- What is the scapulothoracic rythm
- 0-30º no scapular movement, 30-90º 2:1 mvt, >90 1:1
- Name 5 patients history questions for shoulder
- Age, MOI, dominant arm, what aggravated condition, muscle spams, deformity, bruising, wasting, weakness, and heaviness in limb after activity
- Name 5 history questions for shoulder
- Pain type and location, Movement pain, sport, position
- Name 3 causes of shoulder primary and 3 secondary impigment syndrome
- RC tendon degeneration, hooked acromion, GH joint hypermobility ->primary
Muscle weakness or fatigue, muscle hypomobility, capsule tightness -> secondary
- What do we need to observe for shoulder anterior injury
- Step deformity, fountain sign (swelling @ ant. AC), sulcus sign, dominant side
- Reason of scapular dysfunction type 1
- Presence of weak muscle (low trap, lat dorsi, SA, tight pec
- Reason of scapular dysfunction type 3
- over activity of the levator scapula and upper trapezius along with imbalance of the upper and lower trapezius force couple, impingement and rotator cuff lesions
- Reason of scapular dysfunction type 4
- during movement and may indicate the scapular control muscles are not stabilizing the scapula
- What body movement are doing the active movement of shoulder
- glenohumeral, scapulothoracic, acromioclavicular, sternoclavicular, ribs, thoracic, spine
- Reason of scapular dysfunction type 2
- Presence of SLAP lesion weakness of SA, rhomboids, lower, mid and upper trap, long thoracic nerve problem, tight humeral rotator
what to look in posterior view of shoulder
scapular dyskinesia, primary scapular winging, dynamic scapular winging, rounded shoulder, tight or muscle imbalance
reason for primary scapular winging
due to muscle weakness of one of the scapular muscle stabilizers
cause of secondary scapular winging
normal movement of scapula is altered because of pathology in glenohumeral joint
cause of tertiary winging
may be due to lesion of the long thoracic nerve affecting serratus anterior, trapezius palsy (spinal accessory nerve), rhomboid weakness, multidirectional instability, voluntary action, or a painful shoulder resulting in splinting of the glenohumeral joint, which in turn causes reverse scapulohumeral rhythm
cause of scapular duskinestesy
bony: thoracic kyphosis, clavicular fracture or malunion
joint: AC instability, GH internal derangement
neurological: cervical radiculopathy, long thoracic n. palsy, spinal accessory n. palsy
soft tissue: hypo mobility, GH int. rot. deficit, altered m. activation pattern, intrinsic m. pathology
reason for abnormal active mvt of shoulder
scapulothoracic rythme
painful arc: subacromial bursitis, calcium deposit, pertenonitis or tendinitis of RC
apprehension
winging
what does it means when patient can achieve 90 degree of and
test gives a clearer indication of true glenohumeral joint medial and lateral rotation, which are measured when the scapula starts to move.
what happen if GH internal and external rotation is > 1
patient will probably develop shoulder problem
cause of snapping scapula
scapula ribbing over the underlying ribs
which muscle can increase protraction
tight pec , weak lower trap , weak, SA
which muscle increase depression
weak upper trap
caused loss of scapular stabilization
excessive lateral rot of scapula
thigh lat. rotator
secondary impigment
excessive elevation of scapula
functional mvt of shoulder
brush teeth, hair
tuck in t-shirt
reach of shelf
sport specific mvt
2 type of shoulder instability
TUBS, AMBRI
