Shoulder Pain with Movement Coordination Impairments

Question 1

In the shoulder what are the Static and Dynamic Stabilizers?

Answer 1

Static: Joint Capsule and Labrum

Dynamic: Muscle

Question 2

What is the difference between a Dislocation and a Subluxation?
Where do most shoulder displacements occur?

Answer 2

Dislocation: Injury to a joint that causes adjoining surfaces to no longer touch each other

Subluxation: A minor or incomplete dislocation

98% of cases, shoulder displaces anteriorly

Question 3

What is the difference between Bankart lesion and Hill Sachs Defect?

Answer 3

Bankart Lesions: Tear of anterior/inferior labrum
(If we are thinking of a clock of where that tear is, it’ll be 3-6 o’clock)
–Soft Bankart: Labrum only
–Bony Bankart: Fractured rim of glenoid

Hill Sachs Defect: Fracture of Humeral head, occurs during relocation

Question 4

What is a SLAP Tear? What is the MOI?
What is Contraindicated with this injury?

Answer 4

• Superior Labrum torn Anterior to Posterior

MOI: Fall or decelerating in throwing

(If we are thinking of a clock of where that tear is, it’ll be 11-1 o’clock)

With this tear we CANNOT MMT and we need to watch out for long head of bicep tendon

Question 5

What may you find in the Hx of a patient that has Movement coordination impairments?

Answer 5

• Specific MOI/Trauma
• Sense of “instability”
• Deep anterior/posterior shoulder pain
• Fear of certain positions
• Achy after activity

Question 6

Why may you find during the Physical Examination with patients with Movement coordination impairments?

Posture, A/PROM, Joint mob, Movement Analysis, Strength

Answer 6

• With Posture: They may have altered or glenohumeral positioning
• AROM and PROM may be increased or decreased:
  –There may be apprehension (decreasing the motion due to fear)
  –There may be compromised joint integrity (allowing increased motion)
• Joint mobility will be excessive. (Laxity noted)
• Movement Analysis, may be uncoordinated
• Muscle strength, may be decreased with shoulder/scapular muscles

Question 7

Which special test should be done with patient with Movement Coordination Impairments? What do these test assess?

Answer 7

• Active Compression/O’Brien’s Test: Assesses labrum or AC joint
• Load and Shift Test: Assesses excessive Anterior or Posterior mobility at GH joint
• Sulcus Sign: Assess laxity at joint
• Anterior Apprehension Test: Assesses instability/Anterior Dislocation
• Crank/Clunk Test: Assesses labral pathology

Question 8

What are Associated Impairments/Differential Diagnosis with Movement Coordination Impairments?

Answer 8

• Cervical Spine referral
• Thoracic mobility
• Upper quarter muscle length/strength
• Scapulothoracic mobility
• Neurodynamics
• Overhead athlete-specific movements

Question 9

What is the Prognosis with Movement Coordination Impairments?

Answer 9

• 6 weeks to 6 months (Depending on the severity of the injury/laxity
• There may be subsequent episodes of dislocation/pain
• There may be causes to immobilize