Lec Sports 1, Ortho Test LE OMM sports 2, Ortho tests OMM sports 1
AC somatic dysfunction Humeral flexion produces __________ rotation clavicle Humeral extension produces _________ rotation of clavicle The primary somatic dysfunction diagnosed at the AC joint occurs when rotation of the clavicle (about the long axis) becomes restricted dysfunctions are named for the the direction the clavicle likes to go or is easier to go------>>> anterior dysfunction, the clavicle goes into anterior rotation, RESISTS posterior roatation
Humeral flexion produces posterior rotation clavicle Humeral extension produces anterior rotation of clavicle
full can/ empty can test (jobes's) for what ?
IDENTIFY TEAR OF SUPRASPINATUS MUSCLE supraspinatous tendinopathy isolate the supraspinatus muscle (& tendon) functionally to evaluate for injury or inflammation - its main action is abduction in the first 30°. The Full Can is far superior in isolating the supraspinatus compared with the classic Empty Can, since the internal rotation of the Empty Can Test also brings the greater tuberosity under the acromion and makes an impingement more likely - thereby, adding confusion to interpretation (false positive)...
what are the 3 ligaments of the anterior shoulder? what is their function
Ligaments of AC Joint Acromioclavicular Lig. Horizontal Stability Coracoclavicular Ligs Conoid Resists superior disp. Trapezoid Resists AC compression
what tests do you use to suspect rotator cuff tendinosis
Neer, Kennedy-Hawkins, Empty Can (Jobe's Sign), Painful Arc, Scapular Lift Off Test
what type of patient gets rotator cuff partial tears? is partial or full tear more painful
Partial tears are more painful than full thickness tears. Clinical profile: Athlete, patient after 40 years of age with impingement Most partial tears progress to full thickness tears within 2 years.
what type of SC joint dislocations are more common
anterior> posterior anterior is when the clavicle seperates from the sternum and pops out of the chest posterior is when the clavicle is pushed into the chest, this is less common and more serious injury
how do you confirm positive cross-arm/scissor tests
its AC joint problems Diagnostic A-C injection• Pain goes away with Lidocaine injection • MRI or other imaging (U/S or X-ray), based on availability and circumstances.
how do you diagnose subacromial impingement?
positive hawkins/neers test and full can/empty can jobes test MRI best diagnostic tool
what is the less common types of shoulder dislocation injury.
posterior dislocation
what can spurlings test diagnose
radicular shooting pain in the cervical neck= nerve compression non radicular pain indicates facet issue they diagnose burner/stinger spurling can detect brachial plexopathy in 70% of patients
what are the passive range of motion tests , you do these first
spurling cerivcal, impingement testing - Hawkins/Neer, full/empty can) & isometric muscle testing (Rotator cuff, SITS muscles).
anterior dysfuntion clavicle
superior surface of the right clavicle has rotated anteriorly about a long axis down the clavicle (anterior acromioclavicular joint dysfunction). (humerus is in EXTENSION) This can manifest as acromioclavicular pain. Restriction of humeral flexion is associated with anterior clavicle dysfunction
Hornblower's Sign
teres minor pretend you are blowing a horn, toot-toot For extensive tears that include both infraspinatus and teres minor. Pt asked to bring the hands to the mouth. On affected side the elbow assumes a high position and the wrist is in extension. Positive test On the intact side, the patient can reach the mouth without bringing the elbow high.
belly press test
tests your subscapularis (this muscle does internal rotation. if you can't press your hand IN to your belly it is a weak subscapularis) Pt to flex elbow and press palm of hand maximally into the abdomen by internally rotating the shoulder. Positive if the pt demonstrated flexion at the wrist and shoulder adduction and extension. the subscapularis muscle isnt working
What is the Zanca view? what injury is it used for
view 10-15° cephalad tilt and using only 50% of the standard shoulder AP penetrance used to see AC joint seperation
What is the sternoclavicular joint?
where the medial end of the clavicle articulates with the sternum connects UE to torso participates in all UE movements saddle type joint NEEDED FOR THRUSTING ARM AND SHOULDER FORWARD
cross arm/ horizontal adduction test
-Acromioclavicular Ligament test -can use for weightlifters shoulder with osteolysis of distal clavicle -can indicate Acromioclavicular or coracoacromial Ask pt to actively adduct their arm across to the other shoulder. If pain-free, the physician should then passively add compression and adduction to the crossed arm to ensure full loading.
