Unit 2 Weeks 6-7 Shoulder

Question 1

what muscles are considered the humeral stabilizers?

Answer 1

supraspinatus, infraspinatus, subscapularis, teres minor (Rotator Cuff)

Question 2

what muscles are considered the prime movers of the shoulder?

Answer 2

pectoralis major, latissimuss dorsi, teres major, deltoid (LH of biceps, triceps)

Question 3

what muscles are considered the scapular stabilizers?

Answer 3

serratus anterior, latissimus dorsi, trapezius, rhomboids, levator scapulae, pectoralis minor

Question 4

what is the scapulohumeral rhythm?

Answer 4

2:1 ratio of glenohumeral motion to scapulothoracic motion

Question 5

what are the force couples of the shoulder?

Answer 5

deltoid-rotator cuff
upper trap-serratus anterior

Question 6

what are you looking for when looking at joint motion?

Answer 6

quality, quantity, provocation, where in range symptoms produced
scapulo-humeral rhythm: anterior and posterior

Question 7

what functional motions should be looked at in a shoulder evaluation?

Answer 7

hand behind head: combined abd/ER
hand behind back: combined ext, add, IR

Question 8

what are the SA pain tests?

Answer 8

neer’s: shoulder flexion with arm in IR+ over pressure
hawkins-kennedy: 90 degrees flexion with IR

Question 9

what makes up the rotator cuff?

Answer 9

supraspinatus, infraspinatus, teres minor, subscapularis

Question 10

what are the ACJ provocation tests?

Answer 10

cross body adduction
resisted horizontal ext/abd

Question 11

what tests are for the biceps tendon and ACJ/labrum?

Answer 11

speeds test: long head of the biceps/bicipital tendonitis
active compression test: ACJ/labral pathology

Question 12

what are the common locations of tenderness in the shoulder?

Answer 12

subacromial space, supraspin tendon, greater tuberosity, bicipital groove, ACJ line, upper trap and levator scap

Question 13

what does the wall push up test?

Answer 13

serratus anterior weakness
a (+) test = scapular winging

Question 14

what are the scapular alleviation tests?

Answer 14

scapular assistance test
scapular repositioning test

Question 15

what degree of FROM is needed for combing hair, perineal care, washing the contralateral UE, and overhead shelf?

Answer 15

combing: abd 105-120, ER 90, add 30-70
perineal: abd 30-45, IR 90+, abd 75-90
washing: flex 60-90, IR 90, add 60-120
overhead: flex 70-80, ER 45, add 70-80

Question 16

what are some contributing factors to internal rotation loss?

Answer 16

bony adaptation, scapular posture, posterior musculotendinous tightness, shoulder fatigue, posterior capsular tightness (anterior pseudolaxity, superior and anterior/posterior migration

Question 17

what is the kibler classification or scapular posture?

Answer 17

type 1: prominent inferior angle - RTC tendinopathy
type 2: prominent medial border - GH instability
type 3: superior migration of medial border - RTC weakness

Question 18

what is thrower’s sick scapula?

Answer 18

Scapular malposition
Inferior medial border prominence
Coracoid pain and malposition
dysKinesis: labral (inferior/medial border), rotator cuff (superomedial border)

Question 19

what does spinal accessory nerve palsy present as in relation to scapular posture?

Answer 19

upper trap atrophy and scapular depression
(+) flip sign
no medial winging with flexion or abd

Question 20

what does long thoracic nerve palsy present as in relation to scapular posture?

Answer 20

medial winging with active flexion

Question 21

what are the common faults of scapular dyskinesia? what interventions should be done?

Answer 21

increased anterior tilt: stretch UT, pec minor, levator and rhomboids. strengthen serratus and LT
increased IR: stretch pec minor. strengthen serratus and LT
decreased upward rotation: stretch pec minor and pec major. strengthen mid and low trap, rhomboids, serratus

Question 22

what are the shoulder unilateral ratios?

Answer 22

ER to IR: 66-75%
s/p RTC repair ER to abd: >58%

Question 23

what subjective complaints are common with rotator cuff tendinopathy?

Answer 23

anterolateral shoulder pain/tenderness
pain with overhead activities
reports of painful arc of motion
pain with reaching behind back
symptoms lifting or sleeping on affected side
gradual onset

Question 24

what are the contributing factors for rotator cuff pathology?

Answer 24

intrinsic theory: consequence of overuse and/or overload; degeneration
extrinsic theory: bony/articular compression

Question 25

what is tendinopathy? what must be present for diagnosis?

Answer 25

thickened, non-ruptured tendon tendon pathology, pain system changes, motor system impairments

Question 26

what are the modifiable risk factors for RTC pathology?

Answer 26

force couple imbalance/weakness scapular dysfunction ROM loss quickness to fatigue posterior impingement humeral head superior translation

Question 27

what are the non-modifiable risk factors for RTC pathology?

