Term
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Definition
O/I- supraspinous fossa greater tub
N/A-suprascapular n & thoracoacromial
Act.-ABD, depress humeral head, ER, main ABD 0-60
Test post.-ER &abd |
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Term
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Definition
O/I-infraspinous fossa middle of greater tub
N/A-suprascapular n & suprascapular and posterior humeral circumflex a
Act.-ER, depresshumeral head, top 1/3 ABD lower 1/3 ADD
Test post.-ER |
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Term
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Definition
O/I-lateral edge of middle ½ of axillary border of scap caudal greater tubercle
N/A-axillary n & suprascapular and posterior humeral circumflex a
Act.-ER and stab humerus, weak add |
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Term
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Definition
O/I-subscapularis fossa lesser tub of humerus
N/A-upper and lower subscapular nerves & anterior humeral circumflex a
Act.-IR, depress head, add |
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Term
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Definition
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Term
| Tendinitis treatment acute |
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Definition
| decrease inflammation, PROM pain free, gd 1, stop painful activities |
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Term
| Tendinitis treatment subacute |
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Definition
| in pain free, stretch 1 joint at time, accessory gd 2 |
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Term
| Tendinitis treatment settled |
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Definition
| ice after exercise, resistance in pain free range, stretch, gd 3-4 mobs, strengthening, endurance |
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Term
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Definition
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Term
| Tendinosis treatment acute |
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Definition
| pain free, gd 1, stop painful activities |
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Term
| Tendinosis treatment subacute |
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Definition
| arom in pain free, stretch 1 joint at time, accessory gd 2 |
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Term
| Tendinosis treatment settled |
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Definition
| resistance in pain free range, stretch, gd 3-4 mobs, strengthening, endurance |
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Term
| Partial tears best findings |
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Definition
| MSTT, PFC, PFT (typically seen in younger pts) |
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Term
| Partial tears treatment post immobilization |
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Definition
| immob, dynamic stab, grad restore motion start with NSAIDs, ROM, capsular stretching, starting CKC, can start supraspinatus if 90 degrees of abd available, any pushups should avoid more than 90 flexion so no movement of GH |
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Term
| Partial tears treatment post surgery |
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Definition
| immob work avoid atrophy with shoulder shrugs, isometrics, and stab; next start stressing tissue working with pulley, AROM starting MRE to tendon, avoid supra until 10 weeks after |
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Term
| Complete tears best findings |
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Definition
| MSTT, PFC, MMT (typically seen in pts >40 years old) |
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Term
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Definition
| protect first three weeks or til 8, work above and below, codmans, then prom pain free, and progress as normal |
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Term
| Impingement Syndrome defenition |
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Definition
Primarily involves coracoacromial arch intruding on rotator cuff, subacromial bursa or biceps tendon
Pain in lateral brachial region, sharp twinges of pain on various movements, esp. abduction or reaching above shoulder level, gradual onset |
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Term
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Definition
pain lateral brachial region, sharp twinge, gradual onset
AROM – painful arc present at midrange of abd., slight limitation and pain at full elevation
PROM – full ROM is present, may be painful arc on rotation and abd. And pain with full elevation |
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Term
| Impingement Syndrome other causes |
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Definition
Structure – spurs, shape of acromion, rotator cuff thickened, inc prominence of greater tuberosity
Instability/laxity
Hypomobility
Muscle Imbalance
Postural
Extrinsic Factors – nerve, trauma, disease |
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Term
| Impingement Syndrome TSIs |
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Definition
- enlarged subacromial bursa decreased subacromial space and during movement compresses stx
