Common Shoulder conditions Flashcards
Internal (posterosuperior glenoid) impingement
Lead to Secondary impingement
S&S:
- Insidious deep pain
- Posterior/ superior pain with ABD and ER
- Pain during eccentric activities of UL (e.g., throwing a ball)
- Young and active overhead athlete
CA:
Jobe –
Neer + (post P°)
Hawkins –
Apprehension + (post P°)
Relocation + release P°
Overhead athletes: handball, baseball, swimming, volleyball
External (subacromial) impingement
S&S:
- Anterolateral pain
- Pain with overhead activities
- Painful arc with arm elevation
- Complaining of night pain
CA:
Jobe +
Neer + ant
Hawkins-Kennedy +
Apprehension + ant P°
Relocation –
-> Primary impingement
Relocation + release P°
-> Secondary impingement
Primary impingement - structural
Secondary impingement - functional problem such as:
- RC weakness
- Instability
- SD
- Biceps pathology
=> All cause instability of humeral head, affecting shoulder kinematics, and leading to impingement
RC tears
RF: Age > 60 AND weakness in ER AND night pain -> 98% of RC tear
S&S:
- Pain radiating to the lateral mid-humerus or anterolateral acromion
- Pain while lying on the shoulder or sleeping with the arm overhead
- Pain that occurs when reaching above the head
CA:
< AROM, PROM normal
SS/IS: + Jobe test
SC: + lift off and belly press test
Scapular Dyskinesis (SD) - Altered scapular motion and position
May be related also to:
- Bony causes (e.g., thoracic kyphosis or clavicle fracture mal-union)
- Articular causes (e.g., AC or GH instability)
MOI:
Lack of soft tissue flexibility
- Tightness of posterior capsule and pectoralis minor linked to altered scapular kinematics
Lack of muscle performance
- Decreased strength of serratus anterior
- Hyperactivity and early activation of upper trapezius (shoulder shrug during arm elevation)
- Late activation of the scapula stabilizers: middle and lower trapezius
CA:
In resting position, excessive protraction, elevation, and anterior tilt of the scapula, reflected in the observed signs:
- Winging of the scapula (inferior or medial)
- Inferior and medial borders prominence
During arm elevation:
- Early scapular elevation (shrug)
- Rapid downward rotation during arm lowering
SAT +
SRT+
GH instability - Traumatic
Often associated to Bankart and Hill-Sachs lesions (requires surgery)
MOI: Result of a direct contact, leading to anterior dislocation of the humerus 90° ABD + ER
S&S: On observation there is a prominent humeral head and a space below the acromion
CT:
Apprehension + (appr)
Relocation + (appr)
Laxity test (Load and shift test, ant.; Sulcus sign, inf.; Posterior laxity test, post.)
Acquired GH instability - SLAP injury
MOI: Eccentric traction of biceps tendon:
- Eccentric follow-through of long head of biceps tendon after throwing
- Peel-back mechanism during extreme ER
S&S:
- Clunking sound, catching, locking
- Deep shoulder pain, intermittent and related with overhead activities
- Painful arc (?)
- Pain and loss of function particularly in overhead activities
- An athletes will complain about inability to perform activities in high level
- Pain with passive ER in 90 ABD
CT:
O’Brien test +
Speed’s test +
Biceps load II +
(Crank test +)
(Jerk test +)
Glenohumeral internal rotation deficit (G.I.R.D.)
Common in overhead athletes
MOI:
- Repetitive throwing
- Tightening of posterior capsule or posteroinferior capsule leads to an increased anterior translation of humeral head (capsular constraint mechanisms)
- Decreased subacromial space
CA:
< IR ROM
Related to both form of shoulder impingement
Acromioclavicular spain
MOI: Traumatic injury, affecting mainly the capsule, and ligaments, but also muscles, skin, and fascia
(6 categories from slightest to greatest injury)
CT:
Painful arc test + (between 170° - 180°)
Cross body adduction +
Biceps Tendinopathy
Occurs primarily in the long head of biceps tendon
MOI: is a result of shoulder instability, impingement, RC pathology, or overuse of the shoulder
S&S:
- Tenderness in the bicipital groove
- Night pain
- Pain at rest
ST: Speed test +
