Shoulder Flashcards
(197 cards)
1
Q
Function of the shoulder
A
Position/move arm for purpose of hand function
2
Q
The spine of the scapula is usually at the level of what SP?
A
T3
3
Q
Palpate Greater Tubercle
A
Just posterior to bicipital groove
4
Q
Palpate Lesser Tubercle
A
Just anterior to bicipital groove
5
Q
Palpate bicipital groove
A
Anterior to greater tubercle; internal/external rotation, bicep contraction to double check.
6
Q
Deltoids
A
Origin:
(anterior) lateral 1/3 clavicle
(middle) acromion process
(posterior) spine of the scapula
Insertion: deltoid tuberosity
Action: (all) abduction
(anterior) flexion, medial rotation, horizontal adduction
(posterior) extension, external rotation, horizontal abduction
Nerve: Axillary (C5,6)
Artery: anterior and posterior circumflex
7
Q
Supraspinatus
A
Origin: supraspinous fossa
Insertion: greater tubercle (superior facet)
Action: abduction
Suprascapular nerve
Suprascapular artery
8
Q
Infraspinatus
A
Origin: infraspinous fossa
Insertion: greater tubercle (middle facet)
Action: external rotation
Suprascapular nerve
Suprascapular artery
9
Q
Biceps Brachii
A
Origin:
(long) supraglenoid tubercle
(short) coracoid process
Insertion: radial tuberosity and bicipital aponeurosis
Action: GH flexion, elbow flexion, forearm supination
Musculocutaneous nerve
Brachial artery
10
Q
Teres Minor
A
Origin: lateral scapula (superior/middle)
Insertion: greater tubercle (inferior facet)
Action: external rotation
[Can blend in with infraspinatus]
Axillary nerve
Circumflex scapular and circumflex humeral artieries
11
Q
Teres Major
A
Origin: Lateral scapula (inferior portion)
Insertion: Bicipital groove (medial lip)
Actions: internal rotation, adduction, extension
[can blend in with lats]
Lower subscapular nerve
Circumflex scapular artery
12
Q
Subscapularis
A
Origin: subscapular fossa
Insertion: lesser tubercle
Action: medial rotation
Upper and lower subscapular nerves
Circumflex scapular, dorsal, and suprascapular arteries
13
Q
Subclavius
A
First rib to clavicle (middle of inferior surface)
Action: depresses clavicle at sternoclavicular joint; elevates 1st rib at sternocostal and costalspinal joints (during inspiration)
Intercostal nerves
Anterior and posterior intercostal arteries
14
Q
Latissimus Dorsi
A
Origin: SPs of T7-L5, posterior iliac crest, sacrum, R8-12. Occasionally inferior scapula
Insertion: Medial lip of bicipital groove
Action: extension, medial rotation, adduction, anterior pelvic tilt
Thoracodorsal nerve
Thoracodorsal and posterior intercostal artery,
15
Q
Pectoralis Major
A
Origin: medial 1/2 of clavicle; sternum and costal cartilage 1-7
Insertion: lateral lip of bicipital groove
Action: flexion, adduction, medial rotation, horizontal adduction
Medial and lateral pectoral nerves Thoracoacromial artery (branch of axillary)
16
Q
Pectoralis Minor
A
Origin: R 3-5
Insertion: corocoid process
Action: protraction and depression of scapula; elevation of ribs 3-5
Medial and lateral pectoral nerves Thoracoacromial artery (branch of axillary)
17
Q
Serratus Anterior
A
Origin: Anterolateral portion of R1-9
Insertion: Anterior surface of medial border of scapula
Action: protraction and upwards rotation of scapula
Long thoracic nerve Dorsal scapular (subclavian) and lateral throracic (axillary) arteriesi
18
Q
Upper Trapezius
A
Origin: EOP and medial 1/3 of superior nuchal line, nuchal ligament, SP of C7
Insertion: acromion and lateral 1/3 clavicle
Action: scapular retraction and elevation
Spinal Accessory Nerve (CN XI)
Transverse cervical and dorsal scapular arteries
19
Q
Middle Trapezius
A
Origin: SPs of T1-5