Ely Test *prone
-Patient prone -PT flexes patient's knee and attempts to bring heel to ipsilateral buttock If the anterior hip / ASIS remains flat against the table the test is negative and the rectus femoris is not tight. • If the anterior hip / ASIS rises off the table ), the test is positive & rectus femoris is tight.
Log Roll Test
-Patient supine with hip in neutral position -Patient's leg passively rolled into full internal and external rotation Pain - intra-articular pathology. Clicking - acetabular labral tear. Increased range of motion - ligamentous laxity.
what are the stages of subacromial impingement
95% of rotator cuff tears secondary to chronic impingement beneath coracoacromial arch Associated abnormalities: biceps tendinosis/tears Stage I: Reversible edema & hemorrhage typically in active patient < 25 years Stage II: Fibrosis and tendinitis (inflammation) Stage III: Degeneration & rupture often associated with osseous changes most commonly in patient > 40 years
A sprain/dysfunction of the _____________can refer pain to the groin, SI and lateral hip (top) • _______________ can cause posterior hip pain, sciatica, and restricted internal rotation. (bottom - tight left piriformis)
A sprain/dysfunction of the iliolumbar ligament can refer pain to the groin, SI and lateral hip (top) • Piriformis tension can cause posterior hip pain, sciatica, and restricted internal rotation. (bottom - tight left piriformis)
how do you treat major and minor osteolysis of distal clavicle
AC joint local anesthetic and corticosteroid injection often indicated to confirm diagnosis. weightlifter's shoulder or arthritis, or the separation is only minor, Non-operative treatment: NSAIDS, OMT, physical therapy, activity modifications, ACJ injections Operative: indicated for failure of non-operative tx (6 months), cut off the end of the clavicle
how do u treat rotator cuff issues
Activity Modification NSAIDs P.T. Sub-ac injection Ultrasound, Cold Laser (DONT WORK, ITS LIES)
what is the mechanism of injury of a glenoid labrum tear?
Acute tears can occur following dislocation of the glenohumeral joint (Bankart lesion) or as a result of chronic overuse with poor posture or mechanics. Another type of labral tear is found at the top of the labrum and is called a SLAP (Superior Labrum, Anterior to Posterior) tear. This is often seen with trauma from falling on an outstretched hand FOOSH, lifting maneuvers, or overhead throwing activities. S & S: Shoulder pain, clicking, inability to lift arm, signs and symptoms similar to those of rotator cuff and/or biceps tendonitis. • Special Tests: O'Brien, MRI, arthroscopy
what are the three types of PARTIAL rotator cuff tears
Articular surface partial tear - most common, associated with classical impingement Interstitial - not seen at arthroscopy Bursal surface
Speed's Test
Bicipital Tendinitis, long biceps tendon Elbow full extension, forearm supinated, shoulder flexion doctor resists patients flexion of shoulder , pushes supinated arm down
what is imaging for ac seperation
Bilateral anteroposterior (AP) view Axillary lateral view Zanca view 10-15° cephalad tilt and using only 50% of the standard shoulder AP penetrance
how do u do the FABERE or figure 4 test?
End-ROM of abduction and external rotation at about 90° of flexion or slightly more, and then load this position into slightly more abduction and ER. Reproduction of patient's pain at this end-ROM indicates pain from either the hip or SI joint.
how do u test the itb and the tensor fascia lata with a modified thomas test?
