Ortho
6/7/99

Shoulder
Hoppenfeld’s Extremity Book is a good reference
•	Apley’s p92-93
•	Quadrant screen, active clearing test
•	Problem in shoulder joint, may be able to reproduce w/this motion
•	Doesn’t necessarily tell what is wrong
•	Tells where the problem is
•	Abduction and rotation
•	Adduction and rotation
•	W/skin marking pencil mark where hand ends up
•	Functional loss (can’t hook bra, can’t comb hair)
•	Elbow problem
•	Dawbarn’s p105
•	Reproduce pain from subdeltoid and subacromial bursitis
•	Right below acromion, bend backwards, can palpate into the area
•	Pain at night (malignancy)
•	Abduction to 90degress and gives relief
•	Anterior deltoid pops finger out (change in relationship of structures)
•	Review anatomy for structural relationships
•	Tenosynoitis—tendo and synovial sheath inflammation
•	Biceps tendon has a synovial sheath that is continuous w/subscapularis bursa of the shoulder
•	Stenosing—aggrevation, inflammation, fibrotic tissue, tendon is entrapped by the synovium not allowing the tendon to move (lubrication, reduce friction) (common in wrist and ankle)
•	Capsule of glenohumoral joint is large w/extra folds of bursa, allows for normal motion
•	Rolling—like a wheel on pavement
•	Slide—transit motion
•	Shoulder impingement syndrome—supraspinatus tendon (abduction), biceps tendon (flexion)—mechanical property is inferior movement of humerus if doesn’t move impinges on the tendons
•	Can be by itself or along w/other problems of the shoulder
•	Typically bursitis develops secondary to some other mechanical shoulder problem
•	Ludington’s p 117
•	Hands on head
•	Palpate biceps
•	Flex/contract
•	Bulk, contraction, located in proper position
•	Rupture of biceps detected
•	Test for symmetry
•	Impingement sign p114
•	Flexion
•	Reproduction of pain in shoulder
•	90degress,internally rotate of abduction
•	Codman’s (Drop Arm test) p100
•	Rotator cuff muscles (supraspinatus tendon most commonly injured)
•	Supraspinatus
•	infraspinatus
•	teres minor
•	subscapularis
•	raise shoulder up, drop and pt catch
•	pain or completely drop
•	supraspinatus tear (rotator cuff)
•	tendon is functioning as the capsule of the glenohumeral joint
•	deltiod is contracting at this point
•	Dislocation
•	Presents w/trauma
•	Apprehension p94
•	Bryant’s p96
•	Calloways’s p99
•	Dugas p107
•	Masion