Shoulder

Anteriorly translated humerus can be related to weakness of what muscle?

subscapularis

How does the upper trap/UR force couple affect subacromial space during upward rotation?

helps maintain enough space to prevent impingement

Effect of scapular rotator force couple on the length-tension of the deltoid during upward rotation

important for maintaining length-tension of deltoid

Muscle group that provides scapular base for scapulohumeral muscles

upward rotators (traps, serratus)

point vs period prevalence

point: measure of a condition in the population at a given point in time

\
period: proportion of the population with the condition over a specified period of time

Incidence

number of new occurrences of the condition in a population over time

Gender and age group with a high prevalence of shoulder issues

females, 42-46 yo

Shoulder myofascial pain in common in dynamic or static posturing? What kind of occupations?

static posturing, occupations likely computer work, dentists

Risk for persistent shoulder pain when the onset is __ and lasts for over __ months

gradual, 3 months

R shoulder pain referrals from what non-MS origins?

peptic ulcer (duodenal), liver abscess, gallstones, hiatal hernia, R lung/kidney

L shoulder pain referrals from what non-MS origins?

splenic rupture, pancreatitis, cardiac, L kidney

AC vs rotator cuff pain referral pattern?

AC: directly on joint

RC: refers to deltoid tuberosity

What trigger points refer to the deltoid region?

supraspinatus, infraspinatus, and subscapularis

Subscapularis (axillary palpation) will refer pain to the ___

posterior deltoid and posterior wrist

Levator scap and upper trap trigger points?

upper trap: nuchal line and mastoid process

levator: local

Bankart lesions (labral tear) typically between what clock numbers on the R and L side?

3 and 6 on R, 6 and 9 on L

Sprengel’s deformity

underdeveloped and elevated scapula

Individuals with cleidocranial dysplasia will often have ____

absent or diminished clavicles

Clavicles should be what angle at rest?

10 deg of elevation

Scapular position at rest between what vertebrae? Where should root of spine of scapula be? What is orientation in frontal plane?

T2-7; root of spine of scapula at T3/4; 30 degrees anterior to frontal plane

Which structures are likely to be stretched in a humeral anterior glide? What structures are short?

anterior stretched, posterior short

Which humeral syndrome would have short medial rotators and lengthened lateral rotators

humeral medial rotation

humeral syndrome associated with internal rotation or tilted scapula, with forward shoulders

medial rotation

Superior humeral glide puts the scapula into a position of relative *__.* What about the GH joint?

abduction, downward rotation

___ glide of the humerus is associated with downward rotation of the scapula

superior

humeral syndrome associated with capsular pattern loss? associated pathology?

GH hypomobility, adhesive capsulitis

Most common muscles involved in rotator cuff pathology from most to least

supraspinatus, infraspinatus, subscap, and rarely teres minor

Compression fracture of the posterolateral humeral head

hill-sachs lesion

detachment of the labrum from the anterior glenoid rim

bankart lesion

Bankart fracture

bony avulsion of the glenoid rim

primary vs secondary compression cuff disease? (impingement)

\-primary is overcrowding of the subacromial space

\-secondary compression has no anatomic space issue and is more of a instability problem

Functional impacts of secondary compression cuff disease (3)

GH instability, muscle weakness, abnormal scapulohumeral rhythm

posterior impingement/compression occurs in what position?

abducted and externally rotated

What is the site of the lesion in posterior cuff compression/impingement?

posterior/superior labrum or cuff

Anatomic cause of posterior impingement

repetitive contact of greater tuberosity on posterosuperior part of glenoid

Primary tensile cuff disease seen most commonly in what type of activities

aggressive deceleration loads in late phase of activity (overhead/throwing motions)

Calcific tendinopathy likely to occur in what type of rotator cuff pathology

primary impingement syndrome

Onset of pain with calcific tendinopathy

rapid

Hypo or hypermobility with secondary impingement

hypermobility

Rotator cuff pathology likely to have pain in what sleeping position and what UE position

sleeping on the side of pain, when the arm is overhead

What scapular kinematics are often seen that is associated with RC pathology and GH instability?

less upward rotation

anterior tilting

more IR

Tests and measures for impingement syndrome (park)

Hawkins-Kennedy, painful arc, infraspinatus

Tests and measures for full thickness RCT

painful arc, drop-arm, infraspinatus test, ER and IR lag signs

Long or short in insufficient upward rotation: serratus anterior, rhomboids, lower traps, supraspinatus, deltoids, lats

Long - serratus, lower traps

short - supraspinatus, rhomboids, deltoid, lats

With external rotation/adduction of the scapula, long or short muscles: rhomboids, serratus anterior, middle trap

short: rhomboids, middle trap

long: serratus

Interventions for rotator cuff pathology considered not successful if no improvement is seen after _____ months of intervention

3

Most partial RC tears are on the inferior (joint) or superior (bursa) side?

inferior

What is the mumford procedure?

distal clavicle resection for decompression/AC arthritis

Post-op goals for RC tear surgery?

full ROM (want to restore quickly), restore control of the humeral head, maximize ER strength

Avoid theraband strengthening for RC tears post-op during first __ weeks of recovery

