Shoulder Lab

Question 1

Hand behind head

Answer 1

Purpose: Shoulder Clearing, quickly access functional movement
1. Ask patient to put their hand behind their head (end position should be
shoulder flexion and ER with palmar surface of hand on back)
2. Measure symmetry of the middle finger on the spinous process for both sides
3. Positive test (+): involved side significantly less range than the other

Question 2

Hand behind back

Answer 2

Purpose: Shoulder Clearing, quickly access functional movementCues: 1. Ask patient to put their hand behind their back (end position should be
shoulder extension and IR with dorsum of hand on back)
2. Measure symmetry of the thumb on the spinous process for both sides
3. Positive Test (+): Involved side significantly less range than the other

Question 3

Apley’s Scratch test

Answer 3

Purpose: Quick functional movement screen
1. Patient reaches behind their back with one hand and behind their head with the
other hand.
2. Instruct the patient to touch their hands as much as they can.
3. Measure the distance between the hands, noting any dysfunctional scapular
movements.

a. Reaching behind head involves shoulder flexion and external rotation.
b. Reaching behind back involves shoulder extension and internal rotation.

Question 4

Flexion or flexion adduction shoulder

Answer 4

Purpose: To assess the range of motion, mobility, and reproduction of symptoms
of the Glenohumeral Joint/Scapulothoracic Joint.
1. Patient is standing and asked to actively flex their shoulder as far as they
can.
2. The therapist places one hand on top of the patient’s shoulder.
3. The therapist’s other hand is placed as close to axilla as possible underneath
the patient’s arm.
4. The therapist assesses the mobility of the shoulder joint by taking the patient
to end range shoulder flexion.
5. The therapist then over presses the patient’s shoulder in flexion.
6. Therapist asks the patient if they have any pain at each progression into
deeper flexion, example “any pain, any pain, any pain”
7. Repeat with steps 1-5 with a Flexion Adduction force pushing into end range
towards the patient’s head.

Question 5

Hand behind Back and OP of extension, IR and Adduction

Answer 5

Purpose: To assess the range of motion, mobility, and reproduction of symptoms
of the Glenohumeral Joint/Scapulothoracic Joint.
1. Patient is asked to put hand behind back (in extension and IR) so that the
dorsum of the patient’s hand is in contact with his/her back.
2. Therapist stabilizes patient’s shoulder with one hand, and with the other hand
grabs the patient’s forearm.
3. Therapist takes patient into end range extension and asks the patient if they
have any pain at each progression into deeper extension, example “any pain, any
pain, any pain.”
4. Repeat with adduction and internal rotation.
5. Positive Test (+): Reproduction of symptoms, limited mobility compared to
contralateral side

Question 6

Shoulder Flexion ROM

Answer 6

Purpose: To assess and mobilize passive range of motion of the glenohumeral
joint
1. Support the arm by placing one hand on forearm and the other on the upper
Arm.
2. Take the shoulder into flexion and assess the range of motion.
3. Compare to the other side.

Question 7

Shoulder Abduction ROM

Answer 7

Purpose: To assess and mobilize passive range of motion of the glenohumeral
joint
1. Stabilize the arm by placing hand on upper trapezius muscle.
2. Support the arm by placing hand on forearm just distal to the elbow joint.
3. Take the shoulder into abduction and assess the range of motion.
4. Compare to the other side.

Question 8

External Rotation shoulder ROM

Answer 8

Purpose: To assess passive range of motion of the glenohumeral joint
1. Block anterior shoulder with forearm to avoid an anterior glide of the
shoulder.
2. Stabilize arm by placing hand under the elbow joint.
3. Take the shoulder into external rotation and assess the range of motion.
4. Compare to the other side.

Question 9

Internal Rotation shoulder ROM

Answer 9

Purpose: To assess passive range of motion of the glenohumeral joint
1. Block anterior shoulder with forearm to avoid an anterior glide of the
shoulder.
2. Stabilize arm by placing hand under the elbow joint.
3. Take the shoulder into internal rotation and assess the range of motion.
4. Compare to the other side.

Question 10

Shoulder Quadrant

Answer 10

Purpose: A compressive provocation test for structures in the shoulder and for
mobility assessment/treatment
1. Place hand on anterior surface of glenohumeral joint and inferiorly glide the
scapula.
2. Place elbow at 90 degrees of flexion.
3. Stabilize elbow and take the shoulder into quadrant until end range is reached.
4. Mobilize shoulder joint for 30 seconds if stiffness is found.

