shoulder. 2 shoulder movements 1 gleno-humeral joint 50% of abduction 2 further abduction after 90...

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ShoulderShoulder

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Shoulder MovementsShoulder Movements

1 Gleno-humeral joint 50% of abduction1 Gleno-humeral joint 50% of abduction

2 Further abduction after 902 Further abduction after 90º is stopped when º is stopped when greater tubercle greater tubercle impinges on the impinges on the

3 Glenoid rim 3 Glenoid rim

4 This range can be increased when the arm is externally 4 This range can be increased when the arm is externally rotatedrotated

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Role of Deltoid Muscle in Role of Deltoid Muscle in Shoulder AbductionShoulder Abduction

SupraspinatusSupraspinatus initiates the initiates the abduction, then deltoid takesoverabduction, then deltoid takesoverDeltoid has 3 divisions- Deltoid has 3 divisions- AnteriorAnterior division: from the division: from the anterior border and upper surface anterior border and upper surface of the lateral third of the clavicle. of the lateral third of the clavicle. abduction, horizontal flexion and abduction, horizontal flexion and medial rotation of humerusmedial rotation of humerusMedialMedial division: from the lateral division: from the lateral margin and upper surface of the margin and upper surface of the acromion. Abduction of the acromion. Abduction of the humerus at the shoulderhumerus at the shoulderPosteriorPosterior division: from the lower division: from the lower lip of the posterior border of the lip of the posterior border of the spine of the scapula. abduction, spine of the scapula. abduction, horizontal extension & lateral horizontal extension & lateral rotation (hyperextensor)rotation (hyperextensor)

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Causes of shoulder painCauses of shoulder pain

Cervical SpondylitisCervical SpondylitisImpingement syndrome-subacromial bursitis Impingement syndrome-subacromial bursitis may be present. Causes pain when shoulder may be present. Causes pain when shoulder moves 70moves 70ºº-120-120º (ball throwing)º (ball throwing)Rotator Cuff tears- trauma, degenerative disease. Rotator Cuff tears- trauma, degenerative disease. Supraspinatus most commonly inovlved-(trouble in Supraspinatus most commonly inovlved-(trouble in initiating abduction) may lead to ‘frozen’ shoulderinitiating abduction) may lead to ‘frozen’ shoulder

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Frozen shoulderFrozen shoulder

Shoulder-gross restriction of movements, Shoulder-gross restriction of movements, thickening of joint capsule. thickening of joint capsule. Common in 40+ age groupCommon in 40+ age groupPrevious trauma, pain disturbs sleepPrevious trauma, pain disturbs sleepL>RL>RDiabeticsDiabeticsGentle graded exercises/ manipulationGentle graded exercises/ manipulation

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Califying supraspinatus Califying supraspinatus tendinitistendinitis

May be silent, can result in sudden severe May be silent, can result in sudden severe incapacitating painincapacitating painMay affect sub-deltoid bursaMay affect sub-deltoid bursaWarm tender shoulderWarm tender shoulderX-ray shows calcified tendonX-ray shows calcified tendonShortwave diathermy helpsShortwave diathermy helps

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Shoulder-Elbow issuesShoulder-Elbow issues

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1 Hawkins' Impingement Test.1 Hawkins' Impingement Test.

Forward flex the arm to 90 degrees with the Forward flex the arm to 90 degrees with the elbow bent to 90 degrees. The arm is then elbow bent to 90 degrees. The arm is then internally rotated. A positive test, noted by internally rotated. A positive test, noted by pain on internal rotation, may signify pain on internal rotation, may signify subacromial impingement including rotator subacromial impingement including rotator cuff tendinopathy or tear.cuff tendinopathy or tear.

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2 Drop-Arm Rotator Cuff Test.2 Drop-Arm Rotator Cuff Test.

The arm is passively raised to 160 degrees. The arm is passively raised to 160 degrees. The patient is then asked to slowly lower the The patient is then asked to slowly lower the arm to the side. A positive test, noted by an arm to the side. A positive test, noted by an inability to control the lowering phase and a inability to control the lowering phase and a dropping or giving way of the arm, may dropping or giving way of the arm, may indicate a large rotator cuff tear. indicate a large rotator cuff tear.

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3 Empty-Can Supraspinatus 3 Empty-Can Supraspinatus Test.Test.

