(2): Lecture 9: Shoulder Injuries Part 2 Flashcards
Functions of the Rotator Cuff
Move shoulder thru ROM
- abduction: supraspinatus
- internal rotation: subscapularis
- external rotation: infraspinatus + teres minor
acts as humeral head stabilizer
Rotator Cuff strains/tears in YOUNG athlete
- SUDDEN onset
- usually some type of acute overload
- twinge in shoulder
- some limitation in function
- graded 1-3
- responds quickly to rest and rehab
Drop arm test
Helps diagnose RC strains/tears
Abduct arms to sides and drop arms
Tear of cuff - emphasis on SUPRASPINATUS
Rotator Cuff strains/tears in OLDER athlete (35+)
- shoulder pain during activity
- usually SLOWER onset
- inability to sleep on shoulder or w/ arm above head
- usually weak RC
- positive impingement signs
- tendinosis
Shoulder impingement
Primary: due to SHAPE of acromion
Secondary: cause by
- weakness of scapular stabilizers = affects scapular position
- poor centralization of humeral head due to weakness/imbalance of RC muscles
w/ impingement, humerus is pulled too far UP and pinches supraspinatus/subacromial bursa
pain during ROM btwn 70-120 degrees
Muscular imbalance
- deltoid cannot initiate abduction b/c line of pull is parallel to hunmerus (points up)
- supraspinatus can initiate abduction b/c it is perpendicular (first 30 degrees)
- once started, deltoid has a strong superior pull on humerus withing glenoid and takes over
Symptoms of Impingement causing RC tendinitis/tendinopathy
- diffuse pain around acromion and over deltoid
- overhead activities increase pain
- feels OK below shoulder height
- difficulty sleeping on shoulder
Signs of Impingement causing RC tendinitis/tendinopathy
- painful arc (70-120 degrees)
- OK below 90 degrees
- weak external rotators w/ scapula stabilized
- poor scapulohumeral rhythm
- poor jt stability
- POSITIVE HAWKINS-KENNEDY + NEER TESTS
Hawkins-Kennedy Test
tests for IMPINGEMENT
- abduct 90 degrees fwd
- flex at elbow
- internally rotate
Supraspinatus pinched beneath coraco-acromial arch
Neer Test
tests for IMPINGEMENT
straight arm up
supraspinatus pinched beneath coraco-acromial arch
Treatment of shoulder impingement
- palliate pain
- idealize/maintain ROM
- strengthen scapular stabilizers
- strengthen RC
- reinforce proper movement patterns
Special tests
- manual muscle testing
- other structure specific tests (muscle, ligament, bursa, etc)
Manual Muscle Testing
- which muscle are we concerned about?
- what position should it be in?
- how do we interpret this? (Oxford scale)
Structure Specific Special Tests
- which ones do we apply?
Ex. for subscapularis - apprehension
- Fowler Reduction/relocation
Fowler reduction/relocation test
Use hand to push black to re-centralize humeral head = put it back in
- take pressure off anterior IGHL
- A-P pressure on GH jt.
- centralizes humeral head
- takes pressure off anterior capsule
- feels better = positive test
