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Sports med 2
A“Type of pain”
 pins and needles = radiating pain from
cervical pathology
 sharp pain = acute inflammation
 dull, aching, sense of heaviness = chronic
rotator cuff
 deep, aching pain in the neck/shoulder
region = thoracic outlet compression
syndrome (TOCS)
 night pain = rotator cuff tear
 burning pain = acute tendinitis
 weakness, numbness =
nerve pathology
B“specific movements that cause pain”
 neck = cervical spine injury
 shoulder ER = dislocation/subluxation
 above 90 degrees = ACJ
 Normal
 Ability to talk/swallow = SCJ
 Which hand is dominant
 shoulder often lower
 differing ROM
 differing strength
From all sides
 symmetry
• level of shoulders
 muscle
wasting v. hypertrophy
 deformities
 discoloration
 swelling
 how the shoulder is carried
 Step deformity at the ACJ = dislocation
 Flat deltoid = anterior dislocation
 kyphosis: shoulders slumped forwards
 muscle definition
 scapulohumeral rhythm
 scapular winging during flexion and
Anterior structures
 clavicle
 sternoclavicular joint
 sternocleidomastoid
 acromioclavicular joint
 trapezius
 deltoid
 coracoid process
 sternum
 ribs and costal cartilage
humerus and rotator cuff
with thumb on
subscapularis, second,
third and fourth fingers
will be over the insertion
of other three rotator cuff
muscles: supraspinatus,
infraspinatus, teres minor
posterior wall = lats
anterior wall = pec major
medial wall = serratus
Posterior structures
 scapula
 spine of scapula
 medial border of the scapula
 inferior angle
 lateral border
 supraspinatus and infraspinatus
note painful arc (45 – 60 – 100 degrees)
observe scapulohumeral rhythm
first 30 degrees no net movement of the scapula
 30-90 degress scapula abducts and upwardly rotates
1 degree for each 2 degree of humeral elevation
 90 – 180 degrees scapula moves 1 degree for each 1
degree of humeral elevation
 observe any apprehension
 flexion
 ER
Sort of!
 IR
 Extension
 Adduction
 Horizontal adduction/abduction
 Circumduction
 Appley’s scratch test
Apley’s Scratch
Tests for limitations
in motions of the
upper extremity.
Each motion is
bilaterally to
Action 1: The subject is instructed to
touch the opposite shoulder with
his/her hand. This motion checks
Glenohumeral adduction, internal
rotation, horizontal adduction and
scapular protraction.
Action 2: The subject is instructed to
place his/her arm overhead and reach
behind the neck to touch his/her
upper back. This motion checks
Glenohumeral abduction, external
rotation and scapular upward rotation
and elevation.
Action 3: The subject puts his/her
hand on the lower back and reaches
upward as far as possible. This motion
checks glenohumeral adduction,
internal rotation and scapular
retraction with downward rotation