Shoulder Injuries Flashcards
Special Diagnostic Tests for Rotator cuff tendinopathy
Hawkins Kennedy
Shoulder symptom modification procedure
Special Diagnostic Tests for Shoulder instability
apprehension relocation test
AP/PA glide
Sulcus sign
Special Diagnostic Tests for Full-thickness cuff tear
ER Lag
IR Lag
Special Diagnostic Tests for AC Joint Injury
Scarf test
Shear test
Accessory movements of the AC
SLAP (superior labrum anterior-posterior) lesion tests
Passive distraction
Active compression (O’briens)
Labral shear
Pathogenesis and pathophysiology of Rotator cuff tendinopathy
excessive load placed on tendon -> tissue breakdown -> tendinopathy
Symptoms of Rotator Cuff Tendinopathy
• Weak and painful shoulder
• Pain localised to shoulder (can refer into upper arm)
• Mechanical symptoms
• Sharp, catching and pinching with ‘impingement’
o E.g. lifting, reaching, sport, work
o Note sleeping as an issue
• Aches once aggravated
Diagnostic features of (clinical features) Rotator Cuff Tendinopathy
- painful arc (or 60 deg to P2)
- +ve palpation of SITS muscles and tendons
- isometric ER +ve
- isometric Abd +ve
- reduced shoulder strength
Management for Rotator Cuff Tendinopathy
passive therapies: dry needling/massage of supra and infraspinatus & pec minor, joint mobilisation of costovertebral joints, thoracic spine
strengthening:
1. isometric for pain relief: abd + ER
2. isotonic loading (truncate range): flex -> elevation -> ER -> scap elevation -> IR
3. Functional loading
Pathogenesis of Shoulder Instability - Overuse
due to repetitive…
- joint strain
- tissue train
- microtrauma
- stretch
- damage
Symptoms of Shoulder Instability
- apprehension
- fear, anxiety, avoidance
Diagnostic features (clinical features) of Shoulder Instability
- increased/excessive movements active and passive
- apprehension with ABERs
- +ve apprehension relocation test
- AP/PA glide +ve
- Sulcus sign +ve if dislocation
- decreased global shoulder strength
Management of Shoulder Instability
Surgery if young + trauma
Strengthening:
- isotonic loading - progress towards ABERs: IR -> scap elevation -> flex -> elevation -> ER
- functional loading
- closed chain loading
Reason for/effects of using closed chain loading in rehab of shoulder instability
- enhances co-activation of muscles around the shoulder
- increases feelings of security
Risk Factors for Frozen shoulder
systemic: diabetes, CV disease, genetics
extrinsic: general trauma, cervical radiculopathy, stroke
intrinsic: shoulder trauma, shoulder surgery, RC tendinopathy, vaccination
epidemiology: female 3 x more common
Stages of Frozen shoulder inc. features
i. freezing - extreme pain
ii. frozen - extreme stiffness but reducing pain
iii. thawing - resolving stiffness with negligible pain
Duration of Frozen shoulder
18 months (6 months per stage) 1-4 years total
Pathophysiology of Frozen shoulder
Vascular ingrowth into the capsule
Collagen proliferation and contracture
Diagnostic features of Frozen shoulder
Passive elevation decreased
Passive ER decreased (- crepitus)
Isometric ER and Abd clear
only test ER, everything else hurts too much
reduced global strength
Symptoms of Frozen Shoulder (for each stage)
Stiff and painful shoulder
0-6 months:
- pain localised to the shoulder, may refer into upper arm
- constant severe unrelenting pain
- excruciating pain with movement
6-12 months:
- decreasing pain but no change in mobility
12-18 months:
- gradual improvement in mobility
Management of Frozen Shoulder (not exercises)
- clarify diagnosis: surgical review
- reduce pain and promote tissue healing: medication, intra-articular steroid injections, taping, heat, general movement, lifestyle
- rectify impairments: exercise (strengthening), as mobility returns make sure the patient uses the shoulder to its full ability. ROM exercises - wand exercises
Rehab (strength) of Frozen Shoulder
- isotonic loading: elevation, ER, scap elevation, horizontal ext, IR, ext.
- functional loading
Pathophysiology of Glenohumeral OA
Degeneration of articular cartilage and subchondral bone -> narrowing of GH joint (due to osteophyte development)
- synovitis (nociception)
- articular cartilage degradation
- subchondral bone degradation
Symptoms of Glenohumeral OA
- stiff and painful shoulder
- pain localised to the shoulder
- ‘hurts all the time’
- ‘sharp pain’ on movement
- ‘GRINDING’ ‘CRUNCHING’
Diagnostic features of Glenohumeral OA
decreased passive elevation
decreased external rotation (+crepitus)
decreased global shoulder strength
Management of Glenohumeral OA
- clarify diagnosis
- imaging Xray
- 2nd opinions - surgical review -> TSR - reduce pain and promote tissue healing
- medications: NSAIDS, analgesics
- taping - rectify impairment
- exercise (strengthening) - limit range to avoid provocation, dont push it around R2
Rehab of Glenohumeral OA
Shoulder ROM exercises - wand exercises
- isotonic loading
- elevation
- external rotation
- scap elevation
- horizontal ext
- internal rotation
- extension - functional loading
AC joint sprain Type 1 - pathology/description and clinical features
synovitis
pain at the AC joint
AC joint sprain Type 2 - pathology/description and clinical features
complete AC ligament tear
mild step deformity
AC joint sprain Type 3 - pathology/description and clinical features
complete tear of coracoclavicular, conoid and trapezoid ligaments
marked step deformity
AC joint sprain Type 4 - pathology/description and clinical features
significant injury associated soft tissue injury
additional deformity
Management of AC joint sprain Type 1 (inc. acute time period)
conservative
Acute: 1-3 weeks
Management of AC joint sprain Type 2 (inc. acute time period)
conservative
acute: 4-6 weeks
Management of AC joint sprain Type 3 (inc. acute time period)
trial conservative management
<12 weeks
surgical review
Management of AC joint sprain Type 4
Surgery
