Shoulder AC Joint Sprain:
- Classifications = ?
AC Dysfunction
Shoulder AC Joint Sprain - Classifications:
- AC Joint Sprain
- Shoulder Strain/Sprain
- Acromio-clavicular ligament / Coraco-clavicular ligament tear
Shoulder AC Joint Sprain - Characteristics:
- Pain Patterns = ?
- Risk Factors = ?
- Observations = ?
- Examination = ?
AC Dysfunction
Shoulder AC Joint Sprain - Characteristics:
(a) Pain Patterns:
- Pain over the superior aspect of shoulder.
- Range of motion limitations due to pain.
- Horizontal abduction/adduction stress AC joint and replicate pain.
(b) Risk Factors:
- Male are 5x more likely than females.
- Younger Athletes
- Weekend warrior types.
- Fall / Impact on tip / top of the shoulder.
- Fall on elbow.
(c) Observations:
- Palpable step-off of the clavicle.
- Swelling, tenderness.
- Decreased mobility Cytokine-mediated synovial inflammation with adhesions around RTC.
- Contraction of the coracohumeral ligaments limits ER.
(d) Examinations:
- (+) AC Resisted extension test
- Cross body test
- O’Brien’s test
- AC Shear or palpation of AC joint
Shoulder AC Joint Sprain - Manual Therapy:
- Joint Mobilization = ?
- PNF = ?
- Modalities = ?:
AC Dysfunction
Shoulder AC Joint Sprain - Manual Therapy:
(a) Joint Mobilization:
- Grade I & II for pain control
- Tractional/inferior
(b) PNF:
- PNF diagonal ROM/stretching.
- Contract Relax Stretching for improved ROM and capsular mobility.
- Multiple angle isometrics
(c) Modalities:
- Cryotherapy
- Laser
- Other anti-inflammatory applications
Shoulder AC Joint Sprain - Therapeutic Exercise:
- Motor = ?
- Sensory = ?
AC Dysfunction
Shoulder AC Joint Sprain - Therapeutic Exercise:
(a) Motor:
- Pain control techniques of isometrics, codmens, passive stretching.
- Address mobility deficits to restore lost range of motion within pain tolerances.
- Isometrics, Theraband isotonics, weights, single plane progressing to multiple plane endurance.
- RTC strengthening endurance/reactivation.
- Scapular Muscular strengthening.
- All trapezius muscles, serratus, and rhomboids for improved scapular mobility and control.
- Improved mobility of T-spine in all planes especially extension and rotation.
(b) Sensory:
- Undermining / challenging postural stability as progression.
Acromioclavicular Joint Sprain/Seperation:
- Prevalence = ?
AC Dysfunction
Acromioclavicular Joint Sprain/Seperation - Prevalence:
Acromioclavicular Joint Sprain/Seperation:
- Symptoms = ?
AC Dysfunction
Acromioclavicular Joint Sprain/Seperation -Symptoms:
Acromioclavicular Joint Sprain/Seperation:
- TBC/Special Tests = ?
AC Dysfunction
Acromioclavicular Joint Sprain/Seperation - Signs:
Acromioclavicular Joint Sprain/Seperation:
- TBC/Special Tests = ?
AC Dysfunction
Acromioclavicular Joint Sprain/Seperation - Special Tests:
What does AC joint dysfunction sound like in a patient interview = ?
AC Dysfunction
What does AC joint dysfunction sound like in a patient interview ?
- Fall on the tip of shoulder = AC Joint Sprain
- Deformity
- Chronic insidious pain = AC joint impingement
- Pain with horizontal adduction and end range abduction/flexion see with both.
Typical presentation of AC Joint sprain/separation = ?
AC Dysfunction
Typical presentation of AC Joint sprain/separation:
- Trauma based often a fall on the distal end of the shoulder with immediate onset of pain superior aspect of shoulder.
- Palpable lump or change in appearance.
Acromioclavicular Joint:
- What kind of joint = ?
AC Dysfunction
- Plane synovial joint that augments the range of motion (ROM) of the humerus in the glenoid.
AC Dysfunction Test = ?
AC Dysfunction
AC Dysfunction Test:
- Acromioclavicular Resisted Extension Test (*)
- AC horizontal adduction test (Also called crossover or cross-body test) (*)
- Acromioclavicular shear test
- O’Brien Test
- Paxinos sign (basically palpation of joint)
AC Resisted Extension Test = ?
AC Dysfunction
AC Resisted Extension Test:
- AC Resisted Extension Test places the joint in a close pack position.
