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Shoulder Evaluation. Chapter 13, p. 424. Shoulder Anatomy: Scapula. Borders inferior superior Fossa supraspinous infraspinous Processes coracoid acromion Motion (scaption). Shoulder Anatomy: Humerus . Humeral head Tuberosities: Greater (lateral) Lesser (medial)

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Shoulder evaluation
Shoulder Evaluation

Chapter 13, p. 424


Shoulder anatomy scapula
Shoulder Anatomy: Scapula

  • Borders

    • inferior

    • superior

  • Fossa

    • supraspinous

    • infraspinous

  • Processes

    • coracoid

    • acromion

  • Motion (scaption)


  • Shoulder anatomy humerus
    Shoulder Anatomy: Humerus

    • Humeral head

    • Tuberosities:

      • Greater (lateral)

      • Lesser (medial)

      • Bicipital Groove

    • Glenohumeral Joint

      • Instability/laxity

      • Labrum

      • Capsule


    Shoulder anatomy rotator cuff p 432

    Supraspinatus

    assists deltoid in ABD

    ER

    Infraspinatus

    ER/Hor. Abd

    Decelerator (ECC)

    Teres Minor

    ER/Hor. Abd

    Decelerator (ECC)

    Subscapularis

    only pure IR muscle

    Force Couple:

    RC:Deltoid

    Stabilizing effect

    Fig. 13-15, p. 433

    Shoulder Anatomy: Rotator Cuff(P. 432)


    Shoulder anatomy bursae p 437
    Shoulder Anatomy: Bursae(p. 437)

    • Purpose

    • Subacromial bursa

      • location

      • subacromial/subdeltoid


    Shoulder evaluation history p 437 439

    Location

    know the anatomy

    know the biomechanics

    Onset:

    acute?

    chronic?

    worsen or improve with activity?

    Duration of pain?

    PMH (biomechanics)

    Mechanism of injury

    Overhead activity

    Collision

    Excessive ROM

    Repetitive motion

    Complaints

    “sliding out of place”

    aching or “dead”

    popping

    Shoulder Evaluation: History(p. 437-439)


    Shoulder evaluation observation p 439
    Shoulder Evaluation: Observation(p. 439)

    • Position of the head

      • 2º neck injury?

      • Muscle spasm?

    • Level of the shoulders

      • dominant=lower

      • clavicles & scapulae

    • Contour of clavicles

    • Fig. 13-18, p. 439


    Shoulder evaluation observation p 439 442
    Shoulder Evaluation: Observation(p. 439-442)

    • Symmetry

      • muscle tone

      • atrophy (infraspinatus)

      • levels

      • GH joint position

    • Vertebral alignment


    Shoulder evaluation palpation p 442 444
    Shoulder Evaluation: Palpation(p. 442-444)

    • Clavicle

      • SC->AC

      • angulations

      • piano key sign

    • Rotator cuff insertions

    • Glenohumeral (GH) joint

    • Biceps Tendon

    • Anatomy: p.442, 444


    Shoulder evaluation palpation
    Shoulder Evaluation: Palpation

    • Deltoid

    • Spine of the scapula

    • Supraspinatus

    • Infraspinatus

    • Levator scapulae

    • Rhomboids

    • Trapezius


    Shoulder rom
    Shoulder ROM

    • Apley’s Scratch Test

      • Apley’s Scratch test: p.447, Box 13-3

      • opposite shoulder from front

      • opposite shoulder from behind

      • opposite shoulder over head

      • evaluates multiple ROM’s


    Shoulder rom1
    Shoulder ROM

    • Drop arm test

      • P. 449, Box 13-4

      • (+)= Rotator cuff tear

      • Uncontrolled drop in AROM ABD


    Shoulder rom p 437
    Shoulder ROM(p. 437)

    • Scapulothoracic Rhythm

      • GH abduction

      • 2:1 ratio of GH to scapular movement

      • example: 180º =

        • 120º GH

        • 60º scapular rotation

      • bilateral/symmetrical


    Functional testing p 444 458
    Functional Testing(p.444-458)

    • Force Production

      • IR/ER:

        • 3:2 CON

        • 3:4 ECC

    • ROM

      • Flex/Ext

      • ABD/ADD

      • ER/IR

      • Hor. ABD/ADD


    Shoulder pathologies
    Shoulder Pathologies:

