Shoulder complex

Shoulder complex

1. Anatomy

   • Joint
     • ACJ
     • GHJ
     • shoulder girdle
   • Muscles
     • stabilisers
     • Prime movers

2. Differential diagnosis

   • myogenic
     • Rotator cuff related shoulder pain
       • RC tear
         • pain on...
         • treatment
           • ROM and strengthening
           • CSI injection
             • pain
           • Surgery - tendon reconstruction
           • Anterior deltoid programme
       • RC Weakness
         • abduction
         • flexion
         • internal rotation
         • external rotation
     • Biceps brachii tear
   • Arthrogenic
     • frozen shoulder
       • Treatment
         • ROM
           • Active
           • Active assisted
           • passive
         • +/- CSI
         • surgery
           • keyhole
           • manipulation under anaesthetic
     • Acromioclavicular joint
       • irritation
       • disclocation
         • Rockwood classification
           • Type I-II
             • conservative
               • strength and ROM
               • taping - zinc oxide
               • improving WB
           • Type III -VI
             • surgical and conservative
     • Polymyalgia Rheumatica
       • GP referral
         • steroids
     • Cervical stenosis
     • Osteoarthritis
       • strengthening
       • general exercise principles
     • Dislocations
   • neurogenic
     • Cervical radiculopathy
     • Peripheral neuropathy
     • ? thoracic outlet syndrome

3. Subjective assessment

   • Red Flags
     • Night pain
       • constant
       • sweats
     • Subluxation of shoulder
   • THREADSOCS
   • HPC
     • WHIP
       • When
       • How
   • Aggs and eases
   • 24 hour pattern
     • mechanical or non-mechanical
     • early morning stiffness
       • under or over 30 minutes

4. Objective assessment

   • Range of movement
     • AROM
       • Standing
       • movements
         • flexion
           • 160-180
         • external rotation
         • internal rotation
         • abduction
           • 160-180
         • extension
     • PROM
       • Supine
       • If movement is improved - muscular issue
       • If movement is the same - joint issue
   • Strength testing
     • sitting
     • static and through range
     • If painful...
       • short lever
     • movements
       • forward flexion
       • extension
       • internal rotation
       • external rotation
       • abduction
   • Special tests
     • ACJ
       • Scarf test
     • Rotator cuff tear
       • Lift off
       • Abduction hold
       • Belly press
     • Frozen shoulder
       • capsular pattern
         • ER - Abduction - IR
     • biceps tear/ rupture
       • resisted elbow flexion
   • Joint above and below
     • neck
     • elbow

5. General treatment principals

   • pharmacology
   • Weak
   • stiff
   • return to sport

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