The Shoulder Flashcards
What 6 areas can shoulder pain be referred to?
- Lung
- Gallbladder
- Pancreas
- Heart
- Diaphragm muscle
- Some lesions in the shoulder refer pain to the area of the deltoid tubercle
What 3 things should be observed when examining the shoulder?
- Posture
- Scapular Winging
- Step deformity
What area is most likely to experience pain as a result of poor posture?
Low back (63%)
What position is the supraspinatus tendon most easily palpated in?
Shoulder in 20 degrees of extension
What position is optimal for palpating the infraspinatus and teres minor tendons?
Prone on elbows
What 3 components/actions should be included when assessing ROM at the shoulder?
- Functional range of motion by asking the patient to bring the arms over the head
- Scapulohumeral rhythm
- Whether the patient has a painful arc
How should scapulohumeral rhythm be assessed?
- Instruct the patient to elevate both arms simultaneously in the scapular plane.
- Palpate the inferior border of the scapula during this movement.
Assessing scapulohumeral rhythm is a variation of the ______ test.
Lateral Scapular Slide test
What finding indicates abnormal scapulohumeral rhythm or a positive lateral scapular slide test?
Difference between medial border or left vs right scapula and the spine is more than 1.5 cm
difference in the distance between the medial border of the left vs. right scapula and the spine should be no more than 1 ½ cm
True or False: Asymmetrical scapular position indicated dysfunction.
FALSE
Asymmetry is common and often asymptomatic
True or False: Intrarater reliability for resisted isometric testing at the shoulder is poor.
FALSE
Intrarater reliability is good for RI of the shoulder
True or False: Interrater reliability for resisted isometric testing at the shoulder is poor.
TRUE
Where does the C4 nerve root refer pain to? (1)
AC joint
What 3 areas does the C5 nerve root refer pain to?
- GH joint capsule
- Supraspinatus muscle
- Area surrounding the deltoid tubercle
What 5 areas does the C6 nerve root refer pain to?
- Infraspinatus
- Teres minor
- Subscapularis
- Deltoid tubercle
- Lateral elbow
The diagnostic accuracy of the physical examination improves when ______.
Shoulder tests are evaluated in combination
True or False: When used in isolation, the majority special tests have the ability to rule in or rule out the pathology in question.
FALSE
Majority lack ability to rule in or rule out when used in isolation
What 3 signs/sxs form the test cluster for a rotator cuff tear?
- Age > 64
- Weakness in external rotation
- Night pain
What 4 signs/sxs form the test cluster for a FULL thickness rotator cuff tear?
- Age ≥ 60 and
- painful arc test
- drop arm test
- infraspinatus test
What 3 signs/sxs form the test cluster for impingement?
- Hawkins–Kennedy
- painful arc test
- infraspinatus test
What 2 signs/sxs form the test cluster for anterior instability (traumatic)?
- apprehension test and
2. + relocation test
What 2 signs/sxs form the test cluster for a labral tear?
- relocation test
2. + active compression test
What is a standard shoulder arthroplasty?
Conventional shoulder replacement device mimics the normal anatomy of the shoulder
A plastic cup” is fitted into the glenoid and a metal “ball” is attached to the humerus
What is reverse shoulder arthroplasty?
In a reverse total shoulder replacement, the socket and metal ball are switched.
The metal ball is fixed to the glenoid and the plastic cup is fixed to the upper end of the humerus
What muscle does a reverse shoulder arthroplasty rely on to power and position the arm?
Deltoid muscle
What patient population does a revers shoulder arthroplasty work best for?
People with cuff tear arthroplasty
What is another term for frozen shoulder?
Adhesive capsulitis
Adhesive capsulitis: Age? Gender? Etiology?
- Most common in women
- Ages 40-50
- Etiology is unknown
What 2 pathologies are thought to be common precursors to adhesive capsulitis?
- Rotator cuff tendinopathy
2. Impingement Syndromes
Some clinicians believe adhesive capsulitis is _______.
self-limiting (resolves by itself)
How long does it take for adhesive capsulitis to resolve on its own?
