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Purpose- Determine if scapula dyskinesis is contributing to sp. weakness in pts. w/ shoulder pathology
Technique- Empty can test manually produce scapular retraction. repeat empty can test
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SCAPULAR RETRACTION TEST
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SCAPULAR RETRACTION TEST
(+) test = strength w/ scapula retracted
Limitation:Threshold value for change not determined
-
Kibler. AJSM 2006
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SCAPULAR ASSISTANCE TEST
• Purpose – Contribution of scap. dyskinesis to pain/weakness in pts with shoulder pathology
• Technique- Active elevation in sagittal or scapular plane repeat with manual assistance to promote upward rot. & post. tilt
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SCAPULAR ASSISTANCE TEST
+ Test =1. ↓pain of ≥ 2
points on 10 point scale
2. ↓Weakness
Rabin. JOSPT 2006
Greenfield AJSM 1990
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IGHL (posterior band)Teres Minor
Infraspinatus
Teres Major
» ↑ superior labrum strain via ↑ peel back forces
» ↑ Compression on posterior labrum
» ↓ ER compensate w/ ↑ abd. ant capsule stress (tension) micro-instability
» Entrapment of undersurface of posterior RC ( Posterior/ Internal impingement ) Burkhart. Arthroscopy 2003
Clabbers J Sport Rehabil. 2007
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Burkhart. Arthroscopy 2003
Clabbers J Sport Rehabil. 2007
» Late Cocking Phase - Bicep vector’s to more posterior position↑ torsion of biceps anchor/labral attachment medial/lateral gapping of labrum off glenoid
» Normal response» Accentuated by Post GH
tightness!!!Sup view (left)
Burkhart, Arthroscopy 2003
Repetitive Abd/ER » Posterior-inferior
capsule tightnessImpingement of
undersurface of post-sup. RC between posterior labrum and greater tuberosity ↑Ant capsule laxity
Superior view- left shoulder
Walch. JSES 92’
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» HORIZONTAL ADDUCTION
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Meyers Post GH Test
• Technique- Pt. retracts scapula clinician stabilizes scapula passive horizontal adduct. (in neutral rot). Measure > formed between axis of humerus and horizontal plane from superior aspect of shld.
• Inter tester reliability = .94
• Construct Validity p= .004
Myers. AJSM 2007
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MYERS. – SUPINE POST GH TEST
Shoulder Baseball
Players
Tennis
players
Normal Subjects
Dom 105 103 107
Non-Dom 114 111 107
Look for symmetry
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IR ROM :CAUSED BY RETROVERSION + GH TIGHTNESS !!
LIMITATIONOF Measuring IR ROM!
Osseous adaptations in response to tensile stress on posterior capsule( humeral + glenoid retroversion)
Humeral Retroversion
~ Posterior torsion/rotation of humerus in horizontal plane
Humeral / Glenoid Retroversion IR ↑˚17 in pitchers
Irreversible
Beneficial ? - ↑↑ in asymptomatic throwers
Crockett AJSM 02’ , Whitely, JOSPT 2009
≮=30
Generalized Ligamentous Laxity
• Elbow recurvatum = >10˚
• Thumb to forearm opposition = < 1cm
• MCP hyperext. = > 60˚
• DIP hyperext = > 30˚
* Remember: Laxity ≠ Instability
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» Anterior Apprehension Test
• 90/90 position• Passive overpressure at end-
range of ER • If (+) apprehension apply
posterior glide to humerus• (+) Test = Elimination of
• Clunk Test• Anterior Slide Test• Active Compression Test • Dynamic Speed’s TestBiceps Load test I and IIResisted Supination –ER
Test• Pronated Load Test
Strong Evidence
Clunk Test- With the arm abducted to varying degrees overhead, clinician applies anterior force to humeral head while passively rotating humerus (IR/ER).
(+) test = “clunk”. Andrews AJSM 85
’
Anterior Slide With pts. Hand on hip, clinician applies antero-superior force while manually stabilizing scapula. (+) test = pop/crack and pain Kibler. Arhroscopy 95’
CLUNK TEST
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ANTERIOR SLIDE TEST
Active Compression Test -With the humerus in IR & flexed @ 90 and horiz adducted 30˚ , clinician applies downward force repeat w/ humerus in ER
(+) test = Pain “inside” shoulder on 1st
test and no pain on 2nd test.
*AC pathology = pain @AC jointO’Brien AJSM 98’
Dynamic Speed’s – Clinician applies resistance to simultaneous shoulder elevation and elbow flexion. (+) test = Deep shoulder pain > 90˚
Wilk JOSPT 2005
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Biceps Load I• Shoulder @ 90˚ abduction
and max ER,(elbow flexed @ 90, supinated forearm)
• Resisted elbow flexion in order to recreate “peel back” mechanism.
(+) test = Deep shoulder pain.
Biceps Load II – shoulder ispositioned @120˚ abductionKim. Arthroscopy 2001
Kim. AJSM 95’
Resisted Supination External-Rotation Test
Test position : @ 90˚ abduction and max ER, (elbow flexed @ 65-70˚, neutral forearm)
resisted supination/simultaneous passive ER in order to recreate “peel back” mechanism.
(+) test = Deep shoulder pain.
Myers AJSM
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Pronated Load Test Shoulder abducted
90˚ w/ full pronation passive ER to end-range contract biceps to provoke “peelback” force on labrum