Examination of shoulder and cervical spine

Question 1

What is the bony anatomy of the shoulder

Answer 1

Look it up - in slides

Question 2

What are the different types of shoulder movements?

Answer 2

Flexion and Extension
Adduction and abduction
Internal and external rotation

Question 3

What are the composite movements of the shoulder

Answer 3

Internal rotation, abduction & extension
External rotation & abduction

Question 4

What are the rotator cuff muscles?

Answer 4

Supraspinatus
Infraspinatus
Subscapularis
Teres minor

Question 5

What does the supraspinatus do?

Answer 5

Initiates abduction (below 90)
Above 90 deltoid takes over

Question 6

What is the infraspinatus involved in?

Answer 6

External rotation

Question 7

What is the subscapularis involved in?

Answer 7

Internal rotation

Question 8

What is the teres minor involved in?

Answer 8

External rotation

Question 9

What is the deltoid involved in?

Answer 9

Abducts after 90

Question 10

What does the trapezius do?

Answer 10

Shrugs shoulders
Controls scapula movement

Question 11

What are the 3 key points of the examination of the shoulder?

Answer 11

Look

Feel

Move

Question 12

What are you looking for in ‘Look’?

Answer 12

Posture & symmetry
Muscle wasting
Scars, skin changes
Swelling
Deformity

Question 13

What are you looking for in bulk?

Answer 13

Temperature
Bony landmarks
Muscle bulk:
- Deltoid
- Infraspinatus
- Supraspinatus
- Trapezius

Question 14

1st step of move (initial screen)

Answer 14

“Put your hands behind your back”
“Put your hands behind your head”
Watch from front & back
Active (patient) before passive (you)

Question 15

2nd step of move - next steps

Answer 15

Flexion/ Extension
External Rotation
- Elbows tucked in to sides
Abduction
- Painful arc?

Question 16

If the patient has a painful arc what is the pathology?

Answer 16

Pain from 600 – 1200
(Pain 1200- 1800
Acromioclavicular joint pathology)
2 components:
Glenohumeral
scapulothoracic

Question 17

Rotator cuff tests

Answer 17

Supraspinatus - resisted abduction <90
Infraspinatus (teres minor) - resisted external rotation
Subscapularis - “Lift off” test - resisted internal rotation

Question 18

Acromioclavicular joint test - Acromio-clavicular joint osteoarthritis

Answer 18

Scarf test - forced adduction across body

Question 19

End pieces

Answer 19

Assess cervical spine
Assess neurological and vascular status of upper limb

Question 20

What is frozen shoulder (adhesive capsulitis)

Answer 20

Painful restriction all movements
external rotation +++
Who?
>40 yrs
RA, Diabetes, Post-Stroke
(Minor) trauma
Post-operative

Question 21

What is involved in rotator cuff pathology?

Answer 21

Osteophyte impingement
Subacromial bursitis
Supraspinatus tendinitis

Question 22

What is the Look, feel, move of the cervical spine?

Answer 22

Look
Normal lordosis

Feel
Spinous processes
Paraspinal muscles

Move
Flexion/ extension
Lateral rotation
Lateral flexion (ear to shoulder)

Question 23

What are the upper limb reflexes?

Answer 23

Biceps C5,6

Triceps C7,8

Supinator C5,6

Question 24

Upper limb movement and innervation

Answer 24

Shoulder abduction/ flexion - C5
Elbow flexion - C5/6
Elbow extension - C7/8
Wrist flexion/ extension - C6/7
Finger flexion/ extension - C7/8
Finger abduct/ adduct - T1

Question 25

Lower limb movements

Answer 25

Hip flexion - L1/2
Hip extension - L4/5
Knee flexion - L5/S1
Knee extension - L3/4
Ankle dorsiflexion - L4/5
Ankle plantar flexion - S1
Gt toe dorsiflexion - L5

Question 26

What happens in osteoarthritis of spine?

Answer 26

Narrowed intervertebral disc
They have bony spurs

Question 27

Cervical spondylosis symptoms

Answer 27

Pain, stiffness, restricted movement, “crunching” sensation, nerve root symptoms

Question 28

Spinal disc disease symptoms

Answer 28

Pain (worse often on bending forwards)
“Radiculopathy” nerve root pain from impingement
Burning, electric shock, running water

Question 29

What are cervical nerve roots

Answer 29

C1 - C7 are the vertebrae
C1- C8 are the nerve roots
Bulging of C5/6 disc causes compression of C6 nerve root