1. Evaluating the Shoulder & Upper Arm Richard Frazee, MS, LAT, ATC
Program Director
The University of West Florida
Athletic Training

2. Thank you SEATA students Dr. R. T. Floyd & MRs
Thank you SEATA students Dr. R.T. Floyd & MRs. Karen Lew Fierman UWF students
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3. Purpose: 1. Review the Evaluation Process 2
Purpose: 1. Review the Evaluation Process 2. Discuss Scapular Dyskinesia 3. Conduct Shoulder Lab
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4. The Shoulder Complex
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5. Review of the Evaluation Process All you need to know is:
History
Observation
Palpation
Special tests
Range of motion testing-movement patterns
Manual muscle testing
Specific functional/agility tests
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6. 135+ Special Tests of the shoulder!!
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7. Evaluating the shoulder complex
Intimidating?
Where do I begin?
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8. Evaluation Process History Observation Palpation Special tests
Range of motion testing-movement patterns
Manual muscle testing
Specific functional/agility tests
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9. Evaluation Process HOPS Protocol From the HOP, what do we learn?
Consistent sequential method
Thorough and reproducible
From the HOP, what do we learn?
History, MOI, LOP
S – Special Tests- For what?
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10. HOPS Protocol
History-A great deal is learned from listening to the patient
Importance of ROM
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11. Review of the Evaluation Process
Shoulder evaluations can be lumped into four main categories:
Bone/Joint Integrity
Stability
Muscular concerns
Other Soft Tissue Stuff
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12. Evaluation Process To be proficient, you must know:
Functional Anatomy
Joint Mobility
Musculature
Joint Stability
Bony congruence
Ligamentous structure
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13. Review of the Evaluation Process
From the information gathered from HOP, you can determine which “Special Tests” will be appropriate.
History
Detailed
Specific
Pertinent
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14. Observation ROM/ movement patterns Symmetry Deformities Carrying angle
Sensations
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15. Sensations and Possible Causes
Clicking
labral tears, subluxations/dislocations
Snapping
- biceps tendon subluxation, bursal thickening under acromion
Grating
- calcium in joint, bursal or synovial thickening, osteoarthritic changes
Tearing - rotator cuff strain
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16. Sensations and Possible Causes
Locking or catching
- labral tear, loose body
Numbness
- nerve root impingement, cervical rib entrapment, thoracic outlet problem, brachial plexus or cutaneous nerve
Tingling
- neural or circulatory problem, thoracic outlet affecting subclavian artery
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17. Sensations and Possible Causes
Warmth
- active inflammation or infection, red hot burning due to acute calcific tendinitis
Shoulder “Going out”
- subluxing G-H
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18. Palpations Areas of point tenderness Deformities Crepitus
Signs of inflammation
Heat, redness, swelling, What else?
_________ _____________
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19. Special Tests ROM Muscular strength Joint stability
Impingement conditions
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20. Special Tests- Instability
CC?
MOI?
Glenohumoral?
Acromioclavicular?
Why so many Tests?
Over 130 different SPs for shoulder evaluations
Instability may only be reproducible in one specific position
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21. Statistics- Briefly!!
“Statistics are like bikinis- they reveal a lot- but they can also hide the really important things”- author unknown.
Sensitivity- how good is the test if the problem is there
Specificity- how good is it if the problem is not there
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22. Dr. Richard Sellers Dr. Steve Jordan
Sitting -Inspection , palpation, ROM
Neer’s
Hawkins
O’Brien’s
Adduction
Bear Hug
Speed’s
Jobe- Empty Can-scaption-supraspinatus
Deltoid
Dynamic Labral Shear
Biceps Load II- Type II SLAP
ER Strength Test
Belly Press-Pos =wrist flexion
Supine
13. Apprehension
14. Relocation
15. GIRD
ALWAYS IN THE SAME ORDER
2 impingement
3 Rotator Cuff tests
4 Labral tests
2 biceps test
2 instability tests
2 AC joint tests
Others as needed- based on HOP
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23. It’s not just the shoulder!
A thorough evaluation of the scapula and Scapulo-Thoracic (ST) rhythm must be included.
ST motions, and muscles responsible:
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24. The University of West Florida Athletic Training Program

