Shoulder Impairments Flashcards
1
Q
Scapular rhythm
A
- 2:1 ratio overall (glenohumeral: scapular thoracic)
- During first 60 degrees of flexion or 30 degrees of abduction, scapula doesn’t move much as is seeking position of stability in relation to humerus (setting phase)
- With increasing ROM, scapula increases its contribution and ratio may approach 1:1
2
Q
What structures get impinged under the subacromial arch?
A
- Supraspinatus
- Long head of biceps
- Subacromial bursae
- Infraspinatus
- Labrum & joint capsule (internal impingement; pinched by glenohumeral joint)
3
Q
Causes of shoulder impingement
A
- Instability of glenohumeral joint: weakness, capsule & joint laxity
- Dyskinesia (muscle imbalance or neurological motor planning impairment)
- Poor posture
- Arthritis
- Anatomical predisposition
4
Q
Medical diagnosis of shoulder impingement
A
- X-ray (look for arthritis, type of acromion, bone wear & tear, dislocation)
- MRI w/ or w/o dye (identification of soft tissue structures, i.e. muscle, tendon, cartilage)
5
Q
Hawkins Kennedy test
A
- Patient shoulder in 90 degrees flexion, elbow in 90 degrees flexion
- OT support at shoulder, internally rotate shoulder by pressing on proximal forearm
- Pain at shoulder indicates rotator cuff or bicep impingement
6
Q
Neer test
A
- OT depress patient scapula, internally rotate shoulder, and bring into full flexion
- Pain at shoulder indicates rotator cuff or bicep impingement
7
Q
Full can/empty can test
A
- Also known as Jobes test
- Full can: patient shoulder in 90 degrees scapular flexion, thumb facing up; OT support at shoulder, press on proximal forearm
- Empty can: same except patient thumb facing down
- Pain at shoulder indicates rotator cuff impingement
8
Q
Drop arm test
A
- Patient shoulder in 90 degrees abduction and asked to smoothly lower arm
- Sudden drop or unsmooth lowering indicates rotator cuff tear
9
Q
Yergason’s test
A
- Patient elbow in 90 degrees flexion, full pronation
- OT resists patient’s supination on distal forearm while palpating biceps tendon
- Tendon popping out indicates torn transverse humeral ligament
- Pain or tenderness indicates biceps tendinosis or SLAP lesion
10
Q
Speeds test
A
- Patient shoulder in 90 degrees flexion, forearm supinated
- OT support at shoulder, press down at proximal forearm
- Pain in bicipital groove indicates bicep impingement or SLAP lesion
11
Q
Shoulder impingement vs. rotator cuff tear
A
More likely to be rotator cuff tear if patient presents with weak external rotation, weak abduction, & positive impingement sign
12
Q
Conservative treatment for rotator cuff tear
A
- Pendulums
- Strengthening below 90 degrees (including scapular ROM & strengthening)
- Sleep with pillow under affected arm (open-packed position=scapular plane)
- Ice, NSAIDs, cortisone injections
- Soft tissue mobilization
- Improve posture
13
Q
Scapular ROM & strengthening
A
- Clocks ROM (w/ or w/o TheraBand)
- Hand walks
- Is, Ys, Ts, & pulling weeds
- Serratus push up plus
- Unilateral & bilateral retraction
14
Q
Shoulder dislocation diagnosis & treatment
A
- Test for positive apprehension sign (pain with abduction & external rotation at 90 degrees)
- Sling for first 3-4 weeks if 1st dislocation
- Activity modification to diamond-shaped safety zone
- Strengthen subscapularis with IR exercises using TheraBand, biceps & shoulder flexors below 90 degrees
- Stabilization exercises: wall ball, reverse Codman’s
15
Q
Tests for SLAP lesion
A
- Compression rotation
- Anterior/posterior slide
- Speed’s
- Obrien’s (similar to full can/empty can but more provocative)
- Yergason’s
