Chapter 70 - Physical Examination of the Shoulder and Elbow

Question 1

exam maneuvers for supraspinatus

Answer 1

Empty can test
- 70-90 degrees of abduction in the plane of scapular motion, forearm maximally pronated
- resist downward pressure

Champagne toast test
- 30 degrees of abduction in the plane of the scapula, 30 degrees of forward elevation, slight external rotation
- resist downward pressure
** better isolates the supra from the deltoid

Question 2

exam maneuvers for infraspinatus

Answer 2

resisted adducted (neutral) external rotation

Question 3

exam maneuvers for teres minor

Answer 3

Horn blower’s sign
- elbow flexed to 90, arm in 90 of ER, 90 degrees of abduction
- examiner tries to internally rotate the patient’s arm against resistance - weakness = infra weakness
- falling into IR = hornblowers sign

Question 4

exam maneuvers for subscap

Answer 4

belly press
- hand on abdomen with elbow anterior to the wrist

lift off test
- back of the hand at the SI joint
- lift the back of the hand from the SI joint

Bear hug test
- palm on hand on contralateral shoulder
- patient should resist the examiners external rotation

Question 5

as posterior capsular contracture increases what happens to the center of rotation of the humeral head?

Answer 5

HH migrates posteriorly and superiorly causing impingement on the labrum and the cuff between the greater tuberosity and the glenoid

seen in GIRD

Question 6

what pathology is often found in people with GIRD?

Answer 6

SLAP tears, partial articular sided cuff tears

Increased risk if IR deficit >20deg

Question 7

Tests for impingement

Answer 7

Neer:
- arm taken passively through full forward flexion - positive = pain at the anterior tip of the acromion (SAI or RC pathology) - pain relieved with injection of xylocaine

Hawkins:
- 90 degrees of abduction in the scapular plane -> maximally IR -> causes pain = positive.
- legit bangs the GT into the coracoacromial ligament/acromion

Question 8

AC joint tests

Answer 8

** most commonly the distal clavicle will be posterior superiorly displaced

cross arm test:
- 90 degrees forward elevation, maximal adduction
- if performed supine and positive, more indicative of posterior capsular tightness

Paxinos test

Question 9

Tests for a Slap tear

Answer 9

O’Brien Test:
aka active compression test
- 90 degrees forward flexion, elbow fully extended, 15 deg adduction, full IR of the arm
- pain relieved when performed again with arm fully supinated

Question 10

tests for long head of the biceps pathology

Answer 10

speed’s test
- 90 degrees forward elevation, elbow extended, forearms supinated
- pain with downward pressure at the forearm = positive

Yergason
- pain with resisted supination with the elbow held in 90 of flexion

Question 11

Load and shift test

Answer 11

for glenohumeral instability

• patient placed supine
• axial load the humerus into the glenoid
• use other hand to translate the humeral head anterior/posteriorly
  grade 0 - no translation
  I - head moves onto glenoid rim
  II - head can be dislocated but spontaneously reduces
  III - head does not reduce when pressure removed

Question 12

How should the forearm be positioned when testing varus at the elbow

Answer 12

supination

Question 13

How should the forearm be positioned when testing valgus at the elbow

Answer 13

pronation

Question 14

what is posterolateral rotatory insufficiency?

Answer 14

the radius and ulna move together as a subunit, together they rotate EXTERNALLY off the distal humerus

ranges from posterolateral subluxation of the radial head all the way to full posterior ulnotrochlear dislocation

Question 15

Lateral pivot shift test

Answer 15

the elbow moves from a radial head posterior-lateral dislocation in elbow extension to reduced in flexion >40degrees

Question 16

what does pain with resisted wrist flexion in pronation indicate?

Answer 16

medial epicondylitis

Question 17

what does pain with resisted wrist extension in pronation indicate?

Answer 17

lateral epicondylitis

also pain with resisted IF extension