Insertion: Acromion and spine of scapula
Action: scapular retraction
Spinal Accessory Nerve (CN XI)
Transverse cervical and dorsal scapular arteries
20
Q
Lower Trapezius
A
Origin: SPs of T6-12
Insertion: root of the spine of the scapula
Action: scapular retraction and depression
Spinal Accessory Nerve (CN XI)
Transverse cervical and dorsal scapular arteries
21
Q
Rhomboids
A
Origin:
(minor) SPs of C7-T1
(major) SPs of T2-5
Insertion: medial scapula (superior/inferior respectively)
Action: retraction and elevation
Dorsal scapular nerve
Dorsal scapular artery
22
Q
Sternocleidomastoid
A
Origin:
(sternal) manubrium
(clavicular) medial 1/3 clavicle
Insertion: mastoid process (temporal), lateral 1/2 of superior nuchal line (occipital)
Actions: Flexion of lower neck C0-C1 extension Lateral flexion CL rotation
23
Q
Suprascapular Nerve
A
C4,5,6 Brachial plexus Lateral beneath traps and omohyoid Suprascapular notch Swoops laterally around spine of scapula
Suprapinatus
Infraspinatus
24
Q
Axillary Nerve
A
C5,6 Brachial plexus Under clavicle Through axillary space Exits out quadrangular space (three swoops)
Deltoids, T. minor, triceps (long head)
25
Lateral Pectoral Nerve
C5,6,7
Brachial plexus
Under clavicle, emerging just before Pec Minor
Veers medially
Pec major, minor
26
Musculocutaneous Nerve
```
C5,6,7
Brachial plexus
Under clavicle
Straight down arm Under bicep
Enters forearm lateral to bicep tendon
```
27
Subacromial/Subdeltoid Bursa
Extends over supraspinatous muscle and tendon, under acromion and deltoids
Bunches up during elevation of the arm
Easily impinged
28
Subscapular Bursa
Overlies anterior joint capsule
Beneath subscapularis
Articular effusion will manifest with swelling of subscapular bursa
29
GH Joint
Synovial
Ball & Socket
Capsular strength: weak and lax (inferiorly)
Head of the humerus (convex) on Glenoid fossa (concave)
Capsular pattern: ER --> Ab --> IR
Closed Pack: full abduction and ER
Resting: 55-70º abduction; 30º horizonal adduction
30
Glenoid labrum
Surrounds and deepens the glenoid cavity; stabilizes and allows for better articulation
31
Glenohumeral ligaments
Reinforce anterior capsule
Check external rotation (especially middle fibres, which twists)
Inferior fibres thickest
32
Coracohumeral ligament
Fights gravity; strengthens superior capsule
| Similar attachment as supraspiantus
33
Transverse humeral ligament
Holds biceps tendon in place
34
Acromialclavicular joint
Synovial
Modified gliding
Lateral clavicle (concave) on acromion (convex)
Capsular strength: weak and lax
Resting position: arm by side with pillow support
Closed pack: Abduction to 90º
Capsular pattern: Full elevation with pain
35
The AC joint has a(n) __________ articular disc.
incomplete
36
GH Osteokinematics
3 degrees:
flexion/extension
abduction/adduction/
internal/external rotation
37
AC Osteokinematics
3 degrees:
elevation/depression
protraction/retraction
anterior/posterior rotation
38
SC Osteokinematics
3 degrees:
elevation/depression
protraction/retraction
anterior/posterior rotation
39
Convex on concave
Rolls and glides opposite
40
Concave on convex
Rolls and glides in same direction
41
Superior/inferior acromioclavicular ligament
Prevents AC separation
42
Coracoclavicular complex is made up of:
```
Trapezoid ligament
Conoid ligament (posterior/medial)
```
43
Trapezoid ligament
Prevents excessive lateral movement in AC joint
| Part of coracoclavicular complex
44
Conoid ligament
Attaches posteriorly on clavicle and contributes to posterior rotation of clavicle during abduction
45
Locate axillary pulse
midpoint of the axilla
46
Locate bicipital pulse (prox.)
