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MSK_Shoulder_ALL

  1. ROM
    • GH flexion - 180
    • GH extension - 60
    • GH ABD - 180
    • GH IR - 70
    • GH ER - 90
  2. Resting position (Loose-packed) for GH jt
    • 55 ABD
    • 30 horizontal ADD
  3. Closed-packed position for GH jt
    Full ABD & ER
  4. Capsular pattern @ GH jt
    ER > ABD > IR
  5. Blood supply of GH jt - 3
    • Axillary artery
    • Can be palpated - in lateral wall of inferior part of axilla
    • Injury - “crutch palsy”
  6. GH ligament - primary functions - 1
    • Reinforce anterior GH capsule

  7. Transverse humeral ligament - primary function - 1
    • Acts as retinaculum for long head of biceps
  8. Inferior GH ligament - restraints what, when?
    • Primary restraint against anterior & posterior dislocations
    • Most important stabilizing structure w/overhead activities
  9. Scapulothoracic Rhythm - ratio; 1st 30-60 happens where
    • 180 deg ABD - 2:1 ratio
    • 1st 30-60 deg elevation - occurs @ GH jt
  10. GH - requirements for full elevation - 6
    • Scapular stabilization
    • Inferior glide of humerus
    • ER of humerus
    • Rotation of clavicle at sternoclavicular jt
    • Scapular ABD & ER of acromioclavicular jt
    • Straightening of thoracic kyphosis
  11. GH Flexion - Prime movers - 3
    • Anterior deltoid
    • Pec major (clavicular portion)
    • Coracobrachialis
  12. GH Extension - Prime movers - 3
    • Posterior deltoid
    • Latissimus dorsi
    • Trees major
  13. GH ABD - Prime movers - 2
    • Middle deltoid
    • Supraspinatus
  14. GH ER - Prime movers - 2
    • Infraspinatus
    • Teres minor
  15. GH IR - Prime movers - 4
    • Latissimus dorsi
    • Trees major
    • Pec major
    • Subscapularis
  16. GH Horizontal ABD - Prime movers - 3
    • Posterior deltoid
    • Infraspinatus
    • Teres minor
  17. GH Horizontal ADD - Prime movers - 1
    Pec major
  18. Scapula - Protraction - 2
    • Serrates anterior
    • Pectoralis minor
  19. Scapula - Retraction - 2
    • Rhomboids
    • Middle & lower trapezius
  20. Scapula - Depression - mm responsible; d/t what; PT
    • MM responsible - Pec minor + Latissimus dorsi
    • D/t Weakness & lengthening of upper trapezius
    • PT - Shoulder shrugs w/GH jt in its anatomical position w/shoulder flexed to 120
  21. Scapula - Elevation - 2
    • Upper trapezius
    • Levator scapulae
  22. Scapula - upward rotation - 2
    • Serrates anterior
    • Trapezius
  23. Scapula - downward rotation - mm responsible; stretch what mm; strengthen what mm
    • MM responsible - Rhomboids; Levator scapulae; Pec minor
    • Stretch - Rhomboids + Levator scapulae
    • Strengthen - Serrates anterior + Trapezius
  24. Scap Winging - Inferior border; medial border; rotary - describe + mm involved
    • Inferior border - INC scapular tilting - Inferior angle starts to go back posteriorly
    • Medial border winging - Serrates anterior
    • Rotary winging - All trapezius
