Adhesive capsulitis
DD
PE
Treatment
DD
- rotator cuff tear
- biceps tendinopathy
- SLAP lesion
PE
- Observation= Muscle atrophy around shoulder, scapular dyskinesia
- Movement= loss of both passive and active ROM, ER and Abduction
- Resistance to movement in accessory glides of GHJ
- Tenderness on palpation
Treatment aim: reduce pain and restore ROM
- A&E= What, activity modification
- Pain= joint mob distraction (progress: grade, duration)
- ROM= wall walking, pendulum stretches, cane exercises, pulley exercises
Prognosis: 1-1.5 year
ACJ sprain
DD
PE
Mangement
DD
- SA bursitis (imaging)
- clavicular #, distal end
Symptoms
-localised pain
PE
- Swelling, tenderness, pain with abduction and external rotation,
- Positive: Horizontal add w/ over pressure + shrug test
Management
- Decrease pain and protect structure= immobilise in sling 2-3 day G1, up to 6 wks 2 &3 (usually surgery T3 or higher)
- Once pain permits isometric exercises and AC glides
- Scapulohumeral rhythm
RTS= when no localised tenderness and full ROM
Rotator cuff tear
DD
- SLAP
- BBLH
Symptoms
- pain with overhead acitivities
- pain over lateral upper arm
PE
- Movement exam-painful arc of abduction 70-120, loss of ER
- AROM>PROM
- Pain & weakness in MMT
- Drop arm sign, empty can, gerbers lift off,
Management
- Reduce symptoms= activity modification, ICE, MWM
- Motor control (start neutral and progress)’
- start isometric strength, eccentric–> functional
Full tear surgery
Rotator cuff tendinopathy
DD
- impingement
- Supraspinatus tear
SAME as tear but keep management pain free
SLAP lesion
Type 1: frayed and degenerated labrum
Type 2: detached superior labrum and biceps tendon from glenwood rim
Type 3: bucket handle tearing of superior labrum. Remaining labral tissue remains attached to glenwood rim.
Type 4: Extension of displaced bucket handle tear into biceps tendon.
DD
- Biceps tear (biceps load, speeds)
- Rotator cuff (painful arc, MMT)
- Posterolateral impingement (Hawkin’s, Needs)
Symptoms
- pain posterior shoulder esp add
- popping, catching and grinding
- vague deep pain
- instability
- pain throwing + loss of power
PE
- Bicep load test
- crank test
- o’briens active compression test
- pain on posterior joint line
- posterior capsule tightness
Treatment
-Phased strengthening exercises – IR , prone extension, seated row –> IR in abduction – protraction – ER – forward flexion
Surgery - better outcomes in non-athletic population
RTS is low in thrower’s no biceps for 8 wks, then only strengthening at 12 wks
-Sleeper stretch
-AP glide
GIRD
- pain and tightness of posterior shoulder
- decreased cross body abduction
- IR ROM (25 degs less)
- reduce AP glide of GHJ
- may report impingement/instability symptoms
Treatment
- Increase IR – ensuring good scap and HH movement (esp if instability or impingement)
- Sleeper stretch 3x30seconds every day
- Hold-relax techniques
- AP accessory glide
- MWM – AP with IR
Traumatic unidirectional instability
DD
- HH #
- Disruption og GH ligament
- compression of the HOH posterior
PE
-Load and shift, apprehension test (reduced symptoms relocated), sulcus sign
Treatment
- A & E= avoid abd + ER,
- Scapular and RC control and activation
- closed chain to open chain
- strengthening
- kinetic chain exercises
Surgery – 3-4 weeks in sling, pendular exercises after 24 hours, active ER when pain allows, strengthening after 6 weeks. RTS 3-4 months
Post dislocation – 30 abduction for 4-6 weeks, pendular exercises and scaption, restrict IR and add, strengthen after 6 weeks. RTS 4-6 months
LHB tear
DD
- SLAP
- Brachialis tear
Symptoms
- pain over LHB tendon
- pain on passive extension
- pain flex
PE
- reduced ROM flex, pain passive ext,
- speed’s
- yergason’s
Management
- Inflammation= RICER
- pain= refer
- HOH positioning
- posterior capsule stretch
Same slap
Subacromial impingement
Symptoms
- catching, giving, clicking and locking
- pain inferior to acromion and posterior shoulder
PE
- painful mid range arc= 60-120
- decreased strength and motor control rotator cuff (Abd, ER)
- poor neuromuscular control scap
- poor control HOH centering
- impingement test (hawkins, neers)
- empty can and gerbers
- posterior cap tightness
- load and shift + relocation (- primary, + secondary)
Treatment
- SH rhythm and RC control and strength
- Centering HOH
- activity mod–> don’t go into ranges of impingement until correct control
- functional
Posterosuperior impingement- increased
Pain in late cocking phase
PE
- Anterior HH position
- tight posterior capsule
- tender on posterior shoulder
- speeds + neers, negative hawkins + apprehension posterior pain
same as SA
Scapular dyskinesia
Lack of soft tissue flexibility (scapular or GH muscles) or lack of muscle performance (muscle control or muscle strength)
- Conscious muscle control
- improve proprioception
- normalise resting position
- correct timing and control - Muscle control and strength for DA
- scap co contraction
- Exercise with ER component tend to improve scapular muscle recruitment
- strength deficit - Advanced control during sport/occupational movements
- kinetic chain