    • Acromioclavicular injuries

    • Glenohumeral Instability

    • Rotator Cuff Strains

    • Rotator Cuff Impingement

    • Rotator Cuff Tendinitis

    • Biceps Tendon Injuries

    • Thoracic Outlet Syndrome


    Acromioclavicular ac joint injuries p 460 461 table 13 8
    Acromioclavicular (AC) Joint Injuries (p. 460-461, Table 13-8)

    • History

      • Acute trauma or overuse

      • FOOSH mechanism

      • “separated shoulder”

    • Observation

      • Step deformity possible

      • Clavicles not level

    • Examination

      • Traction Test

        • p. 462, Box 13-10

      • Compression Test

        • p.463, Box 13-11

    • Palpation

      • Tender AC joint

      • AC laxity

        • (piano key sign)



    Glenohumeral instability p 463
    Glenohumeral Instability(p. 463)

    • History

      • Unidirectional or multidirectional

      • Anterior/inferior most common

      • Excessive ROM mechanism or FOOSH

      • Easily becomes chronic

      • “Dead Arm Syndrome”

      • Reports a pop

      • Subluxation->dislocation

    • Observation

      • Obvious deformity with dislocation

      • Guarded presentation

      • Bankart lesions

      • Hill-Sachs lesions

    • Palpation

      • Obvious GH deformity

      • Tender at RC insertions

      • Assess instability direction

      • Check radial pulse and sensation


    Glenohumeral dislocations
    Glenohumeral Dislocations

    • Obvious deformity

    • Check distal pulse often

    • Reduction strategies

    • Humeral fx possible

    • Splint and refer +/- reduction


    Gh joint damage
    GH Joint Damage

    Bankart Tear--p. 463

    Torn anterior labrum following chronic GH instability

    Labrum avulses from glenoid fossa

    • Hill-Sachs Lesion—p.466

    • posterolateral humeral head indentation fracture

    • soft base of humeral head impacts glenoid

    • occurs in 35-40% of anterior dislocations & up to 80 % of recurrent dislocat.


    Slap lesions
    SLAP Lesions

    • Superior Labrum AnteroPosterior lesion

    • Near LH Biceps tendon

    • Pain worsens with ECC biceps work (follow-through motions)

    • Sx repair slow rehab progression

    • Classifications:

      • 4 Classes

      • P. 480: Table 13-13


    Special tests slap lesions
    Special Tests: SLAP Lesions

    • O’Brien Test

      • Active Compression test

      • 90-90position with HAdd

      • RROM Trials in IR and ER

      • (+) test= pain or clicking at GH joint (not AC)

      • False (+) common


    Special tests gh joint p 453
    Special Tests: GH Joint(p. 453)

    • Anterior Apprehension Test

      • Identifies chronicity of anterior instability

      • Figure Box 13-5

      • PROM ER of GH in 90-90 position

      • Positive (+)= Extreme guarding during test indicates ant laxity or labrum tear


    Special tests gh joint p 465
    Special Tests: GH Joint(p. 465)

    • Relocation Test

      • Confirms instability in GH joint

      • Box 13-12

      • Apprehension test with posterior GH pressure

      • Positive (+)= increased ER or decreased pain without extreme guarding


    Special tests gh joint p 456
    Special Tests: GH Joint(p. 456)

    • Posterior Apprehension Test

    • Box 13-13

    • PROM post. Force in 90 shoulder/elbow flex

    • Positive (+)= Extreme guarding during test

    • Indicates post. Laxity or labrum tear


    Special tests gh joint p 469
    Special Tests: GH Joint(p. 469)

    • Sulcus Sign

      • Confirms instability in GH joint

      • Box 13-15

      • Traction on humerus

      • Positive (+)= increased opening/laxity at GH joint (AC joint remains NML)


    Rotator cuff strains p 474 table 13 12
    Rotator Cuff Strainsp. 474—Table 13-12

    • History

      • excessive ECC motions

      • excessive ROM

      • Dislocation/subluxation

      • PMH of RC tendonitis

    • Palpation

      • tender at RC insertions

      • possible posterior pain

      • Crepitus possible

    • Observation

      • no significant swelling

      • altered posture

      • overhead motions painful

      • painful arc


    Special tests rotator cuff p 475
    Special Tests: Rotator Cuffp. 475

    • Empty Can Test

      • Cintinela Test

      • Box 13-19

      • (+)= Rotator cuff strain

      • Test (B)