  25. Scapular Winging - mms must be strengthened + which mms stretched
    • Strengthen - Serrates anterior
    • Stretch - Pectoralis minor
  26. Closed-packed position for acromioclavicular jt
    90 ABD
  27. Acromioclavicular jt - Concave-Convex
    Concave moving on convex
  28. Closed-packed position for sternoclavicular jt
    Full elevation of arm
  29. Sternoclavicular jt - Concave-Convex - Superior/Inferior (Elevation/Depression)
    Convex moving on concave
  30. Sternoclavicular jt - Concave-Convex - Anterior/Posterior (ABD/ADD)
    Concave moving on convex
  31. AC joint Dysfunction - pain; onset acute vs subluxation; look of deformity; PT
    • Pain near end-range shoulder ABD
    • Pain/instability w/ABD & GH horizontal ADD
    • Onset - Acute/Sprain - Overhead activity
    • Onset - Subluxation/dislocation - Fall on tip of shoulder or outstretched arm
    • Subluxation/Dislocation - step-off appearance w/dependent arm holding weight
    • PT acute - Sling + AVOID Shoulder elevation
  32. Rotator Cuff Lesions - S/S - 5
    • Catching sensation at 90°
    • Atrophy - Hollowed infraspinatis &/or supraspinatus fossa
    • Pain w/rotation or ABD
    • Can't sleep on involved side
    • W/Arthrography will see leakage of dye into bursa
  33. GH Labral Tears - S/S - 5
    • Instability in shoulder
    • Pain - cannot be localized to a specific point
    • Pain - INC - arm held behind back/overhead activities
    • Pain on resisted flexion of biceps
    • Weakness
    • Special test - Arthroscopic surgery of shoulder
  34. GH Labral tears - grading scale
    • 1 = Fraying
    • 2 = Fraying w/lifting of labrum from glenoid (most common type)
    • 3 = Bucket handle tear (Labrum)
    • 4 = Detachment of LH biceps
  35. GH Dislocation/Subluxation - Mechanism of injury - Anterior/posterior; diagnostic test
    • Anterior-inferior - ABD UE is forcefully ER
    • Posterior - Horizon­tal ADD/IR
    • Diagnostic test - Hill-Sachs lesion noted on x-ray if recurrent
  36. GH Dislocation/Subluxation - Complications - 4
    • Hill-Sachs lesion
    • SLAP Lesion
    • Bankart's lesion
    • Bruising of axillary nerve
  37. GH Labral Tears - What is a SLAP lesion?
    • Superior labrum, anterior to posterior lesion
    • May also involve biceps tendon
  38. GH Labral Tears - What is a Bankart's lesion?
    • Avulsion of anterior/inferior labrum from glenoid
    • Also involves inferior GH lig
    • REQUIRES SURGERY - Sling for 3-4 weeks
  39. GH dislocation/subluxation - pts should avoid what?
    Apprehension position (flexion to 90° or greater, horizontal ABD to 90° or greater, and ER to 80°)
  40. GH Labral Tears - What is a Hill-Sachs lesion?
    Compression fx of posterior humeral head
  41. Subacromial/Subdeltoid Bursitis - S/S - 5
    • Acute onset
    • Pain in anterior/lateral shoulder
    • Painful arc - 60-120° ABD
    • AROM - Limited ABD/IR
    • PROM - Pain on IR at 90 ABD
  42. Biceps Tendonitis - S/S - 5 + PT
    • Onset - After activity or repetitive training (45-65)
