Special Tests Commonly Performed on the Shoulder

Instability, anterior	Load and shift test Crank (apprehension) and relocation test
Instability, posterior	Load and shift test Posterior apprehension test Norwood test
Instability, inferior	Sulcus sign Feagan test
Impingement test	Neer test Hawkins-Kennedy test Posterior internal impingement test
Labral lesions	Clunk test (Bankart/SLAP) Active compression test of O’Brein (SLAP) Biceps tension test (SLAP)
Scapular stability test	Lateral scapular slide tests Wall/floor pushup Scapular retraction test
Muscle tendon pathology	Speed test Yergason’s test Empty can test Lift-off test Lag or spring back test
Neurological involvement	Upper limb tension test
Thoracic outlet syndrome	Roos test (EAST)

Physiotherapy Treatment of Illiotibial Band Syndrome (ITBS)

Illiotibial Band Syndrome (ITBS)

·         IT Band Syndrome is due to inflammation of the IT Band which is a thick fibrous band of tissue that runs down the outside of the hip and thigh, connecting just below the outside of the knee.

·         This condition is most common in runners.

Factors that Contribute to Injury

•          People who suddenly increase their mileage or activity may develop IT Band Syndrome.

•          Running or hiking downhill is also a common cause of ITBS.

•          Other common factors are poor foot mechanics (over-pronation), old running shoes, and running on a crowned road or track.

•          Abnormal running biomechanics

•          Poor pelvic or core stability

•          Tightness in specific joints

Signs and Symptoms

•          Pain over the outside of the knee with running

•          Pain increases with downhill activities

•          Pain decreases with rest

•          Tender to the touch

•          Any movement of the knee may be painful

Physiotherapy treatment and advice

•          Rest and icing at least 5 times per day for 10 minute intervals

•          Avoid training of uneven surfaces

•          Proper footwear (orthotics or new shoes)

•          Stretching exercises to increase the flexibility of IT band, piriformis and gluteal muscles

•          Modify activities and biomechanical correction

•          Gradual increases in mileage

•          Alternate running direction on track and road.

•          Joint mobilization

•          Dry needing

•          Core stability exercise

•          Kinesio-taping

•          Use of appropriate IT band straps

Stretching

•          It must be done slowly and gradual

•          It should not be bouncing of jerky.

•          Hold for 10 sec, keep 10 sec rest and repeat for 10 times (10-10-10)

•          Stretch before and after activity

•          Stretch both legs

•          Stretch IT band, piriformis, gluteal and hamstring muscles.

Strengthening

•          Once the acute painful stage gets subside, strengthening exercise should be started using resistance with weights or thera-bands.

Definition, Diagnosis and Treatment of Carpel Tunnel Syndrome

Carpal Tunnel Syndrome (CTS)

·         Repetitive stress injury

·         Due to inflammation of the tissues around the median nerve

·         Results in reduced nerve transmission; pain, numbness, and tingling in wrist, hand, and fingers (except little finger)

Causes of CTS

Work-related

·         Repetition

·         High force

·         Awkward joint posture

·         Direct pressure

·         Vibration

·         Prolonged constrained posture

Medically-related

·         Fractures

·         Arthritis

·         Diabetes

·         Obesity

·         Acromegaly

·         Long term hemodialysis

·         Pregnancy

Symptoms

·         Pain in wrist and hand

·         Numbness and tingling in fingers

·         Weakened grip

·         Feeling of swelling in hand

·         Worsened pain at night with rest

Diagnosis

Medical History

·         Job

·         Symptoms

·         Medical conditions

Physical Exam

·         Tinel’s sign (tapping median nerve)

·         Phalen’s test (compression of nerve)

·         Muscle strength (thenar strength)

Diagnosis

Lab tests

·         X-ray

·         MRI

X-ray and MRI

·         X-ray: check for arthritis or fractured bones; not useful for detecting CTS 

·         MRI: to estimate severity of CTS: not used routinely but is capable of detecting abnormalities indicative of CTS.

Electrodiagnostic tests

·         Electromyography

·         Nerve conduction (electric shocks)

Electromyography (EMG)

·         To confirm diagnosis

·         Indwelling or surface electrodes; electrical activity is displayed on a screen (benefits vs. disadvantages)

·         Conditions such as obesity and anxiety can slow conduction speed and cause skewed results

Nerve Conduction Studies

·         Surface electrodes on hand and wrist

·         Small elec. shocks applied to nerves in fingers, wrist, and forearm (measure speed of conduction)

·         Can detect 84% of people with CTS

·         Can eliminate 95% of cases that are not CTS

Investigative Tests

·         Researchers reported on a computer-assisted device

·         Measures pinch and grip strength and finger pressure

·         Accurate and consistent way to diagnose CTS

Treatments

Conservative

·         Rest, Ice, Heat

·         Brace

·         Physical therapy

·         Drugs

·         NSAIDS  (ibuprofen naproxin, aspirin): recommended EARLY in the inflammation cycle

·         Corticosteroids: decrease in tendon strength & mass over time

       Surgery

·         Endoscopy

·         Mini Open Release

·         Percutaneous Balloon Carpal Tunnel-Plasty

       Alternative Therapies

·         Vitamins (B6)

·         Chiropractic methods

·         Acupuncture

·         Electromagnetic fields