Prac Viva

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Author:
Anonymous
ID:
153757
Filename:
Prac Viva
Updated:
2012-05-15 03:06:29
Tags:
Shoulder
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Description:
Shoulder lab
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  1. What are the questions you would for a shoulder pt?
    • - mechanism of injury- dislocation, swinging arm injury
    • - site and nature of the pain- above or below of the shoulder, pain above the shoulder- look at neck, shoulder ain on shoulder, radiates below elbow maybe the neck.
    • - paraesthesia- from neck
    • - pain response- minor injury- sharp pain, night pain etc
  2. What are the specific questions you would ask in regards to the arm with pain and sleep?
    • - lying on affected arm- if you cant at night might be a jt problem- pain on overhead reaching above- impingement?- painful arch- pain on rapid or ungarded movements- frozen shoulder
    • - overuse- laxity, impingement, R/C injury, age variable, usually localised pain, will also get a painful arc in flex and abduction to 90 degrees- tear will show on ultrasound
    • - pain after use- arthritic nature of pain
  3. What do you need to kep in mind in regards to shoulder pts history?
    • - night pain- tumors in lungs can give night pain
    • - general health
    • - past history of cancer
    • - hand dominance
  4. When observing a pt with shoulder pain what do we look for?
    • - shape and contour -rounded, dropped one side, forward positioned
    • - wasting- supraspinatus, deltoid, infraspinatus
    • - hand position- IR/ ER
    • - scap position- winged, pec min tightness
    • - shoulder positin- head of humerus
    • - over developed mm
    • - head of humerus will sit approx 1/3 forward more than this is a problem
  5. Conduct active movements for a shoulder pain pt
    • - clear cervical spine, elbow
    • - flex/ ext
    • - abduction
    • - internal rot- hand on the sacrum
    • - ext rot arm by your side
    • - hand behind head HBH
    • - hand behind back HBB
    • - horizontal flex (adduction)- arm up to 90 degree flex, then reach to other shoulder
    • Notes/
    • lead with thumbs
    • any pain at baseline and if it comes on
    • OP- hold behind and OP
    • if hitch pain on that side
    • OP for abd- hold above shoulder and OP
  6. Active movements for shoulder pt
    • - flex- pain, range, end feel, scapulohumeral rhthm
    • - abd- arcs, scapulo humeral rhythm
    • - ext
    • - int rot- neutral and 90 abduction
    • - ext rot in neutral and 90 abd
    • - HBH- extends elbow back
    • - HBB- level reached eg sacrum, L5
    • - horizontal flexion
    • P inhibition- can prevent mm moving
  7. What causes winging of the scap?
    • - nerve problems
    • - weak SA
  8. What passive movements would you conduct for a shoulder pt?
    • pt either in sitting or lying
    • flex- stabilise the scap
    • ext
    • IR- 90 degrees of arm, stabilise scap
    • ER- same as above
    • OP
  9. What resisted movement would you perform on a pt with shoulder problems?
    • Static- tell you if you have weakness and rot cuff tear- weakness and no pain.
    • - flex- elbow ext and pronation
    • - abd- abd 30 degrees and elbow f 90 degrees
    • - add- same as above supra/ deltoid
    • - int rot- neutral and 90 degrees abd (can do in prone)
    • - ext rot- same as above
    • - Gerbers push off- HBB to L3- subscap and push against your hand
  10. When in supine lying what can you assess on a shoulder pt?
    • Palpate:
    • - AC jt line
    • - Greater tuberosity
    • - Acromion
    • - Tendons- Long head of biceps (LHB) pt int and ext rot, supraspinatus- hand over sacrum.
  11. Conducting lockng on a pt with shoulder problems?
    • Pt supine
    • - arm under the medial border of scap with fingers over trap to prevent shrugging
    • - hold elbow flexed, abduct arm towards a position of full GH abd
    • - should be painless and not limited

