Podcast
Questions and Answers
What is the primary biomechanical role of the rotator cuff in glenohumeral joint stability?
What is the primary biomechanical role of the rotator cuff in glenohumeral joint stability?
- To internally rotate the humerus
- To externally rotate the humerus
- To compress the humeral head against the glenoid (correct)
- To abduct the arm beyond 90 degrees
During the acceleration phase of throwing, which muscle group is primarily responsible for generating the forceful internal rotation?
During the acceleration phase of throwing, which muscle group is primarily responsible for generating the forceful internal rotation?
- Infraspinatus and subscapularis
- Posterior deltoid and teres minor
- Supraspinatus and anterior deltoid
- Subscapularis, pectoralis major, latissimus dorsi, and teres major (correct)
In the context of shoulder biomechanics, what is the significance of the scapular plane?
In the context of shoulder biomechanics, what is the significance of the scapular plane?
- It dictates the range of internal rotation
- It aligns the glenoid fossa more effectively with the humerus, optimizing joint congruity (correct)
- It reduces the risk of posterior instability
- It determines the effectiveness of deltoid contraction
Which structure provides approximately 50% of the increased socket depth for the glenohumeral joint?
Which structure provides approximately 50% of the increased socket depth for the glenohumeral joint?
During shoulder abduction, what action is required to prevent the greater tuberosity from impinging on the acromion?
During shoulder abduction, what action is required to prevent the greater tuberosity from impinging on the acromion?
Which anterior stabilizing structure of the glenohumeral joint is most likely compromised in a Bankart lesion?
Which anterior stabilizing structure of the glenohumeral joint is most likely compromised in a Bankart lesion?
According to the material, what is the typical position of the arm when posterior shoulder dislocation occurs?
According to the material, what is the typical position of the arm when posterior shoulder dislocation occurs?
Inferior shoulder instability can be tested with which of the following examination techniques?
Inferior shoulder instability can be tested with which of the following examination techniques?
What type of glenohumeral instability is characterized by symptomatic instability in multiple directions (anterior, posterior, and inferior)?
What type of glenohumeral instability is characterized by symptomatic instability in multiple directions (anterior, posterior, and inferior)?
Which of the following is a key characteristic of Acquired Instability due to Overstress (AIOS) in overhead athletes?
Which of the following is a key characteristic of Acquired Instability due to Overstress (AIOS) in overhead athletes?
What is the primary focus during the initial rehabilitation phase for glenohumeral laxity?
What is the primary focus during the initial rehabilitation phase for glenohumeral laxity?
According to Bigliani's classification, which type of acromion shape is most associated with subacromial impingement?
According to Bigliani's classification, which type of acromion shape is most associated with subacromial impingement?
During the physical examination for rotator cuff tendinopathy, which of the following best describes the position for Neer's test?
During the physical examination for rotator cuff tendinopathy, which of the following best describes the position for Neer's test?
A patient with suspected rotator cuff pathology reports night pain that is poorly relieved by analgesics. What is the prognostic implication of these symptoms?
A patient with suspected rotator cuff pathology reports night pain that is poorly relieved by analgesics. What is the prognostic implication of these symptoms?
Which of the following is the primary function assessed by the Empty Can test?
Which of the following is the primary function assessed by the Empty Can test?
Which of the following best describes a PASTA lesion?
Which of the following best describes a PASTA lesion?
In which stage of calcific tendinitis is a patient most likely to experience severe pain?
In which stage of calcific tendinitis is a patient most likely to experience severe pain?
According to Gartner's classification used in the text, which type of calcific deposit appears translucent and cloudy without clear circumscription, indicating a resorptive phase?
According to Gartner's classification used in the text, which type of calcific deposit appears translucent and cloudy without clear circumscription, indicating a resorptive phase?
What is the primary focus of non-operative treatment for adhesive capsulitis?
What is the primary focus of non-operative treatment for adhesive capsulitis?
Differentiate Internal impingement from subacromial. What motion causes pain in internal?
Differentiate Internal impingement from subacromial. What motion causes pain in internal?
Increased laxity in what ligamentous structure is a common finding with multidirectional instability (MDI)?
Increased laxity in what ligamentous structure is a common finding with multidirectional instability (MDI)?
What is the action to test the patients strength when trying to assess the Teres Minor?
