shoulder problems

shoulder problems

1. winging of scapula

   • serratus anterior/long thoracic
     • difficulty elevating the arm above 120
   • trapezius
     • Inability to shrug shoulders
   • strain of rhomboids
     • difficulty pushing elbow back against resistance with (hand on the hip)
   • muscle imbalance or contractures
     • winging of upper margin of scapula on adduction and lateral rotation

2. anterior dislocation

   • structures affected: subscapularis, long of biceps,GH ligament(anterior band of inferior ligaments)axillary nerve, anterior capsule and glenoid labrum
   • MOI: Posterior directed force to the arm while humerus is in elevation, ER, H. abduction
   • MOI: forces against arm in abducted and laterally rotated
   • posterior capsule is tight
   • pain@below 60 degrees abduction
   • special test:
     • Load and shift test
     • crank and relocation test
   • weak scapular stabilizers
   • apprehension associated with H.abduction and lateral rotation

3. impingement

   • results from the mechanical wear of the rotator cuff againts the anteroinferior 1/3 of the acromion in the suprahumeral space
   • pain @60-120degrees abduction
   • special test:
     • neer's test
     • hawkin's kennedy test
     • posterior internal impingement test

4. rotator cuff tears

   • classic night pain
   • weakness predominantly noted in abduction and lateral rotators
   • loss of motion
   • special test:
     • Drop arm test
     • empty can test

5. posterior dislocation

   • MOI: repetitive force against forward flexed humerus
   • positive posterior drawer sign
   • restricited in pitching activities such pitching and golf, restricted ability in pushing activities,
   • special test:
     • load and shift test
     • posterior apprehension test
       • slipping or popping of the humerus out the back
     • norwood test

6. frozen shoulder

   • Inability to perform ADL due to LOM
     • active movement: Restricted ROM, shoulder hiking
       • passive movement: limited ROM in capsular pattern

7. bursitis

   • pain on (B) PROM and AROM