2.3.3. SG Clinical Shoulder Exam

Question 1

What joints make up the shoulder region?

Answer 1

Glenohumeral, Acromioclavicular, sternoclavicular, scapulothoracic

Question 2

How much bony stability in the shoulder?

Answer 2

Lack of bony stability in the shoulder (only 30% of the “ball” is touching the “socket”)

Question 3

Where does the shoulder gain stability

Answer 3

For stability, the shoulder relies on secondary structures that are either dynamic or static

Question 4

Describe the static secondary structures of the shoulder

Answer 4

Cartilage, ligaments and joint capsule. Think of the capsule as Saran wrap and the ligaments as folds in that wrap. Most important part is the glenoid labrum which is basically a suction cup that extends off the glenoid to grab more of the humeral head. It increases contact area by 15% and the depth of the glenoid by 50%.

Question 5

Describe the Dynamic structures of the shoulder

Answer 5

Muscles of the rotator cuff, SITS - Supraspinatus, infraspinatous, teres minor and the subscapularis.

Question 6

Function of the SITS muscles

Answer 6

exert an infero-medial force that sucks the ball down on the “tee” to keep it all together while the large deltoid, lats and pecs are are exerting an upward force with shoulder movement that would cause the shoulder to fall apart

Question 7

Force pathway along shoulder

Answer 7

Forces must travel from the acromioclavicular joint, along the clavicle, to the sternoclavicular and around the first rib until reaching the spinal cord

Question 8

Inferior directed force on the clavicle

Answer 8

Inferior directed force will cause an AC joint disruption (AC separation or “shoulder separation”)

Question 9

Medially directed force on clavicle

Answer 9

Medially directed overload force will cause a fracture in the middle of the clavicular S-curve

Question 10

What does the A.C. Joint permit us to do?

Answer 10

allows for the first 10-20 degrees of shoulder abduction and forward flexion

Question 11

What does the S.C. joint allow us to do?

Answer 11

Withstands tremendous force in the sagittal and transverse planes while allowing practically limitless coronal plane movement

Question 12

Impingement Syndrome

Answer 12

a failure of the SITS muscles to counter the upward force of the larger muscles, leading to the supraspinatous and subacromial bursa along with others to get pinched between the humeral head and the acromion, causing pain

Question 13

As someone abducts their arm and pain increases, what do we know?

Answer 13

Upward rising with a pain increase means that AC joint is getting more compressed

Question 14

What are we looking for during inspection?

Answer 14

Swelling, erythema, bruisng, atrophy, deformity

Question 15

What do we palpate?

Answer 15

AC Joint, Clavicle, SC Joint, supraspinatous and infraspinatous (checking for atrophy)

Question 16

What ROM do we check in the shoulder?

Answer 16

Flexion, ABduction, External Rotation, Internal Rotation

Question 17

What are our strength tests?

Answer 17

Empty Can External Rotation Lift Off Test

Question 18

Empty Can Test?

Answer 18

Tests the supraspinatous Have patient abduct arm to 90 degrees with imaginary can facing upwards. Have them internally rotate while you push their arm down. Full can test also tests the supraspinatous and is the exact same except the thumb is up.

Question 19

External rotation test

Answer 19

Elbow flexed at 90 degrees and adducted to patient’s side. Have the patient externally rotate against resistance.

Question 20

Subscap “lift off” test?

Answer 20

Have patient place hand behind their back, palm facing away. Lift away from the back with resistance

Question 21

What else do we test besides the strength tests at this point in the exam?

Answer 21

The rest of the neurovasculature via sensation testing of dermatomes

Question 22

What vasculature tests do we do?

Answer 22

Distal radial pulses

Question 23

What types of special tests do we have?

Answer 23

Impingement Tests Instability Tests AC Joint Test

Question 24

Impingement tests use what movement the most?

Answer 24

Internal rotation of the shoulder

Question 25

Impingement tests

Answer 25

Neer’s Hawkins

Question 26

Neer’s Test

Answer 26

With arm at rest, internally rotate shoulder. Passivley flex the shoulder. Positive test is one where there is pain with the flexion.

Question 27

Hawkin’s Test

Answer 27

Place arm at 90 degrees with elbow flexed at 90 degrees supported by examiner for relaxation. Examiner then stabilizes proximal to the elbow with outside hand and with the other holds proximal to the patient’s wrist. Ends with a quick move of the arm into internal rotation, which if causing pain is a positive test.

Question 28

Instability Tests

Answer 28

Apprehension Test Relocation Test

Question 29

Apprehension Test

Answer 29

Arm at 90 degrees abduction, begin to externally rotate the shoulder starting at 0 degrees rotation. Continue to passively externally rotate the shoulder until resistance occursor patient shows “apprehension.” Positive test is apprehension, or a feeling that the shoulder will dislocate

Question 30

Relocation Test

Answer 30

Only done with positive apprehension test. Redo the apprehension and stop just before the apprehension. apply posteriorly directed force to the proximal humerus and begin to posteriorly rotate the shoulder again. If the patient gains more external rotation, then the test is positive

Question 31

Test for the AC Joint?

Answer 31

AC Cross Chest Adduction (Scarf) Test

Question 32

Scarf Test

Answer 32

Put shoulder and elbow at 90 degrees flexion. Patient places palm on top of opposite shoulder with elbow at shoulder level. If no pain, test further by pressing down on elbow while patient resists. Positive test if pain in AC joint.