is Concave ant/post, and convex sup/inf .
Clavicle moves on sternum.
so:

ant/post movement is concave on convex
infer/super movement is convex on concave

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51
Q

The SC joint has a(n) _____________ complete disc.

A

Complete. (Helps prevent medial separation)

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52
Q

To increase elevation in SC joint, glide the clavicle

A

Inferiorly

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53
Q

To increase depression in the SC joint, glide the clavicle

A

Superiorly

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54
Q

To increase protraction in the SC joint, glide the clavicle

A

anteriorly

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55
Q

To increase retraction in the SC joint, glide the clavicle

A

posteriorly

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56
Q

Osteokinematic movement of the distal bone will equal the arthrokinematic movement of the _________, which will determine the arthrokinematic movement of the ______, via the rule of __________;

A

Roll
Slide/Glide
Concave/Convex

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57
Q

MMT grading

A 
5 normal
4 good (breaks)
3 fair (against gravity, but no resistance)
2 poor (AAROM)
1 trace (contraction, no movement)
0 absent
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58
Q

Concave on convex

A

roll and glide in same direction

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59
Q

Convex on concave

A

roll and glide in opposite directions

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60
Q

MMT delts

A

90º shoulder abduction, elbow flexion

Therapist applies downward pressure

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61
Q

MMT anterior deltoid

A

From 90º abduction, arm slightly horizontally adducted, externally rotated.

Pressure is applied into adduction and slight extension (down and back)

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62
Q

MMT posterior deltoid

A

From 90º abduction, arm slightly extended, internally rotated

Pressure is applied into adduction and slight flexion (down and forward)

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63
Q

MMT lower traps

A

Prone. Arm in Y fly position, extended. Fonzie thumb.

Apply downward pressure

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64
Q

MMT upper traps

A

Seated. Shoulder elevated, Lateral flexion so ear moved toward shoulder.

Pressure applied to separate ear and shoulder

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65
Q

MMT mid traps

A

Prone. Arm extended in T fly position. Fonzie thumb.

Apply downward pressure.

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66
Q

MMT subscapularis

A

Cop hold position, hand lifted slightly off back

Pressure applied pushing arm toward back

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67
Q

MMT supraspinatus

A

Seated, shoulder & elbow at 90º, then slightly externally rotated and moved slightly forward. IL lateral flexion; CL rotation.

Apply downward pressure (I think)

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68
Q

MMT infraspinatus

A

Prone. Shoulder abducted to 90º, elbow flexed at right angle (1/2 stick ‘em up cactus)

Place hand under arm near elbow to stabilize humerus. Apply pressure towards medial rotation

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69
Q

MMT Teres minor

A

Supine. Robot Barbie arm, slightly abducted.

Stabilize humerus by medial elbow.
Apply pressure towards medial rotation.

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70
Q

MMT pectoralis major – upper

A

Supine. Shoulder flexed to 90º, elbow extended

Stabilize opposite shoulder.
Pressure applied toward horizontal abduction

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71
Q

MMT pectoralis major – lower

A

Supine. Shoulder flexed, elbow extended, arm slightly medially rotated and adducted towards opposite hip.

Stabilize opposite shoulder.
Pressure applied laterally and superiorly

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72
Q

MMT rhomboids

A

Prone. Arm extended in T fly position, thumb DOWN.

Resist downward pressure

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73
Q

MMT levator scapulae and rhomboids

A

Prone, head turned to tested side. Elbow flexed, arm slightly laterally rotated, shoulder elevated, scapula retracted and downwardly rotated.

Hold elbow and shoulder.
Apply pressure to elbow in direction of scapular abduction and upward rotation.
Apply pressure to shoulder in direction of depression

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74
Q

Anterior/Posterior sternoclavicular ligaments

A

Resist separation/subluxation

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75
Q

Interclavicular ligament

A

Part of SC joint. Bridges the two clavicles.

Checks excessive medial movement.

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76
Q

Costoclavicular ligament

A

Part of SC joint.
Medial movement –> checks elevation
Lateral movement –> checks

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77
Q

How does the shoulder maintain passive stability?

A
  1. inferior lip of the glenoid fossa (cavity faces lateral, forward and superior)
  2. coracohumeral ligament and superior joint capsule
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78
Q

How does the shoulder maintain active stability?