      • Multiple tests/trials


    Special tests rotator cuff p 455
    Special Tests: Rotator Cuffp. 455

    • Gerber Lift-Off Test

    • Box 13-7

    • Position: shoulder IR behind back

    • Lift hand away from back

    • Isolates subscapularis


    Shoulder impingement p 470 p 471 table 13 11
    Shoulder Impingement(P. 470, p. 471--Table 13-11)

    • History:

      • usually chronic

      • common with overhead sports

    • Observation:

      • limited AROM

      • painful arc

      • altered mechanics

      • usually no obvious inflammation

    • Palpation:

      • possible crepitus

      • tender RC insertions

      • possible bicipital groove pain

    • Examination

      • Neer’s test

      • Hawkins test


    Rotator cuff impingement special tests
    Rotator Cuff Impingement: Special Tests

    • Neer’s test

      • P. 472: Box 13-16

      • PROM shoulder flexion

      • (+)= pain at endrange

      • May indicate LHB pathology


    Rotator cuff impingement special tests1
    Rotator Cuff Impingement: Special Tests

    • Hawkin’s test

      • P. 473—Box 13-17

      • PROM shoulder IR with flexion

      • (+)= pain at endrange

      • May indicate LHB pathology


    Rotator cuff tendinitis p 471
    Rotator Cuff Tendinitis(P. 471)

    • History:

      • slow onset

      • PMH~impingement or instability

    • Observation:

      • decreased AROM

      • guarded presentation

      • possible post. Atrophy

    • Palpation:

      • subacromial/deltoid pain

      • Posterior pain possible

      • RC insertions painful

    • Examination:

      • Drop arm test

      • Empty can test

      • Impingement tests


    Biceps tendon pathology p 4476
    Biceps Tendon Pathology(p. 4476)

    • History:

      • PMH~RC pathology

      • Overuse or acute onset

      • Forced ROM (ER or Ext) with elbow ext.--ECC or CON

    • Observation:

      • altered mechanics

      • Inflammation

    • Palpation:

      • Tender at bicipital groove

        • Transverse ligament

      • Subluxation of BT

      • dec. MMT in biceps

    • Examination:

      • Yergason test

      • Speed’s test

      • Impingement tests


    Biceps tendon pathology special tests p 477
    Biceps Tendon Pathology: Special Tests(p. 477

    • Yergason Test:

      • Attempt to sublux BT

      • Resisted elbow flexion/supination

      • (+)=pop/snap with pain

        • transverse lig. Sprain

        • biceps tendonitis

        • biceps impingement

      • Box 13-20


    Biceps tendon pathology special tests p 478
    Biceps Tendon PathologySpecial Tests:(p. 478

    • Speed’s Test:

      • Confirms BT inflammation

      • Resisted flexion with GH in anatomical position

      • (+)= pain at BT with RROM

        • no pop/snap felt

        • Box 13-21


    Thoracic outlet syndrome p 480
    Thoracic Outlet Syndrome(P. 480)

    • History:

      • Usu. congenital problem

      • C7 “extra rib”

      • Neurovascular complaints as structures are compressed

    • Observation:

      • x-rays indicates “extra” rib

      • Poor posture (rounded shoulders, forward head)

    • Palpation:

      • Decreased pulse with Adson’s test

      • Altered sensation/temperature

      • Joint edema possible

    • Examination

      • Adson’s test

      • Allen test


    Thoracic outlet syndrome special tests p 482 box 13 24
    Thoracic Outlet SyndromeSpecial tests:p.482—Box 13-24

    • Adson’s test:

      • Attempt to reproduce pressure on neurovasc. bundle

      • ER/ext of shoulder with ext of neck

      • Monitor radial pulse during test

      • (+)= diminished pulse during test

        • false (+) frequent

        • test (B)


    Thoracic outlet syndrome special tests p 483 box 13 25
    Thoracic Outlet Syndrome Special tests:p. 483—Box 13-25

    • Allen test:

      • Attempt to reproduce pressure on neurovasc. bundle

      • ABD/ Hor. ABD of shoulder with rot of neck

      • Monitor radial pulse during test

      • (+)= diminished pulse during test

        • false (+) frequent

        • test (B)


    Pitching motion p 438
    Pitching Motion(P. 438)

    • 5 phases

    • 90 º GH ABD

    • Trunk and legs for power

    • CON-ECC forces for power and protection

    • Pitcher vs. Catcher?


    Shoulder motion
    Shoulder Motion

    • Mobility > Stability

    • OveruseAltered Biomechanicsinjury

    • Good biomechanics prevent injury


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