Examined side hip should remain on table in a relaxed psoas situation. However, if the: I f the examined side hip is abducted from sagittal line with the femoral acetabular joint, the ITB is tight. If the examined side hip has findings of #3 above, and the toes are externally rotated, the TFL is tight.
you do theses tests last (third) if you need them
Finish with labral testing (if needed): need 2 out of 3 tests (one of which has to be a Crank or other compressive test), or a Passive Distraction Test to be positive to have good suspicion for this
RIB dysfunction
Free Inhalation "Up in Front, Down in Back" = Inhaled rib(s): Extended spinal segment Free Exhalation "Down in Front, Up in Back" = Exhaled rib(s): Flexed spinal segment exhaled and inhaled ribs are stuck in their position, so exhaled rib is stuck in exhalation and can't move into inhilation action
how do u diagnose a burner/stinger
Full cervical ROM No tenderness Unilateral transient weakness in C5, C6 muscles (deltoid, biceps) Can have + Spurling test
What is the scour test?
Here, we are using the head of the femur as a mortar and the acetabulum like a pestle... • With compression axially up the length of the femur, the femoral head is then circumducted in the acetabulum in progressively larger circles, basically 'scouring' the acetabulum.
how is the AC joint dysfunctions classifies in the CHICAGO MODEL
In Chicago, these dysfunctions are thought to occur about a long axis down the clavicle. These dysfunctions are torsional in nature with the flat (superior) surface of the clavicle oriented more anteriorly than the adjoining flat surface of the acromion.
what does the modified thomas test measure? how do u do it
Measures the resting length of the: Rectus femoris Iliotibital band Tensor fascia lata Pt supine with legs hanging off table at mid-thigh. Pt brings unexamined side knee up to the chest just far enough to bring the lumbar curve and sacrum both to be flat on the table. Examined side hip should remain on table in a relaxed psoas situation. However, if the: examined hip lifts off the table, the iliopsoas is tight. (Classic test) examined side lower leg is not within 80°- perpendicular to gravitation line, the rectus femoris is tight. (Modified test)
how do u confirm a labral tear after doing the obreins test
Need 2 other SLAP tests - one of which must be a compressive test. • MRI w/ arthrogram, or other imaging (U/S or X-ray), based on availability and circumstances.
what do you need in addiction to the crank test to confirm a labral tear ?
Need 2 other non-compressive SLAP tests. • MRI w/ arthrogram, or other imaging (U/S or X-ray), based on availability and circumstances.
what causes a posterior dislocation of SCJ? what about anterior ?
Posterior dislocations are a result of a direct posterior force to clavicle. (less common) Anterior dislocations result from a compressive force on the shoulder, pushing clavicle medial and anterior.
what are the 2 types of subacromial impigement that u can get? what causes them
Primary extrinsic impingement, rotator cuff (RTC) Subacromial impingement syndrome (SAIS), supraspinatus impingement Progressively painful compression of supraspinatus tendon (SST) & Subacromial bursa between humeral head and coracoacromial arch Secondary extrinsic impingement Impingement associated with instability, the unstable shoulder has the humerus ride up and it squishes the supraspinatous muscle Athletes in overhead throwing activities No osseous abnormality of the coracoacromial arch
posterior femoral acetabular impingment (FAI)
Pt is in lateral recumbent position, hip to be examined is up. Place cephalad hand over the posterior aspect of the femoral-acetabular joint to monitor for click as you do the following maneuver. Abduct and externally rotate the femoral head to near maximum end-ROM, then extend the hip. Do several passes of this, initially without, and then with, compression into acetabulum. A palpable 'click' over the posterior hip joint is considered a positive exam - especially if it reproduces patient's symptoms.
anterior femoral acetabular impingement exam
Pt is supine, place cephalad hand over the anterior aspect of the femoral-acetabular joint to monitor for click as you do the following maneuver. Flex the knee to near maximum end-ROM, then adduct and internally rotate the femoral head. Do several passes of this, initially without, and then with, compression into acetabulum. A palpable 'click' over the anterior hip joint is considered a positive exam - especially if it reproduces patient's symptoms.
how do u do scour test
Pt is supine, place cephalad hand under the posterior hip to give counterforce to the compression, as well as to monitor the SI in case the ROM exceeds that of the femoral-acetabular limits and starts to engage the SI. Compress into the hip joint initially to assess for any pain prior to circumduction. Then, gently (but with progressive force) circumduct the femur - I do both clockwise and counter- clockwise, and with internal and external rotation in each pass. Do several passes of this, initially without - and then with - compression into acetabulum as you widen the circles. • The test is considered positive if it reproduces patient's symptoms, and indicates an intraarticular source of the patient's symptoms. Also monitor for crepitus or grinding in the joint.
