Frozen Shoulder

Frozen shoulder, is also known as adhesive capsulitis. Though presenting with similar symptoms, this is not arthritis.

Frozen should is more common, the older we get, p often occurring in clients aged fourty and above. Poor posture and injury to the shoulder are also signifigant risk factors.

By massaging and stretching the inner rotators of the shoulder, gradually increasing the strength of the external rotators and improving posture; it is our hope to help improve the client’s ROM.

Orhopedic Test.

Neer’s test is a special test for the shoulder that tests for shoulder impingement. It is a simple test that is performed by your therapist by lifting your shoulder up and then adding overpressure at the end of the range of motion.

Pain at this end range means that the test is positive and that impingement of the shoulder is likely causing your shoulder pain. The test doesn’t tell which structure—the bursa, a ligament, or the rotator cuff, is being pinched in your shoulder. It merely tells you that something is being pinched.

Speed’s Test. The biceps tendon resides in a groove in the front part of your upper arm, and pain here may indicate that you have biceps tendonitis. Speed’s test is a shoulder special test for biceps tendonitis.

Your therapist performs Speed’s test by having you raise your arm until it is parallel to the floor. With your palm facing up, your physical therapist then pushes your arm down while you resist

Pain in the front part of your shoulder, while you are resisting the push from your therapist, may indicate that you have biceps tendonitis.

Apprehension Test. The test is performed with you lying on your back. Your physical therapist then bends your elbow to 90 degrees and moves your arm out to your side. The PT then rotates your shoulder so that the back of your hand moves towards the floor. This is called external rotation of the shoulder.

If you feel like your shoulder is about to pop out of joint, or if it actually pops out of joint, the test is positive. Of course, this position is likely to cause you apprehension, and thus the name of the test.

Sulcus Test. To do this test, you simply hang your arm down at your side, and your therapist then gently, but firmly, pulls down on your arm.

A positive sulcus sign is when a small divot, or sulcus, appears at the top of your shoulder joint. This means that your shoulder may be pulling away from the socket, indicating shoulder instability.

AC joint compression test. To perform the test, your therspist places one hand on the front of your shoulder and one hand on the back of your shoulder. Your therapist then pushes their hands together, compressing the AC joint. If intense pain if felt, then the test is positive and an injury to the AC joint is suspected.

The Hawkin’s Kennedy test is another test for shoulder impingement. It is performed by your physical therapist who raises your arm with your elbow bent about 90 degrees. The arm is then brought in front of the body, and your elbow is then raised up while your forearm is lowered.

Pain in the shoulder indicates that structures in the shoulder like the rotator cuff or the bursa are getting pinched.

Drop Arm Test. The test is done by having your therapist lift your arm out to the side of your body while keeping your arm straight. Your therapist then drops your arm (hence the name of the test).

A positive test occurs when you are unable to hold your arm out to the side and it falls to your side. This means that you might have a rotator cuff tear.

Empty Can Test. Just raise your arm out to the side, bring your arm forward about 6 to 8 inches, and turn your hand down, like you are pouring out a can of soda.

From this position, your therapist can gently push on your arm, and pain or weakness indicates a positive test for a possible supraspinatus tear or problem.

Anterior Neck Flexors Strength Test

Purpose:
To asses the strength of the neck flexors (SCM, anterior scalene, supra and infrahyoids, longus colli and capitis, and rectus capitis anterior)

Procedure:

Patient is supine
Patient abducts arm to 90°, flexes the elbows to 90°, and rest their dorsal hands on the table.
Patient tucks chin, and then lifts head off the table.
Patient keeps the head lifted off the table (Grade 3). Patient resists therapist posteriorly-directed pressure (Grade 5)

Positive Sign:
Weakness of Anterior Neck Flexors if Patient is unable to keep the neck in flexion against gravity or the therapist’s pressure.

Anterolateral Neck Flexors Strength Test

Purpose:
To asses the strength of the Anterolateral Neck Flexors (SCM and scalene on one side).

Procedure:

Patient is supine
Patient abducts arm to 90°, flexes the elbows to 90°, and rest their dorsal hands on the table.
Patient rotates the head away from the side being tested. Therapist stabilizes the side being tested.
Patient lifts the head into slight flexion and hold it against gravity.
Patient keeps the head lifted off the table (Grade 3).
Therapist holds the temporal region on the side being tested.
Therapist pushes in an oblique posterolateral direction, away from the tested side.

Positive Sign:
Weakness of the Anterolateral Neck Flexors if the patient is unable to keep the neck in flexion against gravity or the therapist’s pressure.

Cervical Compression Test

(for patients who cannot rotate or extend their head)

Testing For:
Compression of cervical nerve root or facet joint irritation in the Lower Cervical Spine

Procedure:

Patient is seated.
Patient’s head is in neutral.
Therapist stands behind patient.
Carefully apply compression downward on the head of the patient.

Positive Sign:
Radiating pain or other neurological signs in the same side arm (nerve root) and/ or pain local to the neck or shoulder (facet joint irritation).

Cervical Distraction

Purpose:
To relieve the pressure on the cervical nerve roots (may be used after Spurling’s or Cervical Compression Tests)

Procedure:

Patient is supine or seated. Patient’s head is in a neutral position at all times throughout the procedure.
Therapist grasps the patient’s head at occiput and temporalis. One hand on either side of the head.
Slowly traction the patient’s head in a superior direction. Maintain the traction for at least 30 seconds.

First Rib Mobility Test

Purpose:
To test the mobility of Rib 1

Procedure:

Patient is seated.
Patient fully rotates their head away from the side being tested.
Patient then fully flexes the head to their chest.

Positive Sign:
Patient has limited neck flexion. The cause for the hypomobilty may be tight scalenes