Shoulder

Question 1

What is the DASH questionnaire?

Answer 1

patient asked about 30 functional tasks, scored 0-4 on the tasks. max score is 80
LOWER score= greater disability

Question 2

what is the shoulder pain and disability index (SPADI)?

Answer 2

measurement of 13 items scored on VAS, 8 items physical function, 5 items pain related
Max score=100
HIGHER score= greater disability

Question 3

What is the ASES questionare?

Answer 3

10 items scored on VAS
Max score=100
LOWER score= greater disability

Question 4

What should you look at when observing a patient with shoulder pathology?

Answer 4

irritability of the condition
(Are they holding their arm close to them?)
posture
head position
scapular dumping?

Question 5

Order of shoulder screen assessments?

Answer 5

AROM/PROM
repeated movement testing
joint play
muscle performance
functional testing
Provacation palpation

Question 6

How do you assess movement patters of an individual with shoulder pathology?

Answer 6

observe if they are using their shoulder for movement.
Are they substituting with scapula, trunk, or head?

Question 7

potential causes for Traumatic onset of shoulder pain?

Answer 7

fall onto lateral shoulder
forced external rotation
dislocation (dashboard/steering wheel during MVA)
FOOSH (posterior dilocation

Question 8

Potential causes for insidious onset of shoulder pain?

Answer 8

overhead use
lifting and carrying
seated work life
Change in athletics, occupation, ADL’s
Change in health status

Question 9

Complaints of popping/shifting can indicate potential injury to what?

Answer 9

general instability
weakness of RC/capsule

Question 10

Complaints of clicking, snapping, grinding can indicate?

Answer 10

Clicking: labral issue
grinding: arthritic issue
Snapping: tendon/ bone issue

Question 11

C/O aching can indicate?

Answer 11

muscle issue

Question 12

C/O sharp pain, numbness, dead arm can indiciate?

Answer 12

nerve issue

Question 13

C/O of shoulder stiffness can indicate?

Answer 13

arthritis issue

Question 14

what degree range is the glenohumeral painful arc?

Answer 14

60-120*

Question 15

what degree range is the acromioclavicular painful arc?

Answer 15

170-180*

Question 16

Source of neuromuscular shoulder pain?

Answer 16

cervical radiculopathy
Brachial plexopathy
neurologic amytrophy
Focal mononeuropathy
Muscular dystrophy

Question 17

Source of cardiovascular shoulder pain?

Answer 17

Cardiac ischemia, thoracic outlet syndrome, aortic disease, axillary thrombosis

Question 18

Source of pulmonary shoulder pain?

Answer 18

pneumonia, pulmonary embolism, pneumothorax, pneumoperitoneum

Question 19

Source of malignant shoulder pain?

Answer 19

metastatic cancer

Question 20

source of abdominal shoulder pain?

Answer 20

billary disease, hepatic disease, pancreatitis, splenic injury, perforated viscuss

Question 21

What is Ehlers-Danlos disorder?

Answer 21

defect in collagen synthesis, higher rates of hypermobility
higher incidence of dislocation

Question 22

what is marfan’s syndrome?

Answer 22

Genetic disorder of connective tissue, disproportionately long limbs, fingers, statue, predisposal to CV disorders
Hyper mobile—> higher incidence of dislocation

Question 23

Beighton index hypermobility score ranges?

Answer 23

0-3: normal
4-9: hypermobile
5 positions: 8 total components (tested on both sides)

Question 24

What are some warning signs that shoulder pain may be visceral?

Answer 24

constant pain, no relief with rest
insidious onset
pain in throbbing
Fever, nausea, weight loss, dizziness
pain changes with eating, sneezing, breathing, walking

Question 25

Warning signs that shoulder pathology may be a fracture?

Answer 25

traumatic onset pain worse during sleep

Question 26

Why is age >50 a red flag complaint?

Answer 26

they have increased risk of RC tear or other serious patholgies

Question 27

why is night pain and weight loss a red flag complaint?

Answer 27

Sign of cancer

Question 28

Where does an MI refer pain to?

Answer 28

left shoulder

Question 29

why is pleurtic pain a red flag complaint?

Answer 29

increased risk for pancoast tumor

Question 30

List the red flag complaints?

Answer 30

age>50 night pain, weight loss fever pain unrelated to activity, not relieved with rest history of smoking History of cancer Pleuritic pain

Question 31

What are you looking for in regards to skin characteristics?

Answer 31

vasculature incisions/lesions

Question 32

What are some potential defects you may see in the arm?

Answer 32

Popeyes sign suprascapular atrophy subscapular atrophy axillary atrophy Accessory long thoracic

Question 33

Signs that the shoulder complex has impaired smoothness?