25. The University of West Florida Athletic Training Program

26. Clinical Examination of Shoulder Injuries
Palpation of the posterior shoulder
Spine of the scapula Superior angle
Inferior angle
Infraspinatus
Teres minor
Supraspinatus
Teres major
Rhomboid major
Rhomboid minor
Levator scapulae
Trapezius
Latissimus dorsi
Posterior deltoid
Triceps brachii
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27. Part 2 Scapular Dyskinesia
Defined as:
Visible alterations in scapular position and motion patterns.
believed to occur as a result of changes in activation of the scapular stabilizing muscles; damage to the long thoracic, dorsal scapular, or spinal accessory nerves
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28. SICK Scapula Scapular malposition, Inferior medial border prominence,
Coracoid pain and malposition,
dysKinesia of scapular movement
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29. SICK Scapula
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30. Philip McClure, PhD, PT, , et al, developed a clinical method for identifying scapular dyskinesia. Table 1. Scapular Dyskinesia Test: Operational Definitions and Rating Scale Operational Definitions Normal scapulohumeral rhythm: The scapula is stable with minimal motion during the Initial 30° to 60° of humerothoracic elevation, then smoothly and continuously rotates upward during elevation and smoothly and continuously rotates downward during humeral lowering. No evidence of winging is present.
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31. Scapular dyskinesia: Either or both of the following motion abnormalities may be present.
Dysrhythmia: The scapula demonstrates premature or excessive elevation or protraction, non-smooth or stuttering motion during arm elevation or lowering, or rapid downward rotation during arm lowering.
Winging: The medial border and/or inferior angle of the scapula are posteriorly displaced away from the posterior thorax.
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32. Kibler et al'- reported the reliability of a visually based
classification system for scapular dysfunction that defined
3 different types of motion abnormalities:
Type 1 = inferior angle prominence,
Type II = medial border prominence.
Type III = excessive superior border elevation.
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33. Scapular Dyskinesia Type I
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34. Scapular Type II
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35. Type I –Inferior Angle prominence
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36. Type I –Inferior Angle prominence
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37. Type I –Inferior Angle prominence
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38. Type II -Medial Border prominence
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39. Scapulo-humeral rhythm
The Rotator Cuff
The four rotator cuff muscles, the supraspinatus, infraspinatus, subscapularis, and teres minor are responsible for the important movement and function of the shoulder.
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40. “The function of the rotator cuff is to position the head of the humerus so that the glenoid fossa provides the optimal biomechanical platform for humeral motion regardless of the position of the hand in space.” Dr. Frank Jobe The initial action of the supraspinatus is to depress, compress, and stabilize the head of the humerus into the glenoid fossa.
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41. Importance of understanding the function of the muscles that act on the scapula
Strength balance between large scapular muscles and small rotator cuff muscles
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42. Kent Morgan, MS, CSCS
Understanding how the body moves and understanding how joints work together and effect what other joints do is very important. constant postural changes perform a movement repetitively, predictable muscle imbalances that would need to be addressed.
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43. Part 3 LAB Time Can you name/recognize the following conditions??
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44. # 1____________________
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45. #2 Palpation site for what??
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46. #3. X-ray indicates : ___________
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47. # 4. All three pics reveal a ___________________.
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48. What Happened!!?? # 5. ___________________ # 7. ______________________
# 6. ____________________s
# 7. ______________________
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49. #8 The diagram labeled C represents a:
Grade 2 sternoclavicular separation
Grade 2 acromioclavicular separation
Grade 3 sternoclavicular separation
Grade 3 acromioclavicular separation C

50. 9. Label each of the boxes with the correct term:D E C DD E

51. Answers Myositis Ossificans/Blocker’s Exostosis Biceps Brachii
Epiphyseal fx. Of humerus
Pectoralis rupture
Biceps brachii rupture from origin
Biceps brachii rupture from insertion
Fx clavicle D.
A-AC, B- Supraspinatus, C-clavicle, D-Anterior Labrum, Elong head of biceps
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52. GET A PARTNER. Share your techniques https://www. youtube. com/watch
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53. Anterior Instability Perform, compare and discuss:
Load & Shift (Anterior/Posterior Translation) Test vs. Apprehension (Crank) Test
Any other two tests
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54. Glenoid Labrum Glenoid Labrum Clunk Test vs. O’Brien Sign test
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55. Tests for Scapular Stability
Winging Scapula Test vs. Lateral Scapula Slide Test
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56. Tests for Thoracic Outlet Syndrome
Roos Test (EAST) vs. Wright Test or Maneuver vs. Costoclavicular Syndrome (Military Brace) Test
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57. Differential Diagnosis
Differentiate between:
Anterior Impingement and AC sprain
SupraspinatusTendinitis and Subacromial Bursitis
Glenoid Labrum tear and Inflamed rotator cuff
Glenohumeral dislocation and Clavicular fracture
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58. In Conclusion Thorough Evaluation
Accurately depicting source of the problem
Specific strength/rehabilitations exercise
Total arthrokinematic picture.
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59. Thank You!
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