Obriens test consists of ____
Pt seated or standing, physician brings pt's arm into about 90° of flexion, 15° adduction and then internal rotation initially with thumb side down. Instructing the patient to resist the downward force with only their shoulder (not their back or waist) and to add external rotation (ask pt to imagine pulling "the sword from the stone"), the physician applies a progressive downward force up to moderate load (20-30#). If painless, test is negative. If reproductive of pain, the arm is then put into the starting position again, but this time with the thumb up, and the same progressive downward force is applied. If the pain is not reproduced this time, test is positive and likely indicates SLAP lesion. superior labral tear from anterior to posterior If pain is still reproduced, then indicates a biceps tendonitis or A-C pathology.
how do you do gaenslens test, what does it test for
Pt supine - stabilize contralateral pelvis to prevent rotation of lumbar spine as you abduct and extend ipsilateral hip. • If pain reproduced:• Early = hip is source of pain • Late = SI is source of pain • Can tell difference by noting increased tension in contralateral ASIS as ipsilateral hip end-ROM for extension is reached and the sacropelvis starts to accept the load.
how do you do the buttock sign test
Pt supine - start with straight leg raise until pain onset. Then with knee flexed, passively (and slowly) flex the hip. If pain is dramatically greater (and usually earlier in ROM) than that caused by straight leg raise test, then concerning for: • Septic bursitis• Ischio-rectal abscess Sacral, upper femoral or ilium neoplasm, fracture or infection Loose femoral prosthesis
Crank Test Procedure
Pt supine, physician brings pt's arm into about 90° of flexion, 15° adduction and then internal rotation initially with thumb side down. arm is basically like you are putting the back of your head into your palm The other hand stabilizes the scapula, preventing scapulothoracic issues from interfering w/ the test. • Physician then applies an axial force into the G-H joint, then progressively larger circles are made. If the pain is reproduced, test is positive and likely indicates SLAP lesion, especially if another one or two SLAP tests are positive.
how do u do spurlings test?
Pt usually seated. The physician passively extends the neck and then rotates & sidebends to the same side. your eat is trying to touch your shoulder If pain hasn't been reproduced with extension first, nor with the sidebending/rotation - then added compression axially down the cervical column along the lateral facets from the top of the head. Radicular pain/shooting that is reproductive is a classic positive test & indicates nerve compression. Non-radicular reproductive pain indicates facet.
what are the 3 motions of the ribs?
Pump handle motion Increase in the Anteroposterior diameter of the thorax. Typically found in the upper ribs. Bucket handle motion Increase of the transverse diameter of the thorax. Typically found in the lower ribs. Caliper motion Motion of ribs 11 and 12
what is diagnosis and tx for bruner/stinger
Radiographs are typically normal Cervical foraminal stenosis seen on x-ray (or MRI) may disqualify patient from sports EMG may be appropriate if symptoms persist beyond 3 weeks Athlete should be removed from play until completely asymptomatic, use of a sling is encouraged Return to play is a clinical decision. Athlete should be asymptomatic and have pain free full range of motion of the neck and shoulder and a normal neurologic exam. OMT focuses on somatic dysfunction of the cervical /thoracic region as well as the first rib and tender points in the muscles
what causes osteolysis of distal clavicle
Repetitive overhead activity / throwing can lead to microtrauma to the AC joint
what is weight lifters shoulder ? what causes it? what test do u use for it
Repetitive overhead activity / throwing can lead to microtrauma to the AC joint and osteolysis of the distal clavicle. weightlifters/body builders and football players Distal Clavicle Osteolysis Clinical Evaluation Pain localized to the AC joint which is exacerbated by overhead motion and cross-body adduction. AC tenderness to palpation TO TEST DO THE Cross-body Adduction Test: aka HORIZONTAL adduction stress test arm is maximally adducted with the arm in 90 of forward elevation. Pain localized to the AC joint indicates AC joint pathology. AC joint local anesthetic and corticosteroid injection often indicated to confirm diagnosis. Relief of symptoms after injection confirms AC joint pathology
what muscles are injured in rotator cuff tendinosis? how does this happen
Structures Injured: Supraspinatus, Infraspinatus, Teres Minor, or Subscapularis tendon. Mechanism of injury: Micro trauma secondary to poor shoulder posture / mechanics.
what are the 2 types of shoulder instabilities? how do you treat them?