The arms are abducted to 90 degrees and The arms are abducted to 90 degrees and forward flexed 30 degrees. With the thumbs forward flexed 30 degrees. With the thumbs turned downward, the patient actively resists turned downward, the patient actively resists a downward force applied by the examiner. A a downward force applied by the examiner. A positive test is indicated by weakness positive test is indicated by weakness compared with the contralateral side and may compared with the contralateral side and may indicate rotator cuff pathology, including indicate rotator cuff pathology, including supraspinatus tendinopathy or tear.supraspinatus tendinopathy or tear.

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4 Lift-Off Subscapularis Test.4 Lift-Off Subscapularis Test.

With the arm internally rotated behind the With the arm internally rotated behind the patient's lower back, the patient internally patient's lower back, the patient internally rotates against the examiner's hand. A rotates against the examiner's hand. A positive test is indicated by the inability to lift positive test is indicated by the inability to lift the hand off of the back and may indicate the hand off of the back and may indicate subscapularis tendinopathy or tear.subscapularis tendinopathy or tear.

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5 External Rotation/ 5 External Rotation/ Infraspinatus Strength Test.Infraspinatus Strength Test.

The patient's arms are held at their sides The patient's arms are held at their sides with the elbows flexed to 90 degrees. The with the elbows flexed to 90 degrees. The patient actively externally rotates against patient actively externally rotates against resistance. A positive test is indicated by resistance. A positive test is indicated by weakness compared with the contralateral weakness compared with the contralateral side and may be associated with infraspinatus side and may be associated with infraspinatus or teres minor tendinopathy or tear.or teres minor tendinopathy or tear.

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6 Cross-Body Adduction Test.6 Cross-Body Adduction Test.

The arm is passively adducted across the The arm is passively adducted across the patient's body toward the contralateral patient's body toward the contralateral shoulder. Pain may indicate acromioclavicular shoulder. Pain may indicate acromioclavicular joint pathology, including chronic sprain or joint pathology, including chronic sprain or osteoarthritis. osteoarthritis.

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7 Apprehension and 7 Apprehension and Relocation Tests.Relocation Tests.

With the patient supine, the patient's arm is With the patient supine, the patient's arm is abducted to 90 degrees and the elbow is abducted to 90 degrees and the elbow is flexed to 90 degrees. Pain and a sense of flexed to 90 degrees. Pain and a sense of instability with further external rotation may instability with further external rotation may indicate shoulder instability. Relief of these indicate shoulder instability. Relief of these symptoms with a posteriorly directed force on symptoms with a posteriorly directed force on the proximal humerus is a positive relocation the proximal humerus is a positive relocation test and further supports diagnosis of test and further supports diagnosis of shoulder instability.shoulder instability.

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Pg 737-738: Pg 737-738: thoracic outlet syndromethoracic outlet syndrome can be vascular or neural. can be vascular or neural. Scalene muscles are the main players – with fibrosis or cervical disc Scalene muscles are the main players – with fibrosis or cervical disc compression can cause, can also be slouching and sagging shoulders. compression can cause, can also be slouching and sagging shoulders. Aging, obesity, or women with big boobs can suffer from this also. Aging, obesity, or women with big boobs can suffer from this also. Might need breast reduction. Might need breast reduction.

Pain, numbness, weakness can be illicited by compressing on the Pain, numbness, weakness can be illicited by compressing on the Erb’s point. Erb’s point.

Vascular sx can be pallor of the nails, disappearance of radial pulse, Vascular sx can be pallor of the nails, disappearance of radial pulse, extreme response to cold with spasms. Can get gangrene of the extreme response to cold with spasms. Can get gangrene of the digits. Venous obstruction is marked by swelling and blueness of the digits. Venous obstruction is marked by swelling and blueness of the area. area.

Chest Xray will show this syndromeChest Xray will show this syndrome

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Horner’s SyndromeHorner’s SyndromeSymathetic compression of the ganglion by a tumor of the lung. Ipsilateral, pinpoint Symathetic compression of the ganglion by a tumor of the lung. Ipsilateral, pinpoint pupils, myosis, droopy eyelid. Loss of sweating on that half of the face. Hydrosis. pupils, myosis, droopy eyelid. Loss of sweating on that half of the face. Hydrosis. Can be mistaken for thoracic outlet syndrome. Can be mistaken for thoracic outlet syndrome.

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Low Back Pain

From lumbar to sacral. Kyphosis, scoliosis, Trauma, spondylolisthesis can be the prb. So can Systemic illnesses such as ulcerative cholitis which feels like sacroiliitis. Ankylosing spondylosis also, which starts as a stiff back. If sx of bloody diarrhea, suspect the UC.

Older people will get OA of the lower spine. Obesity can put strain on the back. Excessive lumbar lordosis – women have it anyhow, but gets worse in preggers.