Shoulder pain

Shoulder pain

1. Special tests: Subacromial pain & rotator cuff mm/tendon

   • Lateral job for all: rule in/out
   • ERLS for supra/infra & t-minor, mainly supra (ER): rule in/out
   • Belly press & bear-hug for subscap (IR): rule in
   • Drop arm for supraspinatus (abd): rule in
   • Neer test for subacrom (IR): rule out
   • Hawkins-Kennedy for subacrom PS (IR): rule out

2. DAY 1 MUST HAVES

   • Physiologic ROM of primary region: 30 GHJ, 30-90= 30 GHJ + 30 STJ (SCJ mainly), 90-180 = 60 GHJ + 30 STJ (ACJ mainly)
     • AROM (+OP if no Sx but limited ROM)
       • Abduction (GHJ120/c180)
       • Horizontal adduction
       • Flexion (GHJ100/complex180)
       • ER (GHJ50/c90)
       • Hand behind back (Ext/add/IR)
     • PROM if Sx
       • Flexion (100 GHJ)
       • Abduction (120 GHJ)
       • Horizontal adduction
       • ER @ 0 & 90 abd, IR @90 (GHJ ER 50 & IR 70)
     • ROM & interview may indicate
       • inert
         • suspect stiffness/restriction > Accessory mobs. (QQSE) Tx = Grades I-IV: Sx vs resistance.
           • inferior: in neutral, 90 & 120 flex, 90 abd
           • AP in neutral & loose pack
           • AP of SC
           • PA in prone
           • AP & inferior on AC
         • suspect laxity > special test. Assess MMT/STR if +
           • GHJ laxity/instability
             • Load & shift
             • sulcus sign
             • apprehension & relocation
       • contractile
         • MM Length. Tx w/ stretch
           • Lats & Teres major (limits ER & flex)
           • Pecs major & minor (limits abd & ER)
         • strength: MMT @end-range. Tx w/ resistance (irritability & intent)
           • abd @90 for med delt & supraspinatus
           • Flex @90 for ant delt
           • IR/ER in prone
           • Horizontal add (supine for pec major)
           • Rhomboid in prone
           • Upper traps/levator scap (seated)
         • integrity: SRT in open pack. Tx w/ iso strength
           • flexion
           • Abduction
           • IR & ER
           • elbow flexion
       • Neural
         • motor control: repetitive or specific movements or fear > Sx. Progress/regress by changing difficulty
           • whole or part task or segmental
           • OKC: global mm, one joint
             • Open-book arm lifts tripod in quadruped, standing, or plank in stable surface. Standing: AROM or theraband for IR, ER & diagonals. Prone scapular retractions (Y & T)
           • CKC: local mm, multiple joints, better for dynamic stability
             • scapular retraction/protraction in quadruped, standing, or plank/tripod w/ stable or unstable surface. **Bilateral ER w/ theraband
   • Screen secondary region
     • C-spine
       • ROM values: flex (45-50), ext (80), Rot (80/80), sidebend (40)
         • Sx + limited in Ext, R rotation & R sidebend = PPIVMs on 3 segments
           • If R-side stiffness > upglides to open R IVF
         • no Sx but limited in L sidebend, L & R Rot = AROM + OP
           • Taut in L sidebend by mm (stretch on R neck) > mm length
             • + R Rot limit = Upper traps
             • + L Rot limit = Levator scap
       • Motor control (sustained posture)
         • Quadruped Ext & Rot
     • Neuro
       • UQ SEGMENTAL: Sensory, motor, DTR
     • Visceral/vascular: Liver, gallbladder
   • VITALS (BP/HR/RR), FAA (gardening in kneeling/quadruped), POSTURE (standing & quadruped), OUTCOME MEASURE (SPADI, NDI)
   • Palpation: GHJ, ACJ, Scapula (superior/middle border), supraspinous fossa; levator scap, upper traps semispinalis, occipitals. Tx = STM if +