UE Diagnostic Manual - Movement Coordination Deficit Shoulder

Question 1

what diagnoses falls under the umbrella of mvmt coordination at shoulder

Answer 1

labral pathology
shoulder instability
AC Joint Pathology

Question 2

outcome measures associated with mvmt coordination deficit at shoulder

Answer 2

Quick DASH
SPADI
PSS

Question 3

most common population for mvmt coord deficit

Answer 3

throwing athletes following FOOSH +/- dislocation

or

fall on tip of shoulder for AC jt

Question 4

labral injury classifications

Answer 4

Superior Labrum Anterior to Posterior (SLAP)

Bankart Tear (anterior tear)

Question 5

types of SLAP tears

Answer 5

1-5 or Complex

Question 6

Type 1 SLAP tear qualification

Answer 6

frayed/degenerated superior labrum with normal biceps anchor

Question 7

Type 2 SLAP tear qualification

Answer 7

detachment of superior labrum and biceps anchor
– can be associated with GH dislocation / anterior instability

Question 8

Type 3 SLAP tear qualification

Answer 8

bucket handle tear of superior labrum without extension into biceps tendon

Question 9

Type 4 SLAP tear qualification

Answer 9

bucket handle tear with extension into biceps tendon

superior labrum and biceps tendon remain attached

partially torn biceps tendon may displace superior flap into joint

Question 10

complex SLAP tear qualification

Answer 10

combination of ≥2 types

Question 11

qualification for Bankart tear

Answer 11

possible hills sachs lesion

aka fracture to posterior humeral head

Question 12

thought process when considering SLAP tear

Answer 12

throwing athlete? hx of it?

FOOSH?

forceful arm traction / trauma?

Question 13

common forms of shoulder instability

Answer 13

trauma based (FOOSH)

history of dislocation

general laxity (beighton scale)

Question 14

thought process when considering general GHJ instability

Answer 14

sudden onset +/- trauma?

participation in contact sports?

joint hypermobility?

Question 15

common motions that cause pain in those with AC joint separation

Answer 15

reaching across body
UE weight bearing
at ≥ 90° flex / abduction

Question 16

Grade 1 AC Joint separation qualification

Answer 16

significant pain

partial tearing of AC and/or coracoclavicular (CC) ligament

Question 17

Grade 2 AC Joint separation qualification

Answer 17

complete tear of AC ligament

CC ligament intact

step-off visible

Question 18

Grade 3 AC Joint separation qualification

Answer 18

AC and CC ligament torn (full separation)

large step-down visible

Question 19

thought process behind AC jt separation consideration?

Answer 19

participation in contact sports?

age and sex?

direct compression/trauma to that area? ie falling on the superior aspect of shoulder

Question 20

ROM findings associated with mvmt coordination deficit at shoulder

Answer 20

decreased OH ROM

pain with UE WB

pain/instability in specific positions
at end range

apprehension with P/AROM

catching/clicking with mvmt (labral)

pain with horizontal add (AC)

Question 21

muscle performance findings associated with MCD at shoulder

Answer 21

pain with contraction/stx of bicep

potential for spasms if recent

pain with heavy lifting

Question 22

palpation findings associated with MCD at shoulder

Answer 22

pain w/palpation of bicipital area

step-off deformity (AC)

Question 23

joint mobility finding associated with MCD at shoulder

Answer 23

hyper mobility of jt in specific or global direction

Question 24

special tests associated with MCD at shoulder

Answer 24

beighton (general)
AC shear test
apprehension test w/ relocation
sulcus sign
anterior slide test
biceps load test II

Question 25

interventions indicated for MCD at the shoulder

Answer 25

coordination/activation of muscles coordinated co-contraction activities weight bearing activities (GHJ Stability) chain exercises normalize mvmt reduce stress to tissue medical intervention

Question 26

what muscles need to be trained to improve coordination/muscle activation

Answer 26

RTC muscles Scapula-Thoracic muscles

Question 27

explain intervention timeline associated with coordinated co-contraction activities

Answer 27

isometrics early on dynamic joint stability later on

Question 28

what chain exercises are indicated

Answer 28

shoulder girdle core and LE

Question 29

how to normalize movemenet

Answer 29

graded loading of muscles graded functional return

Question 30

medical interventions associated with MCD at shoulder

Answer 30

relocation if dislocated surgical repair/stabilization NSAIDs or Corticosteroid injections (AC)

Question 31

key points for protection phase of RTC repair

Answer 31

sling w/ ABD pillow for 2-8 wks (dependent upon tear size) no AROM (prom at 2 weeks) do not load, lift, push or pull with affected arm

Question 32

key points for protection phase of glenohumeral capsule stabilization

Answer 32

protect surgical repair minimize pain and inflammation PROM in flexion, ABD, IR in scapular plane ABD sling for 2 weeks (14 days) no ER ROM past neutral 7 days post-op isometrics and rhythmic stabilization ex are indicated

Question 33

key points for protection phase of shoulder labral repair

Answer 33

sling for 4 wks / sleep included no PROM inro ER / ABD for 2 wks no rotation above 60° ABD for 2 weeks no shoulder extension past neutral no active bicep contraction (4wks) no ER in 90/90 for 6 wks No AROM until 4 wks (bicep included)