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Extremity Adjusting > Shoulder Girdle Q and A's Gindl > Flashcards

Shoulder Girdle Q and A's Gindl Flashcards

1
Q

How long do you palpate the radial artery when performing Adson’s?

A

10-20 seconds, enough to decide if the pulse volume had changed

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2
Q

What does a + Adson’s indicate?

A

TOS caused by Scalenus anticus syndrome— pressure on the subclavian artery and brachial plexus

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3
Q

What usually causes Scalenus Anticus syndrome?

A

Subluxation

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4
Q

What can you do for a patient with Scalenus-Anticus sundrome?

A

Adjust the subluxation, use moist head to relax the muscles, and stretch

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5
Q

What Dx is suspected with a positive Adson’s when the head is turned away from the side being palpated?

A

Reverse Adson’s

-Maybe Scalenus medius syndrome or a cervical rib.

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6
Q

T/F Cervicals ribs that cause loss of patency are usually acute conditions

A

True.

-Usually an acute exacerbation, because bone will normally modify away from the artery

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7
Q

What syndrome(s) might cause a positive Allen’s Test?

A

TOS, Cervical subluxation, Reynaud’s syndrome (loss of patency in the arteries of the extremities)

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8
Q

Dawburn’s Test findings

A
  • Positive = pain over the subacromial bursa disappears in abduction of the arm indicating subacromial bursitis
  • Pain throughout abduction = G-H I
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9
Q

3 parts to Drop Arm Test:

Describe from least to most invasive and the Dx for each.

A

Part 1 = patient attempts to raise their arm, if they can’t the doctor will raise it for them. The patient will then lower the arm to their side against gravity. If the arm drops fast it’s often a severe tear (Grade 3) of the rotator cuff (MC supraspinatus)

Part 2 = Starting with the patient’s arm at 90 degrees of abduction, the Dr. will apply a little pressure to the arm while the patient lowers it to their side (some resistance). If the arm fails here, it is a moderate tear (Grade 2) of the rotator cuff

Part 3 = With the patient’s arm at 90 degrees abduction, the Dr. will apply an impulse (S-I) to the arm. If this is positive it is a mild tear (Grade I) strain of the rotator cuff

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10
Q

Positive Dugas

-what does it indicate?

A

Patient can’t touch the chest wall with the affected arm/elbow while holding the opposite shoulder

-Indicates a current shoulder dislocation/separation

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11
Q

What is a positive Eden’s Test?

-what does it indicate?

A

Decreased radial pulse volume

  • TOS
  • Costoclavicular syndrome
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12
Q

How to treat for a positive Eden’s Test?

A

Determine if it’s due to muscle guarding, often a hypertonic pectoralis major, which needs to be stressed out.

-May be due to a cervical, thoracic, or rib subluxation and may be helped by adjusting

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13
Q

Questions to ask a patient if they have a positive Eden’s Test?

A
  • Do they carry a backpack or heavy objects in front of them at work?
  • Have they ever had an accident with the seatblet on, fractured or dislocated their clavicle, or had a shoulder problem?
  • Have they ever fallen on their shoulder or with an outstretched hand/arm (FOOSH)?
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14
Q

Shoulder Apprehension Test

-What does it indicate?

A

Look of alarm on the face or the patient pulls away from the pressure

-Indicates that the G-H joint is unstable, or has a propensity to dislocate

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15
Q

Postivie Wright’s Test

-What does it indicate?

A

A 10-15 degree difference in right vs left abduction by feeling for the point we lose the radial pulse from one arm to the other

-Positive means TOS from Hyperabduction syndrome

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16
Q

What is the most common muscle to cause a positive Wright’s test?

-What causes this muscle to become shortened or go into contraction?

A

Pectoralis minor

-Cervical subluxations, subacromial bursitis, rolled shoulder posture, other types of TOS

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17
Q

Positive Yergason’s

-What does it indicate?

