Shoulder

Question 1

Primary Scapular Stabilizers

Answer 1

-serratus
-rhomboids
-traps
-levator

Question 2

Secondary Scapular Stabilizer

Answer 2

-lats
-pec minor

Question 3

Impingement Syndrome

Answer 3

-scompression and damage to soft tissue within the structure (MC: subacromial, supra, infra, bicep)

S/S: ant/lat pain and flx/abd for external inpingement, pos pain and ER/IR issues for internal, weakness of RTC muscles, ROM issues

Cause:
Primary: structure abnormalities (internal impingement), dimished space
Secondary: excessive acromion curve

Better: rest

Worse: overhead activities

Treatment:
-PT: inflammation, scapular increase strength, normalize scapulothoracic rhythm

Question 4

Rotator Cuff Tears

Answer 4

-SITS
I: Bursitis or tendonitis, pain
II: partial rotator cuff
III: full thickness, loss of ROM and strength

S/S: deltoid pain, greater tub, upper trap

Cause: chronic and degenerative
Intrinsic: blood supply
Extrinsic: acromion morphology, acute injury

Better: out of aggravating position, retraction

Worse: recruitment of supra, protraction

Treatment:
-PT: increase ROM, prevent freezing, strength
-Non surgical: loss of strengthh
-Surgical: immobilized, no AROM for 4-6w, PROM, scap mobilization

Question 5

Biceps Tendon Pathology

Answer 5

Tendonitis: acute inflammatory
Tendonosis: degenerative; microtrauma
Rupture
Tendinopathy

S/S: anterior GH pain, weakness in shoulder
Cause: mechanical stress, overhead mmt, functional factora

Better: avoidance of lifting, stretching

Worse: overhead lifting

Treatment:
-PT: 6-8w recovery, rest < massage < mobilization < stabilitty < stength (closed then open)

Question 6

Shoulder Labral Tears

Answer 6

-SLAP (superior labrum ant to post)
-Bankheart (2-6oclock, bicep tendon ass. witth ant dislocation)
-Psterior Labral Lesions (internal impingement)

S/S: aching, instability, catching, popping

Cause: FOOSH, overhead mmt, traction, trauma, dislocation, impingement

Better: out of agg. position, retracion

Worse: overhead activity, liting, hands behind back

Treatment:
-PT: prehab: ROM, prevent freezing, strength
-Surgical: Slap (no PROM ER, no bicep AROM 4w), Bankhart (no ER past 30 4w)
-isometrics, scap mobilization

Question 7

Shoulder Instability

Answer 7

-laxity of joint capsule

S/S: pain over deltoid, weakness, neural irritation

Cause: overhead repetitive mmts, dislocations/subluxations, trauma

Better: avoid aggr.

Worse: 90/90, overhead activity

Treatment:
-PT: reduce chance of redislocation, ROM, strength

Question 8

Adhesive Capsulitis

Answer 8

-inflamed and stiff shoulder capsule

S/S: loss of ROM, pain in deltoid, nocturnal pain hallmark

Phase 1: insidious, nocturnal pain
Phase 2: diminished pain, ROM loss
Phase 3: pain gone, ROM increases 12-24

Cause:
Primary: insidious
Secondary: response to trauma
-DM, hyperthyrpidism, hypertriglyceridemia

Better: pendulum exercises, steriod injections

Worse: moving arm

Treatment:
-PT: ROM,
-closed manipulation under anesthesia