Question 11

shoulder locking

Answer 11

Purpose: A compressive provocation test for structures in the shoulder and for
mobility assessment/treatment (supraspinatus, coracoacromial ligt.,
glenoid labrum, A-C jt., subacromial bursa, lesser involvement of long
head of biceps and infraspinatus)

1. Therapist places proximal hand under patient fully supinated.
2. Therapist applies a downward glide on scapula with fingers flexed over
   shoulder and palmer surface on patient’s scapula.
3. Bend patient’s elbow and rest their hand on therapist’s proximal shoulder.
4. Therapist stabilizes patient’s hand by tucking their chin on patient’s wrist.
5. Therapist uses their distal hand to internally rotate the patient’s humerus.
6. With patient in internal rotation therapist abducts arm until locking or stopping
   occurs.
7. Therapist then moves arm anterior and posterior slightly
8. Proceed to verify if more abducted can be achieved in the original line of
   movement, keeping internal rotation
9. Patient should be able to achieve locking and lock without pain

Question 12

Shoulder open pack

Answer 12

55 degrees abduction, 30 degrees horizontal

adduction

Question 13

Glenohumeral Horizontal Adduction Measurement for Posterior Capsule
Tightness

Answer 13

Purpose: To determine tightness in posterior capsule which affects IR and flexion
1. Stabilize lateral border of scapula with a posteriorly directed force towards
table.
2. Distal hand holds proximal portion of forearm and passively horizontal
adducts arm.
3. Goniometer: midline of humerus and perpendicular to table.
4. Positive test (+): Tightness. Shoulder at least get elbow to nose (midline).

Question 14

shoulder Posterior glide

Answer 14

Purpose: Assess and mobilize inferior capsule mobility for shoulder external
rotation
1 Ask patient to relax because this will be a passive test.
2. Locate the head of the humerus.
3. Grasp the head of the humerus in a pincer grip and use the other hand closest
to the patient to apply a grade 1 traction
4. Glide the head of the humerus into posterior lateral direction
5. Assess the amount of movement and look for reproduction of pain.
6. Compare with other side

Question 15

shoulder anterior glide

Answer 15

Purpose: Assess and mobilize inferior capsule mobility for shoulder external
rotation
1 Ask patient to relax because this will be a passive test.
2. Locate the head of the humerus.
3. Grasp the head of the humerus in a pincer grip and use the other hand closest
to the patient to apply a grade 1 traction
4. Glide the head of the humerus into a anterior medial direction
5. Assess the amount of movement and look for reproduction of pain.
6. Compare with other side.

Question 16

shoulder caudal glide

Answer 16

Purpose: Assess and mobilize inferior capsule mobility for shoulder elevation

1. Ask patient to relax because this will be a passive test.
2. Locate the head of the humerus.
3. Use the other hand closest to the patient to apply a grade 1 traction
4. Apply the mobilization hand over the top of the head of the humerus
5. Glide the head of the humerus into an inferior or caudal and lateral direction
6. Assess the amount of movement and look for reproduction of pain.
7. Compare with other side

Question 17

Palpation AC joint(thickening)

Answer 17

Purpose: AC joint thickening comparison
1. Palpate clavicle to the distal end
2. Move distally until you find the acromion.
3. Palpate the joint by using your fingers to feel the point at which the distal end
of the clavicle and acromion meet.
4. Compare side to side for postural symmetry.
5. You can also observe for drop off deformity.

Question 18

A-C shear test

Answer 18

Purpose: Provocation shear test of the AC joint
1. Ask patient to relax because this will be a passive test.
2. Palpate the AC joint.
3. Using both hands grip either sides of the joint with palmer surface of hands,
thumbs facing therapist.
4. Interlace fingers, elbows should be out to the sides, forearms parallel with the
Floor.
5. Add compressive force through the joint.

Question 19

palpation of SC joint

Answer 19

Purpose: To assess for tenderness, mobility, instability, or sprain.

1. Identify the sternal end of the clavicle
2. Identify the sternum
3. The connecting point is the SC joint
4. Assess for balance and symmetry compared to the other side.

Question 20

SC joint A/P glide

Answer 20

Purpose: To assess mobility and mobilize to increase retraction
1. Dummy thumb with other thumb on top of S-C joint.
2. Mobilize posteriorly.
3. Positive test (+) if hypomobile/symptom reproduction compared to the other
side.