12 months
List 4 interventions that treat adhesive capsulitis.
- Short term PT
- Stretching of GH joint and surrounding musculature
- Minimize atrophy
- Increase strength
True or False: The most improvement in function during recovery from adhesive capsulitis occurs in the late stages.
FALSE
Occurs early
What 6 interventions are recommended by the JOSPT 2013 CPG for treating adhesive capsulitis?
- Corticoid Injections
- Patient education
- Modalities
- Joint Mobilizations
- Translational manipulations
- Stretching exercises
Corticosteroid injections should be given inconjuction to what 2 treatments to provide short term pain relief?
- Shoulder Mobility
2. Stretching
What 3 goals should be targeted when providing patient education?
- Describes the natural course of the disease
- Promotes activity modification to encourage functional, pain-free ROM
- Matches the intensity of stretching to the patient’s current level of irritability
What 3 modalities, combined with mobility and strengthening, are may be used to treat adhesive capsulitis?
- Short wave diathermy
- Ultrasound
- Electrical Stimulation
When is it permitted to use translational manipulation in pts with adhesive capsulitis?
When the patient is not responding to conservative treatment.
What causes impingement?
Caused by anything that decreases the space in the subacromial area, causing the subacromial structures to be impinged between the acromium and humerus
What are 8 possible causes of impingement syndrome?
- Impaired Posture
- Rotator cuff/biceps tendinopathy
- Subacromial bursitis
- Calcium deposits in GH joint or rotator cuff tendons
- Hook shaped acromion (type III)
- Shoulder Instability
- Adhesions in inferior/posterior capsule
- Weakness in rotator cuff muscles
What happens to the GH joint with kyphosis/protracted scapulae?
GH joint becomes positioned into flexion and abduction making it difficult to hold the humerus in the glenoid.
What happens to the acromion with poor posture?
Acromion jams against the biceps and/or subscapularis muscle with overhead activities.
What occurs at the humeral head as a result of adhesions in the inferior and posterior joint capsule?
Causes the humeral head to jam against the acromion with movement into shoulder elevation
What muscles contribute to the force couple generated with shoulder elevation?
- The middle deltoid and supraspinatus muscles contract to abduct the shoulder.
- The infraspinatus, teres minor and subscapularis muscles contract to counteract the tendency of the deltoid and supraspinatus muscles to elevate the humeral head in the glenoid, setting the humerus in the glenoid.
What 6 interventions can be used to treat impingement?
- Exercise
- Tape
- ECSWT
- Laser
- Manual Therapy
- NSAIDs/corticosteroids
True or False: PT is better than surgery in treating rotator cuff injuries.
FALSE
Insufficient evidence to support one intervention over the other
What 2 interventions are primarily used in treating GH instability?
- Instruction in activities and positions to avoid
2. Strengthening exercises to shoulder musculature
What is the most common type of shoulder instability?
Anterior joint instability
What position does anterior GH injuries usually occur?
Abduction and ER
Weakest position of the GH joint biomechanically
What positions should be avoided with anterior joint instability?
Abduction to 90 degrees of full ER
What 3 muscles should be strengthened to provide a buttress against further anterior subluxations?
- Biceps
- Coracobrachialis
- Subscapularis
What 4 muscles should be strengthened to control osteokinematic movement into abduction and external rotation?
- Pectoralis major
- Latissimus
- Teres major
- Subscapularis
What 2 muscles should be strengthened to prevent the arthrokinematic motion of anterior movement of the humeral head in the glenoid?
- Infraspinatus
2. Teres Minor
Intervention is most effective if the patient continues _______ beyond PT episode of care/
Prescribed exercise regimen
What happens to the labrum if it is treated surgically following a labrum tear?
The labrum is clipped or sutured back in place
What should the surgeon evaluate at the shoulder prior to surgery?
- Shoulder Instability
- If the shoulder is unstable then the instability must also be addressed during the surgery, otherwise the tear is likely to reoccur
True or False: Therapeutic exercise and joint mobilization is superior to therapeutic exercise alone for treating shoulder dysfunction.
FALSE
No consensus
