J.

Suresh Babu
MPT 1
st
year
Shoulder complex consist of four joints Such as

Gleno Humeral Joint.
Acromio Clavicular Joint. Anatomical Joints.
Sterno Clavicular Joint.
Scapulo Thoracic Joint. Functional Joint.
Anatomy

Pectoralis
Muscle
1. Elevation Through Abduction 170
180
2. Elevation Through Forward Flexion
160 180
3. Flexion Elevation through the plane
of the Scapula. 170 180.
4. Lateral ( External ) Rotation. 80
90
5. Medial Rotation 60 100
6. Extension 50 - 60
7. Adduction 50 75

8. Horizontal adduction or abduction
(cross flexion / cross extension 130
9. Circumduction 200
10. Scapular protraction
11. Scapular Retraction
12. Combined movements ( if necessary )
13. Repetitive movements ( if necessary )
14. Sustained positions ( if necessary )


Scapulo Humeral Rhythm. SC & AC Joint Movement.

Flexion
Extension
Elevation

Horizontal Flexion
Horizontal Extension

Protraction
Retraction
Posterior Rotation.
Anterior Rotation.
Superior Glide of AC joint
Inferior Glide of SC joint.
Compression of SC & AC
Joint.
Distraction Of SC & AC
Joint.
Antero Posterior
Movement.
Postero Anterior Movement.
Patient Profile
Age Factors..
40 yrs to 60 yrs Rotator cuff Degeneration.
Primary impingement due to degeneration for more than 35
yrs
Secondary impingement due to instability common for
below 20yrs age group.
Calcification can occur at the age group of 20 to 30 yrs.
Frozen shoulder occurs 45 to 60 yrs and also may occur due
to trauma at any age group.
Acromio clavicular degeneration occurs for age group of
around 15 to 30 yrs for weight lifters and gym practioners.
Occupation.
Labour ( FCI corporation). Common for muscle tendon
pathology and acromio clavicular degeneration.
Professional players ( Base ball, Bowlers, Javelin throw)
Chief complaints.
Specific Problems
History Taking.
Mechanism of injury..
Past medical history..
Any Previous treatment..
Tenderness.
Warmth.
Any Abnormal bony prominence.
Tone of the muscle
Active and Passive ROM
Muscle power..
Special tests.

1. Elevation Through Abduction 170 180
2. Elevation Through Forward Flexion 160
180
3. Flexion Elevation through the plane of the
Scapula. 170 180.
4. Lateral ( External ) Rotation. 80 90
5. Medial Rotation 60 100
6. Extension 50 - 60
7. Adduction 50 75

8. Horizontal adduction or abduction (cross
flexion / cross extension 130
9. Circumduction 200
10. Scapular protraction
11. Scapular Retraction
12. Combined movements ( if necessary )
13. Repetitive movements ( if necessary )
14. Sustained positions ( if necessary )



1.
2.
3.
4.
5.
6.
7.
8.
Anterior Instability
Tests
Posterior Instability
Tests
Inferior &
Multidirectional
Insatiability Tests
1. Load & Shift Test
2. Apprehension Test /
Crank Test
3. Rockwood Test
4. Prone anterior
Instability Test
5. Andrews Anterior
Instability Test
6. Anterior Drawer Test
7. Protzman Test
8. Lefferts Test
9. Dugas Test
1. Load & Shift Test
2. Stress Test / Posterior
Apprehension Test
3. Norwood stress Test
4. Push-Pull Test
5. Posterior Drawer Test
6. Miniaci Test For Post
subluxation
7. Jerk Test
8. Circumduction Test
1. Sulcus Sign Inferior
Shoulder Instability
2. Feagin Test
3. Rowe Test for
Multidirectional
Instability

1.
2.
3.
4.
5.
Internal rotation &
Forceful forward flexion of
shoulder ( jamming
Greater Tuberosity With
Antero inferior Surface of
the acromian process.
Result [+ve]
Supraspinatus Over Use or
biceps tendon injury.

Procedure
Forward flexion of arm 90
medially rotate the shoulder
This movement pushes the
supraspinatus tendon against the
anterior surface of the coraco
acromio ligament and corocoid
process.
Result supraspinatus
paratenonitis/tendinosis or
secondary impingement

Supine lying
Procedure
Painful arc test
Supine lying Arm is abducted &
laterally rotated which
normally leads to inferior glide
of humerus in abduction and
postero inferior glide during
forward flexion.
Normally pain occurs in active
ROM but when repeated the
pain disappears with the
humeral head depressed.
Result - Mechanical impingement
under the acromian process.

Abduction
Forward flexion

Supine position Procedure
Supine lying arm 90 degree
abducted 15 -20 degree
forward flexion & maximum
lateral rotation.
Rotator cuff & humeral head
impinges the postero
superior edge of the glenoid
labrum when the arm is
abducted externally rotated.
Result Kissing of labrum
posteriorly.

Left hand supports post
aspect humeral head
other hand holds
humerus above elbow.
Result A clunk or
grinding sound
indicates a positive test
which indicates the tear
of labrum
pushes Anteriorly
Lateral Rotation


1.
2.
3.
4.
5.

1. Arm Abduction & external rotation
45 to 60 degree middle gleno humeral ligament, coraco
humeral, inferior gleno humeral & anterior capsule
2.
3.

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2.
3.
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Supination elbow
completely extended
resist the forward
flexion. Palpate the
tendon Aggravates pain
Result Biceps
tendinitis
Internal rotation