-supraspinatus tendonitis =inflammation is decreased space and during movement decrease power therefore head low (supraspinatus t insertion has poor blood flow)
- weakness of rotator cuff muscles = high humeral head
- tight pec minor/major causes IR giving decreased clearance of greater tub,
- hooked acromion: less space therefore during elevation acromion and humeral head approximate
- edema: fluid decreases space but DOESN’T cause muscle inhibition
- hypomobile capsule: causes decreased ability of humeral head to inf = contacts acromion
- effusion: affects limited joint motion of jt stability causing decreased cohesion, causes inhibition of muscles and no inferior glide
- hypermobility= humeral head excessive superior movement therefore get elevation into acromion |
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Term
| Impingement Syndrome treatment |
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Definition
| US, TFM, posture education, pendulum exercises, active warm-up, remedial strengthening exercises with arm abd to side to prevent impingement, unweight ABD then Fl, isometrics isotonics (free weight, MRE) stress tendon longitudinally attain strong rotator cuff before initiating shoulder elevation above 90 degrees, shoulder shrugs and abd 90 pushups to work on proper scap, D1 flexion pattern before D2F, CKC |
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Term
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Definition
1. Location: Subdeltoid/subacromial:
- beneath deltoid muscle and on top of supraspinatus m.; attaches to acromion- (pain with ER and overhead activities – warmth and swelling ant shld)PFC & PFT
Subscapular: - on top of anterior joint capsule beneath subscapular m; communicates with capsule - pain with active abd, flex, ext – warmth and swelling lat shld)PFC & PFT |
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Term
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Definition
lateral brachial region pain, intense, constant dull, throbbing pain, very little relief found in any position, all movements are painful, pain usually arises within 12 to 72 hours
AROM – marked restriction in all planes, severe pain with elevation
PROM – restricted by pain in non-capsular pattern with “empty” end-feel, no resistance to movement but patient requests movement to cease secondary to pain; pain >60 abd or 90 flex |
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Term
| Acute Bursitis Best Findings |
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Definition
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Term
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Definition
| ice, sling, pulsed US to improve BF & remove irritants, maintain ROM with wand etc, gd I and II and progress |
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Term
| Bicipital Brachii Tendinitis |
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Definition
| Most common cause is as a secondary involvement of biceps after impingement or tearing of rotator cuff, may also be related to shoulder laxity, instability or traction overload, injury often occurs from rapid overhead movements involving shoulder abd and ER and excessive elbow flex and sup (pitchers, racquet sports, swimmers), may also be associated with partial subluxation of tendon or laxity of transverse humeral ligament |
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Term
| Bicipital Brachii Tendinitis |
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Definition
| PFC, PFT, MSTT (MLT to find reactivity) |
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Term
| Bicipital Brachii Tendinitis |
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Definition
| ice, TFM to long head of biceps, re-strengthening |
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Term
| Bicipital Brachii Tendinitis |
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Definition
| S vague pain and snapping in region of ant shoulder and tendon; yergasons to r/o t. humeral l |
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Term
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Definition
| rotator cuff weakness, damage to anterior capsule, GH ligament, and/or glenoid labrum |
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Term
| Glenohumeral Instability TUBS |
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Definition
traumatic patients exhibit unilateral or unidirectional instabilities caused by a Bankart lesion and usually require surgery to stabilize the shoulder joint
i. types: bony: rib of glenoid avulsion
soft: tear of glenoid capsule |
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Term
| Glenohumeral Instability AMBRII |
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Definition
atraumatic, multidirectional unstable patient, usually bilaterally involved, in whom rehabilitation is the first tx, if fails then inferior interval shift procedure is performed which tightens the inferior capsule and rotator interval
PROM accessory - ↑ movement
PROM accessory end feel – capsule laxity |
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Term
| Glenohumeral Instability Hx |
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Definition
ascertain the degree, direction and onset, may have felt a “slipping out of the joint”, apprehension, ask patient to reenact the MOI, ask if patient can voluntarily dislocate the shoulder
* Observation – ant displacement of humeral head
Accessory mobility testing - ↑ movement with capsular laxity end-feel
