Shoulder

Question 1

Where can pain be referred to the shoulder from?

Answer 1

Lung
Gallbladder
Pancreas
Heart 
Diaphragm

Question 2

Why perform an UQSE?

Answer 2

Clear C-spine

Question 3

What are you looking during observation?

Answer 3

Scap winging
Posture, alignment
AC step deformity

Question 4

Whats the best position to palpate the supraspinatus tendon?

Answer 4

Pt supine, with upper arm off table and thumb tucked into belt loop
(20 deg extension)

Question 5

Position to best palp infra & teres minor?

Answer 5

Prone on elbows

Question 6

What is the painful arc?

Answer 6

60-120 degrees of abd hurts, but after it doesnt

Question 7

Pain to resistance patterns intra vs interrater reliability

Answer 7

Intra- good

Interrater- no bueno

Question 8

Neuro exam-
C4 refers pain to __
C5 refers pain to __,__,__
C6 refers pain to __,__,__,__,__

Answer 8

AC jt

GH jt capsule, supraspinatus, area surrounding deltoid tubercle

Intra, teres minor, subscap, deltoid tubercle, lat elbow

Question 9

Shoulder arthroplasty: standard vs reverse

Answer 9

Standard- ball in humerus and glenoid is plastic cup

Reverse- glenoid is ball, plastic is humerus. This works better for RC tear arthropathy bc it relies on diff muscles to move arm. This surgery relies on DELTOID instead of RC.

Question 10

Frozen shoulder background

Answer 10

Women, 40-50s
Etiology unknown
DM & hypothyroidism associated with frozen shoulder
RC tendinopathy & impingement common precursors

Question 11

Is adhesive capsulitis self limiting?

Answer 11

No, some clinicians believe it is and will resolve in 12months but NAH. LOW QUALITY says it will lead to improvement

Question 12

What does the literature say about early tx?

Answer 12

Mod evidence suggested most improvement with early interventions

Question 13

Level of evidence for shoulder adhesive capsulitis interventions?

Answer 13

Corticosteroid-STONG
Pt ed- MOD
Modalities- WEAK
Jt mob-WEAK
Translational manip- WEAK
Stretching- MOD

Question 14

How can poor posture cause impingement?

Answer 14

Forward flexion/kyphosis/protracted scap- GH jt position is in flexion and ABd relative to GH normal posture. So now the GH ligaments are no longer in a position to hold the humerus in the glenoid. RC muscles must contraccct to hold humerus in glenoid and therefore susceptible to overuse injury.

Acromion jams against biceps and subscap with overhead activities.

Question 15

Other causes of impingement?

Answer 15

RC/biceps tendinopathy
Subacromial bursitis
Calcium deposits in GH jt or RC tendons
Hook shaped acromion
Shoulder instability- if numeral head not stable in glenoid, shoulder moves everywhere and jams into acromion
Adhesions to inf or post jt capsule- causes hum head to jam against acromium with movement into shoulder elevation

Question 16

Another important reason for impingement relating to weakness in infr, teres minor and subscap muscles

Answer 16

During shoulder elevation- these muscles act as a force couple. Middle delt and Supra contract to abduct. This then causes numeral head to elevate in glenoid fossa. Infra teres minor and subscap contract to counter tendency of delt and Supra muscle to elevate numeral head in the glenoid- setting the humerus in glenoid.

If infra teres minor and subscap are weak, then hum head is more likely to jam against acromion.