TUBS= traumatic, unidirectional, bankart, surgery), in 40% of cases get injury to labrum and glenoid bone AMBRII= atraumatic, multidirectional, bilateral rehabilitation is the main treatment, inferior capsular tightening, and interval reconstruction)
what is patricks test? how is it different from FABERE?
The motions of flexion, abduction, and external rotation into the end-position like the Fabere's. • Difference is, you pay attention to the timing of the patient's pain (Early = hip; Late = SI) by monitoring either the SI or contralateral ASIS (like the Gaenslen's).
Posterior Dysfunction Diagnosis of clavicle
The superior surface of the right clavicle has rotated posteriorly about a long axis down the clavicle (posterior acromioclavicular joint dysfunction). This can manifest as acromioclavicular pain. Restriction of humeral extension is associated with posterior clavicle dysfunction humerus likes flexion and clavicle likes posterior rotation THEY DONT LIKE TO GO INTO HUMERUS EXTENSION AND CLAVICLE ANTERIOR ROTATION
what are the 1st and 2nd rib dysfunctions
These ribs are very short, especially the 1st rib. 1st and 2nd rib dysfunctions tend to be elevated posteriorly Resist downward (caudad) pressure. Most direct techniques for these ribs involve a caudad force on the rib. The 1st rib often follows T1 in sidebending, and the elevated 1st rib is on the side opposite the posterior component of T1. Ex) T1- rotated and sidebent left. The 1st rib is elevated on the right. Cervical sidebending testing can be useful in evaluating 1st rib. Often scalene tension will affect cervical sidebending and 1st rib mechanics. Anterior and middle scalene muscles attach to the 1st rib. Posterior scalene attaches to the 2nd rib.
what is the purpose of hawkins and neers test
These tests attempt to 'pinch' the subacromial space between the greater tuberosity of the humerus and the acromion. • Both involve internal rotation and flexion of the shoulder, just in different sequences to get there...
Spurling's Test for what ???
This test involves lateral nerve root compression by extension and sidebending, resulting in neuroforaminal encroachment. Classic tests reproduce patient's radicular / shooting pains for nerve root compression; and local, non-radicular reproduction of patient's pain from facet compression.
how do you tx rib dysfunctions?
Treatment of key rib of group dysfunctions BITE Key rib- Bottom rib of an Inhaled group Key rib- Top rib first of an Exhaled group
Burners/Stingers classic symptom?
Unilateral tingling in arm not typically isolated to a single dermatome Usually resolve quickly Within 1-2 minutes Better with elevation of arm and hand, which decreases neural tension
what is brachial plexopathy? what causes it
a nerve issue caused by burner and stinger injury Can have weakness of the deltoid, biceps, supraspinatus, and infraspinatus, weakness of shoulder abduction
what is the action of each of these ? supraspinatus, infraspinatus, teres minor, subscapularis
abduction external rot external rot internal roation
What is the lightbulb sign?
abnormal AP radiograph in posterior shoulder dislocations When their shoulder dislocates posteriorly, it also internally rotates, making the humoral head appear like a _________
what is the scissor test
ac joint pathology Pt seated, arm relaxed. Physician places heel of hand on clavicle anteriorly (medial to the A-C joint) & the heel of the other hand on the spine of the scapula, then squeezes the two heels of hands together. This induces a 'scissoring' across the A-C joint. If either reproduces pt's pain, an acromioclavicular ligament or joint injury / inflammation is likely.
