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| 1st visit | sidelying ER (or standing w/same motion), prone ER, empty or full can
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| add on 2nd visit | horizontal abd w/scap retract & maybe push-up +
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| add on 3rd visit | rows
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| stretch | pec stretch in corner
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| synovial jts | GH, AC, SC
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| GH (glenohumeral jt) | head of humerus in glenoid
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| glenohumeral lig | limits ant displacement & ER (superior, middle, inferior)
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| coracohumeral lig | limits flex & ext
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| SC (sternoclavicular) jt ligs | ant sternoclavicular, interclavicular (not articular fibrocartilage disc), SC jt glides during elevation, depression, protraction & retraction of scap
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| AC (acromioclavicular) jt ligs | acromioclavicular, coracoclavicular (conoid & trapezoid), very small gliding mvmts during scap mvmts
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| bursa of shd | can be called subacromial or subdeltoid bursa
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| jt capsule | large, loose, inferiorly taut/superiorly folds upon self, very redundant. lined w/synovial tissue. inc the tendon of long head of biceps. tendons of cuff & GH lig support the jt capsule & provide stability
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| glenoid labrum | deepens glenoid, fibrocartilage ring. if torn can be traumatic or degenerative. it's an avascular area, if torn prob needs sx
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| capsular pattern | limited ER, ABD, IR. arthrokinematics, end feel-springy (capsular is normal), convex moving on concave
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| rx capsular pattern | passive stretching & jt mob
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| mm of shd | infraspinatus, teres minor, subscapularis, deltoid, coracobrachialis, pectoralis, biceps, triceps, pec minor
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| pec major | O-med 1/3 of clavicle, sternum, costal cartilage of 1st 6 ribs. I-lat lip bicipital grv of humerus. A-shd add, IR, hor ADD, shd flex 60, shd ext 60. N-lat & med pec
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| pec minor | O-ant surface, 3-5th ribs. I-coracoid process of scap. A-scap depress, protract, down rot & tilt. N-med pec
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| ant delt | O-lat 1/3 of clavicle. I-delt tuberosity. A-shd abd, flex, med rot, hor add. N-axillary
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| middle delt | O-acromion process. I-deltoid tuberosity. A-shd abd. N-axillary
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| post delt | O-spine of scap. I-deltoid tuberosity. A-shd abd, ext, hyperext, lat rot, hor abd. N-axillary
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| teres minor | O-axillary border of scap. I-greater tubercle of humerus. A-shd lat rot, hor abd. N-axillary
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| infraspinatus | O-infraspinous fossa of scap. I-greater tubercle of humerus. A-shd lat rot, hor abd. N-suprascapular
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| subscapularis | O-subscap fossa of scap. I-lesser tubercle of humerus. A-shd IR. N-subscapular
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| upper trap | O-occipital bone, nuchal lig. I-outer 1/3 of clavicle, acromion process. A-Scap elevation & upward rot. N-spinal accessory
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| middle trap | O-spinous processes of C7 thru T3. I-scap spine. A-scap retraction. N-spinal accessory
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| lower trap | O-spinous processes of middle & lower throacic vertebrae. I-base of scap spine. A-scap depression & upwd rot. N-spinal accessory
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| rhomboids | O-spinous processes of C7-T5. I-vertebral border of scap btw spine & inf angle. A-scap retract, elevation, down rot. N-dorsal scap
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| serratus ant | O-lat surface of upper 8 ribs. I-vertebral border of scap, ant surface. A-scap protract & up rot. N-long thoracic
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| coracobrachialis | O-coracoid process of scapula. I-med surface of humerus near midpoint. A-stabilizes shd jt. N-musculocutaneous
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| biceps brachii | O-long head:supraglenoid tubercle of scap. short head: coracoid process of scap. I-radial tuberosity of radius. A-elbow flex, forearm sup. N-musculocutaneous
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| triceps | O:long head:infraglenoid tubercle of scap. Lat head: inf to greater tubercle on post humerus. med head:post surface of humerus. I-olecranon process of ulna. A-elbow ext. N-radial
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| mm of scapula | rhomboids, upper trap, middle trap, lower trap, serratus
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| ER | infraspinatus & teres minor
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| IR | subscapularis
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| shd observation | posture, symmetry, PROM/AROM/end feel, crepitance, tender areas, painful arc
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| coracoacromial arch | formed by: acromion, croacoacromial lig. houses:gr tubercle, rot cuff tendons, biceps tendon, subacromial bursa