Answer 33

clicking, popping, grating

Question 34

What are you looking for during inspection of the shoulder?

Answer 34

Skeletal abnormalities (posture, prominence) Skin characteristics Defects (popeye or ludington sign) Hypertrophy (upper trap)

Question 35

Axillary n. issue would result in atrophy of which muscles?

Answer 35

delt and teres minor

Question 36

accessory n issue would result in atrophy of which muscles?

Answer 36

trapezius, SCM

Question 37

Suprascapular n. issue would result in atrophy of which muscles?

Answer 37

infraspinatus, supraspinatus

Question 38

subscap nerve issue would result in atrophy to which muscles?

Answer 38

subscapularis (upper+ lower), teres major (lower)

Question 39

Long thoracic n issue would result in atrophy to which muscles?

Answer 39

serratus ant. (scapular winging)

Question 40

what does it mean if mid range AROM is unstable?

Answer 40

pathology not related to capsule

Question 41

what does it mean if end range AROM is unstable?

Answer 41

pathology most likely related to joint capsule

Question 42

Normal range of shoulder... Flexion? Abduction? Extension ER? IR?

Answer 42

180 180 60 90 70

Question 43

ER 90* scaption and abduction is associated with which capsular instability?

Answer 43

anterior dislocation

Question 44

Horizontal Adduction and IR are associated with which capsular instability?

Answer 44

posterior dislocation

Question 45

how do you assess movement patters of an individual with shoulder pathology?

Answer 45

observe if they are using their shoulder for movement. Are they substituting with scapula, trunk, or head?

Question 46

how do you assess glenohumeral active range of motion?

Answer 46

you dont its only done passively

Question 47

what is a derangement in the shoulder?

Answer 47

internal distrubance in normal resting position of joint resulting in pain

Question 48

How does shoulder derangement present?

Answer 48

rapid changes in symptoms pain most likely intermittent limitations depend on the day Usually insidious onset

Question 49

How does shoulder articular dysfunction present?

Answer 49

intermittent pain pain at end range when structures are stretches no rapid change in symptoms

Question 50

How does shoulder contractile dysfunction present?

Answer 50

intermittent pain pain with active contraction no rapid changes of symptoms

Question 51

How does postural syndrome present?

Answer 51

Normal tissues under sustained loads Resolves with position changes

Question 52

which joint play movements can be do in glenohumeral joint?

Answer 52

anterior, posterior, inferior glides

Question 53

what joint play movements can be done at scapula?

Answer 53

elevation depression upward/downward rotation protraction retraction

Question 54

what joint play movements can be done at AC joint?

Answer 54

anterior posterior glide

Question 55

What joint play movements can be done at sternoclavicular joint?

Answer 55

superior, inferior anterior, posterior

Question 56

What joint play movements can be done at thoracic spine?

Answer 56

CVP IVP

Question 57

what glides occur during flexion?

Answer 57

posterior and inferior glide

Question 58

what glides occur during extension?

Answer 58

anterior

Question 59

what glides occur during abduction?

Answer 59

inferior glide @ humerus Inferior glide @ clavicle

Question 60

What glides occur during IR?

Answer 60

posterior glide

Question 61

What glides occur during ER?

Answer 61

technically anterior glide but since many people have bad posture (posterior glide)

Question 62

Should u do shoulder or scapular MMT first?

Answer 62

scapula will affect where you place support during shoulder assessment

Question 63

Rule IN rotator cuff syndrome if?

Answer 63

symptoms worsen with overhead activity midrange catching sensation MMT to RC flexion and abduction= pain RC weakness

Question 64

Rule OUT RC syndrome if?

Answer 64

MMT is pain free RC and biceps have normal strength Loss of passive ROM

Question 65

Diagnostic cluster for RC tear?

Answer 65

Age>65 Night pain ER weakness also Age>60 painful arc drop arm infraspinatus

Question 66

>_____* loss of force at 10*abduction is indicative of?

Answer 66

50% RC tear

Question 67

What tests help to confirm full thickness supraspinatus tear?

Answer 67

empty/full can External rotation lag sign

Question 68

what tests help to confirm full thickness infraspinatus tear?

Answer 68

external rotation lag sign

Question 69

what tests help to confirm full thickness subscap tear?

Answer 69

lift off + belly press or bear hug + belly press

Question 70

What tests help to confirm rotator cuff partial tear?

Answer 70

painful arc

Question 71

What does speeds test help to diagnose?

Answer 71

long head of biceps tendinopathy

Question 72

What does ludingtons test help to diagnose?

