Week 1 - Common shoulder conditions and assessments

Question 1

What are the static stabilisers of the GHJ?

Answer 1

• Glenohumeral ll.

* Labrum

Question 2

What are the dynamic stabilisers of the GHJ?

Answer 2

• RC (supraspinatus, infraspinatus, teres minor and subscapularis)

Question 3

What is the function of the GHJ dynamic stabilisers?

Answer 3

• centre humeral head in glenoid
• prevent ant. and post. translation of head of humerus
• counteract humeral elevation caused by deltoid

Question 4

What are red flags?

Answer 4

• Tumour (pHx of cancer, >50y.o, unexplained weight loss, pain at rest, mass)
• infection (red skin, fever, systemically unwell, compromised immune system)
• Fracture/dislocation

Question 5

Steps of observation…

Answer 5

• L vs. R.
• front, BACK, side
• static vs. dynamic

Question 6

What are the special tests for RC tear/ impingement/ tendinopathy? And which mm., if any, do they bias?

Answer 6

• external rotation lag sign (bias: supra/infraspinatus)
• Lift off (bias subscapularis)
• Empty can (weakness +/- pain)
• Hawkins-Kennedy
• Allinghams

Question 7

What are the special tests for labrum pathology?

Answer 7

• Biceps load II (SLAP)

* Crank test

Question 8

What is the special test for instability?

Answer 8

• Apprehension/relocation test (ant. instability)

Question 9

What are the S&S for a clavicle fracture?

Answer 9

*VERY painful, localised swelling and point tenderness

Question 10

What are some examples of serious pathology’s of the shoulder?

Answer 10

• Clavicle fracture
• Neck of humerus fracture
• Ant. glenohumeral dislocation

Question 11

What is primary impingement?

Answer 11

The structural narrowing of the subacromial space (e.g. due to osteophytes)

Question 12

What is secondary impingement?

Answer 12

Impingement that is NOT due to structural deformities (i.e. functional encroachment due to:

• RC weakness
• instability
• scapular dyskinesis)

Question 13

What is external impingement?

Answer 13

Encroachment of soft tissue in the subacromial space

Question 14

What is internal impingement?

Answer 14

Encroachment of RC tendons between humeral head and glenoid rim (more unique to overhead athletes)

Question 15

What is RC tendinopathy?

Answer 15

Pathology of RC tendons resulting from overuse and excessive shear compression forces

Question 16

What is SLAP (sup. labrum ant. to post.)?

Answer 16

Glenoid labrum injury where tear extends from ant. to biceps tendon to post.

Question 17

What is a non-SLAP labrum injury?

Answer 17

a tear in the labrum caused from degeneration, bankart

Question 18

Stable vs. unstable labrum injury

Answer 18

• stable - majority of labrum/tendon still attached

* unstabe - majority of labrum/tendon torn

Question 19

What are properties of glenoid labrum injuries?

Answer 19

• MOI: traumatic or non-traumatic (repetitive overhead activity)
• S&S: post. pain (+/- grinding or catching)
• IMT: biceps provocative

Question 20

What are the two different causes of shoulder instability?

Answer 20

• Traumatic: forceful abduction and ER

* Atraumatic: laxity of j. capsule due to repetive overhead mvmt

Question 21

What are some signs of AC j. disorders?

Answer 21

• Tenderness over AC j.
• localised pain @ AC j.
• step deformity
• pain w/horizontal adduction

Question 22

What are the stages of adhesive capsulitis?

Answer 22

• stage 1 (2-9m): inflammatory (aka freezing)
• stage 2 (4-12m): adhesive stage (aka frozen)
• stage 3 (5m-3y): recovery stage (aka unfreezing)

Question 23

What are the risk factors for adhesive capsulitis?

Answer 23

• female
• > 40
• post-surgery