physioterapy salve
TRANSCRIPT
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Shoulder Orthopedic
Tests
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Tendinitis
(Supraspinatus)Supraspinatus tendinitis is a commoninfammatory condition o the shoulderthat causes anterior shoulder pain.
Pain is present especially in abduction.
The painul arc is between 60 and 0 oabduction.
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Tendinitis
(Supraspinatus)!linical Si"ns and Symptoms#nterolateral shoulder pain
Pain sleepin" on the a$ected side
Sti$ness!atchin" o the shoulder durin" use
Pain on acti%e and passi%e ran"e o motion
&ocal tenderness
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Supraspinatous
Tendinitis TestProcedure' Patient seated. #bduct thearm to 0 with the arm betweenabduction and orward feion. #bduct
a"ainst resistance.Positi%e Test' Pain or weaness o%er theinsertion o the supraspinatous tendonmay indicate tendinitis or tear. Pain o%er
the deltoid may indicate a strained deltoidmuscle.
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Supraspinatous
Tendinitis Test
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#pley Scratch Test
Procedure' Patient seated. Place hand oa$ected shoulder behind head to touchsuperior an"le o opposite scapula. Place
hand behind bac to touch inerior an"le oopposite scapula.
Positi%e Test' Pain indicates tendinitis othe tendons o the rotator cu$* usually the
supraspinatous tendon.
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#pley Scratch Test
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+eer ,mpin"ement Test
Procedure' Patient seated. -rasp the patientswrist. Passi%ely mo%e the shoulder throu"horward feion.
Positi%e Test' Shoulder pain and a loo oapprehension on the patients ace indicate apositi%e si"n. This su""ests o%eruse in/ury o thesupraspinatous muscle or biceps tendon.
Structures a$ected' This mo%ement /ams the"reater tubercle o the humerus a"ainst theanterior inerior border o the acromion* thusirritatin" the tendon.
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+eer ,mpin"ement Test
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Tendinitis (icipital)
The biceps brachii has two heads* the lon"and the short.
The lon" head tra%els o%er the superior
aspect o the humeral head.
The lon" head is the tendon a$ected bybicipital tendinitis.
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Tendinitis (icipital)
!linical Si"ns and Symptoms
#nterior shoulder pain
Pain on palpation o the bicipital "roo%e.
Pain on acti%e and passi%e elbow feionand etension.
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iceps Tendon
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Speeds Test
Procedure' Patient seated with elbowetended* supinated* and the shoulderfeed orward to 12. Place your 3n"ers in
the bicipital "roo%e and your oppositehand on the patients wrist. ,nstruct thepatient to ele%ate the arm orward a"ainstresistance.
Positi%e Test' Pain or tenderness in thebicipital "roo%e.
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Speeds Test
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&ippmans Test
Procedure' Patient seated. 4lbow feed to0. Stabili5e the elbow with one handand with the other palpate the biceps
tendon and mo%e it rom side to sidewithin the bicipital "roo%e.
Positi%e Test' Pain indicates bicipitaltendinitis. #pprehension may indicate a
subluation or dislocation o the tendonout o the "roo%e or a rupture o thetrans%erse humeral li"ament.
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&ippmans Test
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ursitis
The subacromial bursa o%erlies the rotatorcu$ tendons.
sually bursitis is associated with tendinitis
o the ad/acent supraspinatus tendon.
!ommon causes o bursitis are trauma*o%eruse* repeated multiple traumas* and
improper eecuted acti%ity.
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ursitis
!linical Si"ns and Symptoms
#nterolateral shoulder pain
Pain sleepin" on the a$ected side
Sti$ness7!atchin"8 o the shoulder durin" use
Pain on acti%e and passi%e ran"e o motion
&ocal tenderness
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Subacromial ursa
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Subacromial Push9
utton Si"nProcedure' Patient seated. #pply pressureto the subacromial bursa.
Positi%e Test' &ocal pain su""ests
infammation o the subacromial bursa(bursitis).
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Subacromial Push9utton Si"n
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#nterior -lenohumeral,nstability
#nterior shoulder instability is the ma/orcause o dislocations.
This is due to weaness o the anterior
structures o the "lenohumeral /oint' theanterior capsule* "lenohumeral li"aments*rotator cu$ tendons* and "lenoid labrum.
The most common cause o shoulderdislocation is a all on an outstretched arm.
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#nterior -lenohumeral,nstability
!linical Si"ns and Symptoms
Painul arc (i dislocated)
:eelin" o shoulder slippa"e
#pprehension on mo%ement!repitus on mo%ement
,ncreased shoulder "irth (i dislocated)
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#nterior #pprehensionTest
Procedure' Patient seated. #bduct thea$ected arm to 0 and eternally rotate itslowlywhile stabili5in" the posterior aspecto the shoulder with the opposite hand.