What is the action to test the patients strength when trying to assess the Teres Minor?
What part of the anatomy is affected by SNYDER's category of SLAP classification?
What part of the anatomy is affected by SNYDER's category of SLAP classification?
After experiencing a SLAP, what is the main ROM to avoid in wks 1-3 of rehab?
After experiencing a SLAP, what is the main ROM to avoid in wks 1-3 of rehab?
What position with the arm is the best for seeing if a joint has subluxed?
What position with the arm is the best for seeing if a joint has subluxed?
What is a benefit to the arthroscopic approach to the joint for long head of biceps tendonitis?
What is a benefit to the arthroscopic approach to the joint for long head of biceps tendonitis?
Which condition has noted that "US can show fluid in tenosynovium, thickened, hypoechoic, disorganised, hypervascular..."
Which condition has noted that "US can show fluid in tenosynovium, thickened, hypoechoic, disorganised, hypervascular..."
What is the pathology, if a LHB condition has had several steroid injections?
What is the pathology, if a LHB condition has had several steroid injections?
Which of these injuries has the most likely population of weight lifters?
Which of these injuries has the most likely population of weight lifters?
When viewing AP XR near bone, one may consider more ceph tilt. How many degrees?
When viewing AP XR near bone, one may consider more ceph tilt. How many degrees?
What is a likely treatment post-op for ACJ reconstruction?
What is a likely treatment post-op for ACJ reconstruction?
Midshaft clavicle fractures are at a high rate to have what sequelae?
Midshaft clavicle fractures are at a high rate to have what sequelae?
Neurovascular examinations during midshaft clavicle fractures assess what area specifically?
Neurovascular examinations during midshaft clavicle fractures assess what area specifically?
A tear in the Pec Major may affect what part of the deltoid?
A tear in the Pec Major may affect what part of the deltoid?
What position is used when testing muscle wasting?
What position is used when testing muscle wasting?
What test is recommended when considering what pathology is occurring with compression tests?
What test is recommended when considering what pathology is occurring with compression tests?
Which of the following best identifies the main goal when assessing pain and neurologic tests?
Which of the following best identifies the main goal when assessing pain and neurologic tests?
Describe the best response to the pain level when assessing what the next step of activity should be?
Describe the best response to the pain level when assessing what the next step of activity should be?
What are the 3 areas to have pain when describing shoulder pain with a Brachial Plexus Injury?
What are the 3 areas to have pain when describing shoulder pain with a Brachial Plexus Injury?
At what week post-op should a patient be weightlifting, after having had a pectoralis muscle?
At what week post-op should a patient be weightlifting, after having had a pectoralis muscle?
What pathology is present when testing muscles to discover a Gilliatt Sumner Hand condition?
What pathology is present when testing muscles to discover a Gilliatt Sumner Hand condition?
What structural deficit is MOST likely present when a patient experiences anterior glenohumeral instability?
What structural deficit is MOST likely present when a patient experiences anterior glenohumeral instability?
Which finding during a shoulder examination BEST indicates inferior instability?
Which finding during a shoulder examination BEST indicates inferior instability?
When evaluating a patient for multidirectional instability (MDI), which finding would BEST support the diagnosis?
When evaluating a patient for multidirectional instability (MDI), which finding would BEST support the diagnosis?
In overhead athletes with Acquired Instability due to Overstress (AIOS), what adaptation is MOST likely observed in the glenohumeral joint?
In overhead athletes with Acquired Instability due to Overstress (AIOS), what adaptation is MOST likely observed in the glenohumeral joint?
What is the PRIMARY focus of closed-chain exercises in the rehabilitation of glenohumeral instability?
What is the PRIMARY focus of closed-chain exercises in the rehabilitation of glenohumeral instability?
A patient presents with rotator cuff tendinopathy and reports increased pain with overhead activities. During the examination, which finding would STRONGLY suggest extrinsic compression?
A patient presents with rotator cuff tendinopathy and reports increased pain with overhead activities. During the examination, which finding would STRONGLY suggest extrinsic compression?
During the assessment of a patient with suspected rotator cuff pathology, which of the following best indicates a full-thickness tear?
During the assessment of a patient with suspected rotator cuff pathology, which of the following best indicates a full-thickness tear?
