MS II 4
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. What would you like to do?
post glide at GH helps w what 3 motions?
to distract GH joint, start w pt where?
- 90 degrees flex
- do lat distraction by wrapping hands right into axilla
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
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
GH jt lateral glide details
flat surface of palm of PT's hand in axilla, facing lat, other hand on elbow
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.
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
3 joints of shoulder that'll dislocate
- ANT sublux or dislocate:
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
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
7 basic elements of exam/eval
- structural exam
- active movment testing
- passive movement testing
- resistive testing
- special tests, other tests (neuro)
- specific paplaption
if no pain in AROM, should you do PROM?
nah, it's moot
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
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
what to look for in subjective exam of shoulder?
- dominant arm
- neck/thorax problems
- systems review - search for referred pain
- job/sport - simulate offending mvmnts
- PMH, PSH
- social history
what to look for in "observation & palpation?"
- attitude of arm
- body postures/habits
- willingness to move
- atrophy or hypertrophy - which muscles?
- note edema symmetry
what to palpate for?
- tenderness (capsule, tendon, bursa, etc)
- analyze alignment & position
how to "clear the head and neck"
- cervical clearing:
- have head lean to sides, rotate, turn,
- look for pain and assymetry
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
pain where in abd ROM indicates supra/infraspinatus problems?
45-60 degrees abd, with unpainful areas on either side
pain where in abd suggests acromioclavicular troubles?
- supraspinatus & radial nerve
- a circle a bit sup to deltoid groove in hum
3 areas that'll refer pain to the L shoulder
4 areas that'll refer pain to the R shoulder
- gall bladder
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
where is T3 dermatome?
armpit - and it's big, bleeding into chest, down inf arm, down under armpit
where is T2 dermatome?
armpit and upper chest, and also inner arm
where is C4 dermatome?
shoulder, and some sup chest and neck
where is C5 dermatome?
lateral arm, if arm is abd to 90 it's the upper surface
where is C6 dermatome?
lat arm, but a wider surface, going more ant than C5 does
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
where are the T4,5,6 dermatomes?
chest, by ribs osame name?
supraclavicular N dermotome is where?
shoulder, where suprascap is
axillaryN dermotome is where?
over the body of deltoid
post brachial cutaneous N dermotome is where?
post humerus, distal to the axillary/deltoid region
lower lat brachial cutaneous N dermotome is where?
lower lateral humerus
medial cutaneous N dermotome is where?
medial distal humerus
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)
- 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
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
What would you like to do?
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