Chapter 21:
The Shoulder
Common Injuries
 Impingement
syndrome
 Rotator cuff
tears
 Muscle strains
 Tendonitis
 Biceps tendon
rupture
 Dislocation
 Glenoid labrum
injuries
 Multidirectional
instabilities
 Acromioclavicular separation
 Brachial plexus
injury
 Fractures
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Shoulder
Treatment/Rehabilitation
 Taping and exercise can help deal
with injury and potential injury to the
shoulder.
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Humeral Head Relocation
 This procedure helps with humeral
head stability. The left thumb
provides a posterior glide to the
humeral head as the short stretch
tape is applied.
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Corner Stretching
 Standing in a corner, with hands
supporting against both wall
surfaces, lean forward to stretch the
pectoral muscles.
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Horizontal Stretching
 The stretch pictured here will help
stretch the muscles on the back
side of the shoulder.
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Shoulder Muscle Stretches
 With a towel used as shown in text
Figure 21-17, the right shoulder is
stretched into an internally rotated
position.
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Shoulder Adduction
 To strengthen shoulder adductor
muscles, use an elastic band
attached to a fixed object, and pull
downward toward the body.
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Deltoid Muscle
Strengthening
 Step on one end of an elastic band,
then pull straight up close to the
body and hold for 5 to 10 seconds.
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Internal Shoulder Rotators
 With the arm in a handshake
position, pull an elastic band across
the front of the body.
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External Shoulder Rotators
 Start with the arm in a position that
crosses the body. Then pull an
elastic band outward as the arm
moves into a handshake position.
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Pectoralis Major
 Stand with the arm extended and
hand externally rotated against a
wall. Gently rotate the body to
stretch the muscle.
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Trapezius
 While sitting, hold onto the table
edge and stretch away.
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Deltoid Muscle Abduction
 Stand sideways against a wall, then
isometrically lift upward with the
forearm against the wall. Hold 5 to
10 seconds.
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Shoulder Extension
 To strengthen the muscles used for
shoulder extension, pull an elastic
band with the arm moving from a
forward position to the side of the
body.
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Special Tests
 Certain tests can be performed
that aid in the evaluation of injury.
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Hawkins Impingement Test
 With the arm and elbow flexed to 90
degrees and the arm rotated
internally, apply overpressure to
internal rotation. Anterior shoulder
pain indicates rotator-cuff
tendonitis.
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Neer’s Impingement Test
 Passively flex the arm to end range
and apply gentle overpressure.
Anterior shoulder pain indicates
rotator-cuff tendonitis.
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Crossover Impingement
Test
 Passively adduct the arm horizontally
to end range. Pain in the AC joint is
a positive sign for rotator-cuff
tendonitis.
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Rotator Cuff Injury
 Shoulder hiking during active
abduction is an indication. The
drop-arm sign is pain and loss
of control in midrange as the arm
is lowered.
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Supraspinatus Muscle
 The supraspinatus manual muscle
strength test has the arm lifted,
thumb pointing down. A downward
force is a test for weakness
(compare to other side).
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Gilchrist’s Sign
 With a fully elevated arm holding
2 pounds, lower the arm (palm up).
A painful click or snap at 90 degrees
indicates biceps long-head
dislocation/subluxation.
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Speed’s Test
 With shoulder flexed to 90 degrees
(palm up), apply downward
pressure. Pain in the bicipital
groove indicates biceps long-head
tendonitis.
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Clunk Test
 With the subject supine, passively
abduct the arm with one hand while
bouncing the humeral head with the
other. A click or pop may indicate a
glenoid labral tear.
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Sulcus Sign Test
 With the shoulder relaxed, hold the
elbow and distract the arm
inferiorly. A gaping between the
lateral acromion and humeral head
indicates inferior shoulder
instability.
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Posterior Glide Test
 With the subject standing, brace the
posterior shoulder while pulling the
anterior superior humerus.
Excessive movement indicates
posterior gleno-humeral instability
(compare to other side).
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Feagin’s Test
 With the subject’s arm resting on
the clinician’s shoulder, gently pull
down at the shoulder. Excessive
movement indicates inferior
glenohumeral instability (compare
to other side).
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Anterior Apprehension Test
 With the arm at 90 degrees
abduction and the elbow at 90
degrees, gently apply external
rotation. A reaction of apprehension
and possible instability indicates
anterior shoulder instability.
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Acromioclavicular
Shear Test
 With arms at the side, squeeze with
both hands between the anterior
and posterior shoulder. Pain
indicates a sprain of the AC joint.
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Roos Test
 With arms in the position shown in
text Figure 21-29 A and B, the
subject opens and closes the hands
once per second for a minute.
Tingling in the arms and hands
indicates thoracic outlet syndrome
(TOS).
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