Shoulder Flashcards by Amanda Ginther

What are intrinsic factors of RTC tendinopathy?

Tendon degeneration due to age
neovascularization
change in vascularity with age
thinning of tendon and increased thickness of the structure
fatty infiltration

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what are extrinsic factors of RTC tendinopathy?

abnormal scapulohumeral rhythm
shortening of posterior/inferior structures and pec minor
thoracic kyphosis
abnormal muscle activation patterns of RTC and scapular stabilizers
osseous changes to the AC joint or coracoacromial ligament due to overuse

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What are the 3 types of shoulder impingement syndrome (SIS)?

subacromial impingement
intrinsic impingement
internal impingement

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what is subacromial impingement?

RTC tendons on the bursal side become comprssed in the subacromial space

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what is intrinsic impingement?

tendon degeneration associated with age, shoulder muscle dysfunction, and overuse of the shoulder

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what is internal impingement?

compression of the articular side of the infraspinatus tendon between between the superior-posterior glenoid rim and the head of the humerus when positioned in 90deg external rotation and 90deg abduction. It is associated with extrinsic factors and commonsly seen in overhead athletes. Sx is pain in the RTC

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What is Glenohumeral Internal Rotation Deficit (GIRD)?

A type of internal impingement. PROM will reveal excessive ER and limited IR with an asymmetry of 25deg or more btwn involved and uninvolved sides

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During functional testing, what symptoms are associated with supraspinatus impingement?

pain and weakness with abduction and external rotation during resisted isometric testing

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What is the Hawkins-Kennedy test?

test of subacromial impingement

client in 90deg scaption or forward flexion, with elbow flexed, arm is passively move into IR

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What is Neers Impingement Test?

test of subacromial impingement

place client in end-range flexion with slight IR and provide overpressure

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what is Yergason’s test?

a test of involvement of the long head of the biceps in subacromial impingement

resisted elbow flexion with supination

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What is the test for posterior internal impingement?

internal impingement between supra and infraspinatus and the posterior superior portion of the glenoid labrum

client is supine in a 90/90 throwing position and overpressure is applied toward more ER and extension

positive test is pain in posterior shoulder

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What are the 3 progressive phases/goals of non-operative rehab for SIS?

Progressions are based on gradual tendon loading and include:
1. decreasing pain and increasing ROM through pain relief modalities and manual techniques, taping, activity modification, postural education, & isometric ther ex for scapular stabilizers and RTC in pain-free tolerance
2. increase ROM and soft tissue extensibility while continuing to decrease pain through pec minor and posterior capsule stretching, job mob to GH and scapulothoracic joints, and isotonic exercise for RTC and scapular stabilizers
3. Progressive strengthening and proprioceptive retraining once strength is 4/5 manual testing or equal to uninvolved side and there is normal GH rhythm

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What are the 3 phases of rehab afer acromioplasty or subacromial decompression (SAD)?

Phase I: 0-2 weeks, decrease pain and increase PROM, pendulum exercises, wear sling between exercise

Phase 2: 2-6 weeks, manage pain, increase PROM, progress A/AAROM, sling as needed

Phase 3: 6-12 weeks, increase to full AROM, strengthen stabilizers for retrurn to function, full end-range AROM and PROM, open and closed chain kinetic training, plyometrics and proprioception drills

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3 symptoms associated with RTC tear

weakness with abduction and external rotation
nocturnal shoulder pain
greater than 60 years of age

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3 tests for supraspinatus tear

CHampagne Toast
Drop Arm Test
Jobe’s or Empty Can

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2 tests for infraspinatus and teres minor tears

External rotation Lag Sign
Horn Blowers

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3 tests for subscapularis tears

LIft Off test
Bear Hug Test
Belly Press

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Describe the Champagne Toast test

test of supraspinatus tear
Position GH joint at 30deg abduction and flexion with slight ER, as if moving to perform a champagne toast. Apply resistance in this position

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describe the Drop Arm Test (aka Codman’s test)

test of supraspinatus tear
Passively elevate pt’s shoulder to 90deg abduction and ak them to hold this position x10s. Postive test when client is unable to hold

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Jobe’s/Empty Can Test

Test of supraspinatus tear
Pt holds arm out into 90deg of scaption and thumb pointed down into internal rotation. Apply resistance

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Describe the External Rotation Lag Sign

special test for infraspinatus and teres minor tears

pt’s elbow flexion to 90deg and humerus held at 20deg elecation in scapular plane at maximal ER less 5deg to allow for elastic recoil
pt asked to hold this position. positive if pt cannot hold position actively. record magnitude of lag to nearest 5deg

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Describe Horn Blower’s Test

test for infraspinatus an teres minor tears
flex pt’s elbow to 90 and shoulder in 90deg and place pt into 5deg less than full ER. Positive if they cannot hold this position

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Describe the Lift Off Test

special test for subscapularis tear
place arm on dosum of the back and ask pt to internally rotate arm to lift hand off back. Pos test if pt unable to lift hand away from their back

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Describe Bear Hug Test

special test for subscap tear Place involved hand on opposite shoulder. Hold this position while therapist attempts to pull hand from shoulder using an ER force. Positive if pt cannot hold the position

describe the Belly Press test

special test for subscap tear ask pt to push into their belly while keeping wrist straight. Positive test is wrist flexion and elbow dropping to side

supraspinatus action

abducts shoulder

infraspinatus and teres minor action

externally rotate shoulder

subscapularis action

internally rotates shoulder

what nerve innervates rhomboids?

dorsal scapular nerve, derived from C4 and C5 nerve roots

nerve most commonly injured in proximal humerus fx?

