shoulder Flashcards
shoulder GH ROM
flexion 180 abduction 180 IR 90 ER 90 extension 60
GH joint open pack
55 deg abduction
30 deg horizontal adduction
neutral rotation
GH joint closed pack
max abduction, ER
scapulohumeral rhythm
first 30-60deg elevation GH
then 2:1 = 120 GH:60 scapulothoracic
scapular upward rotation muscles
upper and lower trap
serratus anterior
scapular downward rotation muscles
rhomboids
levator scapulae
pectoralis minor
joint mobilization for ER
anterior glide
adhesive capsulitis - posterior glide
shoulder labrum special tests
o’briens - slap lesion
speeds - Superior labral tear or tendinitis
yergason’s - Torn transverse humeral ligament, bicipital tendonitis or tendinosis
crank - labral instability
clunk - glenoid labrum tear
instability tests
anterior instability
posterior instability
shoulder GH capsular pattern
ER, Abduction, IR
shoulder SC and AC capsular pattern
pain at extremes of ROM
shoulder SC and AC open and closed pack
open: arm resting by side
SC closed: max shoulder elevation
AC closed: arm abducted 90deg
painful arc in 60-120 degrees of shoulder flexion
what special test next? suspect?
impingement: Neers Hawkins Kennedy Infraspinatus MMT Empty Can (Jobe) - Supraspinatus tendonitis, impingement, partial tear
treatment program for adhesive capsulitis
primary treatment: gentle progressive stretching exercises with the focus on increased active range of motion.
O’Brien’s test for?
SLAP tears, Superior labral tear
interventions:
- subacromial bursitis
- difficulty with overhead activities
Shoulder rotation, esp ER, strengthening the rotator cuff, which will be the MOST helpful at treating subacromial bursitis.
what pathology?
pain with extreme flexion and internal rotation,
passive range of motion WNL
Subacromial bursitis
what pathology?
pain with cross-body movements
Acromioclavicular joint lesion
most common cause Hill-Sach’s lesion
most likely to occur with anterior shoulder dislocation which creates a divot in the cortex of the humeral head.
primary or secondary impingement?
- Worsening pain with overhead activity
- rotator cuff weakness
secondary
primary or secondary impingement? mechanically narrow the subacromial space such as - osteophytes, - hooked acromion, - malposition after fracture, - increased subacromial soft tissue
primary
adhesive capsulitis end feel
firm
capsule shrinks and sticks
what test(s)? Rotator cuff pathology
external rotation lag sign
resisted external/internal rotation/supraspinatus.
what test(s)? crossover test
Acromioclavicular joint pathology
what test(s)? bicep tendon pathology
Speed’s Test
yergasons
biceps load
ludington
what pathology?
- Gross symptomatic instability in more than one direction
- caused by hyperlaxity in ligaments and GH joint capsule, symptomatic instability
glenohumeral multidirectional instability
pivot shift test
which way is leg rotated?
what does it test for?
medial rotation of the leg
ACL
reverse pivot shift test
which way is leg rotated?
what does it test for?
lateral rotation
PCL
what test? + indicates what pathology?
arm in 90 degrees of abduction and 30 degrees of horizontal adduction with the thumb pointing downward.
supraspinatus test
+ supraspinatus tendon tear, impingement, suprascapular nerve pathology
what test? + indicates what pathology?
arm in 90 degrees of abduction and external rotation with the elbow also flexed to 90 degrees
Roos test
+ thoracic outlet syndrome
what test? + indicates what pathology?
arm in 90 degrees of flexion before being medially rotated
Hawkins-Kennedy impingement test
+ shoulder impingement specifically involving the supraspinatus tendon
what test? + indicates what pathology?
positioned with the arm in a resting position at their side with the elbow flexed to 90 degrees and the forearm pronated
Yergason’s test
+ bicipital tendonitis
what test? + indicates what pathology?
- Patient’s arm is placed in 90 degrees of flexion in the scapular plane and 90 degrees of elbow flexion.
- Therapist then laterally rotates the shoulder to end range and asks the patient to hold the position.
- Positive: inability to hold the test position (i.e., hand springing back toward midline)
lateral rotation lag sign
infraspinatus or teres minor lesion
- both ER
what test? + indicates what pathology?
- patient to medially rotate the arm behind the back with the dorsum of the hand resting in the mid-lumbar region.
- Therapist then instructs the patient to attempt to lift the hand off the back.
- Positive: unable to lift hand off back
lift-off sign
lesion of the subscapularis muscle
- shoulder IR, innervated by the subscapular nerve (C5-C6).
what pathology?
- drop arm test was positive,
- magnetic resonance imaging confirmed that the rotator cuff was not torn.
Axillary nerve palsy
deltoid acts as a primary abductor of the shoulder, innervated by the axillary nerve (C5-C6)
what pathology?
generalized weakness, sensory disturbances and pain in the shoulder, arm, and hand.
thoracic outlet syndrome
shoulder arthrokinematics
Flexion and medial rotation
humeral head rolls anterior, slides posterior
shoulder arthrokinematics
Extension and lateral rotation
humeral head rolls posterior, slides anterior
if adhesive capsulitis glide posterior for ER
shoulder arthrokinematics
Abduction
humeral head roll superiorly, slides inferiorly
shoulder arthrokinematics
Adduction
humeral head rolls inferiorly, slides superiorly