diagnose this patient pain over AC joint, trapezius muscle and anterior shoulder they play football, soccer, ice hockey (pushed laterally into rink), horseback riding, and wrestling. trauma, can see uneven shoulders , abnormal contour positive cross arm and scissor test
acromioclavicular seperation
what causes an anterior dislocation of SC joint? who gets this type of injury?
an indirect mechanism like a blow to the anterior shoulder that rotates the shoulder backward and transmits the stress to the joint. Ligamentous laxity, more common in young girls, is associated with recurrent atraumatic anterior dislocations of the sternoclavicular joint.
what is the most common shoulder instability
anterior and inferior stability, it stretches anterior bracial plexus
diagnose this patient Patients typically present with their head tilted toward the affected side and hold the affected arm across the trunk with the uninjured arm.
anterior or posterior SCJ dislocation
C5 neurological level comes out between what disks, what muscles it innervates , reflex and sensations
between disk c4-c5 bicepts reflex deltoid and biceps muscle sensation across chest via the clavical area sensation is lateral arm via axillary nerve
nerve root c7 neurological level comes out between what disks, what muscles it innervates , reflex and sensations
comes out between c6-c7 tricepts reflex muscles are wrist flexors, finger extension, and triceps, sensation is middle finger
root c8 neurological level comes out between what disks, what muscles it innervates , reflex and sensations
comes out between c7-T1 comes out under C7 no reflex finger flexion and hand intrinsic muscles sensation= medial forearm, little pinky and ring finger medial anter brachail cutaneous nerve
nerve root c6 neurological level comes out between what disks, what muscles it innervates , reflex and sensations
comes out between vertebrae C5-C6 brachioradialis reflex/biceps reflex muscles are wrist extensors and flexors sensation is lateral forearm and thumb via musculocutenoes nerve
nerve root T1 neurological level comes out between what disks, what muscles it innervates , reflex and sensations
comes out between vertebrae t1-t2 intrinsic hand muscles does the medial arm via medial brachial cutaneous nerve
what are the 2 AC joint tests ? what do they look for
cross arm and scissor tests These tests attempt to strain and compress the A-C joint, looking for inflammation of the joint itself or injury to the supporting ligaments.
what are the ligamentous and joint stress tests , you do these second in your assessment
cross-arm & scissor for A- C, apprehension, sulcus, Crank test
diagnose this patient Repetitive overhead activity / throwing weightlifters/body builders and football players. Also occurs in hockey and lacrosse players. usually men Pain localized to the AC joint which is exacerbated by overhead motion and cross-body adduction. AC tenderness to palpation what tests would need to be positive in this patient
distal clavicle osteolysis +cross arm test +scissor test
what is the passive distraction test for and how do u do it?
for a labral tear Pt supine, with arm in 150° of abduction, elbow extended, forearm supinated, and upper arm stabilized to prevent humeral rotation. Physician then pronates the forearm, while maintaining starting humeral position. If this reproduces patient's pain, or pt reports a pain deep inside the glenohumeral joint either anteriorly or posteriorly - the test is considered positive and indicative of a SLAP tear. This test is considered reliable enough to rule in a SLAP lesion on its own...but not to rule one out!
bear hug test
for subscapularis muscle Pt to flex elbow and place hand on opposite shoulder. Pt attempts to resist external rotation as examiner tries to lift pt's hand. Positive if pt cannot maintain hand position on shoulder. patient is actively roating arm inward to resist doctors external roatation force
What is the cross arm test?
for the AC joint Ask pt to actively adduct their arm across to the other shoulder. If pain-free, the physician should then passively add compression and adduction to the crossed arm to ensure full loading.
what is a scapular Y view x ray
head of the humerous in the Y, if the head of the humerus is shifter anteror of posterior u can see it on this view
external roation lag test is for
infraspinatus muscle (infraspinatus muscle normally does external roation) Pt is asked to keep the arm in external rotation. Intact side - pt can keep the arm in external rotation position when the examiner lets the arm go. Affected side - pt cannot keep the arm in external rotation, and the arm comes back to neutral.
crank test is for what
labral tear trying to catch periodically with a 'pinching mechanism', like a meniscus - this is how the exam works.
describe Hawkins Test?