A

Rotator cuff muscles

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79
Q

Active Ligaments

A

Another name for the rotator cuff muscles. They kick in to maintain congruency and stability of the GH joint when the joint capsule goes slack as arm is lifted away from the body

80
Q

What two conditions can cause abnormal alterations and compromises to shoulder stability?

A

Thoracic kyphosis

Muscle paresis

81
Q

“Pseudo-abduction”

A

In thoracic kyphosis, scapula downwardly rotated, no longer supported by stabilizing lip of the glenoid fossa.

SITS on 24/7.

Can lead to impingement syndrome

82
Q

GH joint capsule during abduction

A

As arm abducts, twist in glenohumeral ligament tightens, pulls head of the humerus into glenoid fossa.

Around 90º the tension on the twist is at it’s maximum, and it untwists, causing the arm to externally rotate.

Prevents greater tubercle from colliding with acromial arch.

83
Q

Muscle force couple

A

Muscles that exert EQUAL force in different directions, producing one movement.

84
Q

Muscle force couple in shoulder

A
  1. deltoids - SITS => abduction
  2. traps - serratus anterior => scapular upward rotation
  3. biceps long head with itself => stabilizing rather than extending
85
Q

Delts/SITS and arm movement

A

Delts pull humerus upwards and outwards
SITS pull inwards and downwards

Allows shoulder elevation

86
Q

Traps/Serratus Anterior and scapular rotation

A

Traps pull scapula up and in, down and in, and serratus anterior pulls laterally.

Scapula pinwheels in upward rotation

87
Q

Biceps self-force coupling

A

Long head of bicep depresses humeral head as arm abducts.
As arm externally rotates, the bicep tendon lines up with the suprascapular fossa.

New LOP causes the biceps long head to act as a stabilizer instead of an extensor.

88
Q

Phase 1 of scapular rhythm

A

Phase I. 0-30º humerus only

89
Q

Phase 2 of scapular rhythm

A

Phase II. 30-90º 40º humeral abduction; 20º scapular rotation; clavicle elevation 15º

90
Q

Phase 3 of scapular rhythm

A

Phase III. 90-180º 60º humeral abduction; 30º scapular rotation
15º clavicle posterior rotation (because of scapular elevation, via conoid ligament)

91
Q

How is the spine involved in GH abduction?

A

last 160-180º

If BL, just extension

If UL:
T1&2 extend, IL lat flexion, IL rotation
R1&2 depress and move posteriorly
Lower T spine CL lateral flexion

92
Q

Anterior brachial pain may indicate:

A

bicipital tendonitis

adhesive capsulitis

93
Q

Lateral brachial pain may indicate

A

supraspinatus tendonitis
bursitis

Impingement syndrome

adhesive capsulitis

94
Q

Superior/lateral pain may indicate

A

AC sprain

95
Q

Step deformity

A

AC separation (grade 2 or 3 sprain)

96
Q

Sulcus sign

A

Sagging or flattening below the acromion process, where rounded deltoid would be.

Indicative of a dislocation or deltoid paralysis

97
Q

Scapular winging

A

Entire medial border moves away from the posterior chest wall

98
Q

Dynamic scapular winging

A 
Possible problems with:
serratus anterior
LTN
muscle imbalance
rhomboid strain
upper trap sprain
99
Q

Static scapular winging

A

Structural deformity of the scapula, clavicle, spine or ribs

100
Q

Scapular tiltting

A

Superior or inferior angle of the scapula lifts away from chest wall.

Indicative of weakness and instabilty

101
Q

Functional ROM of the shoulder

A

Combing back of head (open chain)
Reaching into back pocket (open chain)
Apley’s scratch test
Getting out of chair using armrests (closed chain)

102
Q

Painful arc

A

first 45-60º – no pain because no pinching

Painful GH arc: 60-120º pinching under acromial arch may cause pain

Painful AC arc: 160/170-180º. impingement (general pain); AC/SC joint involvement (specific pain)

103
Q

Reverse Scapulohumeral Rhythm

A

Scapula moves more than the humerus during abduction

Indicative of frozen shoulder

104
Q

Quickie Test for Scapular Winging

A

Wall pushup

GH flexes to 90˚, face guest and push into elbow posteriorly, grasp ventral surface of the scapula and push dorsally against resistance.