axillary

nerve most commonly injured in fx of middle third of the humeral shaft?

radial nerve

nerve that innervates latissimus dorsi?

thoracodorsal

nerve that innervates trapezius (upper fibers)?

accessory nerve

nerve that innervates coracobrachialis

musculocutaneous nerve

nerve that innervates subscapularis

subscapular nerve

nerve that innervates levator scapulae

dorsal scapular nerve

nerve that innervates subclavius

5th and 6th cervical nerves

what is the innervation and action of teres major?

adducts and interally rotates the shoulder. Innervated by lower subscapular nerve derviced from posterior cord of C5-C6

which muscles are horizontal abductors of the shoulder?

infraspinatus, posterior deltoid, and teres minor

what is the function and innervation of the coracobrachialis muscle?

flexion and adduction of glenohumeral joint innervated by a branch from the lateral cord and the musculocutaneous nerve originates on coracoid process and attaches to midportion of humerus

what is the function of the supraspinatus

abducts the shoulder and stabilizes humeral head in the GH joint during movement

what do infraspinatus and teres minor do?

externally rotate the humerus and stabilize humeral head during GH movement

what does teres major do?

internally rotates, adducts, and extends the shoulder

what does latissimus dorsi do?

internally rotates, adducts, and extends the shoulder

what are the four acromion shape types?

1. flat (15% population) 2. curved (43%) 3. hooked (39%) 4. convex/upturned (3%)

what is an arthrogram?

injecting a spinal needle into the shoulder joint under fluoroscope followed by injection of contrast medium to diagnose possible labral pathology

when treating RTC tendinitis/impingement, what main treatments should be performed?

strengthening the deltoid and scapulothoracic stabilizers while stretching pec minor

what are the scapular stabilizers?

serratus anterior, rhomboid major and minor, levator scapulae, and trapezius

what is a force couple?

2 forces of equal magnitude that work in opposite directs to produce rotation on a body

what are two force couples that move the shoulder?

1. levator scap, upper trap, lower trap, and serratus anterior produce a smooth, rythmic motion to rotate and protract the scapula during UE elevation 2. RTC and deltoid are a force couple of the GH joint

what is a SICK scapula?

Scapula Infera Coracoid Dyskinesis A muscular overuse fatigue syndrome commonly seen in athletes with 3 major components: 1. scapula drops or is lower than other side 2. scapula is protracted 3. scapula displays increased abduction compared to other side

what clinical test can help differentiate between cervical pain from primary shoulder pain?

subacromial injection can differentiate between referred neural pain from cervical region. relief of pain with subacromial injection confirms shoulder pathology as the source of pain

what is the action of serratus anterior?

scapular abduction and upward/downward rotation of the scapula

what is the rotator interval?

anatomical space between the anterior border of the supraspinatus and the superior border of the subscapularis and reinforced by the coracoacromial ligament

what is a Hill-Sachs lesion?

impaction fracture of the posterosuperior humeral head

which exercises target periscapular strengthening and treatment of glenohumeral stability?

push-ups with a plus is the primary exercise others include prone extension, horizontal abduction at 90deg with full external rotation, lawnmower, dynamic hug, and wall slide on forearms all target serratus anterior and middle and lower trapezius muscles

In a GH arthroplasty, which is the only muscle transected and then repaired upon closure

subscapularis

what is the ideal GH angular position for shoiulder arthrodesis?

30deg abduction 30deg flexion 30deg internal rotation

in which direction does a shoulder typically dislocate after conventional TSA?

abduction and external rotation

in which direction does a shoulder typically dislocate after rTSA?

adduction with combined internal rotation and extension this position allows the prosthesis to escape anteriorly and inferiorly

what is the capsular pattern for adhesive capsulitis?

both AROM and PROM are limited with PROM being restricted in the capsular pattern of external rotation being most limited followed by abduction and internal rotation

where do most adhesions occur in adhesive capsulitis?

In the anteroinferior portion of the capsule this should be the focus of mobilization, modalities, and stretching

where does the subscapularis refer pain?

posterior deltoid, scapula, posterior arm, and wrist

where does infraspinatus refer pain?

anterior deltoid, shoulder joint, and medial border of the scapula, and to the front and lateral aspects of the arm and forearm

what RTC muscle is the main stabilizer of the scapula?

subscapularis b/c of this, most sholder injuries involve subscapularis subscap function affects scapular-humeral rhythm, thus causing abnormal shoulder mechanics during movement

what is the "terrible triad of the shoulder"?

rare combination of anterior shoulder dislocation, RTC tear, and neurologic injury

what is a "sail sign"?

radiograph finding which appears as a sail from a boat sign of effusion in the anterior fat pad of the elbow

in what position would you place your arm to isolate infraspinatus for palpation?

90 deg flexion, slight horizontal adduction, and external rotation

when is shoulder AROM typically initiated after a standard post-op medium sized RTC repair?

6 weeks post-op rehab typically includes PROM, pain-control, pendulum, elbow ROM, and modalities x6 weeks

which cervical structures can refer pain to the shoulder?

discs, facets, nerve roots, intrinsic soft tissue (muscles, ligaments, joint capsules), and extrinsic musculature cervical screenings such as ROM, spurling's test, and cervical distraction test can help differentiate

what is the capsular pattern for the GH joint?

External rotation limited more than abduction; abduction limited more than internal rotation

A positive scapular flip sign occurs when the medial border of the scapula flips from the thoracic wall. This pathology can be an indicator of what type of palsy?

Spinal accessory nerve palsy

Shoulder Flashcards

(73 cards)