Lab Class 17

Learning Objectives

At the end of this lab class:

  • You will be able to carry out joint play assessment of the shoulder joint.
  • You will be able to summarize what shoulder impingement is and demonstrate provocative tests for the condition.
  • You will be able to execute muscle length and muscle strength tests for muscles around the shoulder joint.

Special Testing and Joint Play of the Shoulder

Welcome to lab class 17! In the previous class you have learned about basic examination of the shoulder. In this week we are going to look at a couple of special tests & muscle length tests.

The shouldergirdle is a complex comprised of four joints working in synergy to allow for movement. The joints are the Glenohumeral (GH) Joint, Acromioclavicular (AC) Joint, Sternoclavicular (SC) Joint, and the Scapulothoracic Joint.

One of the most frequently encountered pathological conditions of the shoulder girdle is the shoulder impingement. Start the video playlist below to learn about the theory behind shoulder impingement as well as about tests to asses it:

As a first step - and if we assume that your first hypothesis for your patient's shoulder pain is shoulder impingement syndrome - you would want to confirm or reject your hypothesis of shoulder impingement, there are 4 very common tests that you can perform:


If you could confirm your hypothesis of shoulder impingement syndrom with the aforementioned tests, you would like to know which structure is actually impinging. In shoulder impingement syndrome, the subdeltoid bursa, as well as different muscles resp. their tendons can be affected. Watch the videos below to learn about how you can assess involvement of different muscles/tendons of the rotator cuff in shoulder impingement:

Furthermore, the shoulder labrum can be affected after dislocations for example. Check out the Kim's test and biceps load II for the condition below:

Limited capsule mobility (especially the dorsal capsule) can be a contributing factor to shoulder impingement syndrome.  To learn about the joint play movements watch the video below:

 

Case

Ms. Anne Marble is a 22-year-old volleyball player and she comes to your practice because of pain in her right shoulder. She had been overseas for a semester abroad where she didn't play a lot of volleyball. Now she is back with her team and she was eager to play again. During the past weekend, she played a tournament in Amsterdam. She had felt pain in her shoulder for a while after games but the pain was even worse after the long tournament. During a game, the shoulder is painful when serving overhead shortly before she moves towards hitting the ball. In daily life, she notices the pain when she combes her hair or when putting on a sweatshirt.

Tasks:

1) Fill in and upload an RPS for Anne to Google Drive and discuss your version with your classmates. Make assumptions. You will find case notes at the end of next weeks module.

2) Practice the multiple special tests for shoulder impingement with the flowchart in mind! Smooth handling will help you get a good workflow.

Preparation for next week:

1) Be prepared to know about elbow anatomy, possible movements in the joint, and what restricts movement.