105
Q

Range of motion testing

A

AROM (painful movements last)
If AROM is normal, or painful at end-range, then POP
Resisted ROM

Pain in PROM/POP –> joint play
Pain inResisted ROM –> MMT

106
Q

Shoulder dermatomes/myotomes

A

C4,C5, C6

107
Q

Dermatome: C4

A

Upper shoulder to base of neck; top of anterior and posterior chest

108
Q

Dermatome: C5

A

Lateral upper arm

109
Q

Dermatome: C6

A

Distal anterior biceps, lateral forearm

110
Q

Myotome: C4

A

Shoulder shrug

111
Q

Myotome: C5

A

GH abduction

112
Q

Myotome: C6

A

Waiters tray carry (elbow flexion, wrist extension)

113
Q

What muscle has a TrP that refers along the biceps tendon?

A

Infraspinatus

114
Q

Purpose of special testing

A
  1. confirm or refute specific pathology
  2. identify involved structures
  3. confirm orthopedic assessment findings
  4. dictate Tx
  5. ID CIs, modifications
115
Q

Overuse syndrome

A

Any noxious, repeated activity leading to micro trauma of involved tissues.

116
Q

Cardinal sign of tendinitis?

A

Pain on length, strength and palpation

117
Q

Intrinsic vs extrinsic factors in overuse syndromes

A

Intrinsic:posture, vascular supply

Extrinsic: ADLs, occupation, sports

118
Q

Tendinitis

A

Overuse injury causing inflammation of the tendons.

119
Q

Supraspinatus Tendinitis

A

A dynamic ligament
Poorly vascularized
Strained through repetitive movements (abduction and flexion) and posture.

May lead to impingement syndrome, bursitis, adhesive capsulitis

120
Q

Which tendon is particularly vulnerable to calcification?

A

Supraspinatus

121
Q

Bicipital Tendinitis

A

Usually secondary to another GH issue, usually impingement or rotator tear.

Inflammation may cause tendon to stick in groove.

Cortisone injections may cause tendon to weaken –> rupture.

Repetitive overhead movements (abduction, ER, elbow flexion and supination) – pitchers, swimmers etc

Possible subluxation of tendon.

122
Q

Long head of bicep acts as

A

Humeral stabilizer

Elbow extension decelerator

123
Q

Two exercises important to impingement prevention

A 
Front raise
(Anterior deltoid)

Shrugs
Push-ups with arms abducted to 90°
(Strengthen upper traps and serratus anterior)

124
Q

Calcific tendinitis

A

In later stage of tendinitis (esp rotator cuff, esp esp supraspinatus)

Fibroblasts –> chondrocytes
Calcified deposits fill up intracellular space in tendons

Increased size, inflammation, swelling, pain, impingement.

Self healing.

May provoke bursitis

125
Q

Tendinitis Grade 1

A

Pain after activity

126
Q

Tendinitis Grade 2

A

Pain at the beginning of activity, and afterwards.

127
Q

Tendinitis Grade 3

A

Pain at the beginning of, during, and after activity.

Activity may be restricted

128
Q

Tendinitis Grade 4

A

Pain with ADLs

Gets worse.

129
Q

Pain at lateral brachial area

A

Supraspinatus tendinitis

130
Q

Pain at anterior brachial region to superior glenoid fossa

A

Bicipital tendinitis

131
Q

Sx of tendinitis

A

Pain on strength, length and palpation

Signs of inflammation.

Difficulty sleeping on affected side

132
Q

ROM: supraspinatus tendinitis

A

AROM: pain with abduction, maybe flexion and medial rotation too (mm shortened)

PROM: same (structure compressed)

RROM: same

133
Q

ROM: bicipital tendinitis

A

AROM: flexion/extension

PROM: extension (maybe flexion)

RROM: flexion

134
Q

Special tests for supraspinatus tendinitis

A

Painful Arc
Drop Arm Test
Empty Can Test

135
Q

Special tests for bicipital tendinitis

A

Speeds

Yergasons

136
Q

Tendinitis Tx: Acute

A

Rest and ice

Reduce inflammation, hypertonicity, maintain ROM, decrease pain, prevent atrophy. Compensatory structures

137
Q

Tendinitis Tx: Chronic

A 
MFR
NMT
Stretch
Frictions 
Swedish
Reset (isometric contraction)

Contrast Therapy

138
Q

CIs: tendinitis

A

Calcification tendinitis (supraspinatus)

Tenosynovitis (bicipital tendon)

Anti inflammatory meds

139
Q

Three big questions during ROM assessment

A

What is being shortened?
What is being lengthened?
What is being compressed?

