Lecture 7: The Shoulder 4

Question 1

Examination of the Shoulder:

1. Observation- what are you looking for?

Answer 1

general bulk and symmetry

• anteriorly and posteriorly
• scapula winging (wall push up)
• sulcus sign (multidirectional instability)

ROM- all ROM and apleys scratch positions for screen
-Is there a capsular pattern present?

Active abduction- scapulohumeral rhythm

• pain at mid range 60-120 think rotator cuff impingement
• pain towards end range (>120 think AC joint pain

Question 2

Evaluation of Shoulder

2. Feel. for what?

Answer 2

Signs of inflammation (bursitis)-oedema + warmth

-palpate painful areas to see if you can find problem structure

Question 3

What could be some differential diagnosis for shoulder pain?

Answer 3

Cervical origin- radicular pain/ numbs/ paresthesia
-scapula pain

Either shoulder:

• pleurisy (inflammation of pleura)
• pneumothorax
• apical lung carcinoma

Left shoulder: myocardial infarction, angina

Right shoulder: liver disease, gall bladder

Question 4

What tests would you do if you suspected a Rotator cuff injury?

Answer 4

1. Empty can test–> tests supraspinatus slide 11

Question 5

What tests would you do if you suspected bicepital tendonitis?

Answer 5

1. Speeds test

slide 12

Question 6

What test would you do if you suspected GH instability?

Answer 6

Anterior apprehension test

slide 13

Question 7

What test would you do if you suspected impingement syndrome?

Answer 7

Neer test pg 14

Question 8

What test would you do if you suspected SLAP lesions?

Answer 8

Active compression test of O’brien

slide 15

Question 9

What test would you do if you suspected AC Injury?

Answer 9

Horizontal Adduction Test

16

Question 10

Treatment/ rehab
depending on severity?
Main objectives?

Answer 10

If tendonitis/ strain/ mild tear- conservative treatment
If moderate to full tear- co-manage or refer
Instability- follow basic rehab principles and co-manage

1. To increase flexibility of shoulder capsule and musculature where indicated
   -following inflammation or periods of inactivity
   -stretching of anterior capsule + ecs
   -stretching of posterior capsule
   -Apleys scratch position
   slide 19 + 20
2. To increase strength of rotator cuff musculature and scapula stabilisers
   - especially indicated for instability
3. Need to assess cervical + thoracic spine too
   - detailed history to rule out visceral