looking for subacromial impingmement, lack of space between greater tuberosity of humerous and acromion Start with pt's shoulder adducted and flexed, then physician passively internally rotates the humerus. theres a hawk on your arm positive test = Impingement of supraspinatus muscle
how does a labral tear happen
mechanisms of injury is like scratching your back between the shoulder blades, shoulder flexed, elbow flexed, and shoulder externally rotated Biceps tendon pulls on cartilaginous labrum surrounding the glenoid fossa (remember pull tabs on cans?) • Tears usually occur with resisted elbow flexion on externally rotated, partially flexed shoulder • Can get caught periodically with a 'pinching mechanism', like a meniscus - or by pulling on the long head of the biceps insertion...this is how the exams work
what is Erb's point
nerve point of the neck, also known as_______ is a site at the upper trunk of the brachial plexus located 2-3 cm above the clavicle.
what are the 3 special tests we use for the glenoid labrum?
o'briens---> labral tear crank test--> labral tear passive distraction test--> labral tear
what is the thomas test for
patient is supine on table, -if back is not completely flat and have lumbar lordosis this is a tight iliopsoas then patient flexes and hugs one knee to the chest you check the straight leg that is still on the table, if it comes off the table the iliopsoas is tight if the leg that is on the table AB ducts then the IT band is tight
empty can test/jobe
positive result indicates supraspinatus tear you are holding an Empty can of coke thumb down result is supraspinatus tear , function of supraspinatous is to abduct, patient is abducting arm against physicians force, which is pushing the arm towards the body and thus is ADduction Start with patient's arms horizontally abducted and in the angle of scapula (30° anterior of frontal plane, the A-P alignment of the G-H joint) and the patient's thumb side of hand down Ask patient to resist slowly progressive downforce by physician until overcoming patient's strength. this action is causing the patient to humerus up and against acromion, with pain of supraspinuatus if it gets impinged
Describe Neer's test
positive test is impigment and irriation of supraspinatus muscle Start with pt's shoulder internally rotated and adducted, striaght in front of them then physician passively flexes the humerus.
describe the mechanism of AC seperation? what sports do these people play?
seperation due to trauma football, soccer, ice hockey (pushed laterally into rink), horseback riding, and wrestling. classified 1-3 not terrible 4-6 serious injury by rockwood classification The most common mechanism of injury is a fall on the tip of the shoulder or a fall on an outstretched hand (FOOSH). force is transmitted indirectly, often only the acromioclavicular ligament is affected, and the coracoclavicular ligaments remain unharmed.
diagnose this patient. what special tests would be positive? Most common signs/symptoms: Insidious onset of shoulder pain, esp with abduction and forward flexion Clinical profile Pain to palpation of the rotator cuff within the range of extension Pain and weakness to supraspinatus testing Younger athletes participating in sports requiring overhead arm movements Range of motion often preserved Painful range of motion Age: Adult > 40 years Gender: M>F
subacromial impingement to diagnose hawkins/neers test for supraspinatus which does abduction full can/empty can aka jobes for supraspinatous
What are the rotator cuff muscles?
supraspinatus, infraspinatus, teres minor, subscapularis
tx for low level and high grade level AC joint seperation
surgery where there is residual pain or unacceptable deformity in the joint after several months of conservative treatment. athletes tx depends on pre-, during, or post-season of sport Types I-II: treated non-operatively, with initial rest followed by a course of physical therapy to maintain flexibility and range of motion and to strengthen surrounding muscles. While Types I and II = partial separation, Types III and above are complete separations. Patients with a Type III personal tx choice, tx depends Surgical treatment of shoulder separation has a high success rate
what does the buttock sign test for?
the goal is to increase pressure in a diffuse way to reproduce pain caused by a space-occupying lesion in the posterior compartment of the hip, by passively flexing the hip. If pain is dramatically greater than that caused by straight leg raise test, then concerning for: • Septic bursitis• I schio-rectalabscess• Sacral neoplasm, fracture or infection• Upper femoral neoplasm, fracture or infection • Ilium neoplasm, fracture or infection• Loose femoral prosthesis
How many cervial vertebrae are there?