What is the MOST likely biomechanical consequence of posterior capsule tightness in the throwing shoulder?
What is the MOST likely biomechanical consequence of posterior capsule tightness in the throwing shoulder?
A patient diagnosed with internal impingement would MOST likely experience pain in which shoulder position?
A patient diagnosed with internal impingement would MOST likely experience pain in which shoulder position?
Which examination finding is MOST consistent with early-stage adhesive capsulitis (frozen shoulder)?
Which examination finding is MOST consistent with early-stage adhesive capsulitis (frozen shoulder)?
Which of the following BEST describes the PRIMARY goal during the initial phase of rehabilitation for adhesive capsulitis?
Which of the following BEST describes the PRIMARY goal during the initial phase of rehabilitation for adhesive capsulitis?
Which of the following anatomical structures is MOST commonly involved in a SLAP tear?
Which of the following anatomical structures is MOST commonly involved in a SLAP tear?
In a patient with suspected long head of the biceps (LHB) tendinopathy, which clinical test would MOST likely reproduce their symptoms?
In a patient with suspected long head of the biceps (LHB) tendinopathy, which clinical test would MOST likely reproduce their symptoms?
What is the MOST common mechanism of injury for a long head of biceps tendon rupture?
What is the MOST common mechanism of injury for a long head of biceps tendon rupture?
A patient reports pain at the AC joint following a fall directly onto the shoulder. Which of the following examination findings would indicate a complete AC joint separation (Rockwood Type V)?
A patient reports pain at the AC joint following a fall directly onto the shoulder. Which of the following examination findings would indicate a complete AC joint separation (Rockwood Type V)?
Following an AC joint injury, which ligament is MOST important for vertical (superior-inferior) stability?
Following an AC joint injury, which ligament is MOST important for vertical (superior-inferior) stability?
What is the PRIMARY mechanism in distal clavicle osteolysis that leads to pain?
What is the PRIMARY mechanism in distal clavicle osteolysis that leads to pain?
When evaluating a midshaft clavicle fracture, what neurovascular structure is at MOST risk?
When evaluating a midshaft clavicle fracture, what neurovascular structure is at MOST risk?
What clinical finding necessitates surgical intervention for a midshaft clavicle fracture?
What clinical finding necessitates surgical intervention for a midshaft clavicle fracture?
What is the MOST likely PRIMARY goal in nonoperative management of a midshaft clavicle fracture?
What is the MOST likely PRIMARY goal in nonoperative management of a midshaft clavicle fracture?
What finding would be MOST suggestive of suprascapular nerve entrapment at the spinoglenoid notch?
What finding would be MOST suggestive of suprascapular nerve entrapment at the spinoglenoid notch?
Which of the following is the MOST common PRIMARY symptom associated with thoracic outlet syndrome (TOS)?
Which of the following is the MOST common PRIMARY symptom associated with thoracic outlet syndrome (TOS)?
What is the MOST concerning potential complication when performing scalene and pectoralis muscle stretching and soft tissue work when treating thoracic outlet syndrome (TOS)?
What is the MOST concerning potential complication when performing scalene and pectoralis muscle stretching and soft tissue work when treating thoracic outlet syndrome (TOS)?
A patient presents with burning pain and paresthesia down the arm following a recent football tackle. Symptoms are reproduced with neck extension and ipsilateral side bending. You suspect a burner/stinger. What examination outcome would indicate return to football?
A patient presents with burning pain and paresthesia down the arm following a recent football tackle. Symptoms are reproduced with neck extension and ipsilateral side bending. You suspect a burner/stinger. What examination outcome would indicate return to football?
A weightlifter reports anterior chest pain diagnosed as pectoralis major tendon tear. If a surgical repair is planned, where is the tendon
A weightlifter reports anterior chest pain diagnosed as pectoralis major tendon tear. If a surgical repair is planned, where is the tendon
When treating a rotator cuff tear, what is a goal of rehab?
When treating a rotator cuff tear, what is a goal of rehab?
In treating multidirectional instability (MDI), which of the following structures is commonly found to be lengthened/stretched?
In treating multidirectional instability (MDI), which of the following structures is commonly found to be lengthened/stretched?
During which phase of throwing is the anterior capsule coiled tightly, while the internal rotators are being stretched, increasing the risk of GIRD and internal impingement?