4

Long head of the biceps is a passive restraint for what areas of translation at the GH joint?

anterior and superior translation

Proximal biceps tendon tendinopathy usually a result of

primary or secondary impingement syndrome

Proximal biceps tendon rupture often due to

chronic tendinopathy

Two causes of long head of biceps instability?

shallow intertubercular groove, torn transverse humeral ligament

Symptoms of LH biceps tendinopathy versus LH biceps instability

tendinopathy - anterior shoulder pain with or without weakness

LH biceps instability - anterior shoulder pain, “popping”

Tests and measures for long head of biceps tendon rupture

Ludington’s test, Speed’s test

tests and measures for LH instability

reproduction of subluxation with M and L rotation

effective exercises for LH biceps tendinopathy

eccentric shoulder or elbow flexion

LH biceps tendon attachment

50% to superior glenoid tubercle

50% to superior labrum

SLAP lesion occurs where on the clock

10 and 2

SLAP tear mechanisms (4)

FOOA, dislocation, repetitive overhead activity, peel-back mechanism of 90/90 (abd./ER)

SLAP lesions are often concomitant with what other injuries (2)

partial thickness RC tear, bankart lesion

SLAP lesion cluster (4)

passive compression, passive distraction, biceps load test, active compression (O'Brien's)

Type I-IV of SLAP lesions

Type I slight fraying of labrum

Type II - detached biceps tendon with or without fraying

Type III bucket-handle tear of superior labrum

Type IV tear up into the biceps tendon

Likely to see pain in what position with SLAP lesions? What motion gets restricted?

pain in 90/90 peel-back, see lack of IR

Non-surgical rehab typically not effective for overhead throwers with what kind of pathologies

SLAP lesion and LH biceps instability

Post-op SLAP lesion repair, should avoid what position? Avoid what kind of activity for first 8 weeks?

avoid 90/90 position, do not want to use biceps for first 8 weeks

Most common direction for traumatic shoulder dislocations? Age and sex most common?

anterior; most common males 18-25

AMBRI

atraumatic multidirectional bilateral rehab instability

TUBS

traumatic, unidirectional, Bankart lesion, surgery

nerve most at risk with GH instability

axillary

Pathologies common with anterior GH instability

Bankart lesion, Hills-Sachs lesion

Pathologies associated with posterior dislocation

Reverse Bankart, reverse Hills-Sachs

Pathologies associated with multidirectional instability (3)

rotator cuff tendinopathy, SLAP, subacromial bursitis

Direction of traumatic instability associated with violent muscle contractions, seizures, and electric shock

posterior instability

Direction of traumatic instability associated with FOOA/PA force

posterior instability

Traumatic anterior instability mechanism in what positions of the shoulder

abduction, extension, ER

Atraumatic anterior instability is associated with what

repetitive overhead activities: throwing, swimming

Atraumatic posterior instability associated with what movements? commonly seen in what sports or exercises?

flexion and MR; seen in O-lineman and bench pressing

tests/measures for anterior stability

anterior apprehension test, relocation tests, anterior release test

tests/measures for GH posterior instability? What position does this put the GH joint in?

posterior apprehension (MR, adduction, flexion)

With anterior GH instability, which part of the capsule would we look at for tightness? What muscles could also be tight?

posterior capsule; external rotators

Proprioception deficit seen especially in what type of instability

multi-directional

Age group with more success with PT intervention against recurrent dislocations?

over 30, higher chance of success with intervention

Test/measure to look at capsule associated with anterior instability of GH

posterior capsule tightness test

Stabilizing structure for external rotation at 0 degrees of abduction versus 90 degrees of abduction

0 - subscap
90 - inferior GH ligament

In the first 3 weeks after a trauma, what program needs to be followed with anterior instability

90/0 program (90 deg flexion, 0 deg LR)

What positions to avoid initially with posterior instability after a trauma?

avoid flexion or adduction with medial rotation

Progression of strengthening for GH instability? What type of exercises effective for addressing stability?

establish stabilization and motor control, then strengthening in CKC exercises with WB

Good exercise for proprioception and stability

eyes closed rhythmic stabilization

Position of avoidance after Bankart lesion surgery repair

90/90

Serratus does what tilt at the shoulder

posterior

Adhesive capsulitis common risk factors (4)

diabetes, thyroid disease, previous episode, female - menopause

Most common type of adhesive capsulitis

primary = idiopathic (no apparent cause)

secondary = trauma/surgery etc

Adhesive capsulitis typically starts in what irritability range

high

Stage 1 of adhesive capsulitis time, pain at what range, symptoms similar to what pathology

0-3 months, pain at end range, symptoms similar to impingement syndrome

Stage 2 of adhesive capsulitis time, ROM, volume of capsule

3-9 months, freezing phase, painful shoulder ROM, capsule decreased volume

Stage 3 of adhesive capsulitis

frozen phase: 9-15 months, less pain but still stiff

Stage 4 of adhesive capsulitis

15-24 months, the thawing stage where some ROM recovered

Adhesive capsulitis typically expect to see what motions at the scapula during elevation

increased and early upward rotation