Answer 72

long head of biceps tendon rupture

Question 73

What test cluster should you use for impingement syndrome?

Answer 73

painful arc infraspinatus test hawkins Kennedy

Question 74

what is the scapular assistance test?

Answer 74

assisting upward rotation Should decrease pain

Question 75

what is scapular resistance test?

Answer 75

stabilization of medial border of scap improves painful arc

Question 76

What does the internal rotation resisted strength test help differentiate between?

Answer 76

RC tendinopathy v.s intra-articular pathology

Question 77

Internal rotation resisted strength test... if IR>ER strength then what is the pathology? If ER> IR what is the pathology?

Answer 77

RC tendinopathy intra-articular pathology

Question 78

What is a hill sachs lesion?

Answer 78

anterior labral tear and posterior humeral head fracture

Question 79

What is a bankart lesion?

Answer 79

anterior inferior labrum tear Issue with instability

Question 80

what is a reverse hill sachs fracture?

Answer 80

anterior medial humeral head fracture

Question 81

What two special tests assess for superior labral tear?

Answer 81

Active compression test biceps tendon II test

Question 82

What two special tests assess for posterior dislocation?

Answer 82

jerk test kims test

Question 83

what two special tests assess for AC pathology?

Answer 83

AC resisted extension active compression test cross body adduction test

Question 84

Rule IN adhesive capsulitis if?

Answer 84

patient is 40-65 gradual onset of worsening stiffness/pain pain + stiffness limit sleeping PROM limited in multiple directions

Question 85

Rule OUT adhesive capsulitis if?

Answer 85

PROM is normal radiographic arthritis is present ER and IR PROM increases with 45* abduction

Question 86

what tendons can you palpate in the shoulder?

Answer 86

supraspinatus infraspinatus teres minor subscap LHB

Question 87

High irritability is characterized by?

Answer 87

high pain levels (7/10) consistent night/resting pain high levels of disability pain before end range AROM < PROM

Question 88

Moderate irritability is characterized by?

Answer 88

moderate pain (4-6/10) intermittent night/resting pain moderate disability pain at end range AROM=PROM

Question 89

Low irritability is characterized by?

Answer 89

pain 3/10 no night/resting pain minimal disability pain with overpressure AROM =PROM

Question 90

Pain control interventions

Answer 90

Pt education PROM in pain free range AROM in pain free range Submax isometrics manual scap stabilization non-thrust Soft tissue techniques Modalites

Question 91

how are submax isometrics prescribed?

Answer 91

5 second hold, no pain, 10 reps, throughout day 5-50% MVIC

Question 92

What are types of soft tissue techniques?

Answer 92

Strain counter strain, AR, PNF, tooling

Question 93

Priority impairments for someone in the mobility group?

Answer 93

pain with motion decreased joint play decreased ROM poor posture Decreased MMT substitution of GH motion with scapulohumeral

Question 94

Intervention strategies for mobility group?

Answer 94

PROM/AAROM/AROM Stretching: PNF, contract relax Non-thrust: III, IV MWM Motor control (sequencing of scap movement)

Question 95

How do you decreased capsule, ligament, fascia extensibility?

Answer 95

creep, stress relaxation

Question 96

how do you stretch a tight muscle?

Answer 96

3-5 sets of 30-60s hold

Question 97

how do you stretch a spasming muscle?

Answer 97

PNF, active release

Question 98

What does the cross-body stretch help?

Answer 98

posterior capsule movement

Question 99

What is a grade V non-thrust?

Answer 99

trust manipulation

Question 100

which direction joint mob increases ER?

Answer 100

posterior glid

Question 101

How do you perform repeated movements for the shoulder joint?

Answer 101

extension with cane sets of 10

Question 102

What exercises can be used for scapula?

Answer 102

I,Y,T

Question 103

what are rhythmic stabilization exercises good for?

Answer 103

multidirectional instability, dislocation, RC tear

Question 104

Give an example of a rhythmic stabilization exercise?

Answer 104

ball on the wall RC and scap exercise with pertubation Bosu ball plank

Question 105

what percent stronger is dominant arm compared to non-dominant?

Answer 105

15-30%

Question 106

Training of what movement will improve all other shoulder movements?

Answer 106

IR/ER training

Question 107

Is training ER /IR in side lying vs standing easier Or harder

Answer 107

harder, adding gravity

Question 108

How do you program RC strength exercises?

Answer 108

starts with 3-5 sets light weight 15-20 reps

Question 109

at what point of rehab do you want to include speed training?

Answer 109

at the end speed increases injury risk

Question 110

Your doing great! Keep up the good work

Answer 110

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