Under mid 1/3 of the belly of the muscle
47
Locate bicipital pulse (distal)
Medial to tendon, in cubital fossa, superior to where you think it is (idiot)
48
Sternoclavicular joint
Synovial
Modified gliding
Resting position: arm by side with pillow for support
Closed pack: Maximal elevation of arm
Capsular pattern: full elevation with pain
49
The only joint that attaches shoulder to thorax
Sternoclavicular
50
Arthrokinematics of sternoclavicular joint
Facet on clavicle is Concave ant/post, and convex sup/inf .
Clavicle moves on sternum.
so:
ant/post movement is concave on convex
infer/super movement is convex on concave
51
The SC joint has a(n) _____________ complete disc.
Complete. (Helps prevent medial separation)
52
To increase elevation in SC joint, glide the clavicle
Inferiorly
53
To increase depression in the SC joint, glide the clavicle
Superiorly
54
To increase protraction in the SC joint, glide the clavicle
anteriorly
55
To increase retraction in the SC joint, glide the clavicle
posteriorly
56
Osteokinematic movement of the distal bone will equal the arthrokinematic movement of the _________, which will determine the arthrokinematic movement of the ______, via the rule of __________;
Roll
Slide/Glide
Concave/Convex
57
MMT grading
```
5 normal
4 good (breaks)
3 fair (against gravity, but no resistance)
2 poor (AAROM)
1 trace (contraction, no movement)
0 absent
```
58
Concave on convex
roll and glide in same direction
59
Convex on concave
roll and glide in opposite directions
60
MMT delts
90º shoulder abduction, elbow flexion
Therapist applies downward pressure
61
MMT anterior deltoid
From 90º abduction, arm slightly horizontally adducted, externally rotated.
Pressure is applied into adduction and slight extension (down and back)
62
MMT posterior deltoid
From 90º abduction, arm slightly extended, internally rotated
Pressure is applied into adduction and slight flexion (down and forward)
63
MMT lower traps
Prone. Arm in Y fly position, extended. Fonzie thumb.
Apply downward pressure
64
MMT upper traps
Seated. Shoulder elevated, Lateral flexion so ear moved toward shoulder.
Pressure applied to separate ear and shoulder
65
MMT mid traps
Prone. Arm extended in T fly position. Fonzie thumb.
Apply downward pressure.
66
MMT subscapularis
Cop hold position, hand lifted slightly off back
Pressure applied pushing arm toward back
67
MMT supraspinatus
Seated, shoulder & elbow at 90º, then slightly externally rotated and moved slightly forward. IL lateral flexion; CL rotation.
Apply downward pressure (I think)
68
MMT infraspinatus
Prone. Shoulder abducted to 90º, elbow flexed at right angle (1/2 stick 'em up cactus)
Place hand under arm near elbow to stabilize humerus. Apply pressure towards medial rotation
69
MMT Teres minor
Supine. Robot Barbie arm, slightly abducted.
Stabilize humerus by medial elbow.
Apply pressure towards medial rotation.
70
MMT pectoralis major -- upper
Supine. Shoulder flexed to 90º, elbow extended
Stabilize opposite shoulder.
Pressure applied toward horizontal abduction
71
MMT pectoralis major -- lower
Supine. Shoulder flexed, elbow extended, arm slightly medially rotated and adducted towards opposite hip.
Stabilize opposite shoulder.
Pressure applied laterally and superiorly
72
MMT rhomboids
Prone. Arm extended in T fly position, thumb DOWN.
Resist downward pressure
73
MMT levator scapulae and rhomboids
Prone, head turned to tested side. Elbow flexed, arm slightly laterally rotated, shoulder elevated, scapula retracted and downwardly rotated.
Hold elbow and shoulder.
Apply pressure to elbow in direction of scapular abduction and upward rotation.
Apply pressure to shoulder in direction of depression
74
Anterior/Posterior sternoclavicular ligaments
Resist separation/subluxation
75
Interclavicular ligament
Part of SC joint. Bridges the two clavicles.
| Checks excessive medial movement.
76
Costoclavicular ligament
Part of SC joint.