Question 21

SC joint P/A glide

Answer 21

Purpose: To assess mobility and mobilize to increase retraction to increase
protraction
1. Dummy thumb with other thumb underneath of SC joint.
2. Mobilize anteriorly
3. Positive test (+) if hypomobile/symptom reproduction compared to the other
side.

Question 22

SC joint cephalad glides

Answer 22

Purpose: To assess for reproduction of pain (sc joint strain or hypomobility) or
to mobilize increase scapular elevation
1. Palpate the Sternoclavicular joint.
2. Place thumb over thumb over caudad aspect of joint.
3. Apply an oscillating cephalad force .
4. Positive test (+) if hypomobile/symptom reproduction compared to the other
side.

Question 23

SC joint caudad glides

Answer 23

Purpose: To assess for reproduction of pain (sc joint strain or hypomobility) or
to increase scapular depression
1. Palpate the Sternoclavicular joint.
2. Place thumb over thumb over cephalad aspect of joint.
3. Apply an oscillating caudad force .
4. Positive test (+) if hypomobile/symptom reproduction compared to the other
side.

Question 24

What are the shoulder Impingement tests?

Answer 24

1. Neer’s Impingement Test

2. Hawkins-Kennedy Impingement Test

Question 25

Neer’s impingement test

Answer 25

Purpose: To determine if there is impingement in subacromial region 1. Shoulder is flexed fully, abducted, and IR (thumb should face in front of pt.) 2. Stabilize and apply shoulder adduction overpressure close to joint. 3. Positive test (+): Pain in subacromial region, look at facial expression.

Question 26

Hawkins-Kennedy impingement test

Answer 26

Purpose: To determine if there is impingement 1. Flex patients shoulder/elbow to 90 degrees 2. Stabilize lateral elbow with one hand and apply IR force with other hand at their wrist 3. Positive test (+): Pain near the coracoid region, look at facial expression

Question 27

What are the rotator cuff manual muscle tests?

Answer 27

1. External Rotation (Infraspinatus and Teres Minor) 2. Internal Rotation (Subscapularis) 3. Abduction (Supraspinatus)

Question 28

ROtator cuff external rotation test

Answer 28

(Infraspinatus & Teres minor) Purpose: To assess for reproduction of pain or weakness of RC muscles 1. Keep arm at side of body with elbow bent to 90 degrees. 2. PT stabilize medial aspect of elbow w/one hand. 3. Apply a medially directed force on dorsal surface just above wrist to create an internal rotation force at glenohumeral joint (patient resists w/external rotation force). 4. Determine symptom reproduction/weakness 5. Positive Test (+): Decreased ability to resist secondary to pain and/ weakness

Question 29

Rotator cuff internal rotation test

Answer 29

(Subscapularis) Purpose: To assess for impingement - reproduction of pain or weakness of RC muscles 1. Keep arm at side of body with elbow bent to 90 degrees. 2. PT stabilize lateral aspect of elbow w/one hand. 3. Apply a lateral directed force on palmar surface just above wrist to create an external rotation force at glenohumeral joint (patient resists w/internal rotation force). 4. Determine symptom reproduction/weakness 5. Positive Test (+): Decreased ability to resist secondary to pain and/ weakness

Question 30

Rotator cuff abduction test

Answer 30

Abduction (Supraspinatus) Purpose: To assess for reproduction of pain or weakness of RC muscles 1. Keep arm at side of body with elbow bent to 90 degrees. 2. PT stabilize contralateral shoulder with one hand. 3. Apply an adduction force on lateral aspect of testing elbow. 4. Determine symptom reproduction/weakness 5. Positive Test (+): Decreased ability to resist secondary to pain and/ weakness

Question 31

WHat are the rotator cuff TEAR tests?

Answer 31

1. External Rotation Lag 2. Internal Rotation Lag Sign 3. Drop Arm Test 4. Full Can/Empty Can Test 5. Subacromial bursa/supraspinatus tendon palpation 6. Belly Press

Question 32

RC external rotation lag

Answer 32

Purpose: To assess rotator cuff tear of infraspinatus or teres minor muscles 1. Passively flex patient's elbow to 90 degrees, abduct shoulder 15 degrees, and maximally externally rotate the patient's humerus 2. Patient is asked to maintain this position 3. Positive test if patient's arm falls into internal rotation

Question 33

RC internal rotation lag sign

Answer 33

Purpose: Subscapularis involvement/tear 1. Lift patient’s arm off of their back (grab wrist and elbow) 2. Instruct patient to hold position 3. Positive test (+): Inability to maintain arm off the back, pain

Question 34

Drop arm test

Answer 34

Purpose: Helpful in determining weak or torn supraspinatus, impingement Cues: 1. Grab their wrist and passively abduct shoulder to 90deg 2. Release the patient’s arm with instructions to hold the arm up and slowly lower down. 3. Prepare to catch the arm. 4. Positive test (+): Pt’s arm drops or does not have smooth eccentric control.

