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What are the questions you would for a shoulder pt?
- - mechanism of injury- dislocation, swinging arm injury
- - site and nature of the pain- above or below of the shoulder, pain above the shoulder- look at neck, shoulder ain on shoulder, radiates below elbow maybe the neck.
- - paraesthesia- from neck
- - pain response- minor injury- sharp pain, night pain etc
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What are the specific questions you would ask in regards to the arm with pain and sleep?
- - lying on affected arm- if you cant at night might be a jt problem- pain on overhead reaching above- impingement?- painful arch- pain on rapid or ungarded movements- frozen shoulder
- - overuse- laxity, impingement, R/C injury, age variable, usually localised pain, will also get a painful arc in flex and abduction to 90 degrees- tear will show on ultrasound
- - pain after use- arthritic nature of pain
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What do you need to kep in mind in regards to shoulder pts history?
- - night pain- tumors in lungs can give night pain
- - general health
- - past history of cancer
- - hand dominance
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When observing a pt with shoulder pain what do we look for?
- - shape and contour -rounded, dropped one side, forward positioned
- - wasting- supraspinatus, deltoid, infraspinatus
- - hand position- IR/ ER
- - scap position- winged, pec min tightness
- - shoulder positin- head of humerus
- - over developed mm
- - head of humerus will sit approx 1/3 forward more than this is a problem
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Conduct active movements for a shoulder pain pt
- - clear cervical spine, elbow
- - flex/ ext
- - abduction
- - internal rot- hand on the sacrum
- - ext rot arm by your side
- - hand behind head HBH
- - hand behind back HBB
- - horizontal flex (adduction)- arm up to 90 degree flex, then reach to other shoulder
- Notes/
- lead with thumbs
- any pain at baseline and if it comes on
- OP- hold behind and OP
- if hitch pain on that side
- OP for abd- hold above shoulder and OP
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Active movements for shoulder pt
- - flex- pain, range, end feel, scapulohumeral rhthm
- - abd- arcs, scapulo humeral rhythm
- - ext
- - int rot- neutral and 90 abduction
- - ext rot in neutral and 90 abd
- - HBH- extends elbow back
- - HBB- level reached eg sacrum, L5
- - horizontal flexion
- P inhibition- can prevent mm moving
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What causes winging of the scap?
- - nerve problems
- - weak SA
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What passive movements would you conduct for a shoulder pt?
- pt either in sitting or lying
- flex- stabilise the scap
- ext
- IR- 90 degrees of arm, stabilise scap
- ER- same as above
- OP
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What resisted movement would you perform on a pt with shoulder problems?
- Static- tell you if you have weakness and rot cuff tear- weakness and no pain.
- - flex- elbow ext and pronation
- - abd- abd 30 degrees and elbow f 90 degrees
- - add- same as above supra/ deltoid
- - int rot- neutral and 90 degrees abd (can do in prone)
- - ext rot- same as above
- - Gerbers push off- HBB to L3- subscap and push against your hand
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When in supine lying what can you assess on a shoulder pt?
- Palpate:
- - AC jt line
- - Greater tuberosity
- - Acromion
- - Tendons- Long head of biceps (LHB) pt int and ext rot, supraspinatus- hand over sacrum.
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Conducting lockng on a pt with shoulder problems?
- Pt supine
- - arm under the medial border of scap with fingers over trap to prevent shrugging
- - hold elbow flexed, abduct arm towards a position of full GH abd
- - should be painless and not limited
Used when signs and symptoms are minimal, labrum injury
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Conduct a quadrant on a pt with shoulder problems
- -start at locked position
- - relax pressure maintaining abduction to allow the arm to be moved anteriorly to the frontal plane
- - abduct and lat rot through small arc approx 30 degress lateral to fully elevated position
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What are the accessory movements you can conduct on a pt with shoulder problems?
- - PA
- - AP
- - Longitudinal caudad
- - Lateral movement
- - scapulo- thoracic movements
- - A/C jt- AP and PA
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Conduct an PA on a shoulder problems pt
- head of humerus
- arm on towel
- arm across body
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Conduct an AP on a pt with shoulder problems?
- Note use AP and PA for frozen shoulder
- - heel of hand
- - neutral
- - flexion and abduction
- - hand under the scap
- More flex, more pillows
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Conduct a longitudinal caudad on a shoulder pt?
- Pt in neutral
- Abduction
- Elbow flexed
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Conduct a lateral movement on pt with shoulder problem
- - hold elbow in
- - hand in arm pit
- - pain relief
- - help with abduction
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Conduct AP/ PA on the AC jt
- - end of clavical
- - not really useful
- - will diagnose if it is the AC jt
- - move scap/ thoracic jt around
- - useful for nerve problems
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What activities would you conduct with a shoulder pt in prone lying?
- - mm test- scap control
- - lower trap test- arms by side- hold scap up and slowly lower put into same position
- - serratus ant- forearm support, on elbows, supination, down low and lift body up slowly
- - clear cervical or thoracic spine and elbow
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What are the special tests for the shoulder?