Medial movement --> checks elevation
Lateral movement --> checks
77
How does the shoulder maintain passive stability?
1. inferior lip of the glenoid fossa (cavity faces lateral, forward and superior)
2. coracohumeral ligament and superior joint capsule
78
How does the shoulder maintain active stability?
Rotator cuff muscles
79
Active Ligaments
Another name for the rotator cuff muscles. They kick in to maintain congruency and stability of the GH joint when the joint capsule goes slack as arm is lifted away from the body
80
What two conditions can cause abnormal alterations and compromises to shoulder stability?
Thoracic kyphosis
| Muscle paresis
81
"Pseudo-abduction"
In thoracic kyphosis, scapula downwardly rotated, no longer supported by stabilizing lip of the glenoid fossa.
SITS on 24/7.
Can lead to impingement syndrome
82
GH joint capsule during abduction
As arm abducts, twist in glenohumeral ligament tightens, pulls head of the humerus into glenoid fossa.
Around 90º the tension on the twist is at it's maximum, and it untwists, causing the arm to externally rotate.
Prevents greater tubercle from colliding with acromial arch.
83
Muscle force couple
Muscles that exert EQUAL force in different directions, producing one movement.
84
Muscle force couple in shoulder
1. deltoids - SITS => abduction
2. traps - serratus anterior => scapular upward rotation
3. biceps long head with itself => stabilizing rather than extending
85
Delts/SITS and arm movement
Delts pull humerus upwards and outwards
SITS pull inwards and downwards
Allows shoulder elevation
86
Traps/Serratus Anterior and scapular rotation
Traps pull scapula up and in, down and in, and serratus anterior pulls laterally.
Scapula pinwheels in upward rotation
87
Biceps self-force coupling
Long head of bicep depresses humeral head as arm abducts.
As arm externally rotates, the bicep tendon lines up with the suprascapular fossa.
New LOP causes the biceps long head to act as a stabilizer instead of an extensor.
88
Phase 1 of scapular rhythm
Phase I. 0-30º humerus only
89
Phase 2 of scapular rhythm
Phase II. 30-90º 40º humeral abduction; 20º scapular rotation; clavicle elevation 15º
90
Phase 3 of scapular rhythm
Phase III. 90-180º 60º humeral abduction; 30º scapular rotation
15º clavicle posterior rotation (because of scapular elevation, via conoid ligament)
91
How is the spine involved in GH abduction?
last 160-180º
If BL, just extension
If UL:
T1&2 extend, IL lat flexion, IL rotation
R1&2 depress and move posteriorly
Lower T spine CL lateral flexion
92
Anterior brachial pain may indicate:
bicipital tendonitis
| adhesive capsulitis
93
Lateral brachial pain may indicate
supraspinatus tendonitis
bursitis
Impingement syndrome
adhesive capsulitis
94
Superior/lateral pain may indicate
AC sprain
95
Step deformity
AC separation (grade 2 or 3 sprain)
96
Sulcus sign
Sagging or flattening below the acromion process, where rounded deltoid would be.
Indicative of a dislocation or deltoid paralysis
97
Scapular winging
Entire medial border moves away from the posterior chest wall
98
Dynamic scapular winging
```
Possible problems with:
serratus anterior
LTN
muscle imbalance
rhomboid strain
upper trap sprain
```
99
Static scapular winging
Structural deformity of the scapula, clavicle, spine or ribs
100
Scapular tiltting
Superior or inferior angle of the scapula lifts away from chest wall.
Indicative of weakness and instabilty
101
Functional ROM of the shoulder
Combing back of head (open chain)
Reaching into back pocket (open chain)
Apley's scratch test
Getting out of chair using armrests (closed chain)
102
Painful arc
first 45-60º -- no pain because no pinching
Painful GH arc: 60-120º pinching under acromial arch may cause pain
Painful AC arc: 160/170-180º. impingement (general pain); AC/SC joint involvement (specific pain)
103
Reverse Scapulohumeral Rhythm
Scapula moves more than the humerus during abduction
Indicative of frozen shoulder
104
Quickie Test for Scapular Winging
Wall pushup
GH flexes to 90˚, face guest and push into elbow posteriorly, grasp ventral surface of the scapula and push dorsally against resistance.
