Shoulder Exam and Intervention Flashcards
Define differentiation
- The action or process of differentiating
Cervical Myelopathy CPR
- Abnormal gait
- Hoffman’s test
- Inverted supinator sign
- Babinski sign
- Age ≥45 years
Illness script for proximal humerus fractures
- Elderly females with osteoporosis
- Low energy ground level fall (FOOSH) typical in elderly or high energy in younger
- Presets like soft tissue swelling, contusion, reduced AROM
- Management: referral, imaging, if non-displaced & stable begin progressive ROM
GHJ dislocation illness script
- Younger & contact sports or collagen disorders
- MOI: trauma in anterior direction to the shoulder at end range ABD+ER
- Anterior is more frequent dislocation direction
- Acute dislocation check neurovascular
- Traumatic associated conditions: Hill-Sachs lesion (humerus), labral tears
- Generalized instability in 2 planes of movement and age 20-30 years
AC fracture illness script
- Clavicle Fx is most common shoulder complex type Fx
- Middle 3rd more common than distal 3rd
- MOI: fall onto lateral shoulder or direct impact
- Coracoclaviccula ligament are key for displacement
- Conoid (medial) & trapezoid (lateral) provide primary resistance to superior displacement of the lateral clavicle depending on fracture location
Screening for clavicle dislocation
- Movement screen: rotates 40-50º posteriorly with shoulder elevation
- Coracoclavicular ligs: controls vertical motion & superior inferior stability
- Acromioclavicular ligs: controls horizontal motion & anterior posterior stability
- AC D/L: disrupts AC & possible CC ligs
- SC D/L: collision contact sports; atraumatic if ligamentous laxity
Types of AC dislocations
- I = sprain, non-displaced
- II = <25% clavicle elevation, AC ruptured
- III = clavicle elevation, AC, CC ligs & joint capsule ruptured, deltoid & trap detached
- All ruptured/detached
- IV = clavicle displaced posterior into trap
- V = elevated space >25mm
- VI = clavicle displaced behind coracobrachialis & biceps tendons
Exam flow for a shoulder examination
- Interview
- Observation
- Screening
- Movement scripts/testing
- Palpation & joint mobility testing
- MMT
- Shoulder special Tess
- Performance tests if needed
Describe the scapulohumeral rhythm
- GHJ allows 120º and scapulothoracic allows 60º
- For every 2º humeral elevation the scapula should elevate by 1º
Scapular motions
- 60º of upward rotation
- 40-60º of IR/ER
- 30-40º of anterior/posterior tipping
- Elevation/depression or protraction/retraction
How do you bring out scapular dyskinesia
- Add a low weight with arm elevation
- Dumping: downward rotation with return from elevation
- Winging: medial border not stays close along the thoracic cage
Scapular specific mobilizations test
- Scapular retraction test
- Modified scapular assistance test
- Scapular reposition test
Closed packed position of shoulder joint
- 90º ABD & full ER or full ABD & ER
- End range throwing position
Open packed position of shoulder joint
- 55º ABD & 30º horizontal ABD
- Scaption
Describe the shoulder ligaments and their purpose
- Coracoclavicualr: anchor the clavicle to the scapula
- Coracoacromial: prevents superior displacement of humeral head
- Coracohumeral: strengthens superior glenohumeral joint capsule
What is the GHJ capsular pattern
- ER > ABD > IR limited
- ER limited more than ABD and ABD limited more than IR
- Occurs in a 3-2-1 ratio
When are the anterior GH ligaments under tension
- Shoulder extension, ABD, and/or ER
When are the poster GH ligaments under tension
- Shoulder flexion and ER
When are the inferior GH ligaments under tension
- Shoulder ABD, extension, and/or ER
- Primary restraint against anterior/posterior dislocation of humeral head
Where does the supraspinatus refer for myofacial pain
- Spine of scapula
- Hot spot on lateral shoulder/deltoid insertion
- Down the arm laterally to the wrist
- Hot spot on lateral elbow/olecranon
Where does the infraspinatus refer for myofacial pain
- Unilateral suboccipital neck area
- Hot spot on lateral shoulder/deltoid insertion
- Hot spot on anterior shoulder down middle of bicep muscle belly
- Down lateral arm across back and palm side of hand
Where does the latissimus dorsi refer for myofacial pain
- Hot spot on unilateral back at inferior angle of scapula
- Across scapula into the axilla and down medial arm across the 4th/5th digits front/back
Where does the Subsacpularis refer for myofacial pain
- Across whole scapula
- Hot spot on poster deltoid area/axilla but not in axilla
- Down arm along triceps muscle belly
- Across middle deltoid
- Hot spot on back of wrist and across carpal bones
Partial thickness RTC tear illness script
- Anterior lateral pain
- Pain w/overhead motion/painful arc
- Night pain
Full thickness RTC tear illness script
- Anterior lateral pain, constant ashiness, night pain, pain that wakes
- Compensatory shoulder shrugging w/overhead motion
- Gross functional disabilities
- Age >40
Partial RTC tear cluster
- Hawkins Kennedy
- Painful arc
- Infraspinatus muscle test
Full RTC tear cluster
- Drop arm test
- Painful arc
- Infraspinatus muscle test
Describe SNout and SPIN
- Sensitivity is a true positive rate
- Snout = when Neg. it rules it OUT
- Specificity is a true negative rate
- Spin = when Pos. it rules it IN
Describe the IRRST (internal rotation resisted strength test)
- Used to assist with clinical reasoning
- Can help differentiate between rotator cuff, extra-articular, and intra-articular
Mobility differences based on rotator cuff, extra-articular, and intra-articular issues
- RTC: IR is stronger than ER
- Extra-articular: IR and ER are relatively equal in strength
- Intra-articular: IR is weaker than ER