Answer 27

secondary impingement ligamentous laxity

Question 28

what grouping of objective findings are consistent with a rotator cuff tear?

Answer 28

weakness with ER (+) drop arm test (+) painful arc

Question 29

what are the 4 stages of adhesive capsulitis and their timelines?

Answer 29

1: synovial rxm w/out adhesion (up to 3 months) 2: painful/freezing; agressive synovitus (3-9 months) 3: frozen; progressive capsuligamentous fibrosis (9-15 months) 4: thawing (15-24 months)

Question 30

what are the adhesive capsulitis rehab irritability classifications?

Answer 30

high: >7/10, increase disability, AROM < PROM moderate: 4-6/10, moderate disability, AROM = PROM low: <3/10, minimal disability, AROM = PROM

Question 31

what are the signs and symptoms consistent with proximal biceps pathology?

Answer 31

localized anterior shoulder pain (bicipital groove) provocative ROM pain with resisted elbow flexion/wrist supination Ludington's sign

Question 32

what signs and symptoms are consistent with superior labral anterior-posterior tears (SLAP)?

Answer 32

deep shoulder pain at maximal ER with throwing intermittent popping/catching during rotation loss of external rotation strength with accompanying atrophy in infraspinous fossa decreased velocity and control (dead arm)

Question 33

what signs and symptoms are consistent with anterior glenohumeral dislocation?

Answer 33

pain flattened deltoid/head humerus near axilla arm support and head abd/ER

Question 34

what is the MOI for anterior glenohumeral dislocation? posterior?

Answer 34

anterior: abduction and ER posterior: adduction and IR

Question 35

what signs and symptoms are consistent with anterior glenohumeral dislocation?

Answer 35

pain protect posture: add and IR limited ER and elevation flattened deltoid and prominent coracoid

Question 36

what are the common symptoms of shoulder instability?

Answer 36

pain feeling of weakness sensation abnormal mechanics (clicking, catching, clunking) instability (subluxation/dislocation) pain with WB (posterior)

Question 37

what is included in the shoulder instability cluster? which rule in/out?

Answer 37

apprehension: both sulcus: spin load-shift: spin anterior release: both relocation: both

Question 38

what is included in the labral tear cluster? which rule in/out?

Answer 38

crank: spin obrien's: snout resisted supination/ER test: both

Question 39

what are the common symptoms of little league shoulder (proximal humeral epiphysiolysis)?

Answer 39

vague anterior shoulder pain TTP superolateral shoulder pain with resisted external rotation reduction in rotator cuff strength and endurance poor scapular control increase in height velocity

Question 40

what rehab considerations are there for ACJ separations?

Answer 40

avoid stress through ROM (horizontal add, IR, end flex and ext) minimize downward displacement (avoid sustained lifting)

Question 41

what is the cervical radiculopathy cluster?

Answer 41

(+) spurling's test (+) distraction test (+) ULTT cervical rot < 60 degrees involved UE

Question 42

what diagnoses fall under shoulder pain with mobility deficits?

Answer 42

adhesive capsulitis/frozen shoulder fractures arthrosis (subacromial impingement, bicipital tendinitis)

Question 43

what are the 4 stages of progression for frozen shoulder/adhesive capsulitis?

Answer 43

Stage 1: looks like impingement, capsular pattern Stage 2: progressive ROM loss all planes, significant, persistent pain, night pain Stage 3: significant ROM loss, compensatory mvmts, severe pain passed Stage 4: pain spontaneously resolved, steady gain of ROM, caps pattern, end-feel before pain

Question 44

what is the test cluster for impingement?

Answer 44

H-K, painful arc, infraspin (ER) resistance test

Question 45

what diagnoses fall under shoulder pain with muscle power deficits?

Answer 45

rotator cuff syndrome

Question 46

what diagnoses fall under shoulder pain with joint stability impairments?

Answer 46

labral tear dislocation instability/sprain: GH, ACJ

Question 47

what is a bankart lesion?

Answer 47

avulsion of the anterior inferior labrum from the glenoid rim

Question 48

what is a hill-sachs lesion?

Answer 48

compression fracture of the posterior humeral head at the side where the humeral head impacted the inferior glenoid rim

Question 49

how is shoulder instability classified?

Answer 49

frequency etiology volition (voluntary vs involuntary) direction degree (dislocation, subluxation, micro)

Question 50

what is the beighton's scale?

Answer 50

(score 0-9, 1 point each, test bilateral) 1. passive dorsiflexion of the 5th finger beyond 90 2. passive thumb opposition to the forearm 3. active elbow hyperextension beyond 10 4. active knee hyperextension beyond 10 5. forward flexion of the trunk with knees fully extended so that the palms of the hands rest flat on the floor >2 = 2.5x more likely to have episode of shoulder instability

Question 51

what diagnoses fall under shoulder pain with with movement coordination impairments?

Answer 51

SICK scapula syndrome posterior impingement (secondary impingement, nerve injuries)