During which phase of throwing is the anterior capsule coiled tightly, while the internal rotators are being stretched, increasing the risk of GIRD and internal impingement?
When a patient with a midshaft clavicle fracture is unable to approximate the limb with the shoulder abducted to 90 degrees and the arm internally rotated , this is a positive test for what condition?
When a patient with a midshaft clavicle fracture is unable to approximate the limb with the shoulder abducted to 90 degrees and the arm internally rotated , this is a positive test for what condition?
When determining if an athlete with a burner/stinger has returned to function after having full neck ROM, strength and had absent pain what additional test should be performed prior to return to play (RTP)?
When determining if an athlete with a burner/stinger has returned to function after having full neck ROM, strength and had absent pain what additional test should be performed prior to return to play (RTP)?
With rotator cuff tendinopathy and subacromial impingement pain, what position of arm movements causes the most pain?
With rotator cuff tendinopathy and subacromial impingement pain, what position of arm movements causes the most pain?
In the arthroscopic approach to a SLAP tear, what anatomical landmark is critical to visualize during diagnosis and repair of the superior labrum?
In the arthroscopic approach to a SLAP tear, what anatomical landmark is critical to visualize during diagnosis and repair of the superior labrum?
What is the BEST initial treatment for joint pain in patients presenting with the condition related to calcific tendinopathy?
What is the BEST initial treatment for joint pain in patients presenting with the condition related to calcific tendinopathy?
What is the MOST likely cause of shoulder pain related to internal impingement for a throwing athlete?
What is the MOST likely cause of shoulder pain related to internal impingement for a throwing athlete?
Non-operative treatment with full effectiveness for adhesive capsulitis, which of the following is the BEST timeline frame for the range of conservative treatments?
Non-operative treatment with full effectiveness for adhesive capsulitis, which of the following is the BEST timeline frame for the range of conservative treatments?
What is the BEST physical examination for a PASTA lesion tear?
What is the BEST physical examination for a PASTA lesion tear?
Flashcards
Scapular Plane
Scapular Plane
Scapular plane is 30 degrees anterior to coronal plane.
Abduction and ER
Abduction and ER
Abduction requires external rotation to clear greater tuberosity from impinging on acromion.
IR contracture Impact
IR contracture Impact
A contracture in internal rotation reduces abduction range of motion to 0-120 degrees.
Full abduction motion
Full abduction motion
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Glenoid Labrum
Glenoid Labrum
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Labrum Impact
Labrum Impact
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Capsule Negative Pressure
Capsule Negative Pressure
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Coracohumeral ligament Function
Coracohumeral ligament Function
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ER and IR balance
ER and IR balance
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Rotator Cuff Role
Rotator Cuff Role
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All cuff aid abduction
All cuff aid abduction
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Muscles in ER Function
Muscles in ER Function
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Subscap Role
Subscap Role
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Throwing Phases
Throwing Phases
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Ligament Injury
Ligament Injury
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Cuff Support
Cuff Support
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Subscapularis avulsion
Subscapularis avulsion
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MOI
MOI
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Position of the shoulder
Position of the shoulder
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Resisting force
Resisting force
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Sulcus Sign for MDI
Sulcus Sign for MDI
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Study Notes
Glenohumeral Joint Stability
- The scapular plane sits 30 degrees anterior to the coronal plane.
- Abduction requires external rotation to prevent the greater tuberosity from impinging on the acromion.
- An IR contracture results in a decreased abduction ROM of 0-120 degrees.
- Full abduction involves both GHJ and scapulothoracic movement.
- 120 degrees is achieved by GHJ movement, and 60 degrees is achieved by movement of the scapulothoracic joint .
Static Restraints of the Glenohumeral Joint
- The glenoid and humeral head have limited articular surface, making joint congruency a minor stabilizing factor.
- The labrum increases the socket depth by 50%, enhancing stability without limiting range of motion.
- Anterosuperior labral variants can occur at the 1-3 o'clock position and include sublabral recesses, sublabral foramen, and Buford complexes (absent labrum + cord-like MGHL).
- The anterior-superior labrum has the poorest blood supply.
- Negative intra-articular pressure in the capsule contributes to posterior stability.
- The coracohumeral ligament, which is in an adducted position, resists inferior translation and external rotation.