- - full/empty can- supraspinatus
- - ER in minus 45 degrees-infraspinatus
- - gerbers push off- subscap- HBB L3
- - apprehension test
- - re-location/ containment test
- - inferior drawer/ sulcus test
- - posterior draw
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What is the empty can test for? Conduct on a pt
- - test for supraspinatus
- - pts flex in scap plan to 90 degrees- thumb point to ground
- - examiner places hand over thepts elbow and apply downward pressure as the pt attempts to raise the arm againt the resistance
- - +ve result for supraspinatus is loss of strength- pain may also be produced, particularly is mm lost and impingement occurs
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What are the strength tests for rotator cuff?
- - Full can/ empty can- supra
- - ER- infraspinatus
- - gerber's push off subscapularis
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What are the stability tests for the shoulder?
- - apprehension test
- - re-location/ containment test
- - inferior drawer/ sulcus test
- - posterior draw
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What is the jobs test for? Conduct this test
- Anterior instability of the shoulder
- - test for ant jt pain due to excessive ant jt laxity
- - pt supine with line of shoulder at the edge of the plinth
- - abduct and externally rot are to the point of onset of pain. May require some overpressure into horizontal extension
- - +ve test is reproduction of pain or feel of instability apprehension
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What is the Gerbers push off test for? Condcut this test
- - to test subscap
- - HBB at L3 level
- - push off and you resist.
- - Weakness and pain are positive tests.
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Your pt presents with expected weakness with infraspinatus conduct the appropriate test for this.
- - ER in minus 45 degres
- - pt sitting
- - elbow bent at little from the body
- - resist ext rotation
- - weakness and pain are positive tests
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When do you conduct stability tests?
- - when the pt has a history of instability
- - inferior instability is the result of a stroke
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Supraspinatus test- note impingement test not realy empty can- usually worsens?
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Conduct a relocation/ containment test on your pt?
- - heel of hand on ant of head of humerus and push posteriorly and then release
- - +ve test- when pt reports an easing of pain when pushed down, and a reurrence when the pressure is released
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Conduct an inferior drawer/ sulcus test
- - used to assess the laxity of the inferior direction
- - inferior subluxation would be prevented by the superior glenohumeral lig passively and the LHB
- - one hand monitoring superior contour of shoulder jt. Other arm providing strong downward force on arm
- - +ve if a significant depression is evident immediately distal to acromion
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You pt presents with suspected posterior instability. Conduct the appropriate test
- - posterior jt laxity
- - pt supine with line of the glenohumeral jt at the edge of the plinth
- - shoulder taken into 90 degrees flex
- - one hand on the pts elbow, other behind shoulder jt
- - examiner pushes along the line of the humerus to translate the humeral head posteriorly across the glenoid fossa
- - +ve sign if pt demonstrate apprehension during hte manoeuvre. Can detect the amount of movement- if humeral head ushes into your hand
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What are the impingement tests?
- - hawkins- kennedy-F 90 degrees, slight add, IR over examiners arm
- - Allighans dynamic impingement- in painful test movements
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Conduct the hawkins- kennedy test on your pt
- - impingement test
- - bring the supraspinatus tendon against the ant portion of the coracoacromial ligament
- - pt standing
- - forward flex the shoulder to 90 degrees, then forcibly int rotate the shoulder
- - +ve test produces pain
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Conduct an imingement test for dynamic impingement
- - allinghams test
- - for pts who demonstrate a painful arc on active or resisted elevation and who test positvie on a static impingement test
- - pt elevates arm to the painful range, then attempts to adduct against the manual resistance provided against the examiner
- - if the pain is relieved, the test is positive
- - seen as a good prognostic indicator for an adduction
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What are some other tests you can conduct for s a problemed shoulder pt?
- - Bicipital tendinitis- speeds test
- - AC jt
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Conduct a test for biceps tendinitis
- - speeds test
- - pt in sitting
- - elbow fully ext and shoulder flexed to 90 degrees
- - resist forward flexion with the forearm in supination, then pronation
- - +ve test is when pain is experienced in the bicipital groove
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AC jt test
- - horizontal flexion
- - arm abducted to 90 degrees, then horizontally flexed across the body
- - palpate the jt simultaneously
- confirm with pressure
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What are you treatment options for a pt with shoulder problems?
- - jt mobilisations- accessory or passive physiological
- Rom exercises- pendular and wand exercises
- - stabiliy/ motor control exercise
- - taping
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WHat are the PPIVMS for the shoulder GH jt?
- - flexion- grade 1- 4
- - IR- a/a
- - ER - a/a
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PPIVMS for the scapulo thoracic?
- - elevate
- - depression
- push inferior angle
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What is the endular exercise?
- - ROM
- - hand and arm swing
- - very small amount of mm used
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WHat is the wand exerise?
- - ROM
- - hold walking stick or brume, lay on back and move in flex, ext, abduction etc
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Longitudinal caudad- relieve Pain
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Lateral caudad- seat belt?
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GH Jt PPIVM flexion
- - use leg as a block- near head
- - dont allow ext and int rot
- - 2 handed
- - grade 4- like quadrant
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