A

The bicepital tendon pops out of the groove

-Popping that is felt/heard indicates bicepital instability

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18
Q

DDx for positive Yergason’s

A
  • Shallow groove
  • Lax/tear/sprain of the transverse humeral ligament
  • Pain with no instability = G-H I
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19
Q

Visualization for A-C PS

A

Stabilize the humeral head into the glenoid fossa, then apply S to I pressure over the distal end of the clavicle

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20
Q

Visualization for G-H I

A

Will see a dimpling or indent of the soft tissue along the GpH joint space (sulcus sign)

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21
Q

Visualization for S-T L

A

Medial (vertebral) border of the scapula had flared lateral in relation to the spine

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22
Q

Visualization for St-Cl S

A

The proximal end of the clavicle sits higher than the opposite shoulder

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23
Q

Fluid motion for A-C PS

A

Stabilize the humeral head into the glenoid fossa, then apply S to I preesure over the distal end of the clavicle

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24
Q

Fluid motion for G-H

A

Stabilize the A-C joint and the scapular spine with the hand closest to the patient. The other hand will hold the elbow the draw the humerus I-S

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25
Q

Fluid motion for S-T

A

To check for medial scapula. The Dr. will place their thumb at the lateral inferior angle of the scapula and press from L-M

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26
Q

Fluid motion for St-Cl

A

Dr. Stands behind the patient and places their 2nd and 3rd digits at the St-Cl joints and asks the patient to shrug their shoulders up and roll them backward/forward

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27
Q

With any shoulder complaint the doctor should rountinely exame the shoulder for these 6 subluxations

A
  • Spine for subluxation
  • A-C
  • G-H
  • S-T
  • St-Cl
  • St-Co
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28
Q

MC misalignment of the A-C joint

-What mechanisms of the adjustment take care of the listing?

A

A-C PS (posterior and superior)

  • Pushing down on the distal end of the clavicle take care of the superiority
  • Pushing slightly forward and externally rotating the arm takes care of the posteriority
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29
Q

What is a shoulder separation?

A

A dislocation of the A-C joint

30
Q

Treatment for A-C subluxation?

-What if it was an A-C dislocation?

A

Subluxation (with fixation) = Do ROM, not immobilize

-Dislocation = immobilize with a brace or reminder tether

31
Q

Move of choice for the G-H joint

A

G-H Traction Supine

-allows us to palpate the joint

32
Q

3 Dx the G-H traction would work for?

A
  • Frozen Shoulder
  • G-H I
  • G-H P
  • G-H Dislocation
  • OA with fixation
33
Q

What tests will help to DDxa G-H I and G-H P?

A

Yergason’s

Dawburn’s

Supraspinatus

Extra information = Appley’s scratch, Teres Major, Anterior Deltoid, Internal and External Rotation

34
Q

What is the most common shoulder misalignment?

A

G-H I

(due to gravity)

35
Q

Indications of a G-H I

A

Shoulder visualizes with a sulcus sign

  • Point tenderness at the anterior aspect of the G-H joint capsule
  • Loss of fluid motion
  • Decrease in Appley’s scratch on EXTERNAL rotation
  • Anterior Deltoid weakness
36
Q

Indications of a G-H P

A
  • Visualizes as normal (no apparent visual changes)
  • Loss of fluid motion
  • Point tenderness at the posterior aspect of the G-H joint
  • Decrease in Appley’s on INTERNAL rotation
  • Teres major muscle weakness
37
Q

What part of the S-H ratio would be decreased with a G-H P?

A

The G-H part

38
Q

What is the LOC for G-H P?

A

P-A

-avoid any S-I

39
Q

How to DDx a G-H P from a G-H I?

A
  • Pain point is posterior; visualizes as normal , not inferior (no sulcus sign)
  • G-H P has decreased ROM on internal rotation, Not external (same for Appley’s)
  • X-ray shows humerus head is posterior and superior, NOT inferior
  • Teres major muscle test is weak on G-H P. Anterior Deltoid is weak on G-H I
40
Q

What is the move of choice for G-H fixation?

A

G-H Traction Supine

-You can palpate the joint space opening instead of trying to jjust visualize it

41
Q

What are the limiting factors for G-H Traction seated?

A

G-H Traction Seated = Dr’s arm in patients arm pit with the thumb up

-Pain tolerance and visualize the joint space opening up. Make sure when performing this on the practical that you are looking at the joint space

42
Q

For G-H I, is the thrusting move the move of choice?

A

NO!

-G-H Supine Traction is the move of choice because you can feel the joint open up

43
Q

What are 3 other DDx for G-H I?