there are 7 but there are 8 cervical nerves C1 exits above C1 vertebrae and this pattern follows until C8 nerve exits below c7 vertebrae. the rest of the vertebrae have the corresponding nerve exit below the vertebrae
what are bruners and stingers . when do they happen?
they are injuries that happen in collision sports like football, one increases future one stretch or compression injury to the brachial pleus Neurapraxias are caused by different mechanisms including: Traction injury Occurs by downward displacement of arm and bending of neck away from side of injury Compression injury Occurs by lateral head turning toward affected side Direct blow Can cause injury with blow at Erb's point superior to the clavicle
adson's test
thoracic outlet syndrome, looks for tight scalene muscles -monitor patients pulse in their wrist -arm is extended at elbow, the shoulder is extended, externally rotated and slightly aBducted -patient takes deep breath and turns head towards ipsilateral arm + is severely decreased or absent radial pulse
What is the Ober test for?
tight IT band The patient lies on their side with the involved extremity up. Both hips are then flexed to 090 . The involved hip joint is returned to neutral to relax the iliotibial tract. With the top knee bent about 450-900, the leg is abducted as far as possible. The leg is then allowed to drop towards the table. With ITB tension, the leg stays elevated. Remember to stabilize the pelvis throughout the test.
Apley scratch test procedure
touch hand to opposite scapula from above and below as if scratching back assess ROM of shoulder aBduction and external rotation=reach behind head and touch opp shoulder internal roation and aDduction= cross arm over chest and touch opp shoulder internal roation and ADDduction=reach behind back and touch inferior angle of scapula, chicken wing like
how do the fabere and patricks test work
used to look for sacroiliac and hip joint problems With flexion, external rotation and abduction of the hip, hip joint is initially put through a broad ROM. F=flexion A=aBduction B E R= external rotation R E= extension At end-ROM for the femoral-acetabular joint, the innominate starts to abduct / externally rotate, placing tension on the anterior SI ligaments.
what do u find on x-ray in body builders
weightlifters shoulder aka osteolysis of distal clavicle AP, scapular lateral and axillary views show spurring, sclerosis and narrowing of AC joint AC joint best viewed with Zanca view. Weighted views indicated if instability is a concern cause u see a big gap
how can you figure out which first rib is elevated ?
while supine grab patients thumbs and stretch their arms above their head Diagnosis: Checking thumb length, the longer thumb indicates the elevated first rib
how do u do the full can/jobe test? what does a positive result show
you are holding a full can of coke thumb up result is supraspinatus tear Start with patient's arms horizontally abducted and in the angle of scaption (30° anterior of frontal plane, the A-P alignment of the G-H joint) and the patient's thumb side of hand up Ask patient to resist slowly progressive downforce by physician until overcoming patient's strength. full can is better than empty can test
what is special about SCJ posterior dislocation
~25% complication rate. Complications include pneumothorax, laceration of the superior vena cava, occlusion of the subclavian artery or vein, and disruption of the trachea. Causing significant disability and even death
What is a Bankart lesion? signs and symptoms
• Acute tears of glenoid labrum following dislocation of the glenohumeral joint or as a result of chronic overuse with poor posture or mechanics. S & S: Shoulder pain, clicking, inability to lift arm, signs and symptoms similar to those of rotator cuff and/or biceps tendonitis. • Special Tests: O'Brien, MRI, arthroscopy
phelps test is for what muscle/ how do u do test
• Gracilis is the only adductor muscle that crosses the knee joint (2-joint muscle) • With the knee flexed, tension is reduced on the gracilis. Mechanism • Pt is prone. • The leg to be examined is passively adducted until the onset of resistance is palpated, and the angle (or distance) is noted. Then the leg is returned to neutral and the knee is flexed. second part • Abduct the leg until the onset of resistance is palpated, and the angle (or distance) is noted. • If the angle (or distance) is greater with the knee flexed, then the gracilis is tighter than the one- joint adductors. This is a positive Phelp's test. • If not, then the one-joint adductors are tighter than the gracilis. This is a negative Phelp's test.