    Used when signs and symptoms are minimal, labrum injury
  12. Conduct a quadrant on a pt with shoulder problems
    • -start at locked position
    • - relax pressure maintaining abduction to allow the arm to be moved anteriorly to the frontal plane
    • - abduct and lat rot through small arc approx 30 degress lateral to fully elevated position
  13. What are the accessory movements you can conduct on a pt with shoulder problems?
    • - PA
    • - AP
    • - Longitudinal caudad
    • - Lateral movement
    • - scapulo- thoracic movements
    • - A/C jt- AP and PA
  14. Conduct an PA on a shoulder problems pt
    • head of humerus
    • arm on towel
    • arm across body
  15. Conduct an AP on a pt with shoulder problems?
    • Note use AP and PA for frozen shoulder
    • - heel of hand
    • - neutral
    • - flexion and abduction
    • - hand under the scap
    • More flex, more pillows
  16. Conduct a longitudinal caudad on a shoulder pt?
    • Pt in neutral
    • Abduction
    • Elbow flexed
  17. Conduct a lateral movement on pt with shoulder problem
    • - hold elbow in
    • - hand in arm pit
    • - pain relief
    • - help with abduction
  18. Conduct AP/ PA on the AC jt
    • - end of clavical
    • - not really useful
    • - will diagnose if it is the AC jt
    • - move scap/ thoracic jt around
    • - useful for nerve problems
  19. What activities would you conduct with a shoulder pt in prone lying?
    • - mm test- scap control
    • - lower trap test- arms by side- hold scap up and slowly lower put into same position
    • - serratus ant- forearm support, on elbows, supination, down low and lift body up slowly
    • - clear cervical or thoracic spine and elbow
  20. What are the special tests for the shoulder?
    • - full/empty can- supraspinatus
    • - ER in minus 45 degrees-infraspinatus
    • - gerbers push off- subscap- HBB L3
    • - apprehension test
    • - re-location/ containment test
    • - inferior drawer/ sulcus test
    • - posterior draw
  21. What is the empty can test for? Conduct on a pt
    • - test for supraspinatus
    • - pts flex in scap plan to 90 degrees- thumb point to ground
    • - examiner places hand over thepts elbow and apply downward pressure as the pt attempts to raise the arm againt the resistance
    • - +ve result for supraspinatus is loss of strength- pain may also be produced, particularly is mm lost and impingement occurs
  22. What are the strength tests for rotator cuff?
    • - Full can/ empty can- supra
    • - ER- infraspinatus
    • - gerber's push off subscapularis
  23. What are the stability tests for the shoulder?
    • - apprehension test
    • - re-location/ containment test
    • - inferior drawer/ sulcus test
    • - posterior draw
  24. What is the jobs test for? Conduct this test
    • Anterior instability of the shoulder
    • - test for ant jt pain due to excessive ant jt laxity
    • - pt supine with line of shoulder at the edge of the plinth
    • - abduct and externally rot are to the point of onset of pain. May require some overpressure into horizontal extension
    • - +ve test is reproduction of pain or feel of instability apprehension
  25. What is the Gerbers push off test for? Condcut this test
    • - to test subscap
    • - HBB at L3 level
    • - push off and you resist.
    • - Weakness and pain are positive tests.
  26. Your pt presents with expected weakness with infraspinatus conduct the appropriate test for this.
    • - ER in minus 45 degres
    • - pt sitting
    • - elbow bent at little from the body
    • - resist ext rotation
    • - weakness and pain are positive tests
  27. When do you conduct stability tests?
    • - when the pt has a history of instability
    • - inferior instability is the result of a stroke
  28. Supraspinatus test- note impingement test not realy empty can- usually worsens?
  29. Conduct a relocation/ containment test on your pt?
    • - heel of hand on ant of head of humerus and push posteriorly and then release
    • - +ve test- when pt reports an easing of pain when pushed down, and a reurrence when the pressure is released
  30. Conduct an inferior drawer/ sulcus test
    • - used to assess the laxity of the inferior direction
    • - inferior subluxation would be prevented by the superior glenohumeral lig passively and the LHB
    • - one hand monitoring superior contour of shoulder jt. Other arm providing strong downward force on arm
    • - +ve if a significant depression is evident immediately distal to acromion
  31. You pt presents with suspected posterior instability. Conduct the appropriate test
    • - posterior jt laxity
    • - pt supine with line of the glenohumeral jt at the edge of the plinth
    • - shoulder taken into 90 degrees flex
    • - one hand on the pts elbow, other behind shoulder jt
    • - examiner pushes along the line of the humerus to translate the humeral head posteriorly across the glenoid fossa
    • - +ve sign if pt demonstrate apprehension during hte manoeuvre. Can detect the amount of movement- if humeral head ushes into your hand
  32. What are the impingement tests?
    • - hawkins- kennedy-F 90 degrees, slight add, IR over examiners arm
    • - Allighans dynamic impingement- in painful test movements
  33. Conduct the hawkins- kennedy test on your pt
    • - impingement test
    • - bring the supraspinatus tendon against the ant portion of the coracoacromial ligament
    • - pt standing
    • - forward flex the shoulder to 90 degrees, then forcibly int rotate the shoulder
    • - +ve test produces pain
  34. Conduct an imingement test for dynamic impingement
    • - allinghams test
    • - for pts who demonstrate a painful arc on active or resisted elevation and who test positvie on a static impingement test
    • - pt elevates arm to the painful range, then attempts to adduct against the manual resistance provided against the examiner
    • - if the pain is relieved, the test is positive
    • - seen as a good prognostic indicator for an adduction
  35. What are some other tests you can conduct for s a problemed shoulder pt?
    • - Bicipital tendinitis- speeds test
    • - AC jt
  36. Conduct a test for biceps tendinitis
    • - speeds test
    • - pt in sitting
    • - elbow fully ext and shoulder flexed to 90 degrees
    • - resist forward flexion with the forearm in supination, then pronation
    • - +ve test is when pain is experienced in the bicipital groove

  37. AC jt test
    • - horizontal flexion
    • - arm abducted to 90 degrees, then horizontally flexed across the body
    • - palpate the jt simultaneously
    • confirm with pressure
  38. What are you treatment options for a pt with shoulder problems?
    • - jt mobilisations- accessory or passive physiological
    • Rom exercises- pendular and wand exercises
    • - stabiliy/ motor control exercise
    • - taping
  39. WHat are the PPIVMS for the shoulder GH jt?
    • - flexion- grade 1- 4
    • - IR- a/a
    • - ER - a/a
  40. PPIVMS for the scapulo thoracic?
    • - elevate
    • - depression
    • push inferior angle
  41. What is the endular exercise?
    • - ROM
    • - hand and arm swing
    • - very small amount of mm used
  42. WHat is the wand exerise?
    • - ROM
    • - hold walking stick or brume, lay on back and move in flex, ext, abduction etc
  43. Longitudinal caudad- relieve Pain
  44. Lateral caudad- seat belt?
  45. GH Jt PPIVM flexion
    • - use leg as a block- near head
    • - dont allow ext and int rot
    • - 2 handed
    • - grade 4- like quadrant

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