- The FADIR tests posterior translation
- All Glenohumeral Ligaments attach from labrum
Dynamic and Regional Considerations
- Glenohumeral ligaments attaching from the labrum provide stability in different arm positions.
- At 90 degrees of abduction, the anterior band of the IGHL resists anterior dislocation (Bankart Lesion), while the posterior band resists posterior translation (Kim Lesion).
- The band is a primary structure that gives way in throwers during a classic anterior dislocation . It's labral attachment causes Bankhart lesions
- The posterior band resists posterior displacement at 90 degrees abduction/flexion and IR, contributing to SLAP tears if tight.
- The rotator cuff's main role is to compress the humeral head against the glenoid.
- All cuff muscles counter deltoid to limit superior migration during abduction
- During ER, the infra, teres minor and supra are all active.
- Subscapularis flexibility and tightness provide mechanical restraint against anterior translation.
Serratus, LHBT, and Throwing Phases
- The serratus and trapezius muscles facilitate scapular rotation and tilt above 90 degrees elevation.
- Scapular rotation & tilt maintains glenoid/humeral congruency under dynamic forces.
- The LHBT anchors to superior labrum and reinforces labrum and capsule with activation.
- It can also be a source of weakness/shearing in SLAP lesions.
- Throwing is divided into 4-5 phases ( follow through and deceleration are commonly grouped together)
- Wind up is minimal force. Driven trunk and hip rotation.
- Cocking early abduction. Loaded ER, injury-GIRD, Int impingement
- Acceleration forceful IR leads to Stabilizing cuff injuries valgus elbow demand (UCL)
- Deceleration eccentric force 500N on posterior cuff limit/extend
- Follow Through
Glenohumeral Dislocations: Epidemiology
- Anterior dislocations comprise 95% of glenohumeral dislocations.
- Occurs annual 1.7% general, Male and young likely to recurrent as activity
- recurrence likely if recurrent younger years. 90 under 20 YO and 50% <25
Glenohumeral Dislocations: Factors and Actions
- Dislocations is previous, loose, cuff tear. esp Ax nerv
- Anterior with abduction, external rotation, and anterior-to-posterior force on the elbow. A posterior-directed force to the shoulder is a less common cause.
- Electrocution and Seizures = Post Dislocation
- Axial force can adduction of Internally rotated arm causes Disruption
- Chronic dislocation +Repetitive Microtrauma – aggravating
- inferior w/axial with Abd
- Anterior band IGHL goes under Load of violent ER
Glenohumeral Dislocations- Damage
- Anterior band of IGHL gives at labral attach or avulsion by bone.
- Cuff Resist Anter dislocation with Postior activation minor. Passive of Subscap forward restraint
- Cartlidge Damage = labral Damage BHAGS bankart 1ghl
- Common HAGL avulsion in old and indication of surgery better results
- Glenio labral Articulation Deform damage , heals med or post.
Glenohumeral Dislocations- nerve and cuff
- L tuberosity=Rare In old or young people
- Aux nerve is only 5.
- cuff=30>40tear to much higher 80>60YO group more
Glenohumeral Dislocations- Bone and history
- Bony banks is to 49%
- Recent bony defects 20-25% and need bony, some 15 athetleet
- hills sachs most
- tubertoty fracture to high with anterior Dislocation >50
- hx. and MOI=abd or external irectorce
Glenohumeral Dislocation- Test and Exam
- test and abd by force
- poppoing. paras, badde,,laxity,shoulder chronic
- General, difficult
- inspect adb and rotation of bone loss
- restrciton on range or resistance is post of humeral head void
Glenohumeral Dislocation- Tests
- chronic lax
- beighoton hyper extention etc on side
- gauge
- load 2 or morse planes
- ant apprehension test supin instability . relocation posterior. aux nerve
- Post in add and internal inability torotation
- prominent shoudel
- axil apply and mvo eto flextions
Glenohumeral Dislocation- XRAY finding
- kim test applies all
- sup and adb
- XRay and test, dislocation and impungnent
- GH, Hill ligh tpost view
Glenohumeral Dislocation- Management
- Enlocstion On all y ax views
- bankart post, all, hills stycker v, GT fractureser, view lt
- Bone with positive therapy etc
Glenohumeral Multidirectional Instability (MDI)- criteria
- instability in two or more planes while symptomatic.
