Basic Shoulder Evaluation (Day #1)

Question 1

Base of Traditional Therapy Pyramid = ?

orange

Basic Shoulder Evaluation

Answer 1

Base of Traditional Therapy Pyramid = Therapeutic Alliance

Question 2

orange

Basic Shoulder Evaluation

Answer 2

Tissue healing and symptom modulation

Question 3

Basic Shoulder Evaluation

Answer 3

Mobility

Question 4

orange and green

Basic Shoulder Evaluation

Answer 4

Orange = Motor movement
Green = Sensory control

Question 5

orange

Basic Shoulder Evaluation

Answer 5

Advanced performance

Question 6

ROM for Shoulder

Basic Shoulder Evaluation

Answer 6

Question 7

During Apley’s scratch test what movements are occuring at the shoulder ?

Basic Shoulder Evaluation

Answer 7

Apley’s scratch test = Medial Rotation with Adduction and Lateral Rotation with Abduction.

Question 8

What is happening in A and B ?

Basic Shoulder Evaluation

Answer 8

A = Neck Reach
B = Back Reach

Question 9

How do you score shoulder mobility evaluation in the FMS?

Basic Shoulder Evaluation

Answer 9

3 = Fists are within one hand length.

2 = Fists are within one-and-a-half hand lengths.

1 = Fists are NOT within one-and-a-half hand lengths.

0 = Pain / can’t perform.

Question 10

How can I tell if the joint is a problem?

• What would you do?

“Play?”

Basic Shoulder Evaluation

Answer 10

Joint play movements:

• Posterior Glide
• Lateral Glide
• Inferior Glide
• Distractive/inferior Glide
• Anterior Glide

Question 11

Two questions to think about while assessing joint play = ?

Basic Shoulder Evaluation

Answer 11

Joint Play Movements Questions:

• Are they symmetrical?
• Do they elicit pain?

Question 12

Posterior Capsular Tightness:

• Posterior shoulder is considered restricted if the client’s arm is unable to drop below = ?
• How would you remedy this = ?

Basic Shoulder Evaluation

Answer 12

Posterior Capsular Tightness:

• Block the scapula as you move the shoulder into horizontal flexion/adduction.
• Posterior shoulder is considered restricted if the client’s arm is unable to drop below a 0° point relative to the horizontal plane.

Question 13

Signs and symptoms of local muscular dysfunction = ?

palpation?

Basic Shoulder Evaluation

Answer 13

Signs and symptoms of local muscular dysfunction:

• Ropy/Ropelike quality
• Taught & Tender
• Knots or Trigger points or banded muscle fibers
• Replication of symptoms distally with palpation of proximal muscles
• Increased tone/tension
• Patient withdraws/flinches to reasonable pressure
• Possible swelling or inflammatory signs

Question 14

Referred pain here makes you think = ?

Basic Shoulder Evaluation

Answer 14

Supraspinatus:

Question 15

Referred pain here makes you think = ?

Basic Shoulder Evaluation

Answer 15

Infraspinatus:

Question 16

Referred pain here makes you think = ?

Basic Shoulder Evaluation

Answer 16

Teres minor/major:

Question 17

Referred pain here makes you think = ?

Basic Shoulder Evaluation

Answer 17

Subscapularis:

Question 18

Referred pain here makes you think = ?

Basic Shoulder Evaluation

Answer 18

Scalene:

Question 19

Referred pain here makes you think = ?

Basic Shoulder Evaluation

Answer 19

Posterior Deltoid:

Question 20

Referred pain here makes you think = ?

Basic Shoulder Evaluation

Answer 20

Upper Trap:

Question 21

Referred pain here makes you think = ?

Basic Shoulder Evaluation

Answer 21

Latissimus Dorsi:

Question 22

When should I tests for neurological dysfunction?

Basic Shoulder Evaluation

Answer 22

When should I Tests for Neurological Dysfunction?

• Do you have signs of neuropathic pain?
• Do you have weakness along the line of a Myotomes or sensory changes along Dermatomes?
• Reflexes tell you about the nerves and spinal cord
• Upper limb neurodynamic (tension) test (brachial plexus tension test)
• Upper limb equivalent of straight leg raising test
• Cervical spine testing (Spurling’s) and Thoracic Outlet Testing
• Repeated Neck movements especially Sidebending/Flexion/Extension

Question 23

Examples of functional outcome measures include = ?

Basic Shoulder Evaluation

Answer 23

Functional Outcome Measures:

• Simple shoulder test (SST)
• Disabilities of the Arm, Shoulder, and Hand (DASH) test or Quick DASH
• Shoulder Pain and Disability Index (SPADI)
• American Shoulder and Elbow Surgeons Score
• Western Ontario Shoulder Instability (WOSI) index

Reminder = Find links to these

Question 24

Assessing what and why ?

Basic Shoulder Evaluation

Answer 24

What

• Median Nerve
• Musculocutaneous nerve
• Anterior interosseous nerve

Why =

Question 25

Assessing what and why **?** ## Footnote *Basic Shoulder Evaluation*

Answer 25

**What**: * Median Nerve * Axillary nerve * (C5, C6, C7) **Why** =

Question 26

Assessing what and why **?** ## Footnote *Basic Shoulder Evaluation*

Answer 26

**What**: * Radial nerve **Why** =

Question 27

Assessing what and why **?** ## Footnote *Basic Shoulder Evaluation*

Answer 27

**What**: * Ulnar nerve * (C8, T) **Why** =

Question 28

Red Flags for the shoulder include = **?** ## Footnote *Basic Shoulder Evaluation*

Answer 28

Red Flags for the Shoulder: (**a**) Constant pain * Not relieved by rest * Non-mechanical pain * Not responsive to treatment * Violent trauma without imaging (**b**) Acute Coronary Syndrome: * 68% of MI’s reported shoulder pain (Lt). * Chest pain, SOB, Upper abdominal pain or dizziness * Men > 30 y/o, women > 40 y/o * Drug Abuse * Fever * Hot, red joint (**c**) Cancer * Pancoast tumor * 10% body mass weight loss, history of smoking, previous history of CA * Soft tissue mass, Night pain worse than during day (**c**) Pain/neuro symptom in shoulder blade or joint * Pinky ring finger pain/weakness (**d**) Liver dysfunction * Hepatitis * CirrhosisLiver dysfunction (**e**) Gallbladder attacks

Question 29

## Footnote *Basic Shoulder Evaluation*