SHOULDER PAIN

ORIENTATION TEST

SHOULDER PAIN

Analisis
patologi

Cervical spine

Thoracic spine

muscles

disc

Capsules

Joint surface
facet & uncinate
osteofit
iritasi radix

neurovege
Myofascial
adhesion

Shoulder

Glenohumeral

Contracture

tightness
Iritasi Jar
sensitif

ischemic

tight
Radicular
pain

Pseudo
radicula
r

hipertone
contract

Positiona
l fault
muscle
tightness

Inflamasi

Blockade
Micro
circulation

tendomuscl
bursae

costoverte

Thoracic outlet

calcification
nyeri lokal/
referal

Capsulo-lig
contracture
brachial nerve
entrapment
nerve ischemic

fibrosis

Nyeri leher dan lengan

Sugijanto, 2016

Nyeri bahu dan lengan impingement syndrome

Keluhan nyeri area deltoid,
terutama angkat lengan,
crepitasi.
Ya
Pada tes abduksi elevasi
tampak paiful arc
humeroscapularYa
rhythm,

Ha: Shoulder
Impingement
syndrome

Jobes test;
Neer test
Hawkin Kennedy test
Isometric resisted external
rot.

H5-7
Penyebab
impingement
Glenohumera
l instability

H1: Superior
capsel

Empty can
test, Abduksi
isometric dan
Palpasi posisi
borgol

Superior capsule
contracture
penyebab
impingement

Tendinitis
supraspinatus
akibat
impimgement

Scapulothora
cal
dyskinetic
Scapular
tiping

Scapular
shrugging

td
k
td
k

td
k

EXTERNAL SHOULDER
IMPINGEMENT

H1:
Supraspinatus

Traksi caudal: no
pain and No
sulcus sign

Ganti hipotesis

Scapular
winging

H2:
Subacromial
bursa
Neer-Hawkin
test, Crepitasi
dan palpasi
posisi
ekstensi
Subacromial
bursitis
akibat
impimgemen
t

Ganti hipotesis

Pemeriksaan red
flag:
Pancoast tumor,
Cervical
instability/disc
lesion, dll
INTERNAL SHOULDER
IMPINGEMENT

H3:
Infraspinatus
External rot
isometric,
Palpasi
posisi
sphynx
Tendinitis
infraspinatus
akibat
impimgement

H4:
Subscapularis

H8: SLAP
lesion

Abdominal
press test,
Internal rot
isometric,
palpasi posisi
netral
Tendinitis
subscapular
is
impimgeme
nt

Sugijanto,

PEMERIKSAAN FISIOTERAPI YG
DIBUTUHKAN
Diutamakan pemilihan evidence untuk:
Pemeriksaan Impingement (5):
Painful

arc
Jobes test
Neer test
Hawkin Kennedy test
External rotation isometric test

Sugijanto, 2015

MUSCLE &TENDON
Painful arc
Supraspinatu
s tendon
Infrapinatus
tendon
MUSCLETENDON

Subsapular
tendon

Isometric abd test

Palpation in borgol

Painful arc

Isometric ext rot

Palpation in sphinx

Painful arc

Isometric ext rot

Palpation in sphinx

Long head
biceps tendon

Painful arc

Isometric int rot

Palpation in netral
Sugijanto, 2015

PEMERIKSAAN FISIOTERAPI YG
DIBUTUHKAN

Pemeriksaan Specific tissue (3x15)

Tendon

M Supraspinatus:

Jobes/Empty can test

Isometric Abduction MLPP
Palpation posisi borgol

Tendon

M Infraspinatus:

Isometric External rotation

Palpation posisi Sphynx

Tendon

M. Subscapularis

Abdominal press test

Isometric Internal rotation
Palpation posisi Netral, diatas tepi

Sugijanto, 2015

PROSEDUR PEMERIKSAAN
FISIOTERAPI
TENDON SUPRASPINATUS
EVIDENCE BASE TEST
Empty can test
Abduction resisted test
Palpasi posisi borgol

Sugijanto, 2015

PROSEDUR PEMERIKSAAN
FISIOTERAPI
TENDON SUBSCAPULARIS
EVIDENCE BASE TEST
Abdominal press test
Internal rotation resisted test
Palpasi posisi netral medial
sulcus bicipitalis

Sugijanto, 2015

PROSEDUR PEMERIKSAAN
FISIOTERAPI
TENDON INFRA SPINATUS
External rotation lag sign
Isometrik rotasi eksternal
Palpasi posisi sphynx

Sugijanto, 2015

SUBACROMIAL BURSITIS
Subacromial
bursa
Painful arc
NeerHawkins test
Palpation in
extension

