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post glide at GH helps w what 3 motions?
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to distract GH joint, start w pt where?
- 90 degrees flex
- do lat distraction by wrapping hands right into axilla
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GH jt inf glide details
- pt supine, shoulder at edge of table
- heel of PT's mobilizing hand on greater tub of pt's shoulder
- other hand holding elbow, can add a bit of traction
- force goes caudally
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GH jt post glide details
- pt supine
- arm in resting pos
- heel of PT's hand on ant inf hum w other hand on elbow to guide hum to make it move as a parallel unit
- force goes post
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GH jt lateral glide details
flat surface of palm of PT's hand in axilla, facing lat, other hand on elbow
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GH jt ant glide in prone, details
- twoel roll or wedge under coracoid
- arm in resting pos
- heel of PT's hand on post humerus, other hand under elbow
- press ant.
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GH jt ant glide in supine
- PT supports arm in resting pos by holding it btwn body and arm
- both f pt's hands wrapped around prox hum, pull up
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3 joints of shoulder that'll dislocate
- ANT sublux or dislocate:
- sternoclavicular
- acromioclavicular
- GH
- POST:
- GH
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5 results of trauma to shoulder, and the 2 most common
- RC impingement (cumulative trauma) biomechanical error - humerus is ramming up on things nort of it bc it's not moving correctly
- RC tear (cumulative trauma or degen)
- biceps tendon ruputer - 2/2 huge trauma at GH jt or the tendon is super-loaded in one exercise and it ruptures
- adhesive capuslitis - capsular irritation or inflam dud to poor osteokinematics of GH jt
- glenoid labrum injury - usually sup & slightly ant
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3 types of itis-es you can get in shoulder from overuse/cumulative trauma/overload of tissue capacity (repetition, 1-sidedness, aging)
- RC tendinitis
- bicipital tendinitis
- subacromial bursitis
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7 basic elements of exam/eval
- subjective
- structural exam
- active movment testing
- passive movement testing
- resistive testing
- special tests, other tests (neuro)
- specific paplaption
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if no pain in AROM, should you do PROM?
nah, it's moot
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6 elements of active movement testign for the shoulder in an exam/eval
- clear jts above & below
- quick tests (tests the shoulder complex)
- quick tests w overpressure
- scapular motions
- GH jt motions
- elbow flexion and extension
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3 basic things to do in passive movement testing in a shoulder exam
- clear jts above &below
- PROM for physiologic motions (osteokinematics) in shoulder complex, ST, and GH jts
- joint mobility testing (aka accessory movement = arthrokinematics) ST, SC, AC, GH jts
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what to look for in subjective exam of shoulder?
- HPI
- dominant arm
- neck/thorax problems
- systems review - search for referred pain
- job/sport - simulate offending mvmnts
- PMH, PSH
- social history
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what to look for in "observation & palpation?"
- attitude of arm
- body postures/habits
- willingness to move
- atrophy or hypertrophy - which muscles?
- note edema symmetry
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what to palpate for?
- temp
- edema
- atrophy
- tenderness (capsule, tendon, bursa, etc)
- analyze alignment & position
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how to "clear the head and neck"
- cervical clearing:
- have head lean to sides, rotate, turn,
- look for pain and assymetry
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how to clear arms
- check scapulothoracic rhythm & symmetry
- hands behind back
- run thumbs up back and look for symmetry in reach distances
- hands behind head
- run hands down back
- elbows at waist and flap hands back and forth for ER and IR
if no pain, apply overpressure
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pain where in abd ROM indicates supra/infraspinatus problems?
45-60 degrees abd, with unpainful areas on either side
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pain where in abd suggests acromioclavicular troubles?
170-180 degrees
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"painful coin"
- Pivko
- supraspinatus & radial nerve
- a circle a bit sup to deltoid groove in hum
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3 areas that'll refer pain to the L shoulder
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4 areas that'll refer pain to the R shoulder
- gall bladder
- lungs
- neck
- elbow
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Pancoast tumor is where? pain from it will radiate where?
- it's in the upper lobe of lung
- pain in surface of shoulder crest, radiating into neck
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where is T3 dermatome?
armpit - and it's big, bleeding into chest, down inf arm, down under armpit
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where is T2 dermatome?
armpit and upper chest, and also inner arm
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where is C4 dermatome?
shoulder, and some sup chest and neck
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where is C5 dermatome?
lateral arm, if arm is abd to 90 it's the upper surface
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where is C6 dermatome?
lat arm, but a wider surface, going more ant than C5 does
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where is C7 dermatome?
- inner arm
- if arm is abd to 90, it's the part that faces forward w/o getting to the top or bottom ridge
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where are the T4,5,6 dermatomes?
chest, by ribs osame name?
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supraclavicular N dermotome is where?
shoulder, where suprascap is
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axillaryN dermotome is where?
over the body of deltoid
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post brachial cutaneous N dermotome is where?
post humerus, distal to the axillary/deltoid region
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lower lat brachial cutaneous N dermotome is where?
lower lateral humerus
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medial cutaneous N dermotome is where?
medial distal humerus
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anterior apprehension test for shoulder
- not judged by pain, just by look of nervousness on pt's face
- pt supine, arm in 90 abd & ER w some horiz abd
- see if pt fears the head of hum will stretch out over inf capsule
- (shoulder & elbow at 90 degrees)
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jobst relocation
- similarto ant apprehension test, but w fist under shoulder and applying pressure down w other hand
- then press on hum head to push it back in
- if this feels like a relief to the pt, there's laxity
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ant drawer test at shoulder
- tests how much hum head goes ant
- pt is prone, y're doing ant distraction
- should get just scap mvmnt
- done in neutral, while normal ant glideis in resting
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