Shoulder Flashcards
(32 cards)
Instability tests
Sulcus sign 0* - 2 or more fingers = abnormal
Sulcus sign 90* - 2 or more fingers = abnormal
Anterior load and shift
Posterior load and shift
Labrum enhances stability (5)
-Expands the overall size and depth of glenoid
-Increases the superior/inferior diameter by 75%
-increases the posterior diameter by 50%
-serves as primary attachment of capsule & GH ligaments
- superior is LHB attachment
Biceps important for what in GH joint?
Anterior stability
Positive on all 4 GH instability tests means what?
Multi-directional instability
SLAP lesion tests
Compression-rotation
Anterior slide
Posterior slide
Speeds test
O’Brien’s compression - not sensitive to specific structures, thumb down - AC, thumb up - SLAP
Yergason’s
Subacromial Pain Syndrome Tests
Neer impingement
Hawkins-Kennedy
Painful Arc test
Scapular assist test
AC joint tests
Cross-body adduction
AC shear
O’Briens active compression
Slap Lesion Grade 1
SLAP degenerative
Marked fraying w/degenerative appearance
Periphery attached
LHB firmly attached
Slap Lesion Grade 2
Degenerative & fraying
Superior labrum & biceps tendon stripped off underlying glenoid
Results in labral-biceps anchor being unstable & pulled away from glenoid
Most common tear
Slap Lesion Grade 3
Bucket handle type tear
Central portion displace into the joint while periphery firmly attached to glenoid
Slap Lesion Grade 4
-Bucket handle tear w/extension into biceps
-Labral flap tends to displace into joint
Slap Lesion Type 1 Treatment parameters
ROM
As tolerated, no restrictions
Protection phase: Biceps (7-10 days)
Return to sport
Dependent on strength & biomechanics of shoulder
Prognosis: 2-4 weeks
Slap lesion type 2 Treatment Parameters
Sling x 4 weeks at all times
Gentle PROM only for week 1.
Full ROM by 6 weeks w/combined ER and abduction the LAST motion achieved
Protection
Avoid biceps resistance ex for 10-12 weeks, no ER beyond neutral x 4 weeks, 40 degrees x 6 weeks
Gentle elbow/wrist/hand ex start day after surgery & continue throughout
After 7-10 days, PT focusing on gentle PROM w/in pain-free range; avoid ER beyond neutral & ext behind body x 4 weeks
Slap Lesion Type 3 Treatment Parameters
ROM: similar to type II BUT 1-2 weeks slower
Protection: same as type II
Return to activity: same as type II
Slap Lesion Type 4 Treatment Parameters
ROM: dependent of surgery. Excision sling for 3 weeks. Full ROM by 6 weeks
Protection: avoid biceps for 6 weeks if tenodesis or 10 weeks if repaired
Return to sport: 8-10 weeks
Return to throwing: 3-4 months
AC joint injuries
Grade 1: AC lig sprain
Grade 2: AC tear and CC ligament sprain
Grade 3: AC and CC ligament rupture
Sites of impingement
AC Joint
Undersurface of Acromion
CA Ligament
Coracoid Process
Subacromial pain syndrome signs
Limited AROM ABD and ER
Painful Arc 70-120
PROM full w/o pain
+ impingement tests
supraspinatus painful and weak
Primary impingement
Degenerative changes to acromion/coracoid
Capsular tightness
Faulty posture
Secondary impingement
Change in F couple/muscle
Abnormal movement patterns of GH/ Scapulothoracic joint
Instability of Scapula or GH joint
3 types of AC morphology
Type 1 Human hanging off a rock, 90% surgery success rate
Type 2: more hooked, 60-70%
Type 3: supah hooked, 50-60%
3 Stages of shoulder impingement
1: Bursitis/Tendonitis: Edema, hemorrhage
2: Partial tear and/or tissue fibrosis
3: Full Thickness Tears
Type 1 Shoulder impingement objective findings
Painful arc
RC and or Scapular Weakness
Positive tests
Stage 2 Shoulder impingement objective findings
Crepitus and Catching
Limited ROM
