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Shoulder Injury Evaluation

Shoulder Injury Evaluation. Justin Landers LAT. Basic Anatomy & Kinesiology. 3 Bone Structures. Clavicle Scapula Humerus. Evaluation Principles. Always follow a standard progression Determine the target tissue What area is injured Get a History is this a new injury, old chronic injury

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Shoulder Injury Evaluation

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  1. Shoulder Injury Evaluation Justin Landers LAT

  2. Basic Anatomy & Kinesiology • 3 Bone Structures • Clavicle • Scapula • Humerus

  3. Evaluation Principles • Always follow a standard progression • Determine the target tissue • What area is injured • Get a History • is this a new injury, old chronic injury • Assessment • Correlate signs, symptoms, biomechanical info

  4. Assessment • what is the primary problem ? • Plan • Treatment • Referral • Short and Long Term Goals • Follow up

  5. Always follow the same plan • Evaluation Order History Observation Palpation Stress

  6. 6 Articulations or Joints • Coraco Clavicular • Sterno Clavicular • Acromio Clavicular • Gleno Humeral • Scapulo Thoracic • Sub Acromial Space

  7. Coraco Clavicular

  8. Sterno Clavicular

  9. Acromio Clavicular

  10. A/C Joint Grade 1+ A/C Separation

  11. Gleno Humeral

  12. Scapulo Thoracic

  13. Sub Acromial

  14. Functional Stability • Shoulder is very unstable from a bony standpoint • Stability is almost totally dependent upon the synergism of the musculotendinous units • The only true bony articulation to the thorax is the S/C Joint

  15. Muscles • 15 muscles move and stabilize the scapula • 9 muscles provide for GH motion • 6 support the scapula on the thorax

  16. The muscles and a lack of restrictive bony or ligamentous structure give the shoulder tremendous range of motion.

  17. It also makes the shoulder very vulnerable to outside forces.

  18. Anterior Capsule • Subscapularis Tendon • Labrum • Anterior Capsular Ligaments • Coraco Humeral, GH, Inferior GH Ligament • Inferior may be the most important ligament in the shoulder • Anterior Synovial pouches and bursae

  19. Rotator Cuff Muscles • Supraspinatus - abduction • Infraspinatus - external rotation • Teres Minor - depression, external rotation, extension • Subscapularis - internal rotation Spells SIT

  20. Cuff Functions • Anterior Posterior Stability • Internal and External Rotation • eccentrically and concentrically • Elevation - Depression • Protraction • Retraction • Joint Translation

  21. Fine Tuners • Stabilizers • Maintain joint contact areas

  22. Movements • Flexion • 90 degrees • Primary Flexors • Anterior Deltoid • Coracobrachialis • Pectoralis Major • Biceps

  23. Movements • Extension • Primary Extensors • Latissimus dorsi • Teres Major • Teres Minor • Triceps

  24. Abduction • Primary Abductors • Supraspinatus • Mid Deltoid • Serratus Anterior • Infraspinatus

  25. Adduction • Primary Adductors • Anterior Deltoid • Pectoralis Major • Subscapularis

  26. External Rotation • Primary External Rotators • Posterior Deltoid • Infraspinatus • Teres Minor

  27. Internal Rotation • Primary Internal Rotators • Subscapularis • Pectoralis Major • Latissimus Dorsi • Teres Major • Anterior Deltoid

  28. Internal Rotation The body limits internal rotation - thus placing the arm behind the body increases the amount of internal rotation

  29. Evaluation Tests • Yergason Test 1

  30. Yergason Test 2

  31. Yergason Test • Positive Findings pain popping Transverse Humeral Ligament Long Head of the Biceps irritation

  32. Speed’s Test

  33. Speed’s Test Positive Findings Pain Weakness Long Head of Biceps Tendon

  34. Drop Arm Test

  35. Drop Arm • Findings Pain Dropping of Arm Supraspinatus Tendon

  36. Apprehension Test

  37. Apprehension Test • Positive Findings • Pain • Feeling of Apprehension about the shoulder potentially re subluxating or dislocating

  38. Relocation Test - Fowler’s Test

  39. Relocation Test • The relocation test eliminates the pain found with an apprehension test. This test acts to re center the Humerus in the Glenoid Fossa

  40. Throwers Test

  41. Throwers Test • Reproduces anterior capsule pain which is indicative of anterior capsular laxity

  42. Rowe Test

  43. Rowe Test Multi Directional Instability Very similar test to the Sulcus Test and it also produces a Sulcus sign

  44. Empty Can Test

  45. Empty Can • Specific for trauma to the Supraspinatus muscle • tendon irritation • impingement and or tear

  46. Impingement Test Primary Secondary

  47. Impingement • Does not occur singularly in a bio mechanical sense • Joint Laxity • Outside trauma

  48. Adson, Allen Test - Maneuver

  49. Adson’s, Allen Test • Thoracic Outlet Syndrome

  50. Stress Testing Joints A/C Joint Stress Testing Counter force weights should be applied to the wrist and not gripped. Bilateral X-Ray comparisons are required

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