Shoulder Pt 2 (diagnoses)

atraumatic shoulder diagnoses

SAIS
RC tear or tendinitis
instability (dislocation or subluxation)
labral tear
adhesive capsulitis
AC injury
OA/RA

subacromial impingement syndrome (SAIS)

ant/lat pain with overhead
scapula winging or dysrhythmia
tight post capsule
hooked acromion or bone spurs
friction on supraspinatus tendon

SAIS diagnosis criteria

ant/lat shoulder symptoms
incr w/ overhead motions
AROM — decr ABD & IR
PROM — painful IR at 90 ABD
pain with resistance
tender below acromion

Hawkins Kennedy test (H-K)

shoulder & elbow at 90
support elbow & passive IR shoulder at wrist
+ if pain

Neer’s test

passively flex pt shoulder
neutral wrist
+ if pain with overpressure

painful arc test

self-report (usually during UE pattern 2)
+ if pain between 60-120 deg

infraspinatus test

aka resisted ER
stabilize at elbow & push into IR at wrist
tell pt to resist IR — watch for pain

SAIS test cluster

painful arc, H-K, infraspinatus
2 positive = moderate confidence
all positive = strong

rule in vs rule out SAIS

rule in = H-K, painful arc, infraspinatus
rule out = H-K & Neer’s

rotator cuff pathology

can progress from SAIS
supraspinatus tendon damage
decr ABD AROM, full PROM (C5)
ant/lat shoudler pain w/ overhead
hx of overhead/repetitive activity

drop arm test

passively raise pt arm into flexion
let go & ask pt to slowly lower
+ if lack control

full & empty can tests

arm in scaption, thumb up (full) or down (empty)
stabilize on shoulder & push down on wrist
+ if pain or weakness

ER lag sign

0 ABD & 90 elbow flexion
max passive ER & tell pt to hold there
+ if cant hold full ER

other RTC tests

infraspinatus integrity — drop sign, hornblower’s sign
subscapularis integrity — IR lag test, belly press test, bear hug test
rent test, lateral jobe

lift off test

pt hand on sacrum, try to pull hand away
+ if cant lift off back

RTC test cluster

drop arm, painful arc & infraspinatus test
3 = strong, 2 = weak
age 60+ w/ + tests
age >65 with weak ER & night pain

rule in vs rule out RTC

rule in = test clusters, ER lag sign, lift off
rule out = full can

shoulder instability

younger age, overhead athlete, chronic shoulder pain/sublux
atraumatic multidirectional bilateral laxity rehab inferior capsule shift (AMBRI)
may damage axillary & suprascapular nn

Hill-Sach’s lesion

indentation fracture of posterolateral head
from ant subluxations

apprehension test

90 ABD, full passive ER
+ if apprehension/discomfort

relocation test

apprehension test + post glide
+ if symptoms relieved

anterior release test

apprehension + relocation + remove post glide
+ if pain or apprehension after remove glide

sulcus sign

distraction on humerus
one hand on shoulder, other pulls down above elbow
+ if gap in subacromial space

rule in vs rule out instability

rule in = ant release, relocation & sulcus
rule out = ant release

labral tear

acute onset (FOOSH), tear glenoid labrum
click/catch/pop/lock
more common in dominant arm
often associated with instability, SAIS & biceps tendinitis

SLAP lesion

superior labral tear anterior to posterior

Bankart lesion

ant/inf glenoid tear

load & shift

stabilize at AC joint (C-grip) & grasp GH head
glide GH head ant
+ if laxity (3 grade levels)
1 = 0-1cm, 2 = 1-2cm, 3 = over glenoid

crank test

pt supine, arm to 160 in scapular plane, flex elbow
press humerus in at elbow
max IR & ER
+ if symptoms or painful

anterior slide

pt hand on hip
hand on shoulder, other on elbow
sup & ant force up elbow
+ if pain or click

biceps load test (II)

pt shoulder in 120 ABD, elbow 90, forearm supinated
full ER
resist elbow flexion
+ if pain

Yergason test

elbow 90 flex & ABD at side
forearm supination, resist pronation

labral tear test cluster

crank, apprehension, relocation, load & shift, inf sulcus

rule in vs rule out labral tear

rule in = test cluster
rule out = biceps load

biceps tendinopathy

ant shoulder pain w/ reaching & lifting
overhead & overuse
biceps pain & weakness (long head), tender
can occur w/ RTC or SLAP tear

speed’s test

90 shoulder flexion, extended elbow, supinate forearm
press down on wrist
+ if pain or weakness

biceps tendinopathy test cluster

palpation + speed’s test

AC joint pathology

from fall, tender to palpation, may feel “step off”
sup & ant shoulder pain
worse with horizontal ADD or pushing

AC injury grades

Grade 1 = AC ligaments stretched, CC intact
Grade 2 = AC ligaments rupture & separate, CC intact
Grade 3 = AC & CC rupture, wide separation

active compression

shoulder flex 90, elbow extended, full IR, 10 deg horizontal ADD
press down at wrist
then full ER & repeat
+ if AC pain with IR & relieved with ER

cross body adduction

shoulder flex 90, elbow slightly bent
hand on shoulder, other at elbow & passive horizontal ADD
+ if AC pain

AC resisted extension

shoulder & elbow flex 90, IR to parallel
resist horizontal ADD
+ if AC pain

AC pathology test clusters

AC resisted extension, cross body ADD & active compression
cross body ADD, active compression, H-K, AC tender

rule in vs rule out AC pathology

rule in = test clusters
rule out = AC resisted extension

adhesive capsulitis

aka frozen shoulder
unknown cause (primary) or after surgery (secondary)
vague ant/lat pain
capsular pattern of loss (ER > ABD > IR)
capsule thickens

ad cap risks

female, >40, sedentary
non-dominant shoulder, Hx of dysfunction
endocrine disorder

ad cap stages

stage 1 = painful (hurts with motion, night pain)
stage 2 = frozen (stiff, lose most ROM)
stage 3 = thawing (ROM incr, pain may decr)

shoulder shrug sign

ask pt to flex arm
+ if shoulder shrugs before 90 degrees

rule in vs rule out ad cap

rule in —> shrug test & symptoms (capsular pattern of loss)
rule out —> coracoid pain test & symptoms (maybe)

glenohumeral arthritis

50+, gradual, broad symptoms & pain
worse with any arm activity
capsular pattern of loss (AROM)
weak RTC

rule in vs rule out GH arthritis

rule in = abnormal hard / rough arc of motion, shoulder shrug & capsular pattern

common traumatic diagnoses

fracture (fx) — scapula, clavicle, prox humerus
dislocation — GH or AC joint

scapular fx

depends on mechanism
from direct hit or fall

clavicle fx

young males or elderly women
fall directly on shoulder

proximal humerus fx

low impact fall
elderly women

GH dislocation

pain, young, Hill’s Sach’s
FOOSH, overhead/ER motion
traumatic unilateral bankart lesion surgery needed (TUBS)

AC dislocation

piano key sign
fall on shoulder