Question 35

Full can and Empty Can Test/Supraspinatus

Answer 35

Purpose: To assess for rupture of tear of RC muscles Cues: 1. Patient is in scaption and 90 degrees of shoulder elevation 2. Thumbs up for full can, thumbs down for empty can 3. Apply force distally and stabilize at shoulder 4. Positive test (+): Decreased ability to resist secondary to pain and weakness

Question 36

Subacromial bursa/ Supraspinatus tendon Palpation

Answer 36

Purpose: To palpate for tenderness/ tear of the supraspinatus tendon or inflammation of the subacromial bursa Patient Position: Seated, shoulder is in extension and internal rotation (hand behind back). Therapist Position: Standing to the ipsilateral and posterior side of the tested Shoulder.

Question 37

Belly Press

Answer 37

Purpose: To test for subscapularis lesion (especially for patient who cannot rotate shoulder enough to take it behind the back. 1. Examiner places a hand on the abdomen to assess the pressure that the patient applies to the abdomen 2. Cue the patient to place the hand of the involved shoulder onto the examiners hand and to press as hard as he/she can into the stomach 3. Cue the patient to attempt to bring the ipsilateral shoulder forward into the scapular plane (causing greater medial rotation) 4. Positive test (+): Patient is unable to maintain pressure on examiner’s hand while moving elbow forward or if patient extends the shoulder

Question 38

Biceps Load II Test

Answer 38

Purpose: Determine if there is a SLAP lesion 1. Abduct patient’s shoulder to 120 deg, flex elbow to 90 degrees, supinate forearm. 2. Take to end range ER, patient is asked to flex elbow while PT resists at distal forearm. 3. Positive test (+): Reproduction of deep shoulder pain with resisted elbow Flexion.

Question 39

2. Resisted supination with external rotation test (RSERT)

Answer 39

Purpose: Determine if there is a SLAP lesion 1. Abduct patient’s shoulder to 90 degrees, flex elbow to 90 degrees, neutral forearm rotation 2. Passively externally rotate shoulder while resisting against supination (patient is supinating against your resistance to activate the biceps) 3. Positive test: Reproduction of shoulder pain, clicking or popping

Question 40

Crank test

Answer 40

Purpose: To rule in/out labral pathology 1. Passively take the Pt’s shoulder to 160 degrees of elevation in the plane of scaption. 2. Therapist places hands on distal humerus and proximal forearm. 3. Load the labrum with an axial compression and crank the arm into IR/ER. 4. Positive test (+): Deep shoulder pain.

Question 41

Jerk Test

Answer 41

Purpose: Posterior Inferior labral lesions 1. Grasp the elbow with one hand and the scapula with the other hand. 2. Elevate patient’s arm to 90 degrees abduction and IR. 3. Apply axial compression-based load to the humerus at elbow maintaining the horizontally abducted arm. 4. Axial compression is maintained as the pt’s arm is moved into horizontal adduction. 5. Positive test (+): Sharp shoulder pain with or without a clunk or click

Question 42

What are the shoulder instability tests?

Answer 42

1. Anterior Apprehension and Relocation Test 2. Load and Shift 3. Sulcus Sign (Superior Labrum)

Question 43

Anterior apprehension and relocation test

Answer 43

Purpose: To assess the range of instability of shoulder anterior dislocation Patient's elbow is flexed to 90 degrees and then passively abduct patient's shoulder to 90 degrees, rest patient's distal humerus on therapist's leg for support 2. Therapist palpates anterior part of shoulder while taking the shoulder into external rotation 3. Positive test is apprehension or fear as the therapist moves the patients arm 4. If apprehension or fear is noted, release slightly into internal rotation 5. Therapist proceeds to add a posterior glide to relocate the glenohumeral joint and then proceed into external rotation again 6. Once end range is felt gently release posterior glide 7. Positive test is apprehension in this position