A
  • G-H P
  • Subacromial bursitis
  • Bicepital tendonitis
  • Bicepital instability
  • Sprain or tear of the rotator cuff
  • Dislocation
  • Heart attack
  • Gall bladder
  • Spleen
44
Q

Where is the patients shoulder placed for G-H P Prone?

-Is this the thrusting move of choice?

A

Supported on the table for stabilization. We don’t want to dislocate it.

-YES, due to the table stabilizing the G-H joint

45
Q

What is the most important LOC for G-H P Seated?

  • What ROM’s do you use to bring it to tension?
  • Where is the pain point?
A

Straight P-A, drop the elbow so that it’s level or below the wrist

  • Abduction and extension
  • Over the posterior aspect of the G-H joint
46
Q

What is the MC shoulder dislocation and why?

-What motions do you take the patients arm through for Kocker’s method of reduction (in order)?

A

Anterior-inferior due to: gravity pulling down and forward; carrying things pulls it down and forward; the anterior glenoid labrum is shallow; and the anterior inferior aspect of the joint capsule is weaker.

-Traction S-I, External rotation, Adduction, internal rotation, finally support in the Dugas position

47
Q

What 3 systems do we want to post check after a relocation?

A

1) Vascular –> Arterial –> check pulse, color or nail beds, warmth (or lack) of hand
2) Neurological –> Reflexes –> pinwheel, sharp/dull, feel hot/cold, muscle test the hand, check muscle tone, decreased pain
3) Musculoskeletal –> biomechanical –> Negative Dugas, X-ray, and visually the shoulder appears rounded

(DO NOT SAY range of motion or fluid motion. The shoulder is hypermobile and can easily redislocate)

48
Q

Describe the 3 parts for Frozen Shoulder (Adhesive Capsulitis)

A

1) Part 1 - Patient’s arm is over the padded back of a sturdy chain, traction S-I to patient tolerance, hold for 60-90 seconds, then check ROM. If no improvement stick with part 1. If improved, go to Part 2
2) Part 2- Same position as part 1, traction S-I which taking through the newly gained ROM (to tolerance). Do 1x per day until progress stops from 1 visit to the next then go on to Part 3
3) Part 3- Determine the more restricted ROMs. At the end of a couple of those apply an impulse, then go back to Part 2 until no progress is noted again betwee visits. (make sure patient is performing exercises at home before proceeding to part 3). Post check ROM comparing R to L sides

49
Q

What can the Dr have the patient do for home treatment of Frozen Shoulder?

A

Part 2 with a family member; arm over the padded back of a chari while swinging a weight or plastic jug filled with sand or water. Finger walking up the wall (abduction), broom handle assistance for ROM, towels to perform Appley’s Scratch exercises, pulley over door or basement beam, etc.

50
Q

What is the most important component to the Frozen Shoulder Treatment?

A

Find out what caused the patient to stop using their shoulder this allowing it to “freeze”, then address that problem. It could be due to scap tissue build up, or DJD/Arthritis

51
Q

Why is a 3 part-traction procedure preferred over surgery for frozen shoulder?

A

Less risk of fracturing the humerus, dislocating the G-H joint, or neurovascular damage

52
Q

Pain points for S-T L and S-T M

A

Deep anterior scapula in the subscapularis muscle

53
Q

How to differentiate a S-T L and S-T M?

A

a) Fluid motion decreased from lateral to medial for S-T L (decreased medial to lateral for S-T M)
b) Visualizaition of distance of the medial border of the scapula from the spine. >3 finger widths for S-T L (< 3 finger widths for S-T M)
c) Appley’s scratch is decreased on internal rotation for S-T L (decreased on external rotation for S-T M)

54
Q

What position is the patient’s arm in for S-T L?

  • Where is #11 of the stabilization hand?
  • Where are the fingers of the SH?
  • What direction does the Dr push with the SH to help bring the S-T articulation to tension?
A

Behind the patient’s back while side lying. This is to help pre-stress the scapula from lateral to medial. The Dr will reach their arm through the axillary/arm opening

  • Over the A-C joint
  • Over the G-H joint
  • S-I
55
Q

What position is the patient’s arm in for S-T M Side-lying?