105
Range of motion testing
AROM (painful movements last)
If AROM is normal, or painful at end-range, then POP
Resisted ROM
Pain in PROM/POP --> joint play
Pain inResisted ROM --> MMT
106
Shoulder dermatomes/myotomes
C4,C5, C6
107
Dermatome: C4
Upper shoulder to base of neck; top of anterior and posterior chest
108
Dermatome: C5
Lateral upper arm
109
Dermatome: C6
Distal anterior biceps, lateral forearm
110
Myotome: C4
Shoulder shrug
111
Myotome: C5
GH abduction
112
Myotome: C6
Waiters tray carry (elbow flexion, wrist extension)
113
What muscle has a TrP that refers along the biceps tendon?
Infraspinatus
114
Purpose of special testing
1. confirm or refute specific pathology
2. identify involved structures
3. confirm orthopedic assessment findings
4. dictate Tx
5. ID CIs, modifications
115
Overuse syndrome
Any noxious, repeated activity leading to micro trauma of involved tissues.
116
Cardinal sign of tendinitis?
Pain on length, strength and palpation
117
Intrinsic vs extrinsic factors in overuse syndromes
Intrinsic:posture, vascular supply
Extrinsic: ADLs, occupation, sports
118
Tendinitis
Overuse injury causing inflammation of the tendons.
119
Supraspinatus Tendinitis
A dynamic ligament
Poorly vascularized
Strained through repetitive movements (abduction and flexion) and posture.
May lead to impingement syndrome, bursitis, adhesive capsulitis
120
Which tendon is particularly vulnerable to calcification?
Supraspinatus
121
Bicipital Tendinitis
Usually secondary to another GH issue, usually impingement or rotator tear.
Inflammation may cause tendon to stick in groove.
Cortisone injections may cause tendon to weaken --> rupture.
Repetitive overhead movements (abduction, ER, elbow flexion and supination) -- pitchers, swimmers etc
Possible subluxation of tendon.
122
Long head of bicep acts as
Humeral stabilizer
| Elbow extension decelerator
123
Two exercises important to impingement prevention
```
Front raise
(Anterior deltoid)
```
Shrugs
Push-ups with arms abducted to 90°
(Strengthen upper traps and serratus anterior)
124
Calcific tendinitis
In later stage of tendinitis (esp rotator cuff, esp esp supraspinatus)
Fibroblasts --> chondrocytes
Calcified deposits fill up intracellular space in tendons
Increased size, inflammation, swelling, pain, impingement.
Self healing.
May provoke bursitis
125
Tendinitis Grade 1
Pain after activity
126
Tendinitis Grade 2
Pain at the beginning of activity, and afterwards.
127
Tendinitis Grade 3
Pain at the beginning of, during, and after activity.
Activity may be restricted
128
Tendinitis Grade 4
Pain with ADLs
| Gets worse.
129
Pain at lateral brachial area
Supraspinatus tendinitis
130
Pain at anterior brachial region to superior glenoid fossa
Bicipital tendinitis
131
Sx of tendinitis
Pain on strength, length and palpation
Signs of inflammation.
Difficulty sleeping on affected side
132
ROM: supraspinatus tendinitis
AROM: pain with abduction, maybe flexion and medial rotation too (mm shortened)
PROM: same (structure compressed)
RROM: same
133
ROM: bicipital tendinitis
AROM: flexion/extension
PROM: extension (maybe flexion)
RROM: flexion
134
Special tests for supraspinatus tendinitis
Painful Arc
Drop Arm Test
Empty Can Test
135
Special tests for bicipital tendinitis
Speeds
| Yergasons
136
Tendinitis Tx: Acute
Rest and ice
Reduce inflammation, hypertonicity, maintain ROM, decrease pain, prevent atrophy. Compensatory structures
137
Tendinitis Tx: Chronic
```
MFR
NMT
Stretch
Frictions
Swedish
Reset (isometric contraction)
```
Contrast Therapy
138
CIs: tendinitis
Calcification tendinitis (supraspinatus)
Tenosynovitis (bicipital tendon)
Anti inflammatory meds
139
Three big questions during ROM assessment
What is being shortened?