140
Q

Tendinitis/Bursitis Differentiation Test

A

RROM. Increasing resistance:

–> increased pain = tendinitis

–> pain constant, unchanged
= bursitis

141
Q

How to tell difference between tendinitis and strain?

A

MOI

Traumatic/sudden vs gradual onset

142
Q

Painful Arc

A

Sign of GH/AC impingement

Pain between 45-120° (worst at 90°) –> GH impingement
Diffuse pain

Pain between 160/70-180°
> AC impingement (sprain, OA)
Local pain

143
Q

Bursitis

A

Inflammation of bursa

144
Q

Subacromial (Subdeltoid) bursa

A

On top of supraspinatus, under acromion and deltoid.

Susceptible to impingement under acromial arch, and damage from calcified supraspinatus tendon

145
Q

Subscapular bursa

A

Over anterior joint capsule; under subscap tendon

146
Q

Joint effusion will cause visible swelling to which bursa?

A

Subscapular

147
Q

NMT

A

Segmental stripping on muscle belly, followed by either OI release at MT junction, or tendon bowing.

148
Q

Bursitis CIs

A

No compressions
Nothing onsite when acute
If infective leave it the hell alone.

149
Q

Bursitis Sx

A

Lateral brachial pain, referred below elbow.

If acute, signs of inflammation. Constant pain with sudden onset

Chronic: localized pain during compression or activity.

150
Q

Bursitis (GH): ROM

A

Pain with AROM, PROM, RROM

AROM – all movement affected esp abduction

PROM – noncapsular pattern, empty end feel

RROM – hesitation in some moves, strong and pain free in others.

151
Q

GH bursitis: special tests

A

Painful arc

Painful ROM of affected muscles

Neer Impingment

Bursitis/tendinitis differentiation.

152
Q

Causes of GH

Impingement

A
  1. mechanical anatomic (size of tunnel)
  2. Vascular (ability of tissue to heal)
  3. Kinesiological (muscle imbalances, posture)
153
Q

Impingement syndrome

A

Inflammatory condition

Inadequate space between the AC and GH joints

SITs muscles, subacromial bursa and biceps tendons impinged.

154
Q

Muscle force coupling and impingement syndrome

A

Imbalance – infraspinatus and T minor don’t depress humeral head enough to clear acromion during abduction.

155
Q

Hyperkyphosis and impingement syndrome

A

Relatively constant internal rotation –> inadequate external rotations –> compression.

156
Q

Impingement Syndrome: Stage 1

A

Self-limiting
Mostly supraspinatus; maybe biceps
Edward and haemorrhaging of subacromial bursa

Pain with activity, progress to ADLs

157
Q

Impingement Syndrome: Stage 2

A

Tendinitis and bursitis persist

Possible fibrosis

158
Q

Impingement syndrome: stage 3

A

Development of bony changes (bone spurs, eburnation of humeral tuberosity, changes to acromion and AC joint)

Ruptures (partial or complete) of tendons

159
Q

Eburnation

A

Wearing away of cartilage

160
Q

Is impingement syndrome reversible?

A

Stages 1 & 2: reversible with manual Tx, rest, stretching, strengthening

Stage 3. Surgery indicated.

161
Q

Impingement Syndrome: Sx

A

Insidious lateral brachial ache

Sharp twinges on certain movements (abduction)

162
Q

Impingement syndrome: ROM

A

AROM/PROM: painful arc. Full ROM in early stages that may decrease with progression

End feel: later stages may be empty (pain) or abnormal hard

RROM: pain with maximal contraction. (Strong & painful: intact tendon; weak & painful: tear)

163
Q

Special tests for GH Impingement

A

Hawkins-Kennedy Impingement test

Never impingement test

Drop Arm test

Empty Can test

Speeds test

164
Q

Impingement Syndrome: CIs

A

Like tendinitis and bursitis

Don’t joint mob bony changes

Cautious of corticosteroid injections

165
Q

Shoulder instability

A

Dislocation or subluxation at GH joint

Separation at AC joint

166
Q

GH posterior dislocation

A

Most common.
Excessive flexion, adduction, internal rotation.

Forward fall

167
Q

GH anterior dislocation

A

Excessive abduction and external rotation

Backward fall

168
Q

Test after Posterior GH dislocation

A

Push-Pull

169
Q

Test after anterior GH dislocation

A

Rockwood

170
Q

Test after Inferior GH dislocation

A

Feagins

171
Q

GH dislocation and hypo/hypermobility

A

When chronic, often hypomobile generally but hypermobile in direction of injury.