  • Where is #11 of the stabilization hand?
  • Where are the fingers of the SH?
  • What direction does the Dr push with the SH to help bring the S-T articulation to tension?
A

In front of the patient’s body while side lying. This is to help pre-stress the scapula from medial to lateral.

  • Over the G-H joint
  • Over the A-C joint
  • I-S
56
Q

What are the 3 most common mistakes for S-T M prone?

-In what direction does the Dr push the stabilization hand to help bring the S-T articulation to tension?

A

a) The patient’s shoulder should be off the table
b) Dr should stand opposite the side of contact (reach across the medial aspect of the scapula)
c) Dr should use an inferior contact hand
- SH pushes S-I

57
Q

What direction does the clavicle most commonly subluxate?

-Is traction a post check for St-Cl S?

A

Superior

-NO, it is actually a procedure and should be dont before St-Cl S

58
Q

How should the patient be placed for St-Cl Traction Supine?

A

Supine with the scapula off the table

59
Q

For St-Cl Traction Seated, what do we do with the arm opposite the side of contact?

-Why?

A

We hold back the shoulder opposite the side of contact?

-To isolate the St-Cl joint and not rotate the thoracics

60
Q

For St-Cl S, how do we bring the joint to tension before the thrust?

-Describe the thrust

A

By bringing the arm into abduction and extension

-Straight S-I with maybe a little torque (fingers with torque up toward the axilla, radial deviation with the wrist)

61
Q

Which rib levels may commonly need St-Co thrusting adjusting procedures?

-Where is the pain point?

A

Ribs 2-5

-Right over the St-Co joint of the involved rib. If it’s a superior rib the pain may be located over the top of the rib head, if it’s an inferior rib, the pain may be located over the bottom of the rib head

62
Q

What is the best way to post check the St-Co joint?

A

Fluid motion. Palpate the involved rib(s) (fingers above and below the ribs) while seated and have the patient take a very deep breath in (uses the accessory muscle of respiration) while bringing the shoulders up, then exhale all the way out feeling excursion of the ribs

63
Q

DDx for pain that runs along the rib all the way around the thoracic cage?

A
  • Thoracic subluxation
  • Shingles
  • Intercostal neuralgia
  • Rib fracture
  • Tumor
  • Heart attack (if on the left side)
64
Q

How far up and back do we go with the patient’s shoulder for St-Co Traction Seated?

-How far up and back would we go for a rib#2 compared to rib#5?

A

To the patient’s tolerance or until you feel the joint open up (whichever comes first)

-Not as far, it won’t take as much rotation/extension for rib 2

65
Q

How should the patient be placed for St-Co Traction Supine?

-Which way should the Dr’s fingers be pointing?

A

Supine with the scapula off of the table, even further for lower ribs

-Fingers pointed M-L and some I-S for ribs 2 and 3. More M-L and S-I for ribs 4 and 5 (You should follow the angle of the rib, remember it changes the lower you go in the rib cage)

66
Q

What is the limiting factor for bringing the arm posterior and superior for St-Co Traction Supiine?

A

Patient tolerance or until you feel the joint open up (whichever comes first)

67
Q

What is the patient placement for St-Co I and St-Co S?

  • What is the doctor’s stance?
  • What do you do for patient safety?
A

Supine on the center of the table

  • Side of involvement, straight away so you don’t add a body drop.
  • Turn their face away so you don’t hit them with your elbow (St-Co S), or fingers (St-Co I)
68
Q

What are the breathing instructions for St-Co I?

-What phase of breathing should you see improvement on (inspiration or expiration)?

A

Take a deep breath in and hold

-Inspiration

69
Q

What type of breathing would show aberrant motion with a St-Co S?

A

On expiration, the rib doesn’t come down

70
Q

How do you get your LOC to be S-I for St-Co S?

-What breathing instructions do you give the patient to help pre-stress the rib?

A

Drop your elbow down close to the chest wall.

-Take a deep breath in, blow it all the way out and hold

71
Q

Why do you give breathing instructions for St-Co subluxations?

A
  • Take a breath in to oxygenate the lungs
  • Blow out the air so the musculature is pulling down on the rib and opens up the joint space below the rib
  • Hold to keep from forcing the residual air out of the patient’s lungs. Also stops the patient from starting to take a new breathe in

Extremity Adjusting (5 decks)

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