Shoulder Evaluation 11 Flashcards
1
Q
Shoulder Joint Traits
A
- Most mobile joint in body
2. most unstable
2
Q
Functional unit of shoulder?
A
Shoulder Girdle
3
Q
3 bones of shoulder?
A
- Clavicle
- Humerus
- Scapula (coracoid and acromion)
4
Q
3 true synovial joints?
A
- Glenohumeral
- Sternoclavicular
- Acromioclavicular
5
Q
2 functional joints
A
- Suprahumeral
2. Scapulothoracic
6
Q
2 accessory joints
A
- Costosternal
2. Costovertebral
7
Q
Functional Anatomy:
EARLY Phase shoulder ABduction
A
Glenohueral + suprahumeral
8
Q
Functional Anatomy:
MID-LATE Phase shoulder ABduction
A
Scapulothoracic + Sternoclavicular + acromioclavicular
9
Q
Humerus ROM:
Flexion
A
180
10
Q
Humerus ROM:
Extension
A
60
11
Q
Humerus ROM:
ABduction
A
180
12
Q
Humerus ROM:
ADduction
A
40-50
13
Q
Humerus ROM:
HZ ABduction
A
130-145
14
Q
Humerus ROM:
HZ ADduction
A
40-50
15
Q
Humerus ROM:
Internal Rotation
A
90
16
Q
Humerus ROM:
External Rotation
A
90
17
Q
Acromioclavicular palpation:
for TART-GH position? ROM
A
- GH 60 HZ ABduction
- 60 Coronal ABduction
- Int and Ext rotate GH joint (direct correlation to AC rotation)
- Normal rotation = 10 deg
18
Q
Scapular Motion (6):
A
- Elevation
- Depression
- ABduction (Protraction)
- ADduction (Retraction)
- Upward rotation (Forward Tilt)
- Downward rotation (backward tilt)
19
Q
Sternoclavicular motion:
ABduction - clavicle movement?
A
Distal end: superior
Proximal end: Inferior
20
Q
Sternoclavicular motion:
ABduction - Test?
A
Pt supine
Have patient shrug
21
Q
Sternoclavicular motion:
Flexion-movement
A
Distal end: anterior
Proximal end: Posterior
22
Q
Sternoclavicular motion:
Flexion-test
A
Pt supine
Reaches for the ceiling FORCEFULLY!!!?!?!?
23
Q
Myofascial Release-Scapulothoracic Dysfunction:
Pt. position?
A
Lateral recumbent
24
Q
Myofascial Release-Scapulothoracic Dysfunction:
What shoulder is on the table?
A
The uninvolved shoulder
25
Myofascial Release-Scapulothoracic Dysfunction:
| What shoulder is up?
The involved shoulder
26
Myofascial Release-Scapulothoracic Dysfunction:
| Doctor position?
In your FAAACE!!
27
Myofascial Release-Scapulothoracic Dysfunction:
| Doc Setup?
Contacts scapula posteriorly w/both hands
28
Myofascial Release-Scapulothoracic Dysfunction:
| Tests?
Check ease of motion in 6 scapular motions.
1. Elevation
2. Depression
3. ABduction (Protraction)
4. ADduction (Retraction)
5. Upward rotation (Forward Tilt)
6. Downward rotation (backward tilt)
29
Myofascial Release-Scapulothoracic Dysfunction:
| Direct
1. Force into barrier-tissue creep
2. associated w/viscoelastic properties of tissues
3. REASSES
30
Myofascial Release-Scapulothoracic Dysfunction:
| Indirect
1. F away from dysfunction.
2. Until tissue relaxation stops
3. Hard for doctor to asses = more concentration needed
31
Articulatory Techniques-Elevated/ADducted clavicle:
| Pt position
Supine
32
Articulatory Techniques-Elevated/ADducted clavicle:
| Doc position?
Head of table
33
Articulatory Techniques-Elevated/ADducted clavicle:
| Doc Setup?
1. Pt neck fully flexed and resting on doc chest (locks out spinal motion)
2. Thumbs on sternal clavicle
34
Articulatory Techniques-Elevated/ADducted clavicle:
| Force?
1. Caudal force on sternal clavicle
| 2. Doc springs clavicle when patient exhales to release restriction
35
Spensor's Technique:
| Style?
Low velocity-high amplitude springing-GH dysfunctions
so smooth spencer!
36
Spensor's Technique:
| Application?