172
Q

Position for RROM

A

Neutral

173
Q

Special tests after GH sublux/dislocation

A 
Shoulder Apprehension Test
Rockwood
Feagin
Push-Pull
Sulcus Sign
174
Q

When treating a GH dislocation/sublux, what should happen before restoring ROM in direction of dislocation

A

Strengthen dynamic ligaments

175
Q

Tx goals after GH sublux/dislocation

A

Acute: pain management

Subacute: prevention of atrophy, scarring

Chronic: correction

176
Q

GH sublux/dislocation: Sx

A

Sulcus sign
protective posturing

Acute: pain, bruising, spasm, effusion

Subacute: unstable joint, decreased ROM, reduced edema, pain

Chronic: localized joint capsule pain when stressed, decreased bruising, stable except in direction of injury, restricted ROM, HY

177
Q

GH sublux/dislocation CIs

A

Never ever ever joint play in direction of injury

178
Q

Shoulder (AC) Separation

A

Sprain/rupture of AC ligaments (and possibly coracoclavicular complex) and/or possible displacement of the AC joint

179
Q

AC Separation: Grade 1

A

Damage to AC ligament
CCC intact

No step deformity

180
Q

AC Separation: Grade 2

A

Damage to AC joint and ligament
CCC damaged

Step deformity

181
Q

AC Separation: Grade 3

A

Rupture of the AC joint and ligaments
Rupture of CCC

Marked step deformity

182
Q

In an AC separation with complete avulsion of CCC from clavicle, the distal clavicle may be displaced posteriorly into or through the

A

Trapezius

183
Q

In an AC separation with complete avulsion of the CCC, the lateral end of the clavicle may be displace inferiorly into

A

The bicep/coracobrachialis tendon

184
Q

Special test after AC separation

A

AC Shear Test

185
Q

AC Separation: Tx

A

Acute: pain management. No testing beyond AROM, no joint play

Subacute: Decrease spasm, prevent atrophy (XFF, joint play 1/2, NMT, TrP), isometrics to prevent atrophy and increase stability

Chronic: Decrease scar tissue (XFF), joint mobs 3/4 (Grade 1 and 2), Isotonics to increase strength and stability

186
Q

Muscle: XFF then stretch
Ligament: XFF then ________

A

Joint mobilization

187
Q

AC separation: Remex Goals`

A
  1. create stability (strengthen SITs, periscaps)
  2. increase ROM
  3. recreate proprioception
188
Q

Adhesive Capsulitis

A

AKA frozen shoulder

Decreased AROM/PROM in ER/Abduction
Painful
Restriction according to capsular pattern

189
Q

Etiology of adhesive capsulitis

A

Primary: idiopathic

Secondary: just about anything to do with the shoulder

190
Q

Adhesive Capsulitis: Phase 1

A

Freezing/painful phase.

Hallmark: severe nocturnal pain over lateral brachial region

Gradual onset

191
Q

Adhesive Capsulitis: Phase 2

A

Subacute/Frozen phase

Pain diminishes; stiffness increases (following capsular pattern)

192
Q

Adhesive Capsulitis: Phase 3

A

Thawing Phase (chronic)

Pain continues to diminish, ROM increases.

Can take years.

193
Q

Adhesive Capsulitis: Sx

A

Hyperkyphosis
Muscle spasm
Capsular pattern of restriction
Reverse scapulohumeral rhythm

194
Q

Reverse Scapulohumeral Rhythm

A

When adhesive capsulitis limits abduction, the scapula elevates to “cheat” the move. 1:1 rhythm

195
Q

Progression of ReMex

A

Gradual; do not increase inflammation

Acute: rest, ice

In subacute/chronic: stretch –> strengthen (isometric -> eccentric -> concentric) –> proprioception –> dynamic stabilization

196
Q

ReMex too much?

A
  • discomfort lasting more than 2 hours in acute/subacute; 4 hours in chronic.
  • discomfort requiring medication
  • pain at rest
  • extreme fatigue, weakness
  • reactive spasm
197
Q

Adhesive Capsulitis: Tx

A

MFR (Xhand chest, bow pecs, shear ant delt)

Distract, inferior glide GH

Release pecs, subscap

Friction joint capsule

Rhythmic stabilization

Swedish to clear

Ortho Tx 700 (12 decks)

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