UE Diagnostic Manual - Movement Coordination Deficit Shoulder Flashcards
what diagnoses falls under the umbrella of mvmt coordination at shoulder
labral pathology
shoulder instability
AC Joint Pathology
outcome measures associated with mvmt coordination deficit at shoulder
Quick DASH
SPADI
PSS
most common population for mvmt coord deficit
throwing athletes following FOOSH +/- dislocation
or
fall on tip of shoulder for AC jt
labral injury classifications
Superior Labrum Anterior to Posterior (SLAP)
Bankart Tear (anterior tear)
types of SLAP tears
1-5 or Complex
Type 1 SLAP tear qualification
frayed/degenerated superior labrum with normal biceps anchor
Type 2 SLAP tear qualification
detachment of superior labrum and biceps anchor
– can be associated with GH dislocation / anterior instability
Type 3 SLAP tear qualification
bucket handle tear of superior labrum without extension into biceps tendon
Type 4 SLAP tear qualification
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
complex SLAP tear qualification
combination of ≥2 types
qualification for Bankart tear
possible hills sachs lesion
aka fracture to posterior humeral head
thought process when considering SLAP tear
throwing athlete? hx of it?
FOOSH?
forceful arm traction / trauma?
common forms of shoulder instability
trauma based (FOOSH)
history of dislocation
general laxity (beighton scale)
thought process when considering general GHJ instability
sudden onset +/- trauma?
participation in contact sports?
joint hypermobility?
common motions that cause pain in those with AC joint separation
reaching across body
UE weight bearing
at ≥ 90° flex / abduction
Grade 1 AC Joint separation qualification
significant pain
partial tearing of AC and/or coracoclavicular (CC) ligament
Grade 2 AC Joint separation qualification
complete tear of AC ligament
CC ligament intact
step-off visible
Grade 3 AC Joint separation qualification
AC and CC ligament torn (full separation)
large step-down visible
thought process behind AC jt separation consideration?
participation in contact sports?
age and sex?
direct compression/trauma to that area? ie falling on the superior aspect of shoulder
ROM findings associated with mvmt coordination deficit at shoulder
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)
muscle performance findings associated with MCD at shoulder
pain with contraction/stx of bicep
potential for spasms if recent
pain with heavy lifting
palpation findings associated with MCD at shoulder
pain w/palpation of bicipital area
step-off deformity (AC)
joint mobility finding associated with MCD at shoulder
hyper mobility of jt in specific or global direction
special tests associated with MCD at shoulder
beighton (general)
AC shear test
apprehension test w/ relocation
sulcus sign
anterior slide test
biceps load test II
interventions indicated for MCD at the shoulder
coordination/activation of muscles
coordinated co-contraction activities
weight bearing activities (GHJ Stability)
chain exercises
normalize mvmt
reduce stress to tissue
medical intervention
what muscles need to be trained to improve coordination/muscle activation
RTC muscles
Scapula-Thoracic muscles
explain intervention timeline associated with coordinated co-contraction activities
isometrics early on
dynamic joint stability later on
what chain exercises are indicated
shoulder girdle
core and LE
how to normalize movemenet
graded loading of muscles
graded functional return
medical interventions associated with MCD at shoulder
relocation if dislocated
surgical repair/stabilization
NSAIDs or Corticosteroid injections (AC)
key points for protection phase of RTC repair
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
key points for protection phase of glenohumeral capsule stabilization
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
key points for protection phase of shoulder labral repair
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)