Assessment or Treatment
Articulates humeral head through ROM in fossa while stretching periarticular soft tissues
Increases movement
37
Spensor's Technique:
| Pt Position
1. Lateral recumbent w/affected shoulder up
2. knees and hips flexed,
3. back straight and perpendicular to the table
4. Head supported by a pillow
38
Spensor's Technique:
| Doc position
In your faaaace!!
39
Spensor's Technique:
| Doc grabs...
1. forearm to FLEX the elbow
| 2. Top of shoulder-lock out shoulder girdle (limits scapular movement)
40
Spensor's Technique:
| All steps general
1. Each technique 6-8 times
2. stop if there is pain!
3. try to exceed previous motion each time
4. return to neutral each time
41
Spensor's Technique:
| Order of motions (7)
1. Extension
2. Flexion
3. Circumduction
4. Circumduction w/traction
5. ABduction/ADduction
6. Internal Rotation
7. Traction Stretch
42
Spensor's Technique:
| Extension
1. Move pt arm in sagittal plane
2. Extend shoulder and return to neutral position
3. Increase extension with each motion (6-8 times)
43
Spensor's Technique:
| Flexion
1. Flex shoulder and straighten elbow until arm is over pt's ear
2. Repeat in rhythmic fashion
44
Spensor's Technique:
| Circumduction
1. Flex elbow and ABduct shoulder to 90 deg
2. Lock shoulder and use elbow as pivot
3. gently rotate shoulder in circular motion
4. start clockwise and get bigger
45
Spensor's Technique:
| Circumduction w/traction
1. extend elbow and ABduct arm 90
2. Lock Pt scapula in position and rotate humerus
3. Rock the clock. then counter clock
4. Maint tain TRACTION at wrist
46
Spensor's Technique:
| AB/ADduction
ABD:
1. Place upper hand on shoulder
2. Flex elbow with their hand resting on your forearm below elbow joint
3. Physician lower's arm gently and exerts UPWARD pressure on pt's flexed elbow
4. Bring shoulder into ABduction
ADD
1. Maintain above position
2. Gently exert DOWNWARD pressure on flexed elbow
3. Bring pt upper arm into ADduction
47
Spensor's Technique:
| Internal Rotation
1. Pt hand behind lower ribs w/flexed elbow (Sassy position)
2. Doc uses upper hand to lock scapula
3. lower hand draw pt's elbow forward and down (internal rotation)
4. Pt's elbow released and maneuver repeated
48
Spensor's Technique:
| Traction Stretch
1. Pt hand on doc shoulder, elbow straight
2. Doc clasps hands around pt's upper arm
3. Provide gentle pull, lifting humeral head away from fossa
4. physician can lean back for more force
49
ME-GH-Flexion and extension dysfunction: ME and ROM?
1. Stabilize shoulder girdle w/one hand
2. Contact olecranon w/other hand
3. flexion 180
4. Extension 60
50
GH-Int/Ext Rotation: ME and ROM
1. Pt SEATED or LAT RECUMBENT
2. Stabilize shoulder and contact olecranon with other
3. ROM = 90/90
51
GH-AB/ADduction: ME and ROM
1. ME principles
2. ABD = 180
3. ADD = 40-50
52
SC-ADduction dysfunction:
| Pt position?
Supine
53
SC-ADduction dysfunction:
| Doc position?
On affected side
54
SC-ADduction dysfunction:
| Doc Setup?
1. one hand on proximal clavicular head
2. Other hand grasps patients wrist
3. Hold arm extended and internally rotated
55
SC-ADduction dysfunction:
| Treatment
1. Have patient raise arm against doc hand 3-5 and ME dat shit
56
SC-HZ extension Dysfunction:
| Pt position?
Supine
57
SC-HZ extension Dysfunction:
| Doc position?
On affected side
58
SC-HZ extension Dysfunction:
| Doc setup?
1. one hand on restricted clavicle
2. Other hand behind axilla to cover scapula
3. Patient holds physician's shoulder
59
SC-HZ extension Dysfunction:
| treatment
1. Doc flexes clavicle to manubrium until SC movement palpated
2. Post force on proximal clavicle simultanious
3. patient pulls their shoulder down toward table (3-5 seconds)
4. Doc provides isometric resistance. ME repeats
60
HVLA-SC ADduction:
| Pt position?
Supine
61
HVLA-SC ADduction:
| Doc position
At head of table
62
HVLA-SC ADduction:
| Doc Setup?
1. Inferior force w/thenar eminence of monitoring hand over SC joint that is restricted
2. Physician grasps pt's arm on side of dysfunction and exerts a cephalad traction force on arm
3. Correction achieved by exerting a downward thrust through SC joint while simultaneously inducing a rapid traction force through pt's arm.