Question 44

Load and shift test 0-3 grading scale

Answer 44

Purpose: Assessment of instability of the shoulder. Specifically looking at how far the humeral head glides over the glenoid fossa. Purpose: Assessment of instability of the shoulder. Specifically looking at how far the humeral head glides over the glenoid fossa.Therapist stabilizes scapula and grabs head of humerus. 2. Therapist moves humeral head anterior and posteriorly to assess how much 3. The humeral head glides on the glenoid fossa 4. Look for excess mobility compared to other side 5. Grades 0-3 a. Grade 0: Normal is up to 25% glide b. Grade 1: Glide of 25-50% (0-1cm) c. Grade 2: Glide >50% but reduces (humeral head feeling right over the edge of glenoid fossa) (1-2cm) d. Grade 3: Glide >50% but does not reduce (>2cm)

Question 45

Sulcus sign

Answer 45

Purpose: Determine if there is laxity or labral tear. If superior labrum is torn, might have resting sulcus passively. 1. Measure in centimeters distance b/n inferior surface of acromion and superior portion of humeral head. 2. Repeat test in supine position w/shoulder in 20 degrees abduction and in forward flexion while maintaining neutral position.

Question 46

Speed's test

Answer 46

Purpose: Determine if there is biceps tendinopathy, anterior shoulder pain 1. Have patient with shoulder flexed to 90, elbow extended and forearm fully supinated. 2. Apply downward force at distal forearm and other hand palpates the bicipital groove. 3. Positive test (+): Pain or popping/crepitus of the bicipital tendon at the groove.

Question 47

Shoulder IR MWM

Answer 47

Purpose: Painful IR, increase IR ROM 1. Therapist adds adduction force with body. 2. Proximal hand is on medial side of mid-humerus in the axilla (to add a spacer) 3. Distal hand is on proximal forearm to add an inferior traction force 4. Patient uses a towel to pull the arm behind back with uninvolved arm 5. HEP: add spacer with a towel between the arm at mid-humerus and use IR with towel.

Question 48

2. Shoulder Elevation MWM

Answer 48

Purpose: Painful elevation, increase shoulder elevation/flexion ROM Cues: 1. Have patient’s arm rest on therapist’s shoulder and that therapist hand is applying a lateral glide force. 2. Patient actively leans forward into shoulder flexion. 3. Adjust direction of glide until pain is abolished. 4. Multiple repetitions are done.

Question 49

SHoulder PA Grade I or II for irritable patients

Answer 49

Purpose: Ease irritable/painful shoulder especially following mobilizations of high grade 1. Place both of your thumbs on the posterior surface of the humeral head with fingers wrapped over the shoulder and proximal humerus. 2. Using the thumbs, apply a posterior to anterior grade I or II mobilization for 30 seconds.

Question 50

Shoulder Passive Physiologic ER for easing

Answer 50

Purpose: Ease irritable/painful joints following joint mobilizations 1. Stand in a staggered stance so your thigh provides a block. This is to comfort the patient and make them feel sure their arm will not more outside their comfort range. 2. Holding the patient’s wrist gently oscillate their arm through about 30 degrees to create an arc of external to internal rotation. 3. Continue the gentle oscillations for 30 seconds. Useful for easing patient out of grade III and IV mobilizations.

Question 51

Glenohumeral head anterior glide

Answer 51

Purpose: Increase glenohumeral joint mobility anteriorly to increase external rotation 1. Stabilize the clavicle in a wedge or using a towel so that the acromion is blocked, but the humeral head is free to move. 2. Place patient’s hand on a stool so elbow is flexed to approximately 90 degrees and shoulder is in neutral rotation. 3. Apply a grade I traction force to the humerus using your distal hand. 4. Using your proximal hand apply grade I-IV (based on patient tolerance and desired effect) mobilizations in a posterior to anterior direction. Use the “meat” of your hand or pad with a towel for patient comfort. Mobilization bouts last between 30 seconds to 1 minute with 30 seconds rest for 3 repetitions. 5. Following grade III or IV mobilizations it is helpful to ease the patient out with 5-10 seconds of grade I and II. 6. Using the stool or your arms apply an end range stretch in external rotation following the three mobilization bouts 7. Once patient’s irritability is known gradually increase duration of mobilization and/or increase mobilization grade. 8. Using the stool to support the arm, gradually position the arm into further degrees of external rotation during the mobilizations once irritability is known to be low and range is gained. 9. Encourage patient to use new range with active motion bouts of 3x30 as long as the motion is pain free. 10. Reassess range following each round of 3 mobilization bouts.