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| impingement pn | when arm is overhead & then no pn when arm is down
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| downward rotation | force couple-pec minor, levator, rhomboids
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| upward rotation | force couple-upper traps, lower traps & serratus
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| scapulohumor rhythm | after 30-45 degrees of elevation there is 2:1 ratio. 2 degree GH motion: 1 degree scapular motion
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| role of posture | fwd tilt of scap, over stretched, wk rhomboids, serratus & trap wkness, tight pec minor/maj, levator, compression of subacromial space, faulty mechanics of shd elevation
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| bicipital tendinitis test | pn in ant inner shd w/resisted sup
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| drop arm test | pt unable to lower arm from 90 ABD, complete tear of supraspinatus
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| apprehension test | slowly abd & ext rot-ant glenohumeral dislocation
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| adsons test | TOS
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| impingement test | flex, IR, add humerus so that cuff impinges under acromion-pn indicates impingement
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| Apley's scratch test | opp shd, behind back, behind head
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| Speeds test | resist-GH flex w/elbow ext & palpate bicipital groove for bicipital tendonitis
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| traumatic shd dislocation | forceful abd & rot of the humerus. subscapularis tendon overstretches or tears along w/ant jt capsule & glenoid labrum. often unidirectional & more likely to require sx
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| non-traumatic shd dislocation | laxity of jt capsule w/o trauma. usually bilateral & multidirectional. may respond to rehab
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| PT management-non-surgical ant dislocation acute phase | usually have to follow MD protocol-RICE (may be immobilized in sling for 4 wks), PROM except ER w/ABD, AAROM ER amt frequently ordered by MD, Codmans/mm setting
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| PT management-non-surgical ant dislocation sub acute phase | AROM to wrist & elbow, physical agents for pn/edema, when ordered progress to AAROM, AROM, isometrics & resistive ex for cuff strengthening, cross friction massage, stretching, strengthening but cont to avoid ABD/ER
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| PT management for general shd instability | stretching generally not focus of rx, esp into ER, gen shd strengthening indicated esp RC & scapular mm, correction of poor posture to take stress of soft tissues, may need to modify activity to prevent overuse
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| Bankart repair | labrum & ant capsule reattached to glenoid
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| capsulorrhaphy (capsular shift) | loose capsule pinned or sutured (ETAC-electrothermally assisted capsulorrhaphy)
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| repair of a SLAP (sup labrum extending ant to post)lesion | reattach torn structures (usually labrum & biceps)
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| ant dislocation-post op rehab | wk 1-2-ROM & isometrics/ wk 3-4 begin resisted ex/ some protocols contraindicate ER & ABD for 1st 4 wks post op/ return to activity in 6-9 mos
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| adhesive capsulitis | frozen shd
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| primary adhesive capsulitis | unknown etiology. unknown stimulus produced. profound histological changes in the capsule resulting in fibrosis
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| secondary adhesive capsulitis | minor trauma or episode of inflammation that leads to disuse, tissue shortening & adhesions. onset is gradual & initially pn is the primary complaint, may be related to diabetes, immobilization
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| adhesive capsulitis S&S | pn in lat shd that initially is severe but eventually subsides to dull ache & stiffness, severe loss of motion in capsular pattern. motion is often restricted w/in 2-3 wks. night pn, cant sleep on involved side, empty end feel
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| adhesive capsulitis PT management acute/subacute | pn management AROM/PROM
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| adhesive capsulitis PT management chronic | jt mob, aggressive stretching, strengthening, some require manipulation under anesthesia, many spontaneously resolve but may take 2 yrs
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| most common cause of shd pn | biceps tendonitis
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| biceps tendonitis S&S | tenderness, pn w/stress to tendon (ie strong isometric contraction, sharp twinges on certain mvmt common, esp ext rot, abd) AROM-painful arc common. PROM-generally full
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| PT management of bicipital tendonitis acute & subacute | management w/physical agents and rest. ionto /phono used commonly
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| PT management of bicipital tendonitis chronic | heat, begin AAROM, AROM, resistive, friction massage, mobilization, stretching, must rx underlying cause (abt 80% posture & wkness of scap or RC mm)
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| bursitis | pretty rare, often occurs secondary to impingement or chronic tendonitis