    • Local snapping sensation over bicipital groove
    • AROM - worse w/ABD/ER
    • PROM - Pain on combined extension of shoulder/elbow
    • Resisted - INC w/resisted elbow flexion & supination
    • PT - initial ECCENTRIC
  43. Supraspinatus Tendonitis — Calcific - S/S - 5
    • Intense pain/swelling in deltoid region
    • UE held in protective ADD
    • Painful arc from 60-120°
    • No relief w/rest
    • Ca+ deposits seen on x-ray
  44. Humeral neck fractures - Occur how? PT for proximal
    • FOOSH - fall onto an outstretched UE among older osteoporotic women
    • Early PROM is important in preventing capsular adhesions
    • Doesn’t require immobilization or surgical repair - fairly stable fx
  45. Spinal accessory nn lesion - what is seen?
    • Innervates - SCM, Trapezius
    • Inability to ABD arm beyond 90 deg
  46. Musculoskeletal nn lesion - what is seen?
    • Innervates - coracobracialis, biceps, brachialis
    • Weak elbow flexion w/elbow supinated
  47. Long thoracic nn lesion - what is seen?
    • Innervates - serratus anterior
    • Pain/inability on flexing a fully extended arm
    • Winging of scapula at GH 90 forward flexion
  48. Supra scapular nn lesion - S/S - 2
    • Innervates - supraspinatus, infraspinatus
    • Hollowed supraspinatus & infraspinatus fossa
    • Pain INC w/GH flexion, Scapular ABD, Cervical rotation to opposite side
  49. Axillary nn lesion - what is seen?
    • Innervates - deltoid, teres minor
    • Inability to ABD arm w/neutral rotation
  50. Thoracodorsal nn lesion - what is seen?
    • Innervates - latissimus dorsi
    • Marked difficulty to resist GH extension, GH IR
  51. Shoulder - special tests for Impingement - 4
    • Neer’s test
    • Hawkins-Kennedy test
    • Painful arc
    • Yocum (yolk)
    • Posterior impingement test
  52. Name test; What does it test? Describe; (+)
    • Neer’s test
    • Impingement in shoulder @ anterosuperior glenoid rim or coracoacromial ligament
    • “close to ear”
    • PT prevents scapular rotation w/one hand
    • PROM full elevation between flexion/ABD - IR
    • (+) Pain from 70-120
  53. Name test; What does it test? Describe; (+)
    • Hawkins-Kennedy
    • Impingement in shoulder - Supraspinatus
    • “Hike & crank”
    • PROM 90 deg arm flexion in plane of scapula
    • Elbow at 90
    • Crank arm into IR
    • (+) Pain
  54. Name test; What does it test? Describe; (+)
    • Yocum
    • Impingement in shoulder - Supraspinatus
    • Pt self ABD arm to 90 & places hand on opposite shoulder
    • Pt elevates elbow w/o shrugging of shoulder
    • (+) Pain
  55. Name test; What does it test? Describe; (+)
    • Supraspinatus (empty can) test
    • Identifies tear/impingement of supraspi­natus tendon Or possible suprascapular nn neuropathy
    • 1st position - Shoulder at 90/no rotation - resist shoulder ABD
    • 2nd position - IR / 30 horizontal ABD - resist ABD
    • (+) Pain or weakness in 2nd position
  56. Name test; What does it test? Describe; (+)
    • Infraspinatus test
    • Subacromial impingement
    • PT sitting
    • Elbow 90 deg flexion/ neutral forearm/elbow ADD against body/ shoulder end-range ER
    • PT IR arm against pt’s isometric resistance
    • (+) Pain
  57. Name test; What does it test? Describe; (+)
    • Drop Arm test (Codman’s)
    • Rotator cuff tear + Supraspinatus weakness/eccentric control
    • Pt lifts arm to 90 ABD w/palm down & than lowers it slowly
    • (+) Pain; Arm will drop
  58. Name test; What does it test? Describe; (+)
    • ER lag sign
    • Supraspinatus/Infraspinatus tear
    • PT sitting, PT behind pt
    • PT places arm in 90 elbow flexion; 20 deg shoulder elevation in scapular plane
    • PROM ER - @ end-range asks pt to hold position
    • (+) Lag that occurs w/pt inability to hold arm near full ER
  59. Name test; What does it test? Describe; (+)
    • IR lag sign
    • Subscapularis tear
    • Pt sits/stands
    • PROM maximum IR: arm behind back, palm on small of back facing out
    • PT lifts arm off back; asks pt to hold the lifted off position
    • (+) Inability to hold arm lifted off back
    • Substitution: elbow extension to help keep arm in that position
  60. Name test; What does it test? Describe; (+)
    • Sulcus sign
    • Inferior GH instability
    • Pt’s arm relaxed at side
    • PT distracts arm inferiorly
    • (+) Presence of sulcus space distal to acromion
  61. Name test; What does it test? Describe; (+)
    • Anterior apprehension test
    • Anterior shoulder dislocation/instability
    • Pt supine w/PT hand located posteriorly jQuery110104883473573263779_1484508769408?
    • PT ABD & ER arm
  62. Name test; What does it test? Describe; (+)
    • Relocation test (Fowler; Jobe relocation test)
    • Anterior shoulder dislocation
    • After performing steps for Anterior apprehension test do the following
    • PT posterior stress on humerus by pressing on proximal part of humerus anteriorly from behind
  63. Name test; What does it test? Describe; (+)
    • Jerk test
    • Posterior inferior labral lesion
    • Pt sitting
    • PT grasps pt elbow in 1 hand and scapula w/2nd hand
    • PROM 90 deg ABD/IR
    • PT loads humerus axially through elbow while maintaining horizontally ABD arm, than move arm into horizontal ADD
    • (+) Pain
  64. Name test; What does it test? Describe; (+)
    • Clunk test
    • Labral tears
    • Supine, arm in full ABD
    • PT push humeral head anterior while ER humerus
    • (+) Audible clunk
  65. Name test; What does it test? Describe; (+)
    • Crank test
    • Labral tears
    • Pt supine or seated
    • Arm in 160 ABD in scapular plane/ elbow 90/ Maximal ER
    • Push toward jt through elbow while rotating armjQuery110108424500482480812_1484509595905jQuery11240884354134147433_1737054638400jQuery112402545438709929071_1737054704232?
