Shoulder Bony and Soft Tissue

Lab notes ROM Neck - Flexion: Chin to chest, limitations or compensations Extension: Able to see the ceiling, limitations or compensations Lateral flexion: 45 degrees, limitations or compensations Lateral rotation: Chin aligned with shoulder Shoulder - Flexion: 180 Extension: 45 ABD: 180 ADD: 45 ER: 40-45 IR: 55 H ABD: 130 H ADD: 130 Protraction Retraction Circumduction: 200 Elevation/Depression Elbow & Wrist - Flexion: 135 Extension: 0-5 Supination: 90 Pronation: 90 WF: 80 WE: 80 UD: 30 RD: 20 F/E of all finger joints Thumb: Opposition, ABD/ADD Shoulder Special Tests AC jt (+)=Pain or laxity Shears: Compress AC jt, significance: ligaments are stressed through shearing motion Scar test: Passively HADD the shoulder, significance: Compresses AC GH Instability Apprehension/Relocation: Supine, laying with 90 of ABD, passively ER, apply pressure to anterior forearm. Apply pressure, if reduced its positive (+)=apprehension, significance: GH is in a closed pack position and replicates MOI for anterior GH dx Posterior Drawer: Supine, shoulder flexed to 90, elbow flexed to 90, stabilize scap, push (+)= Apprehension, significance: Humeral head is moved posteriorly and that causes laxity Sulcus sign: Grip distal arm, apply downward traction, stabilize scap, (+): indent beneath acromion, significance: Humeral head slides down due to laxity in superior GH ligament Clunk: Obriens Biceps tendon Speeds: Palpate bicipital groove, elbow is extended, shoulder is in flexion, have athl resist, (+)= pain, significance: Reproduces pain Luddingtons: Hands behind head, palpate bicipital groove, (+)= uninjured tendon can be palpated, injured cant, significance: Position allows for palpation Yergasons: Palpate bicipital groove, move athl through supination, (+)=pain/snapping, significance: Positions allows for lesion to be felt Muscle Tendon Pec contracture: Assist athl to lower elbows to table, (+)= elbows don’t reach table, significance: Assesses pec major tightness Lift off: Stand behind athl back, (+)= cant lift hand off back, significance: Sub scap tear RTC strain (Supraspinatus) Drop arm: Lower arms to side, (+): Arm falls uncontrollably from 90 degrees ABD, pain Empty can: ABD to 90, EE, IR, pronated, push down, (+): weakness/pain, significance: Position reproduces symptoms RTC impingement Neer: Passively flex shoulder to reproduce symptoms, (+): passive movement through flexion reproduces symptoms Hawkins Kennedy: Flex elbow, GH jt elevated to 90, IR until pain is experienced (+): pain with motion, significance: Positioning causes symptoms Shoulder Bony and Soft Tissue Trapezius - O: Occiput, SP C7-T12 I: Clavicle, acromion process, scapular spine A: Depression, Elevation, Retraction Levator Scap - O: TP C1-C4 I: Superior angle of scap A: Elevation, downward rotation Rhomboid Major & Minor - O: SP C7-T1 (minor), SP T2-T5 (major) I: Medial border of scapula A: Retraction, elevation, downward rotation Serratus Anterior - O: 8-9 ribs I: Medial border of scap A: Protraction, depression, upward rotation Supraspinatus - O: Supraspinous fossa I: Greater tubercle A: ABD Infraspinatus - O: Infraspinous fossa I: Greater tub A: ER, ADD, EXT, HABD SH Subscapularis - O: Subscapular fossa I: Lesser tub A: IR Shoulder Bony and Soft Tissue Teres Major - O: Inferior lateral border of scap I: Medial lip of bicipital groove A: ADD, EXT, IR of shoulder Deltoid - O: Clavicle, scap spine I: Deltoid tub A: ABD, FL, IR, HADD SH, ER, HABD, EXT Pec Major - O: Clavicle I: Bicipital groove A: ADD, IR, HADD, F, EXT Pec minor - O: Ribs 3-5 I: Coracoid process A: Protraction, depression Lats - O: SP: T2-L5 I: Bicipital groove A: ADD, EXT, IR AC ligament/jt: Sprain, Fx/ Humeral head: Fx SC ligament/jt: Sprain, Fx/ Bicipital groove: Tendonitis Subacromial bursa: Bursitis Acromion: Fx Scapula: Fx Clavicle: Fx Sternum: Fx Cervical Bony and Soft Tissue - Occiput: Traps, ligament nuchae, vision can be affected Inion: Bony protuberance on occiput, cranial alignment Superior nuchal line: Laterally from inion, palpate along occiput, traps SP: Spinal alignment, spinous ligaments TP: Muscle insertions - SCM: Clavicle, manubrium, occiput (I), rotates head to opposite side Lymph node chain Lymph nodes: Under chin, move along jaw line, infection Thyroid gland: Below Adams apple, moving down to cricoid cartilage and then laterally Carotid pulse Parotid gland Supraclavicular fossa: Above clavicle, has subclavian vein/artery Scalene Supraspinous ligament Interspinous ligament Cervical Special Tests C-Spine pathology Compression Test: Seated, neck is in neutral, apply force, if negative do w LF/NE/Rotation (+): pain, significance: Narrowing of neural foramen, facet jt pressure Spurling’s: Seated neck is extended and rotated , (+): pain, significance: Narrowing of neural foramen, facet jt pressure Distraction relief: Seated, hands on base of skull, pull up (+) symptoms subside, significance: Nerve root compression Shoulder distraction: Seated, depress shoulder, LF neck (+): symptoms are reproduced, significance: brachial plexus neuropraxia TOS (Significance: Neurobundle is compressed) (+): Diminshed or absent pulse Adons: Palpate pulse, ER/ABD arm, rotate head to involved side Allens: Palpate pulse, 90 ABD, elbow 90 F, GH ER & ABD, rotate head away ROOS: ABD to 90, EF 90, ER shoulders, open and close hands for one min (+): increase in N&T, heaviness Military Brace: Palpate pulse, HE/ER arms with shoulder depression