Positi%e Test' &ocal pain indicates chronicanterior dislocation. ,t may elicit a loo oapprehension on the patients ace. The
patient may report that the test eels thesame as when the shoulder was dislocated.
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#nterior #pprehensionTest
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;u"as Test
Procedure' Patient seated. ,nstruct him totouch the opposite shoulder and brin" theelbow to the chest wall.
Positi%e Test' ,nability to touch theopposite shoulder because o painindicates anterior dislocation o thehumeral head.
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;u"as Test
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Posterior -lenohumeral,nstability
Posterior "lenohumeral dislocationaccounts or only 2< to =0< o shoulderdislocations.
The head o the humerus dislocatesposteriorly and is ound behind thescapula.
This is caused by trauma to the anterioraspect o the shoulder that orceullydri%es the humeral head posterior.
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Posterior -lenohumeral,nstability
!linical Si"ns and Symptoms
Painul arc (i dislocated)
:eelin" o shoulder slippa"e
#pprehension on mo%ement!repitus on mo%ement
,ncreased shoulder "irth (i dislocated)
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Posterior #pprehensionTest
Procedure' Patient supine. :orwardly feand internally rotate the shoulder. #pplyposterior pressure on the elbow.
Positi%e Test' &ocal pain or discomort anda loo o apprehension on the patientsace indicates chronic posterior shoulderinstability. . The patient may report that
the test eels the same as when theshoulder was dislocated.
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Posterior #pprehensionTest
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>otator !u$ ,nstability
>otator cu$ instability in%ol%es partial orcomplete tearin" o one o the tendons o therotator cu$.
sually the supraspinatous tendon is in%ol%ed.
>otator !u$ ?uscles
Supraspinatus
Inraspinatus
Teres ?inor
Subscapularis
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>otator !u$ ,nstability
!linical Si"ns and Symptoms
Se%ere anterior lateral shoulder pain
Pain when sleepin" on the a$ected side
Sti$ness7!atchin"8 o the shoulder durin" use
Pain on acti%e and passi%e ran"e o motion
&ocali5ed tenderness
nable to abduct shoulder
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;rop #rm Test
Procedure' Patient seated. #bduct thearm past 0. ,nstruct the patient to lowerthe arm slowly.
Positi%e Test' , the patient cannot lowerthe arm slowly or i it drops suddenly* thisindicates a rotator cu$ tear* usually o thesupraspinatus.
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;rop #rm Test
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Supraspinatous Test
Procedure' ,nstruct the patient to abductthe arm to 0. -rasp the patients armand press down a"ainst resistance by thepatient. +et* rotate the shoulderinternally so the thumb points down. Pressdown a"ainst resistance.
Positi%e Test' @eaness or pain may
indicate a tear o the supraspinatus muscleor tendon. ,t may also indicatesuprascapular neuropathy.
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Supraspinatous Test
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iceps Tendon,nstability
The biceps brachii has two heads' lon" andshort.
The lon" head tra%erses the bicipital "roo%e.
# shallow bicipital "roo%e or a la orruptured trans%erse humeral li"ament maysnap the biceps tendon into and out o thebicipital "roo%e.
This will cause anterior shoulder pain withpoint tenderness at the bicipital "roo%e.
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iceps Tendon,nstability
The painul snap may also indicate a tearo the biceps tendon.
# bicipital tendon tear will cause swellin"
and ecchymosis near the bicipital "roo%eand a characteristic bul"in" o the belly othe bicpes muscle near the antecubitalossa (Popeye si"n).
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icipital Tendon
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iceps Tendon,nstability
!linical Si"ns and Symptoms
#nterior shoulder pain
Sti$ness
Pain on acti%e and passi%e ran"e o motion&ocali5ed tenderness
ul"in" o biceps muscle (complete tear)
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Aer"asons Test
Procedure' Patient seated with elbow feed to0. Stabili5e the patients elbow with onehand. -rasp the patients wrist and ha%e himeternally rotate the shoulder and supinate the
orearm a"ainst resistance.
Positi%e Test' &ocal pain or tenderness in thebicipital tendon indicates an infammation othe biceps tendon or tendinitis. , the tendon
pops out o the bicipital "roo%e* suspect a laor ruptured trans%erse humeral li"ament or acon"enital shallow bicipital "roo%e.
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Aer"asons Test
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#bbott9Saunders Test
Procedure' Patient seated. #bduct andmaimally rotate the arm eternally. &owerthe arm to the patients side while palpatin"the bicipital "roo%e with your opposite hand.
Positi%e Test' # palpable or audible clic atthe bicipital "roo%e indicates subluation ordislocation o the bicipital tendon. This iscaused by a ruptured trans%erse humeralli"ament or a con"enital shallow bicipital"roo%e.
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#bbott9Saunders Test