Examination of shoulder and cervical spine Flashcards
What is the bony anatomy of the shoulder
Look it up - in slides
What are the different types of shoulder movements?
Flexion and Extension
Adduction and abduction
Internal and external rotation
What are the composite movements of the shoulder
Internal rotation, abduction & extension
External rotation & abduction
What are the rotator cuff muscles?
Supraspinatus
Infraspinatus
Subscapularis
Teres minor
What does the supraspinatus do?
Initiates abduction (below 90)
Above 90 deltoid takes over
What is the infraspinatus involved in?
External rotation
What is the subscapularis involved in?
Internal rotation
What is the teres minor involved in?
External rotation
What is the deltoid involved in?
Abducts after 90
What does the trapezius do?
Shrugs shoulders
Controls scapula movement
What are the 3 key points of the examination of the shoulder?
Look
Feel
Move
What are you looking for in ‘Look’?
Posture & symmetry
Muscle wasting
Scars, skin changes
Swelling
Deformity
What are you looking for in bulk?
Temperature
Bony landmarks
Muscle bulk:
- Deltoid
- Infraspinatus
- Supraspinatus
- Trapezius
1st step of move (initial screen)
“Put your hands behind your back”
“Put your hands behind your head”
Watch from front & back
Active (patient) before passive (you)
2nd step of move - next steps
Flexion/ Extension
External Rotation
- Elbows tucked in to sides
Abduction
- Painful arc?
If the patient has a painful arc what is the pathology?
Pain from 600 – 1200
(Pain 1200- 1800
Acromioclavicular joint pathology)
2 components:
Glenohumeral
scapulothoracic
Rotator cuff tests
Supraspinatus - resisted abduction <90
Infraspinatus (teres minor) - resisted external rotation
Subscapularis - “Lift off” test - resisted internal rotation
Acromioclavicular joint test - Acromio-clavicular joint osteoarthritis
Scarf test - forced adduction across body
End pieces
Assess cervical spine
Assess neurological and vascular status of upper limb
What is frozen shoulder (adhesive capsulitis)
Painful restriction all movements
external rotation +++
Who?
>40 yrs
RA, Diabetes, Post-Stroke
(Minor) trauma
Post-operative
What is involved in rotator cuff pathology?
Osteophyte impingement
Subacromial bursitis
Supraspinatus tendinitis
What is the Look, feel, move of the cervical spine?
Look
Normal lordosis
Feel
Spinous processes
Paraspinal muscles
Move
Flexion/ extension
Lateral rotation
Lateral flexion (ear to shoulder)
What are the upper limb reflexes?
Biceps C5,6
Triceps C7,8
Supinator C5,6
Upper limb movement and innervation
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
Lower limb movements
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
What happens in osteoarthritis of spine?
Narrowed intervertebral disc
They have bony spurs
Cervical spondylosis symptoms
Pain, stiffness, restricted movement, “crunching” sensation, nerve root symptoms
Spinal disc disease symptoms
Pain (worse often on bending forwards)
“Radiculopathy” nerve root pain from impingement
Burning, electric shock, running water
What are cervical nerve roots
C1 - C7 are the vertebrae
C1- C8 are the nerve roots
Bulging of C5/6 disc causes compression of C6 nerve root