Question 52

Glenohumeral posterior glide

Answer 52

Purpose: Increase glenohumeral posterior glide accessory mobility to increase glenohumeral internal rotation range of motion 1. Position glenohumeral joint in open packed position of about 50 degrees abduction, slight horizontal adduction and slight external rotation. Support the forearm against your body with your elbow and their elbow with your hand. 2. Apply grade I traction 3. Using the “meat” of your hand apply a anterior to posterior mobilization grade I-IV depending on patient’s irritability and desired outcome. 4. Mob for three sets of 30 seconds to 1 minute with 30 seconds rest. Following grade III or IV mobs it is beneficial for the patient to be eased out with a few seconds of grade I and II mobs. 5. After each bout of three mobilization sets an end range stretch of 30 seconds may be applied. 6. Have the patient utilize new range by performing 3 sets of 30 active internal rotation in pain free range. 7. Reassess range following each round of 3 mobilization bouts 8. Once irritability is known and range is gained you can increase the grade and duration of the mobilization

Question 53

Glenohumeral inferior glide

Answer 53

Purpose: Increase glenohumeral joint physiologic motion inferiorly to improve shoulder abduction 1. Stabilize scapula and acromion with a towel roll or wedge. Make sure humeral head is not blocked. 2. Support the patient’s arm against your side with your elbow and also at the distal humerus with your hand. 3. Apply a grade one traction force. 4. Using the webspace between the thumb and pointer finger apply an inferior mobilization to the humeral head. Grade I-IV mobilization can be applied based on patient’s irritability and desired goal. 5. Mob for three bouts of 30 seconds to one minute with 30 seconds rest between bouts. 6. Following grade III or IV mobilizations it is helpful to ease the patient out with 5-10 seconds of grade I and II. 7. An end range hold may be applied for 30 seconds following the mobilization 8. Encourage patient to use new range with active motion bouts of 3x30 as long as the motion is pain free. 9. Reassess range following each round of 3 mobilization bouts. 10. Once irritability is known and range is gained you can increase the grade and duration of the mobilization and abduct the arm slightly more.

Question 54

Scapulothoracic Elevation/ Depression

Answer 54

Purpose: To assess scapulothoracic mobility 1. One hand on the spine of the scapula and one hand (the webbing between index finger and thumb) on the inferior angle of the scapula. The arm on the inferior angle is reaching under the patient’s arm and supporting it. 2. Glide the scapula down for depression and up for elevation.

Question 55

Scapulothoracic Up and Downward Rotation

Answer 55

Purpose: To manually assist scapular upward rotation while the patient reaches above head. 1. The patient is asked to abduct and reach over head as if they are trying to grab something out of a cupboard above head. 2. Therapist assists the scapula into upward rotation adding a slight force to ensure that the shoulder elevates and rotates appropriately. Note: The spine of the scapula should reach to the level of C6 and the inferior angle should reach the mid-axillary line of the thorax. The patient should be asked if the assistance eases the movement and is pain free.

Question 56

Subscapularis length test

Answer 56

Purpose: To assess external rotation range of motion deficits related to subscapularis length 1. Assess external rotation range of motion at 45 degrees of shoulder abduction 2. Next, assess external rotation range of motion at 90 degrees of shoulder abduction 3. If range of motion is more limited at 45 degrees than at 90 degrees of shoulder abduction, this indicates that the subscapularis is the primary limiter of the motion (The origin and insertion of the subscapularis are closer together, allowing for increased ER as compared to a capsular problem where the range of motion would typically get worse)

Question 57

Subscapularis soft tissue mobilization

Answer 57

Purpose: To treat external rotation range of motion deficits related to subscapularis length or trigger points 1. Apply force with fingers tips curled on to the anterior surface of the scapula on the subscapularis muscle 2. Utilize the other hand to apply force through the mobilization fingers 3. If range of motion is more limited at 45 degrees than at 90 degrees of shoulder abduction, this indicates that the subscapularis is the primary limiter of the motion (The origin and insertion of the subscapularis are closer together, allowing for increased ER as compared to a capsular problem where the range of motion would typically get worse)

Question 58

Rotator cuff trigger point assessment and deep pressure to muscles

Answer 58

Purpose: To manually assist scapular upward rotation while the patient reaches above head. 1. Assess the posterior rotator cuff for tissue hypertonicity or trigger points 2. Apply deep pressure Note: The spine of the scapula should reach to the level of C6 and the inferior angle should reach the mid-axillary line of the thorax. The patient should be asked if the assistance eases the movement and is pain free.