Exam (elaborations)
SCS Shoulder Questions (1)
SCS Shoulder Questions (1)
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SCS Shoulder QuestionsCluster for patients with shoulder pain likely to benefit from Cerviocthoracic Manipulation -
ANS-- pain free shoulder flexion <127 degrees
- shoulder IR <53 at 90 deg abduction
- (-) Neers test
- not taking medications for shoulder pain
- symptoms for <90 days
Cluster for rotator cuff pathology - ANS-(+) painful arc sign
(+) drop -arm sign
(+) infraspinatus MMT
Cluster for Subacromial Impingement - ANS-(+) Hawkins-Kennedy Test
(+) Painful arc sign
(+) infraspinatus MMT
A physical therapist who wishes to improve glenohumeral external rotation using joint
mobilizations should direct their glides (on the humerus) in which direction?
Superior glides
Distraction glides
Caudal glides
Posterior glides - ANS-Posterior glides
Correct: The glenohumeral joint does not comply with strict concave-convex rules due to
capsular constraint. The humeral head needs to have enough capsular mobility available to
posteriorly translate on the glenoid during external rotation. This concept was supported in a
recent RCT (see Johnson et al., 2007 download
), which found greater improvements in ER with posterior gleno-humeral glides.
Research does NOT support the use of _________ in the non-operative management of
traumatic anterior shoulder dislocation.
Strengthening of the rotator cuff and scapular stabilizers
Propriocetive training
Shoulder immobilization with a traditional sling for 1-2 weeks
Activity restrictions for 6-8 weeks - ANS-Shoulder immobilization with a traditional sling for 1-2
weeks
Correct: According to Hayes et al., (2002) download
, , immobilization in a traditional sling is not warranted after a primary dislocation. Like most joints
of the body, we want to promote safe ROM (passive or active) after injury, not strict
immobilization.
The next 3 questions will be based on the following scenario:
The patient is an 18-year-old volleyball player who complains of generalized right shoulder pain.
The patient does not recall a specific mechanism of injury but states that the pain has been
recurrent over the past year. The patient complains of pain when reaching for books in the
school locker and during overhead movements while playing volleyball. The patient is right-hand
dominant with no significant past medical history. Her examination is as follows:
Posture: Slight forward head and shoulders
Integumentary: No right shoulder effusion noted; no apparent decrease in right shoulder muscle
tone compared to the left; right shoulder girdle slightly lower than left
ROM: WNL - upper extremities and cervical region
Strength: Left upper extremity 5/5 throughout. Right upper extremity 5/5 except 4/5 noted to the
following muscles: shoulder external rotators; - ANS-Secondary Shoulder Impingement
The patient is an 18-year-old volleyball player who complains of generalized right shoulder pain.
The patient does not recall a specific mechanism of injury but states that the pain has been
recurrent over the past year. The patient complains of pain when reaching for books in the
school locker and during overhead movements while playing volleyball. The patient is right-hand
dominant with no significant past medical history.
Examination:
Posture: Slight forward head and shoulders
Integumentary:
No right shoulder effusion noted; no apparent decrease in right shoulder muscle tone compared
to the left; right shoulder girdle slightly lower than left
ROM:
WNL - upper extremities and cervical region
Strength:
Left upper extremity 5/5 throughout
Right upper extremity 5/5 except 4/5 noted to the following muscles: shoulder external rotators;
middle and lower traps
Sensation:
Intact and bilaterally symmetrical to light - ANS-Weakness of the scapular stabilizers
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