    • PT applies axial load along humerus
    • (+) Pain w/ER
  66. Name test; What does it test? Describe; (+)
    • Biceps load I test
    • SLAP lesion
    • Shoulder ABD 120 w/maximum ER
    • FLex elbow to 90 & supinate forearm
    • Ask pt to flex elbow against resistance
    • (+) Active elbow flexion INC pain
  67. Name test; What does it test? Describe; (+)
    • Pain provocation test (Mimori) ?
    • Labral tear/SLAP lesion
    • Pt sitting
    • Shoulder ABD 90-100 w/ER
    • Forearm into maximum pronation
    • Followed by forearm into supination
    • (+) Pain only w/pronation or more severe w/pronation
  68. Name test; What does it test? Describe; (+)
    • Compression rotation test
    • SLAP lesions
    • Pt supine
    • PROM 90 shoulder ABD/90 elbow flexion
    • PT provides compression force to humerus - followed by rotation from IR to ER
    • (+) Catching or snapping
  69. Name test; What does it test? Describe; (+)
    • O’Brien’s active compression test
    • SLAP lesion vs. AC jt
    • Pt standing / Shoulder 90 flexion / 10 horizontal ADD / maximum IR
    • Resist downward force applied by PT
    • Followed by maximum ER
    • (+) AC jt = Pain “on top of shoulder”
    • (+) SLAP lesion = Pain “inside shoulder” w/IR, that’s relieved w/ER
  70. Shoulder - special tests for Biceps pathology - 2
    • Yergason's Test
    • Speed’s test
  71. Name test; What does it test? Describe; (+)
    • Yergason's Test
    • Ability of transverse humeral ligament to hold long head of biceps within bicipital groove
    • Elbow at 90, forearm pronated
    • Resist supination and ER
    • (+) Tendon of biceps long head will "pop out" of groove
  72. Name test; What does it test? Describe; (+)
    • Speed’s test
    • Biceps tendon pathology
    • “Straight arm test” - Shoulder flex 90/forearm supinated/elbow in full extension
    • PT resist shoulder flexion
    • (+) INC tenderness in bicipital groove
  73. Shoulder - special tests for AC jt - 4
    • Horizontal ADD test
    • AC shear test
    • O’Brien’s Test
  74. Name test; What does it test? Describe; (+)
    • AC shear test
    • PT clasps hands & places heel of one hand on spine of scapula & heel of other hand on clavicle
    • Squeeze bands together, causing compression of AC joint
  75. Name test; What does it test? Describe; (+)
    • Horizontal ADD test
    • AC joint dysfunction or subacromial impingement
    • Pt sitting
    • PROM 90 GH flexion
    • PROM arm into horizontal ADD & applies overpressure
    • (+) Localized pain at AC jt
  76. Concave/Convex - Posterior GH glide INC what? - 3
    • Early flexion (0-45 deg)
    • IR
    • Horizontal ADD
  77. Concave/Convex - Anterior GH glide INC what? - 4
    • Extension
    • ER
    • Horizontal ABD
    • Late flexion (120-180 deg)
  78. To improve overhead activities - what glide? what components are needed?
    • Anterior glide INC ER + late flexion
    • ER - component of full elevation
  79. Concave/Convex - Sternoclavicular Posterior glide INC what? - 1
    Retraction
  80. Concave/Convex - Sternoclavicular Superior glide INC what? - 1
    Depression of clavicle
  81. Concave/Convex - Sternoclavicular Anterior glide INC what? - 1
    Protraction
  82. Concave/Convex - Sternoclavicular Inferior glide INC what? - 1
    Elevation of clavicle
  83. TSA - pre-op presentation - 5
    • Loss of shoulder ROM in a capsular pattern
    • Mm atrophy
    • Tightness in subscap/pec minor/lats
    • DEC scap mobility
    • Possible cervical spine ROM restrictions
  84. Shoulder Impingement - post-op precaution - 1
    Pt. should avoid shoulder elevation greater than 90°
  85. Antero-inferior shoulder dislocation - which nn can be damaged? (+) examination finding
    Axillary nn = weak deltoids
  86. Pt doing self-mobilization exercise seen below Primary objective of this activity is to improve
    • GH ER
  87. Pt doing self-mobilization exercise seen below Primary objective of this activity is to improve
    • GH IR
  88. Stable humeral fx - immobilized for how long? when to start exercises? What type?
    • Immobilized in a sling for 6 wks
    • After 1 week sling should be removed for pendulum exercises
  89. To expose supraspinatus for US - position how?
    Slight ABD & IR
Author
Tanuisha
ID
324275
Card Set
MSK_Shoulder_ALL
Description
MSK_Shoulder_ALL
Updated

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