Sugijanto, 2015

PROSEDUR PEMERIKSAAN
FISIOTERAPI

Pemeriksaan Scapular diskinetic

Abduction-elevation
Static

abducted position
Finding:

Scapular Tipping (pectoralis minor tightness);

Scapular Shrugging (Scalenus tightness);
Scapular Winging (Serratus anterior weakness)

Pemeriksaan SLAP
Pemeriksaan Glenohumeral instability

Aprehension

test
Relocation test

Sugijanto, 2015

MUSCLE &TENDON
Scapular
Tipping

Abductionelevation

Palpation lower
angel on the scapula
Contract relax stretch test of
pectoralis minor m

SCAPULAR
DYSFUNTION

Scapular
winging

Abductionelevation

Palpation to medial
margin
Strength test for
serratus anterior m

Scapular
shrugging

Abductionelevation

Palpation to medial
margin of the scapula
CRS Levator scapular m
Sugijanto, 2015

PROSEDUR PEMERIKSAAN FISIOTERAPI

Scapular dysfunction menurut Kibler

Tipping
Winging
Shrugging

Type 1 dyskinesie
Prominentie angulus
inferior tipping

Type 2 dyskinesie
Prominentie margo medialis
scapulae winging

Type 3 dyskinesie
Prominentie angulus
superior scapulae
mediorotatiestand
shrugging

Sugijanto, 2015

MUSCLE &TENDON
Scapular
Tipping

Abductionelevation

Palpation lower
angel on the scapula
Contract relax stretch test of
pectoralis minor m

SCAPULAR
DYSFUNTION

Scapular
winging

Abductionelevation

Palpation to medial
margin
Strength test for
serratus anterior m

Scapular
shrugging

Abductionelevation

Palpation to medial
margin of the scapula
CRS Levator scapular m
Sugijanto, 2015

INTERVENSI FISIOTERAPI YG
DIBUTUHKAN
MODALITAS DAN METODA
Anatomic Impairment target:
US

dan/atau transverse friction pd

tendon atau bursa
Peregangan capsul superior, mobilization
under caudal traction (MWM)

Functional Impairment target:

Scapulothoracal

stabilization
Postural correction

Disability target

Sugijanto, 2015

PROCESS OF
PHYSIOTHERAPY FOR
MUSCLE IMPAIRMENT
Pasif:
terbatas
springy
Nyeri
kontraks
i

Isometric
: Nyeri
Palpasi:
Nyeri hipertoni
a
CRS test:
Nyeri memendek

Relaksasi
otot
Transverse
friction/
manipulation
Stretching /
C.R.S
Myofascial
release
StabilizationStrengthening exc
Sugijanto, 2015

PROSEDUR INTERVENSI
Intervensi:

Supraspinatus

Transverse

friction posisi ttt,

Stretching,
Caudal

traction/translation dan

Codmann

pendular exercise

Scapulothoracal

movement function

Infraspinatus

Subscapular

Caudal traction

Sugijanto,

SCAPULAR STABILIZATION EXERCISES

Sugijanto,

DYNAMIC STABILIZATION

Sugijanto,

Sugijanto,

PROSEDUR INTERVENSI
Transverse friction
Static inferior traction
Codman pendular exercise
Scapulothoracal movement
function

Sugijanto,

UPPER TRAPEZIUS
PERFORMANCE
Test in shortened length (break
test)
If cannot hold in test position 1015 = long upper trapezius
If cannot hold in whole range
weak

Sugijanto,

LEVATOR SCAPULAR SHORTEN

Saat abduksi elevasi terjadi
Shrugging
Contract relax stretch test
positif

Sugijanto,

PROSEDUR INTERVENSI

Stretching for Pectoralis minor

Strengthening for Serratus
anterior
Stretching for Levator scapula

Sugijanto,

GLENOHUMERAL
INSTABILITY

Joint instability
Passive

instability
Active instability

Capsular stretch test

Apprehension

test
Relocation test (Load and sift
test)

Isometric stability test

Sugijanto,

ANTERIOR AND POSTERIOR

APPREHENSION TESTS
Anterior

Apprehension Test

Posterior

Apprehension Test

Sugijanto,

RELOCATION TEST

Uses

external rotation and posteriorly directed

pressure to allow for increased external
rotation

Sugijanto,

SLAP LESION
Slap test
Athroscopy

Sugijanto,

PROSEDUR TERAPI LATIHAN

Latihan

Postural

correction
Stabilization
Stretching
Mobilization

Sugijanto,

ALAT UKUR/EVALUASI FISIOTERAPI

YG DIBUTUHKAN
Pengukuran nyeri
Pengukuran Stability
Pengukuran ROM,
Analisis scapulohumeral rhytm
Analisis scapulothoracal rhytm
Pengukuran movement disfunction
Pengukuran disabilitas

Sugijanto, 2015