Shoulder Evaluation 1 Flashcards
Specific shoulder exam: IBC categories
- mobility deficits
- instability
- RTC dysfunction
- other
shoulder exam:
mobility deficits
age
40-65
shoulder exam:
mobility deficits
progressive worsening of
pain and stiffness
shoulder exam:
mobility deficits
PROM limitations
multiple directions, esp ER
shoulder exam:
mobility deficits
This motion decreases as the arm abducts
ER
shoulder exam:
mobility deficits
accessory mobility
restricted
shoulder exam:
instability
age
< 40
shoulder exam:
instability
hx of
dislocation
shoulder exam:
instability
excessive
GH accessory motion
shoulder exam:
instability
apprehension with PROM…
flexion
horizontal abduction
ER
shoulder exam:
RTC dysfunction
typical onset
OH motion
acute strain
shoulder exam:
RTC dysfunction
Will see s/s of
impingement
shoulder exam:
RTC dysfunction
weakness of
RTC muscles
shoulder exam:
(IBC classification) “other”
- arthritis
- fx
- ACJ
- neural tension
- fibromyalgia/chronic pain
- post-op
Most commonly referred dx for shoulder dysfunction
impingement syndrome
Impingement syndrome occurs d/t persistent or repeated compression of structures in the
subacromial space
Peak compressive forces in the shoulder occur between
85˚ and 136˚
Primary impingement: symptoms
- pain at night
- pain with OH activities
- stiffness
Secondary impingement:
Often d/t underlying
instability of the GH joint
Another name for posterior impingement
‘under surface impingement’
Posterior impingement:
Patients have posterior shoulder pain in this position
90/90
Posterior impingement:
Supraspinatus and infraspinatus rotate posteriorly, resulting in friction/rubbing along the
posterior superior surface of the glenoid rim
Posterior impingement:
This can develop if posterior RC is not working
dominant posterior deltoid
MRI and US have shown that (%) of asymptomatic subjects have RTC tears
13-34%
Asymptomatic people with RCT have (%) chance of becoming symptomatic
51%
Partial thickness RTC tears usually progress to
full thickness tears
Though full thickness RTC tears do not heal, 33-90% have demonstrated improved
pain
function
Full thickness RTC tears require
- surgical treatment
- subsequent aggressive rehabilitation
These factors create significantly greater stress on the RTC muscles
- capsular laxity
- labral insufficiency
RTC tear tests
- painful arc
- drop arm test
- infraspinatus test
- ER weakness
- lift off/belly off subscapularis
- empty can test
Shoulder IR rotation loss is often associated with _____ tightness and can lead to ______
- posterior capsule
- anterior shear of the humerus
2 key factors indicated in RTC injury (arthrokinematics of GHJ)
humeral head
- anterior translation
- superior migration
Scapular evaluation tests
- Kibler’s subtle scapular dysfunction
- McClure Forward flexion w/ 3-5# weight
**These are purely scapular positioning and observation tests indicating further evaluation is warranted.
Why test supraspinatus in 30˚ abd, 30˚ flex, and slight ER?
good ratio of supraspinatus activation to deltoid
Use this test for teres minor MMT
Patte test
90˚ abduction, 90˚ ER
RTC MMT: subscapularis test position and name
IR behind the back
Gerber Lift-off Position
Full thickness RTC tear test cluster:
When all 3 tests are positive, probability of the pt having a full thickness RTC tear is (%)
91%
Full thickness RTC tear cluster
- drop arm
- painful arc
- weakness with infraspinatus MMT
