Test 3- Shoulder impairments

Question 1

Four joints of the shoulder

Answer 1

Scapulothoracic
Sternoclavicular
Acromioclavicular
Glenohumeral

Question 2

Rhythm of the scapula

Answer 2

2: 1 ratio overall
- During the first 60 degrees of flexion or initial 30 degrees of abduction, the scapula does not move and is seeking position of stability in relation to the humerus
- -> this is called the setting phase

Question 3

Glenohumeral joint

Answer 3

Joint stability is provided by rotator cuff muscles, long head of biceps brachii and extracapsular ligaments

• labrum is very important because it deepens the fossa
• dislocation will be either due to ligament laxity or ligament tear

Question 4

Rotator cuff

Answer 4

• Supraspinatus (most common for dislocation and pinching Nn)
• Infraspinatus (second most common for injury)
• Teres minor
• Subscapularis

Question 5

Supraspinatus function

Answer 5

Supraspinatus is the anchor for the shoulder.

-without it you would not be able to reach beyond 90 degrees of abduction

Question 6

Force couples

Answer 6

Muscles with opposing actions that work together to produce rotation

• Shoulder abduction: deltoid and RTC
• Upward scap rotation: upper and lower trapezius

Question 7

Shoulder impingement

Answer 7

Umbrella term that includes rotator cuff tears as well as several shoulder muscle injuries (compressions or tears) that result in impingement
-usually gradual onset from overuse

Question 8

Common muscles of shoulder impingement

Answer 8

• Suprispinatus, long head of biceps, subacromial bursae, and sometimes the infraspinatus
• All get pinched under subacromial arch

Question 9

Causes of impingement

Answer 9

• Instability of the glenohumeral joint (weakness or joint laxity)
• Dyskinesia: scapula not moving in correct rhythm with humeral head
• Poor posture
• Arthritis: osteophytes can grow down into the subacromial space and stop muscle from moving fully
• Anatomical predisposition

Question 10

External vs. internal impingement

Answer 10

• External: rotator cuff, or bursae getting compressed/pinched on the superior surface by the acromion
• Internal: rotator cuff, labrum or capsule getting compressed/pinched on the under surface by the humeral head

Question 11

SICK scapula

Answer 11

A type of dyskinesia:

• Scapular malposition
• Inferior medial border prominence
• Coracoid pain and malposition
• dysKinesis of scapular motion

Question 12

Painful Arc

Answer 12

Slow arc of motion (abduction) to find out where pain occurs along arc
-Pain from 60-120 degrees: rotator cuff impingement

Question 13

Hawkins Kennedy Test

Answer 13

Shoulder flexed to 90 degrees, elbow horizontally flexed to 90 degrees> push down lightly just proximal to elbow joint
-Pain= positive shoulder impingement

Question 14

Neer Test of Impingement

Answer 14

• Stabilization on shoulder
• Shoulder internal rotation
• Full PROM shoulder flexion
• -> pain= positive sign of shoulder impingement

Question 15

Full can and empty can test

Answer 15

Hand open as if holding a can, arm extended to 90 degrees, practitioner stabilizes at shoulder pushes down on arm

• Full can = external rotation (supination)
• Empty can= internal rotation (pronation); hurts worse, so always start with full can
• ->test for supraspinatus dysfunction

Question 16

Drop arm test

Answer 16

Hold arm at 90 degrees and have pt lower arm slow and controlled

• look for pain and smoothness of motion
• ->pain suggests underlying rotator cuff dysfunction

Question 17

Yergonson’s test for bicep impingement

Answer 17

Stabilize and palpate fot long head of tendon, place thumb over bicipital groove

• Elbow bent at side in 90 degrees with forearm prone
• ->Positive sign= biceps tendon popping out of groove

Question 18

Speeds test

Answer 18

Pt in full supination with a slight shoulder flexion

• resist forward flexion by applying pressure on forearm
• ->positive sign for impingement= pain

Question 19

Rotator cuff treatments

Answer 19

• Ice 15-20 minutes
• Sleep with pillow under affected arm
• Pendulums: bent over in prone; swing arm side to side and back to forth
• Strengthening BELOW 90 degrees
• Soft tissue mobilization
• NO active motion after surgery

Question 20

Codman’s hike

Answer 20

Individuals with shoulder pain or weakness tend to try to lift the shoulder using the shoulder girdle and trunk muscles when reaching overhead

Question 21

SLAP lesion

Answer 21

Superior Labrum of the Shoulder Joint- tear of the superior head of the biceps head in the labrum of shoulder joint
-will not dislocate, but will cause a lot of pain and discomfort

Question 22

Frozen shoulder

Answer 22

Capsule inflammation which causes thickening of the ligaments- can be very painful and causes inability to rotate shoulder
-diabetes and hormones can cause this

Question 23

Adhesive capsulitis

Answer 23

Type of frozen shoulder; traumatic and spontaneous onset

• Freezing phase (most painful> frozen phase> thawing phase
• Ice good, heat bad (inflammatory)
• may take up to 2 years to resolve
• Risk: over 40 y/o, diabetes, immobility, thyroid disease

Question 24

Adhesive capsulitis phases

Answer 24

• Freezing phase: pain with movement and rest, range starts to decrease
• Frozen phase: shoulder is stiff and there is marked ROM loss but less pain
• Thawing phase: ROM slowly starts to improve

Question 25

Types of shoulder replacement

Answer 25

- Hemiarthroplasty: humeral head replaced with a metal ball (after 3 to 4 fractures) - Total shoulder arthroplasty: humeral head and shoulder socket replaced (osteoarthritis, complicated fractures, avascular necrosis) - Reverse total shoulder: glenoid is rounded and humerus is concaved (if rotator cuff is torn badly)