What is being lengthened?
What is being compressed?
140
Tendinitis/Bursitis Differentiation Test
RROM. Increasing resistance:
--> increased pain = tendinitis
--> pain constant, unchanged
= bursitis
141
How to tell difference between tendinitis and strain?
MOI
Traumatic/sudden vs gradual onset
142
Painful Arc
Sign of GH/AC impingement
Pain between 45-120° (worst at 90°) --> GH impingement
Diffuse pain
Pain between 160/70-180°
> AC impingement (sprain, OA)
Local pain
143
Bursitis
Inflammation of bursa
144
Subacromial (Subdeltoid) bursa
On top of supraspinatus, under acromion and deltoid.
Susceptible to impingement under acromial arch, and damage from calcified supraspinatus tendon
145
Subscapular bursa
Over anterior joint capsule; under subscap tendon
146
Joint effusion will cause visible swelling to which bursa?
Subscapular
147
NMT
Segmental stripping on muscle belly, followed by either OI release at MT junction, or tendon bowing.
148
Bursitis CIs
No compressions
Nothing onsite when acute
If infective leave it the hell alone.
149
Bursitis Sx
Lateral brachial pain, referred below elbow.
If acute, signs of inflammation. Constant pain with sudden onset
Chronic: localized pain during compression or activity.
150
Bursitis (GH): ROM
Pain with AROM, PROM, RROM
AROM -- all movement affected esp abduction
PROM -- noncapsular pattern, empty end feel
RROM -- hesitation in some moves, strong and pain free in others.
151
GH bursitis: special tests
Painful arc
Painful ROM of affected muscles
Neer Impingment
Bursitis/tendinitis differentiation.
152
Causes of GH
| Impingement
1. mechanical anatomic (size of tunnel)
2. Vascular (ability of tissue to heal)
3. Kinesiological (muscle imbalances, posture)
153
Impingement syndrome
Inflammatory condition
Inadequate space between the AC and GH joints
SITs muscles, subacromial bursa and biceps tendons impinged.
154
Muscle force coupling and impingement syndrome
Imbalance -- infraspinatus and T minor don't depress humeral head enough to clear acromion during abduction.
155
Hyperkyphosis and impingement syndrome
Relatively constant internal rotation --> inadequate external rotations --> compression.
156
Impingement Syndrome: Stage 1
Self-limiting
Mostly supraspinatus; maybe biceps
Edward and haemorrhaging of subacromial bursa
Pain with activity, progress to ADLs
157
Impingement Syndrome: Stage 2
Tendinitis and bursitis persist
Possible fibrosis
158
Impingement syndrome: stage 3
Development of bony changes (bone spurs, eburnation of humeral tuberosity, changes to acromion and AC joint)
Ruptures (partial or complete) of tendons
159
Eburnation
Wearing away of cartilage
160
Is impingement syndrome reversible?
Stages 1 & 2: reversible with manual Tx, rest, stretching, strengthening
Stage 3. Surgery indicated.
161
Impingement Syndrome: Sx
Insidious lateral brachial ache
| Sharp twinges on certain movements (abduction)
162
Impingement syndrome: ROM
AROM/PROM: painful arc. Full ROM in early stages that may decrease with progression
End feel: later stages may be empty (pain) or abnormal hard
RROM: pain with maximal contraction. (Strong & painful: intact tendon; weak & painful: tear)
163
Special tests for GH Impingement
Hawkins-Kennedy Impingement test
Never impingement test
Drop Arm test
Empty Can test
Speeds test
164
Impingement Syndrome: CIs
Like tendinitis and bursitis
Don't joint mob bony changes
Cautious of corticosteroid injections
165
Shoulder instability
Dislocation or subluxation at GH joint
Separation at AC joint
166
GH posterior dislocation
Most common.
Excessive flexion, adduction, internal rotation.