Special tests – ant/post drawer, inferior instability test |
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Term
| Glenohumeral Instability Tx |
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Definition
ambrii: strengthen the rotator cuff muscles and scapular stabilizing muscles, according to Grimsby – stage 1 = l ow speed, high rep, min resistance in beginning and middle range, stage 2 = increase resistance and add isometrics in inner ROM, stage 3 = increase resistance to 80% of 1RM, also include PNF, CKC to facilitate co-contraction; ant instability focus on: pecs, lats, subscap, anterior del & post delt: teres minor and ext. rotators
Tubs: strengthen l. scap, rhomboids, serratus anterior, la, and traps |
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Term
| Glenohumeral Instability According to PAtla |
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Definition
| strengthen infraspinatus, mid and low trap, serratus anterior and long head of triceps |
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Term
| Scapular Impairment: Dyskinesis and Instability |
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Definition
Can lead to nerve entrapments, shoulder impingement, GH instability or hypermobility, cervical strain, muscle strains, general weakness due to muscle imbalances, altered length tension relationships, variety of scapular syndromes, adhesive capsulitis, thoracic outlet syndrome
-Treat the underlying impairment
-Dull ache or pain in shoulder girdle, atraumatic or traumatic
-May reveal clunking, snapping, or crepitus with arm elev, or winging
-May have increased accessory mobility of the GH jt |
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Term
| Scapular Impairment: Dyskinesis and Instability Tx |
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Definition
| reeducation of postural habits, stretch, strengthen, scapular taping, neuromuscular re-ed |
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Term
| Adhesive Capsulitis – Frozen Shoulder (hypomobile GH joint) |
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Definition
DJD, RA, immobilization, RSD (H&K)
How does it start? No specific cause, tendon partial tear, calcific supraspinatus tendonitis (chronic), prolonged immob., DJD, cervical dysfunction, postural (↑ kyphosis) – (ortho) |
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Term
| Adhesive Capsulitis – Frozen Shoulder (hypomobile GH joint) Hx |
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Definition
| pain in lateral brachial region varying from a constant dull ache to pain felt only with mvmt in restricted ranges, pt often awakes at night when rolling on painful shoulder, gradual onset |
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Term
| Adhesive Capsulitis – Frozen Shoulder (hypomobile GH joint) S&S |
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Definition
SLimitation in capsular pattern ER>abd>IR (AROM and PROM)
Accessory mobility limited in capsular pattern ant>inf>post
Possibly increased muscle tone and induration over lateral brachial region
↓classical AROM - quantity
↓classical PROM – quality tight capsule end feel
↓classical PROM – quantity ER>abd>IR
↓accessory PROM- quantity ant>inf>post
↓accessory PROM – quality tight capsule end feel |
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Term
| Adhesive Capsulitis – Frozen Shoulder (hypomobile GH joint) Tx |
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Definition
SLimitation in capsular pattern ER>abd>IR (AROM and PROM)
Accessory mobility limited in capsular pattern ant>inf>post
Possibly increased muscle tone and induration over lateral brachial region
↓classical AROM - quantity
↓classical PROM – quality tight capsule end feel
↓classical PROM – quantity ER>abd>IR
↓accessory PROM- quantity ant>inf>post
↓accessory PROM – quality tight capsule end feel |
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Term
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Definition
An entrapment compression vasculopathy of the subclavian vessels but more commonly involving the lower trunk or medial cord of the brachial plexus at 4 common sites: Sternocostovertebral space – pancoast tumors, Scalene triangle, Costoclavicular space, Coracopectoral space (according to E1 – entrapped in scalene, between clavicle and 1st rib, and in pec minor)
2. Commonly seen in racquet, throwing and aquatic sports and in occupations such as paper handing, painting and carpentry |
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Term
| Thoracic Outlet Syndrome Hx |
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Definition
pain and parathesias that extend from the lateral aspect of the neck into the shoulder, down the arm and into the medial aspect of the forearm and hand to the little and ring finger, can include nerve symptoms (paresthesia, weakness and pain) and/or vascular symptoms (edema, discoloration, pallor or venous congestion), fatigue in arm, sx may be at night and disturb sleep, may be referred pain to the ipsolateral breast or chest, sensory impairment tends to be in ulnar distribution, pain in dermatomal distribution (C8 and T1)
- Unequal shoulder height, protective positioning of arm to decrease stress on structures, edema in supraclavicular fossa, hand cool to touch, forward head posture, paradoxic breathing with scalene muscle active on inspiration through expiration (dif breathing with diaphragm)
Test MLT’s, rib mobs |
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Term
