Shoulder Exam & Patho

Question 1

Shoulder Impingement, what does stage one of Neer’s classification consist of?

Answer 1

<25yo
repetitive OH activity
tenderness of the insertion of the supraspinatus
painful arc of 60-120 degrees
break test: strong and painful, Pattern: ER, ABD

Question 2

Shoulder Impingement, what does stage two of Neer’s classification consist of?

Answer 2

25-40yo
pain with activity, night pains
decreased P/ROM secondary to fibrosis
crepitus/catching @ >100 degrees of abduction
presence of capsular pattern

Question 3

Shoulder Impingement, what does stage three of Neer’s classification consist of ?

Answer 3

> 40yo
chronic prolonged history of rc tendinitis
sig limitation of P/AROM
laxity with multidirectional instability
break test: weak and painful, Pattern: ER, ABD

Question 4

Jobes 4 groups of shoulder impingement

Answer 4

Group IA: >35 yo (+)impingement sign, no instability

Group IB: >35yo (+)impingement sign, instability present

Group II: <35yo (+)impingement sign, laxity with multidirectional instability, repetitive OH usage

Group IV: <35yo (-)impingement sign, anterior instability secondary to trauma

Question 5

RC tendinitis presentation & MOI

Answer 5

moderate-severe loss of ROM
AROM painful
PROM, painless through direction of mm.
Break: strong and painful

MOI: micro-trauma secondary to repetitive OH activity (insidious onset)

Question 6

RC tear (full), presentation & MOI

Answer 6

Break: weak and painless
sig decreased AROM
Full to near full PROM
may be unstable, pain lying on that side

MOI: trauma or insidious onset from micro-trauma

Question 7

RC tear (partial), presentation & MOI

Answer 7

Break: weak and painful
mod decreased AROM
mod-sig functional complaints
may be unstable, pain lying on that side

Question 8

Adhesive Capsulitis, presentation & MOI

Answer 8

progressive worsening pain & stiffness
functional restriction in OH act, reaching, grooming, etc
PROM limitation in cap pattern ER, ABD, IR, pain @ ER
Joint play restricted in all directions

MOI: insidious onset
40-65yo,
hx of thyroid disease DM
females>male

Question 9

Bankart Labral Tear, presentation & MOI

Answer 9

non specific shoulder pain/ache
catching sensation
avoid FER secondary to sensation of dislocation
symptoms of instability

MOI: <30yo, trauma, repeated dislocation

Question 10

SLAP Labral tear, presentation & MOI

Answer 10

non specific shoulder pain w/ OH and cross body act
popping, clicking, or catching at shoulder joints
deep/vague pain w/in shoulder joint, weak or stiffness

MOI: traction injury
direct blow to shoulder
FOOSH
OH throwing athletes, repetitive traction force

Question 11

Instability, presentation & MOI

Answer 11

<40
hx of dislocation
excessive GH PROM in one or more direction
end range apprehension @ flexion, ABD &/or ER

MOI: trauma, global hypermobility

Question 12

AC sprain, presentation & MOI

Answer 12

pain lying on involved side
pain on superior portion of shoulder
decreased shoulder AROM note pain >160 degree

MOI: direct trauma to superior portion of shoulder
FOOSH

Question 13

SC sprain, presentation & MOI

Answer 13

pain with:
lying on involved side
horizontal ADD
OH act
heavy lifting

MOI: trauma, direct blow to top of shoulder or SC area

Question 14

Biceps tendinitis, presentation & MOI

Answer 14

achy anterior shoulder, exacerbated by lifting, push/pull
pain w/ OH act
vague pain location
symptoms may improve at rest

MOI: repetitive motion, partial traumatic rupture can occur in combination of underlying tendinitis