Shoulder - SC & AC Joints

Question 1

How do you diagnose SC Joint Abduction/Adduction?

Answer 1

Pt is supine

Examiner: Places fingers clavicular head next to sternum

Have pt shrug - Shoulders move superior, Clavicle moves down
- This is SC ABduction

Have pt lower their shoulders downward, clavicle moves upward
- This is SC ADduction

SC Abduction SD is diagnosis when the clavicle is “stuck in Abduction” (superior position)

SC Adduction SD is diagnosis when the clavicle is “stuck in Adduction” (inferior position)

FIND AN ADDUCTION SD

Question 2

How do you diagnose SC Joint Flexion/Extension?

Answer 2

Pt is supine

Examiner places index finger on the clavicular head next to the sternum

Pt flexes shoulder to 90 degrees reaches for the ceiling forcefully

As shoulders move anterior , clavicle moves posterior
- SC Flexion

Pt then lowers arms back to the table

As shoulders move posterior, clavicle moves anterior
- SC Extension

SC Flexion SD is diagnosed if the clavicle is “stuck in Flexion” (clavicle in posterior position)

SC Extension SD is diagnosed if the clavicle is “stuck in Extension” (clavicle in anterior position)

FIND EXTENSION SD

Question 3

How do you perform a Direct Treatment for SC ADduction SD?

Answer 3

SC ADduction SD means the Clavicle likes to be in a superior position (shoulder down, clavicle up)

Perform ART as a Direct Treatment

• Pt lies supine
• Examiner at head of patient
• Pt’s head is put into flexion
• Examiner places thumb on dysfuntional clavicular head and exerts an inferior pressure
• Pt is instructed to inhale and exhale fully
• On exhalation, physician springs the clavicle inferiorly (repeatedly) until restriction is released
• Reassess with TART

Question 4

How do you perform a Direct treatment for SC Horizontal Extension SD?

Answer 4

SC Horizontal Extension SD means clavicle is stuck in anterior position

Perform MET

• Pt is supine
• Examiner stands on side of affected shoulder
• Place one hand on restricted clavicle and other hand behind axilla to cover the scapula
• Pt holds examiners shoulder with hand of affected shoulder
• Examiner pushes clavicle posteriorly while Pt pulls shoulder toward the table for 3-5 seconds

Reassess

Question 5

How do you diagnose the AC joint?

Answer 5

TART:

• Inspect for asymmetry (shifted clavicle/ step off)
• Palpate clavicle on acromion for tenderness/tissue texture Changes
• Assess Range of motion - Horizontal Adduction, Internal Rotation, and External Rotation

FIND IR/ER SD

Question 6

How do perform direct treatment for AC IR/ER SD

Answer 6

AC IR SD means range of motion is reduced in External Rotation compared to IR (less than 90 degrees)

AC ER SD means range of motion is reduced in Internal Rotation compared to ER (less than 90 degrees)

Perform MET

For AC IR SD: Stand behind pt, monitoring affected AC joint while putting them into the ER restriction barrier

• Pt is instructed to resist force (pulling into Internal Rotation) for 3-5 seconds, then relaxed
• Examiner finds new barrier and repeats a few times

Same for AC ER SD but opposite direction

Reassess