| Thoracic Outlet Syndrome Dx |
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Definition
is made by duplex scanning (US with Doppler velocity waveforms), angiography or venography; check dermatomes and myotomes along with spurlings to rule out cervical nerve root impingement; possible positive tinels over scalene and supraclavicular region at insertion to scalene; look at neural tension tests; allen, wright and adson have many false positive (poor specificity) reproduction of symptoms is more reliable
- sensation, Pulse, MLT or PIVM reproducing symptoms |
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Term
| Thoracic Outlet Syndrome Tx |
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Definition
| muscle stretching and strengthening, postural re-ed, mobs of shoulder complex, soft tissue mobs, increase the space of the thoracic outlet, 1st rib mobs |
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Term
| AC joint sprains and degeneration Hx |
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Definition
i. Joint sprain: 75% caused by fall on the shoulder with the arm at the side, other common injuries include FOOSH, repetitive overhead activities, the seatbelt shoulder after whiplash
ii. degeneration: osteophytes or subacromial impingement |
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Term
| AC joint sprains and degeneration S&S |
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Definition
SPain – lat end of clavicle is painful and tender at joint
i. Lump over AC joint or step deformity
ii.AROM – pain with moving arm overhead or horiz add
iii. PROM – painful at the extremes of motion, esp adduction cross-body
iv. Resisted motions are usually pain free
v. Increased motion with accessory mobility testing |
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Term
| AC joint sprains and degeneration Dx |
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Definition
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Term
| AC joint sprains and degeneration Tx |
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Definition
ice and sling, Grade I and II = non-operative, ROM exercises, strengthen scap stabilizers and proximal musculature, Grade III = controversial, Grade IV, V and VI = ORIF
* No good way to treat*
ii. For degeneration of AC joint – dull aching pain with lifting and throwing, tenderness over joint, pain and crepitus with horiz add, tx – rest, NSAIDs, immob., avoid mvmts that stress the jt, jt mobs later, if no results – corticosteroid injections, surgery; strengthen scapular stabilzers |
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Term
| SC joint sprains and degeneration MOI |
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Definition
| Unusual, normally the clavicle will fx or AC jt give way first, MOI = MVA or sports (cycling, horse riding) – direct lateral compression of the shoulder, ant dislocation more common, post dislocation = life threatening |
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Term
| SC joint sprains and degeneration S&S |
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Definition
swelling, crepitus and pain on motion esp horiz add, step deformity, shld held in protraction
-AROM/PROM – pain with full active and passive elevation of scapula and pain on active and passive mvmts of the arm
-Active and passive resisted mvmt of the neck that involves SC muscles may provoke pain |
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Term
| SC joint sprains and degeneration Tx |
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Definition
closed reduction immediately after injury, rest, NSAIDs, immobilization in a swing, strengthen pec minor and subclavius, strengthen muscles attached to clavicle to aid in controlling motions of shoulder girdle complex (UT, pec major sterna fibers)
-Non PT: Gd I: brace x 10 d; Gd 2: may reduce brace x 4 weeks, Gd 3: reduce |
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Term
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Definition
-FOOSH
- examination will provide little evidence of fx, you can usually move arm passively without sx
- pt may have pain in axillary area
-intra-articular fx, pt will come see you after 1 week in sling – keep pt moving – Codman’s
- other complications – stiffness
- if displaced injury to circumflex axillary N. resulting in paralysis and ↓ skin sensation |
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Term
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Definition
– FOOSH or direct blow
- S&S: Flail arm
- extra-articular therefore normal joint mob
-complications – radial N. or brachial A. injury,
- tx – casting or surgery, PT tx effects of fx and immob: swelling, weakness, MLT |
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Term
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Definition
– most common in children, most common site is middle 1/3 of clavicle, lateral fragment tends to be pulled inferior because of weight of arm
- Three types:
i. Displaced clavicle – full fx through clavicle
ii. Undisplaced clavicle
iii. Greenstick Fx – usually in kids, edges on convex side splinter |
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Term
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Definition
– congenital, undescended scapula, scapula are small and MR
-the muscles are underdeveloped and may be fibrous tissue, unilateral or bilateral, decreased abduction |
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