Glenohumeral Multidirectional Instability (MDI)- details
- peaks in second and third decades of life. Involves laxity with shoulder overuse
Glenohumeral Multidirectional Instability (MDI)- Predisposong facotrs
- includes females with power, rotator cuff, and general Eherls . Rarely.
micro trauma , ligaments, stretch are key.
Glenohumeral Multidirectional Instability (MDI)- exam
o what test is a two position in two directions
Beight on and ER are high to see and exam. Palp
Acquired Instability Due to Overstress (AIOS)
- A condition primarily affecting throwers and overhead athletes.
- Repetitive overhead motions cause anterior capsule laxity and posterior capsule issues.
- This can have SubAcromial impingement
- decreased ROM, less with GIRD, post tightness for caps and bad test is all
Glenoid
- Lax, ligated, capsulated, test
High failure at all so cuff better
Glenoid Laxity
- Instability of a joint, in general, relies on if there is issues, needs or it lacks it
- Can be one or both sided
- Instability means a dislocation or at least dislocation
- lax joints also
Rotator Cuff Tendinopathy
- Rotator cuff impingement often equals tear with rotator cuff. Often all disorders or older patients
- 45-65% disorders and linked with poor bio mechanics and hook. More at top
Rotator Cuff Tendinopathy and loading
- Most on tenon load and height load or instability or tension. Also with some damage from a tear
Rotator Cuff Tendinopathy pathology
- Unstable so bal onee
- Combination and extrinsic, with joint and some tension
- Extrinsic more, with shoulder or other, or biceps insertion all messed up
###Rotator Cuff Tendinopathy- features and tests
- Features have test + signs like a tear
- acromian
Rotator Cuff Tear : Exam Findings
- Anterior sub, posterior internal and release with repeating.
- Tests internal and high
Rotator Cuff Tear: History and Interventions
- History is high and surgery or low with exercise, injections, exercises, more and or for a long treatment
Rotator Cuff tear-indications
- Age matters and more of full if has or less of tear etc
- Releasing tear and other for what to do
Rotator Cuff tear - Subclavius
- All are good with repair or cuff, low or great, only with what to get , may need time
calcified Tendopath
- age gender. supra or inf is more
- Endocrine more. in zone then issue. calcium issue then more
- Form resorp and remodel and take new
calcified Tendopath test
- Sub or imping all
- Calcium one 15 insertion
Capsular issues
capsular issues, throwers, late or early rotation
SLAP tears
Occur high due biceps load and scapular motion. All throwers
SLAP tears - factors
Load and high . Test + pain or
SLAP and biceps exam
- Bicep Groove tenderness and may be post side loading
###SLAP - Surgery & Rehab
- Long high strength loss. So balance exercises wlll better help
biceps Tenso exam + findings
- Anteroir of bi esp Groovwe . some snapping or upcut
###ACJ - shoulder or AC
- 9 shoulder injuries are likely AC
- more in Males. Direct to shoulder often by a fall
ACJ- types of injuries and what to look for all
- ACj or lavicie damage is likely with or without
- Cross arm is likely, contour damage
ACJ dislocation types
- CC likely with AP. also weighted stress. look shock relocation
- I IIII A/b need lateral all
ACJ dislocations 5 and after
- V is also
- CC restoration needs high repair but less will help shoulder
- Non oop
- types . some atv and no stability
###ACJ -clavicle and pain and how
- Type 10
Distal clavicle Osteolyis age
- Young, Weightlifers , Rare as such
Distal clavicle Osteolyis history
- Pain load joint is similar
- Find Osteopero .
Clavicle fracture, where is it and what do
- The med shaft and 1 or 3 is most. with muscle around to fracture, may cause
shafts what and how
- sling and fig . A/PROM later.. what ###Shaft fx2 to 10/6 , NonUnions and older and fem . sm
distal facts and history
- distal. older,.
- Neer + bone tests
- Acl ligaments to look most etc
Neurovascular
- Nerve can be injured so
- Post notch
- compression more
- Traction often shoulder
SupraScapular
- All by traction
- Compression
- EMG with
- Decompress or ganglion it
Thoracic outlet.
- Between is most, or the space
- Scalene, shoulder, 20 to 6
- Muscle of the arm for Winging etc
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