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| bursitis S&S | lat arm pn, may refer to arm, dull ache under delt, hx of chronic tendonitis, AROM-noncapsular pattern, may have painful arc, painful elevation
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| bursitis rx | like tendonitis since causes the same...heat, begin AAROM, AROM, resistive, friction massage, mobilization, stretching, must rx underlying cause (abt 80% posture & wkness of scap or RC mm)
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| RTC impingement syndrome | result of repetitive microtrauma to tissues in coracoacromial space & decreased space between acromion & gr tubercle
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| RTC impingement syndrome causes | usually related to overhead activity such as tennis, military press, painting, swimming, ball throwing, associated w/scapular & RC wkness
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| RTC impingement syndrome tissues effected | long head of biceps, subacromial bursa, supraspinatus tendon
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| impingement | underlying cause is crowding of subacromial space, humeral head migrates superiorly during activity/delt overactive, SS underactive
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| impingement syndrome S&S | superior pn esp w/overhead activity, long hx of pn/microtrauma, painful arc (abd btw 70-120), positive impingement signs
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| PT management of impingement | rx like tendonitis, strengthening of cuff & post scap mm, stretching ok but avoid painful arc, correct functional probs, closed chain ex recommended as well as core strength
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| RCT (rotator cuff tear) causes | loss of subacromal space leads to: DJD, spurs, calcific tendonitis, chronic inflammation/scarring, wking of cuff tendon or mm due to age, microtearing or decreased vascularity, GH or scapulothroacic hypermob, or trauma
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| RCT (rotator cuff tear) trauma | microtrauma-esp deceleration phase of throwing-eccentric contraction, can be classified as complete or incomplete (rx conservatively-same as tendonitis)
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| RCT (rotator cuff tear) clinical signs | + drop arm test-full ABD to ADD-arm drops @ 90, loss of ADL function, wkness, + empty can test, PM pn, pn & wkness w/elevation, jt noise, atrophy
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| sx repair of RC | increase space between acromion & tendon, repair of tear w/sutures-reattachment of tendons if complete, arthroscopy most cases
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| most post op RC sx protocol | physician ordered
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| SC/AC jt sprain/dislocation type I | occurs w/trauma to jt but capsule & ligaments are intact
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| SC/AC jt sprain/dislocation type II (subluxation) | occurs when capsule tears but conoid & trapezoid ligaments are not. these connect the coracoid process & acromion
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| SC/AC jt sprain/dislocation type III (separation) | capsule, ligaments, overlying mm are torn & clavicle is displaced
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| TSA (total shd arthroplasty) | done in cases of severe OA, RA, there is option of hemiarthroplasty, outcome relatively poor w/ severely limited ROM & strength
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| PT management TSA | per MD protocol
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| complex regional pain syndrome (CRPS) | formerly RSDS (shd/hand syndrome)- a neuromuscular disorder of unknown etiology that frequently follows some type of trauma or other chronic prob. may also occur in LE, may last from months to years.
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| complex regional pain syndrome (CRPS) S&S | pn, edema, stiffness, discoloration
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| complex regional pain syndrome (CRPS) rx | pts need anti-inflammatories, steroids, sympathetic blocks, rx is difficult, often of limited effectiveness
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| complex regional pain syndrome (CRPS)components | sympathetic nervous system dysfunction, sensory dysfunction such as burning, motor dysfunction, trophic changes (sweating, loss of hair, shiny, temp change, thick nails)
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| complex regional pain syndrome (CRPS) type 1 | (reflex sympathetic dystrophy)- origin not related to nerve injury
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| complex regional pain syndrome (CRPS) type 2 | causalgia- develops after nerve injury
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| complex regional pain syndrome (CRPS) dx is 3/4 of ... | unduly prolonged or intense pn, stiffness, delayed functional recovery, trophic changes
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| PT management of CRPS | decrease pn, massage for edema, elevation/elastic compression, desensitization, manage limited mob depending on acuity, protect involved & uninvolved jts, contrast bath, ice, heat, compression, TENS, estim, phone, early PROM, AAROM, AROM as tolerated
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| common sources of referred pn in the shd region | cervical spine, referred pn from related tissues
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| nerve disorders in the shd girdle region | brachial plexus in the thoracic outlet, suprascapular nerve in the suprascapular notch, radial nerve in the axilla
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