Chapter 21: The Shoulder

Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. Common Injuries Impingement syndrome Rotator cuff tears Muscle strains Tendonitis Biceps tendon rupture Dislocation Glenoid labrum injuries Multidirectional instabilities Acromioclavic-ular separation Brachial plexus injury Fractures Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.

Shoulder Treatment/Rehabilitation Taping and exercise can help deal with injury and potential injury to the shoulder. Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.

Humeral Head Relocation This procedure helps with humeral head stability. The left thumb provides a posterior glide to the humeral head as the short stretch tape is applied. Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.

Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. Corner Stretching Standing in a corner, with hands supporting against both wall surfaces, lean forward to stretch the pectoral muscles. Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.

Horizontal Stretching The stretch pictured here will help stretch the muscles on the back side of the shoulder. Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.

Shoulder Muscle Stretches With a towel used as shown in text Figure 21-17, the right shoulder is stretched into an internally rotated position. Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.

Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. Shoulder Adduction To strengthen shoulder adductor muscles, use an elastic band attached to a fixed object, and pull downward toward the body. Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.

Deltoid Muscle Strengthening Step on one end of an elastic band, then pull straight up close to the body and hold for 5 to 10 seconds. Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.

Internal Shoulder Rotators With the arm in a handshake position, pull an elastic band across the front of the body. Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.

External Shoulder Rotators Start with the arm in a position that crosses the body. Then pull an elastic band outward as the arm moves into a handshake position. Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.

Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. Pectoralis Major Stand with the arm extended and hand externally rotated against a wall. Gently rotate the body to stretch the muscle. Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.

Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. Trapezius While sitting, hold onto the table edge and stretch away. Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.

Deltoid Muscle Abduction Stand sideways against a wall, then isometrically lift upward with the forearm against the wall. Hold 5 to 10 seconds. Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.

Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. Shoulder Extension To strengthen the muscles used for shoulder extension, pull an elastic band with the arm moving from a forward position to the side of the body. Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.

Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. Special Tests Certain tests can be performed that aid in the evaluation of injury. Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.

Hawkins Impingement Test With the arm and elbow flexed to 90 degrees and the arm rotated internally, apply overpressure to internal rotation. Anterior shoulder pain indicates rotator-cuff tendonitis. Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.

Neer’s Impingement Test Passively flex the arm to end range and apply gentle overpressure. Anterior shoulder pain indicates rotator-cuff tendonitis. Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.

Crossover Impingement Test Passively adduct the arm horizontally to end range. Pain in the AC joint is a positive sign for rotator-cuff tendonitis. Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.

Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. Rotator Cuff Injury Shoulder hiking during active abduction is an indication. The drop-arm sign is pain and loss of control in midrange as the arm is lowered. Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.

Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. Supraspinatus Muscle The supraspinatus manual muscle strength test has the arm lifted, thumb pointing down. A downward force is a test for weakness (compare to other side). Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.

Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. Gilchrist’s Sign With a fully elevated arm holding 2 pounds, lower the arm (palm up). A painful click or snap at 90 degrees indicates biceps long-head dislocation/subluxation. Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.

Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. Speed’s Test With shoulder flexed to 90 degrees (palm up), apply downward pressure. Pain in the bicipital groove indicates biceps long-head tendonitis. Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.

Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. Clunk Test With the subject supine, passively abduct the arm with one hand while bouncing the humeral head with the other. A click or pop may indicate a glenoid labral tear. Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.

Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. Sulcus Sign Test With the shoulder relaxed, hold the elbow and distract the arm inferiorly. A gaping between the lateral acromion and humeral head indicates inferior shoulder instability. Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.

Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. Posterior Glide Test With the subject standing, brace the posterior shoulder while pulling the anterior superior humerus. Excessive movement indicates posterior gleno-humeral instability (compare to other side). Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.

Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. Feagin’s Test With the subject’s arm resting on the clinician’s shoulder, gently pull down at the shoulder. Excessive movement indicates inferior glenohumeral instability (compare to other side). Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.

Anterior Apprehension Test With the arm at 90 degrees abduction and the elbow at 90 degrees, gently apply external rotation. A reaction of apprehension and possible instability indicates anterior shoulder instability. Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.

Acromioclavicular Shear Test With arms at the side, squeeze with both hands between the anterior and posterior shoulder. Pain indicates a sprain of the AC joint. Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.

Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. Roos Test With arms in the position shown in text Figure 21-29 A and B, the subject opens and closes the hands once per second for a minute. Tingling in the arms and hands indicates thoracic outlet syndrome (TOS). Copyright ©2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.