Transcript Shoulder - CatsTCMNotes

Shoulder
Shoulder Movements
1 Gleno-humeral joint 50% of abduction
2 Further abduction after 90º is stopped when greater tubercle
impinges on the
3 Glenoid rim
4 This range can be increased when the arm is externally
rotated
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Role of Deltoid Muscle in
Shoulder Abduction
Supraspinatus initiates the
abduction, then deltoid takesover
Deltoid has 3 divisionsAnterior division: from the
anterior border and upper surface
of the lateral third of the clavicle.
abduction, horizontal flexion and
medial rotation of humerus
Medial division: from the lateral
margin and upper surface of the
acromion. Abduction of the
humerus at the shoulder
Posterior division: from the lower
lip of the posterior border of the
spine of the scapula. abduction,
horizontal extension & lateral
rotation (hyperextensor)
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Causes of shoulder pain
Cervical Spondylitis
Impingement syndrome-subacromial bursitis
may be present. Causes pain when shoulder
moves 70º-120º (ball throwing)
Rotator Cuff tears- trauma, degenerative disease.
Supraspinatus most commonly inovlved-(trouble in
initiating abduction) may lead to ‘frozen’ shoulder
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Frozen shoulder
Shoulder-gross restriction of movements,
thickening of joint capsule.
Common in 40+ age group
Previous trauma, pain disturbs sleep
L>R
Diabetics
Gentle graded exercises/ manipulation
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Califying supraspinatus tendinitis
May be silent, can result in sudden severe
incapacitating pain
May affect sub-deltoid bursa
Warm tender shoulder
X-ray shows calcified tendon
Shortwave diathermy helps
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Shoulder-Elbow issues
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1 Hawkins' Impingement Test.
Forward flex the arm to 90 degrees with the
elbow bent to 90 degrees. The arm is then
internally rotated. A positive test, noted by
pain on internal rotation, may signify
subacromial impingement including rotator
cuff tendinopathy or tear.
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2 Drop-Arm Rotator Cuff Test.
The arm is passively raised to 160 degrees.
The patient is then asked to slowly lower the
arm to the side. A positive test, noted by an
inability to control the lowering phase and a
dropping or giving way of the arm, may
indicate a large rotator cuff tear.
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3 Empty-Can Supraspinatus Test.
The arms are abducted to 90 degrees and
forward flexed 30 degrees. With the thumbs
turned downward, the patient actively resists
a downward force applied by the examiner. A
positive test is indicated by weakness
compared with the contralateral side and may
indicate rotator cuff pathology, including
supraspinatus tendinopathy or tear.
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4 Lift-Off Subscapularis Test.
With the arm internally rotated behind the
patient's lower back, the patient internally
rotates against the examiner's hand. A
positive test is indicated by the inability to lift
the hand off of the back and may indicate
subscapularis tendinopathy or tear.
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5 External Rotation/
Infraspinatus Strength Test.
The patient's arms are held at their sides
with the elbows flexed to 90 degrees. The
patient actively externally rotates against
resistance. A positive test is indicated by
weakness compared with the contralateral
side and may be associated with infraspinatus
or teres minor tendinopathy or tear.
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6 Cross-Body Adduction Test.
The arm is passively adducted across the
patient's body toward the contralateral
shoulder. Pain may indicate acromioclavicular
joint pathology, including chronic sprain or
osteoarthritis.
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7 Apprehension and Relocation
Tests.
With the patient supine, the patient's arm is
abducted to 90 degrees and the elbow is
flexed to 90 degrees. Pain and a sense of
instability with further external rotation may
indicate shoulder instability. Relief of these
symptoms with a posteriorly directed force on
the proximal humerus is a positive relocation
test and further supports diagnosis of
shoulder instability.
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Pg 737-738: thoracic outlet syndrome can be vascular or neural.
Scalene muscles are the main players – with fibrosis or cervical disc
compression can cause, can also be slouching and sagging
shoulders. Aging, obesity, or women with big boobs can suffer from
this also. Might need breast reduction.
Pain, numbness, weakness can be illicited by compressing on the
Erb’s point.
Vascular sx can be pallor of the nails, disappearance of radial pulse,
extreme response to cold with spasms. Can get gangrene of the
digits. Venous obstruction is marked by swelling and blueness of the
area.
Chest Xray will show this syndrome
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Horner’s Syndrome
Symathetic compression of the ganglion by a tumor of the lung. Ipsilateral, pinpoint
pupils, myosis, droopy eyelid. Loss of sweating on that half of the face. Hydrosis.
Can be mistaken for thoracic outlet syndrome.
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Low Back Pain
From lumbar to sacral. Kyphosis, scoliosis, Trauma, spondylolisthesis can be the prb. So can
Systemic illnesses such as ulcerative cholitis which feels like sacroiliitis. Ankylosing spondylosis
also, which starts as a stiff back. If sx of bloody diarrhea, suspect the UC.
Older people will get OA of the lower spine. Obesity can put strain on the back. Excessive lumbar
lordosis – women have it anyhow, but gets worse in preggers.
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