- The patient is seated with his or her shoulder in 90 degrees of flexion and internal rotation, and his or her elbow in 90 degrees of flexion.
- The examiner, standing beside the patient, asks the patient to horizontally abduct his or her arm while the examiner provides an isometric resistance to this movement.
- Positive Test: Indicated by pain at the AC joint.
Acromioclavicular Horizontal Adduction Test = ?
AC Dysfunction
Acromioclavicular Horizontal Adduction Test
(also called Crossover or Cross-body Test):
- Patient Standing or sitting.
- Flex the shoulder to 90 degrees and horizontally adduct the arm across the body.
- Positive Test: If there is reproduction of pain at the AC joint.
Acromioclavicular Shear Test = ?
AC Dysfunction
Acromioclavicular Shear Test:
- To test for the presence of acromioclavicular joint dysfunction.
- Sitting with the arm at the side.
- Standing to side of the patient with hands over the acromioclavicular joint.
- Provide compression to the joint.
- Positive Test: If there is reproduction of pain at the AC joint.
Active Compression Test of O’Brien = ?
AC Dysfunction
Active Compression Test of O’Brien:
- To test for the presence of a labral tear or pathology of the acromioclavicular joint
- Sitting with shoulder at 90 degrees, slight horizontal adduction and internal rotation
- Standing to the side of the patient Resist elevation with arm in internal rotation followed by resistance with arm in external rotation.
- Positive Test: If there is pain and weakness experienced on resistance with the arm in internal rotation that exceeds the pain and weakness noted in external rotation, suggesting a labral tear or acromioclavicular joint pathology.
AC Joint Palpation / Paxinos Sign = ?
AC Dysfunction
AC Joint Palpation / Paxinos Sign:
- Client Position: Sitting with bilateral arms relaxed at sides.
- Clinician Position: Standing directly behind the client, facing the shoulder to be assessed.
- Movement: The clinician palpates the AC joint. The clinician applies pressure to the acromion with the thumb, in an anterosuperior direction, and inferiorly to the mid-part of the clavicular shaft with the index and long fingers.
- Positive Test: Is reproduction of concordant pain localized to the AC joint.
SN = 96
SP = 10
Positive (+) LR = 1.1
Negative (-) LR = 0.40
Diagnostic Cluster AC Joint = ?
AC Dysfunction
Diagnostic Cluster AC Joint:
- Additional cluster testing is comprised of the cross-body adduction test, active compression test, Hawkins-Kennedy test, and AC joint tenderness to palpation.
All 3 tests (+):
- SN = 25
- SP = 97
- Positive (+) LR = 8.3
- Negative (-) = LR 0.77
- QUADAS = 11
All 4 tests (+):
- SN = 5 (1-24)
- SP = 99 (95-100)
- Positive (+) LR = 5.70
- Negative (−) LR = 0.96
- QUADAS = 13
Treatment for AC Joint Patients = ?
AC Dysfunction
(a) Traumatic Patients:
- Address impairments
- Restore lost AROM
- Restore increase Strength
(b) Insidious AC joint Impingement:
- Address the impairments
- Mobilize the AC joint
- Improve Scapular mobility & control
- Improve GH joint mobility
- Strengthen the cuff
Take Home message on AC Joint dysfunctions = ?
Flip and Read
AC Dysfunction
Take Home message on AC Joint dysfunctions
- They are a small percentage of the shoulder pathologies.
- Frequently the minor versions will need only a small number of treatments or will improve without PT.
- Your goals are to modulate symptoms and then restore mobility and improve strength as the symptoms allow.
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Fundamentals of Orthopedic Intervention0
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Basic Shoulder Evaluation (Day #1)29
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Each-one Teach-one44
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Shoulder Bursitis & Impingement: Evaluation and Treatment42
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Rotator Cuff Pathologies47
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Labral Pathology and Shoulder Instability45
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Bursitis, RTC, Impingement, Labral - Hypothetical Patient Cases10
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Rehabilitation Guidelines for Type I and Type II Rotator Cuff Repair29
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Shoulder Rehab (For MSK 1)1
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AC Joint Dysfunction20
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Biceps Pathologies20
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All Things Scapular (Scapular Dysfunction, Evaluation, & Interventions)28
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Examination - Elbow, Wrist, and Hand15
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Clinical Anatomy and Biomechanics - Elbow, Wrist, and Hand14
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Examination - Elbow, Wrist, and Hand69
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Evaluation - E/W/H39
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Manual Therapy - E/W/H20