Forward fall
167
GH anterior dislocation
Excessive abduction and external rotation
Backward fall
168
Test after Posterior GH dislocation
Push-Pull
169
Test after anterior GH dislocation
Rockwood
170
Test after Inferior GH dislocation
Feagins
171
GH dislocation and hypo/hypermobility
When chronic, often hypomobile generally but hypermobile in direction of injury.
172
Position for RROM
Neutral
173
Special tests after GH sublux/dislocation
```
Shoulder Apprehension Test
Rockwood
Feagin
Push-Pull
Sulcus Sign
```
174
When treating a GH dislocation/sublux, what should happen before restoring ROM in direction of dislocation
Strengthen dynamic ligaments
175
Tx goals after GH sublux/dislocation
Acute: pain management
Subacute: prevention of atrophy, scarring
Chronic: correction
176
GH sublux/dislocation: Sx
Sulcus sign
protective posturing
Acute: pain, bruising, spasm, effusion
Subacute: unstable joint, decreased ROM, reduced edema, pain
Chronic: localized joint capsule pain when stressed, decreased bruising, stable except in direction of injury, restricted ROM, HY
177
GH sublux/dislocation CIs
Never ever ever joint play in direction of injury
178
Shoulder (AC) Separation
Sprain/rupture of AC ligaments (and possibly coracoclavicular complex) and/or possible displacement of the AC joint
179
AC Separation: Grade 1
Damage to AC ligament
CCC intact
No step deformity
180
AC Separation: Grade 2
Damage to AC joint and ligament
CCC damaged
Step deformity
181
AC Separation: Grade 3
Rupture of the AC joint and ligaments
Rupture of CCC
Marked step deformity
182
In an AC separation with complete avulsion of CCC from clavicle, the distal clavicle may be displaced posteriorly into or through the
Trapezius
183
In an AC separation with complete avulsion of the CCC, the lateral end of the clavicle may be displace inferiorly into
The bicep/coracobrachialis tendon
184
Special test after AC separation
AC Shear Test
185
AC Separation: Tx
Acute: pain management. No testing beyond AROM, no joint play
Subacute: Decrease spasm, prevent atrophy (XFF, joint play 1/2, NMT, TrP), isometrics to prevent atrophy and increase stability
Chronic: Decrease scar tissue (XFF), joint mobs 3/4 (Grade 1 and 2), Isotonics to increase strength and stability
186
Muscle: XFF then stretch
Ligament: XFF then ________
Joint mobilization
187
AC separation: Remex Goals`
1. create stability (strengthen SITs, periscaps)
2. increase ROM
3. recreate proprioception
188
Adhesive Capsulitis
AKA frozen shoulder
Decreased AROM/PROM in ER/Abduction
Painful
Restriction according to capsular pattern
189
Etiology of adhesive capsulitis
Primary: idiopathic
Secondary: just about anything to do with the shoulder
190
Adhesive Capsulitis: Phase 1
Freezing/painful phase.
Hallmark: severe nocturnal pain over lateral brachial region
Gradual onset
191
Adhesive Capsulitis: Phase 2
Subacute/Frozen phase
Pain diminishes; stiffness increases (following capsular pattern)
192
Adhesive Capsulitis: Phase 3
Thawing Phase (chronic)
Pain continues to diminish, ROM increases.
Can take years.
193
Adhesive Capsulitis: Sx
Hyperkyphosis
Muscle spasm
Capsular pattern of restriction
Reverse scapulohumeral rhythm
194
Reverse Scapulohumeral Rhythm
When adhesive capsulitis limits abduction, the scapula elevates to "cheat" the move. 1:1 rhythm
195
Progression of ReMex
Gradual; do not increase inflammation
Acute: rest, ice
In subacute/chronic: stretch --> strengthen (isometric -> eccentric -> concentric) --> proprioception --> dynamic stabilization
196
ReMex too much?
- discomfort lasting more than 2 hours in acute/subacute; 4 hours in chronic.
- discomfort requiring medication
- pain at rest
- extreme fatigue, weakness
- reactive spasm
197
Adhesive Capsulitis: Tx
MFR (Xhand chest, bow pecs, shear ant delt)
Distract, inferior glide GH
Release pecs, subscap
Friction joint capsule
Rhythmic stabilization
Swedish to clear
