Chapter 5: Shoulder Flashcards by Kirsten McDougall

What are the active ranges of motions for the shoulder?

Flexion: 160-180 degrees
Extension: 50-60 degrees
Abduction: 170-180 degrees
Adduction: 50-75 degrees
External rotation: 80-90 degrees
Internal rotation: 60-100 degrees
Cross flexion/cross extension: 130 degrees

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What is the glenohumeral painful arc?

About 45-120 degrees of abduction.

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What is the acromioclavicular painful arc?

About 170-180 degrees of abduction.

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What is scapulohumeral rhythm?

For every 2 degrees of abduction there is 1 degree of scapulothoracic upward rotation.

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What is a SICK scapula?

Scapular malposition
Inferomedial border prominence
Coracoid pain and malposition
dysKinesis of scapular movement

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What is scapular dyskinesis?

An alteration in the normal resting or active position of the scapula during shoulder movement.

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What is the Apley’s scratch test?

Reach to touch the opposite scapula to test range of motion.

Over the shoulder tests abduction and external rotation
Under the shoulder tests addiction and internal rotation

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What are force couples?

Groups of counteracting muscles that show obvious action when a movement is loaded or done quickly.

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What are the agonists and antagonists of scapular protraction?

Agonists: serratus anterior and pectoralis major and minor.

Antagonists: trapezius and rhomboids

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What are the agonists and antagonists of scapular retraction?

Agonists: trapezius and rhomboids

Antagonists: serratus anterior and pectoralis major and minor.

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What are the agonists and antagonists of scapular elevation?

Agonists: upper trapezius and levator scapulae

Antagonists: serratus anterior and lower trapezius

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What are the agonists and antagonists of scapular depression?

Agonists: serratus anterior and lower trapezius

Antagonists: upper trapezius and levator scapulae

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What are the agonists and antagonists of shoulder abduction?

Agonists: deltoid

Antagonists: Supraspinatus

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What are the agonists and antagonists of shoulder medial rotation?

Agonists: Subscapularis, pectoralis major, latissimus dorsi, anterior deltoid.

Antagonists: infraspinatus, teres minor, posterior deltoid

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What are the agonists and antagonists of shoulder lateral rotation?

Agonists: infraspinatus, teres minor, posterior deltoid

Antagonists: Subscapularis, pectoralis major, latissimus dorsi, anterior deltoid

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What are the agonists and antagonists of shoulder adduction?

Agonists: supraspinatus

Antagonists: deltoid

What are the agonists and antagonists of shoulder flexion?

Agonists: anterior deltoid, pectoralis major and biceps brachii

Antagonists: posterior deltoid, latissimus dorsi and triceps brachii

What are the agonists and antagonists of shoulder extension?

Agonists: posterior deltoid and latissimus dorsi

Antagonists: anterior deltoid and pectoralis major

What are the end feels for passive ranges of motion for the shoulder?

Flexion/extension: tissue stretch
Abduction/adduction: bone to bone or tissue stretch
Lateral rotation/medial rotation: tissue stretch
Cross flexion/cross extension: tissue stretch or approximation

What is the Apprehension (crank) test?

Tests for traumatic instability problems of the glenohumeral joint.

Abduct the arm to 90 degrees of abduction and laterally rotate the arm slowly.

The test is positive if there is a look of apprehension on the patients face.

What is the Relocation test?

Tests for traumatic instability problems.

Is the same as the apprehension test but a posterior translation force is applied to the head of the humerus.

The test is positive if pain decreases during the maneuver.

What is the A-P glides (load and shift) test?

Tests for atraumatic instability problems of the genohumeral joint.

With one hand stabilizing over the scapula and the clavicle and the other hand grasping the head of the humerus, gently move anteriorly and posteriorly.

The test is positive if there is any excessive movement.

What is the Feagin test?

Tests for inferior instability of the glenohumeral joint.

The arm is abducted to 90 degrees and fully extended (can hold over your shoulder). Place both hands over the humerus and push down and forward.

The test is positive if a sulcus appears or a look of apprehension appear on the patients face.

What is the Sulcus sign?

Tests for inferior instability of the glenohumeral joint.

With the patients arm relaxed by their side grasp their forearm and pull the arm distally.

The test is positive if a sulcus (indentation) appears.

What is the Hawkins-kennedy test?

Tests for Supraspinatus impingement or paratenonitis/tendinosis. Flex the patients arm to 90 degrees and then forcibly medially rotate the shoulder. The test is positive if there is any pain.

What is the Neer's test?

Tests for supraspinatus impingement and sometimes the biceps tendon. Passively and forcibly flex the arm while medially rotating it. The test is positive if there is any pain.

What is the Sternoclavicular glides test?

Tests for instability to the sternoclavicular joint. Patient lies supine while you pinch/press down on the clavicle. The test is positive if there is any excessive movement.

What is a bankart lesion?

The anteroinferior labrum is torn usually associated with a traumatic anterior dislocation (3-7 o'clock).

What is a SLAP lesion?

The superior labrum is injured usually due to overuse (throwing) or a FOOSH injury (10-12 o'clock).

What is the O'Brien's test?

Tests for SLAP or superior labral lesions. The arm is flexed to 90 degrees with the elbow extended, then horizontally adduct 10-15 degrees and medially rotate (thumb down). Push down. Return to the starting position and laterally rotate (thumb up) then push down again. If there is any pain during the first part but not the second then the test is positive for labral abnormalities.

What is the Clunk test?

Tests for labral tears. With the patient lying supine, place one hand on the posterior aspect of the humeral head and the other hand above the elbow. Fully abduct the arm and then push anteriorly over the humeral head while laterally rotating the arm. The test is positive if there is a clunk or grinding sound. May also cause apprehension if there is anterior instability.

What is the Compression rotation test?

Tests for labral tears. With the patient lying supine, passively abduct the shoulder between 20-90 degrees with the elbow at 90 degrees. Push up through the elbow while passively rotating the humerus back and forth. The test is positive if there is any pain, clicking or catching sensation.

What is the Speed's test?

Tests for bicipital paratenonitis or tendinosis. With the patients arms flexed to 90 degrees, push down on the arms first while they are supinated and then again while pronated. The test is positive if there is any pain especially while the arm is supinated.

What is the Empty can test?

Tests for supraspinatus impingement or neuropathy of the sprascapular nerve. Patients arms are flexed to 90 degrees, cross extended about 30 degrees and medially rotated (thumbs down). Push down on the arms. The test is positive if there is any pain

What are wall push-ups?

Tests for serratus anterior dysfunction (winging scapula). Patient does push-ups against the wall.

What are the upper dermatomes?

- C1: top of the head - C2: temples, forehead and occiput - C3: neck and cheeks - C4: trapezius - C5: deltoid - C6: radial side of the forearm to the thumb - C7: middle finger - C8: medial side of the forearm to the 5th digit - T1: medial upper arm

What are the upper myotomes?

- C1: occipital compression - C2: neck flexion - C3: neck side flexion (right & left) - C4: shoulder elevation - C5: shoulder abduction - C6: elbow flexion/wrist extension - C7: elbow extension/wrist flexion - C8: thumb extension - T1: finger abduction/adduction

What are the upper reflexes?

- Biceps brachii (C5) - Brachioradialis (C6) - Triceps brachii (C7)