GP LECTURE SERIES 2013
THE SHOULDER
Assessment, treatment and functional considerations
Basic rotator cuff anatomy and
function
 Dynamic stability of the
glenohumeral joint
 The RC tendons blend together
to become the joints capsule
 Allows for increased mobility but
compromises stability
 Shallow glenoid fossa supported
by a cartilaginous labrum cover
 RC’s aim to maintain the HOH in
optimal contact with the glenoid
fossa throughout range
3D assessment
• Upper and lower fibres of
trapezius work together to
E/IR the scapula
• Serratus anterior keeps the
medial border of the scapula
in close contact with the
thorax
• If 1 or more of these forces
become under/over active
abnormal shoulder, neck or
back mechanics could result
Thoracic spine and shoulder
function
 Compensatory thoracic spine E,
rot and LF to allows for more
arm elevation
 Hypomobile/stiff spinal and rib
joints mean more movement
needs to take place at the GHJ
 Increase kyphosis protracts the
scapula causing an imbalance
throughout the shoulder girdle
Poor sitting posture & ergonomics
Looking at the bigger picture
 The shoulder and thoracic
spine can also be affected by
structures way down the
kinetic chain
 Core strength and posture are
very important and need to be
addressed
 Often diagnosing a shoulder
condition is simply the
symptom of a much bigger
cause
Hawkins Kennedy Test
 Test for impingement and
bursal bunching
 Position for testing: Arm
abducted to 90 degrees
the examiner administers
a downward pressure on
the forearm into internal
rotation whilst stabilising
the humerus.
Full/Empty can test
 Test for
supraspinatus/infraspinatu
s tear/tendonitis
 Position for testing:
Patient in standing or
sitting abducts arms to 90
degrees.
- Supraspinatus; empty can
- Infraspinatus; full can
Apprehension Test
 Test for anterior instability or recent
shoulder dislocation/subluxation
 Position for testing: patient lies in
supine with shoulder abducted at 90
degrees and in maximal external
rotation. The humerus is supported
and overpressure into external
rotation administered.
 The anterior capsule should be
supported and then overpressure
released to confirm instability
Crank-pivot test
• Designed to identify a
labral tear or SLAP lesion.
• Position for testing:
Patient in supine, arm in
external rotation,
examiner compresses the
humeral head into the
glenoid fossa and pivots
the arm back and forth.
Frozen shoulder
 Related to a loss of range throughout all degrees of
freedom in the shoulder – need to look at all AM’s
 External rotation most affected followed by abduction
and then flexion
 Particular attention should be taken to look at the
scapula - sometimes range may seem equal both
sides, but this is only being achieved by excessive
compensatory scapulothoracic joint movement rather
than normal glenohumeral joint function
Physiotherapy and
Shoulder Disorders
 Analysis of the results and effectiveness of exercise across all
available clinical trials demonstrates that Physiotherapy exercises
for mixed shoulder disorders & rotator cuff diseases are effective at;
- Reducing pain
- Improving muscle strength
- Increasing function
- Improving general well-being
 Unsurprisingly the longer the patients performed the prescribed
exercises the greater the reduction in their pain (Green, Buchbinder
& Hetrick 2013)
Shoulder Impingement
 Manual therapy applied by experienced physical
therapists, combined with a supervised exercise
programme was found to be better than exercise alone for
patients with shoulder impingement syndrome in;
- Increasing strength
- Decreasing pain
- Improving function
(Bang & Deyle, 2000)
Frozen Shoulder
 No evidence that Physiotherapy, Pharmaceutical
intervention or corticosteriod injections change the
outcome of idiopathic frozen shoulder (Brukner & Khan
2006)
 However, early range of motion exercises and
education on the pathway of frozen shoulder are
effecting in restoring range, relieving pain and
improving function (Brukner & Khan, 2006)
 It is also important to correct secondary complications
that may arise from having a stiff and painful GHJt