Shoulder Evaluation

Question 1

3 bones that make the shoulder joint

Answer 1

1. ) Clavicle
2. ) Humerus
3. ) Scapula
   - coracoid
   - acromion

Question 2

name the 3 true synovial joints of the shoulder

Answer 2

1.) Glenohumeral (GH)
2.) Sternoclavicular (SC)
3.) Acromioclavicular
(AC)

Question 3

Name the 2 functional joints of the shoulder

Answer 3

1. ) Suprahumeral

2. ) Scapulothoracic

Question 4

Name the 2 accessory joints of the shoulder

Answer 4

1. ) Costosternal

2. ) Costoverterbral

Question 5

Name the two joints involved in EARLY shoulder abduction.

Answer 5

glenohumeral + suprahumeral

Question 6

Name the three joints involved in MID-LATE shoulder abduction.

Answer 6

scapulothoracic + sternoclavicular + acromioclavicular

Question 7

Testing of the AC joint

Answer 7

Bring GH joint
into 60° horizontal abduction and 60° coronal abduction maximizing AC joint motion. Internally & externally rotate the GH joint.

Question 8

___ of GH joint causes IR of AC joint

Answer 8

Internal rotation of GH joint causes IR of AC joint

Question 9

7 scapular motions

Answer 9

-Elevation
-Depression
-Abduction (Protraction): Away from the spine, combined with a lateral tilt around the thorax
-Adduction (Retraction): Moving closer to the spine
-Upward (Forward) tilt: Turning on a horizontal axis so that the posterior surface faces upward
and the inferior angle protrudes. Accompanied by longitudinal axis rotation of the clavicle
-Upward and Downward rotation: A frontal plane rotation in relation to the glenoid fossa’s elevation or depression.

Question 10

Describe SC joint abduction:

• motion
• testing
• What should be felt?

Answer 10

• Motion: Distal end of clavicle moves superiorly and proximal end moves inferiorly.
• Test motion: Patient is supine; examiner places index finger on clavicular head next to the sternum, the patient then shrugs. An INFERIOR MOVEMENT should be palpated with normal motion at the SC joint.

Question 11

Describe SC joint flexion:

• motion
• testing
• What should be felt?

Answer 11

-Motion: distal end of clavicle moves anteriorly and the proximal end moves posteriorly on the
sternum.
-Test motion: examiner places index finger on the clavicular head next to the sternum; pt flexes
shoulder to 90 deg and reaches for ceiling forcefully. A POSTERIOR MOVEMENT of the
clavicle should be palpated with normal motion at the SC joint.

Question 12

Describe MFR for scapulothoracic dysfuntion

Answer 12

LR, doc faces pt’s front contacting scapula posteriorly.
-Direct MFR: Apply direct force toward the restrictive barrier(s) of the named motion patter of the scapula and maintain until tissue relaxation stops re-establishing proper range of motion.
-Indirect MFR: Apply indirect force TOWARD EASE OF MOTION and marinating until tissue relaxation stops re-establishing proper range of motion. The indirect approach requires more concentration and proprioceptive input on the doctor’s part to follow the
relaxation of tissues toward the ease of motion direction.

Question 13

Describe articulatory technique for elevated clavicle.

Answer 13

Position – Pt lying supine, examiner seated at the head of table
Technique – Patient’s neck, fully flexed, resting against physician’s chest (locks out spinal motion)
- Physician places thumb over sternal end exerting a
downward/caudal pressure on the clavicle
- Pt instructed to inhale and exhale fully. During exhalation the physician springs the clavicle to release
restriction….REASSESS

Question 14

Describe Spencer’s Technique

Answer 14

LVHA springing articulatory technique
Used to tx shoulder restriction caused by hypertonic muscles, early adhesive capsulitis, healed fractures and/or dislocations, and any
other traumatic or degenerative condition in which improved motion is required.
Can be used for assessment, but meant as a treatment modality.
Designed to articulate the humeral head throughout ROM in fossa while stretching periarticular soft tissues
-Person is LR: E, F, Circumduction, circumduction with traction, abd/add, IR, traction stretch

Question 15

Describe GH Flexion and Extension Dysfunctions ME treatment

Answer 15

Stabilize shoulder girdle with one hand, contact olecranon with the other.
Expected flexion: 180°; Expected extension: 60°

Question 16

Describe GH IR/ER Dysfunctions ME treatment

Answer 16

Apply principles and steps of ME to the motions of the GH joint. Treat patient seated or lateral recumbent. Stabilize shoulder girdle with one hand, contact olecranon with the other.
Expected IR: 90°
Expected ER: 90°
Can treat seated or lateral recumbent.

Question 17

Describe GH abd/add dysfunction ME treatment

Answer 17

Apply principles and steps of ME to the motions of the GH joint.
Expected abduction: 180° in coronal plane; Expected adduction: 40-50°

Question 18

Describe SC adduction SD ME treatment

Answer 18

restricted abduction.
Position – Pt lying supine, examiner on side of affected shoulder
Technique: Dr. places one hand on the proximal clavicular head. With the other hand grasp patient’s wrist and hold arm extended and internally rotated.
Pt is instructed to raise arm against physician’s hand toward ceiling (flexion at the shoulder) for 3-5 seconds, then relax. Joint then brought into
new barrier, repeating until no new barriers reached or full ROM restored…REASSESS

Question 19

Describe SC horizontal extension dysfunction ME treatment

Answer 19

= restricted flexion
Position – Pt lying supine, examiner on side of affected shoulder
Technique – Place one hand on the restricted clavicle and the other hand placed behind axilla to cover the scapula. Patient holds physician’s shoulder with the hand of the affected shoulder.
Physician then flexes the clavicle toward the manubrium until movement is palpated in the SC joint by straightening the body and
pulling scapula anteriorly. Posterior force simultaneously applied to
proximal clavicle from anterior to posterior. Patient then pulls their shoulder down toward table and holds position for 3-5 seconds with
physician applying isometric resistance, then relax.
Joint then brought into
new barrier, repeating until no new barriers reached or full ROM restored… REASSESS

Question 20

Name the HVLA technique for the shoulder

Answer 20

SC adduction dysfunction

Question 21

Describe the SC adduction dysfunction HVLA treatment

Answer 21

Position – Pt lying supine; examiner stands at head of table
Technique – physician applies inferior force with thenar eminence of monitoring hand over SC joint that is restricted.
- Physician then grasps pt’s arm on side of dysfunction and exerts a cephalad traction force on the arm.
- Achieve correction by exerting a downward thrust
through the SC joint while simultaneously inducing a rapid traction force through the pt’s arm…REASSESS

Question 22

Name the dysfunction with both ME and HVLA

Answer 22

SC adduction dysfunction