1. Chapter 21:
The Shoulder

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Common Injuries
Impingement syndrome
Rotator cuff tears
Muscle strains
Tendonitis
Biceps tendon rupture
Dislocation
Glenoid labrum injuries
Multidirectional instabilities
Acromioclavic-ular separation
Brachial plexus injury
Fractures
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3. Shoulder Treatment/Rehabilitation
Taping and exercise can help deal with injury and potential injury to the shoulder.
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4. 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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6. Horizontal Stretching
The stretch pictured here will help stretch the muscles on the back side of the shoulder.
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7. 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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9. 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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10. Internal Shoulder Rotators
With the arm in a handshake position, pull an elastic band across the front of the body.
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11. 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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14. 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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17. 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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18. 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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19. 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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28. 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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29. 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 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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