Intro to Joint Examination: Hip and Shoulder Flashcards
What are the movements of the shoulder? (7)
Flexion and extension
Abduction and adduction
Internal and external rotation
Circumduction
What are the movements of the hip? (6)
Flexion and extension
Abduction and adduction
Internal and external rotation
What do you say in the introduction before examining the patient? (4)
Name, role and purpose of examination
Ask if they have any pain
Ask which joints are affected
Gain consent
How do you examine the shoulder?
Look, feel, move and function
LOOK - look from front, side and behind for loss of symmetry, muscle wasting or scars. Look for normal aligment vs deformity and inflammation.
FEEL - feel the temperature over joint line, then palpate
bony landmarks, joint line and surrounding muscles for tenderness, swelling and crepitus.
MOVE - full extension and flexion, abduction, elbow flexed to 90 and tucked into side external rotation (for frozen shoulder). Then do passive movements (while feeling for crepitus). Assess scapula movement during abduction. Resisted movements.
FUNCTION - put hands behind your head, hands behind your back.
How do you position a patient for a shoulder examination?
Ensure the patient is comfortable, in a private area, sitting on the edge of the bed or in a chair. BOTH shoulders should be exposed for comparison.
Give some examples of abnormalities of the shoulder. (4)
Left shoulder subluxation and wasting of the deltoid, supra- and infraspinatus
‘Step’ deformity of left shoulder due to acromioclavicular separation
Anterior dislocation
Right trapezius muscle wasting
How do you assess scapulo-humeral rhythm?
Observe (comparing both sides) and lightly palpate over the scapula as the patient abducts their arm through its full range.
With the shoulder, what are you feeling for anteriorly?
Sternoclavicular joint, length of the clavicle, acromioclavicular joint, acromion, humeral head
With the shoulder, what are you feeling for posteriorly?
Tenderness and pain over supra- and infraspinatus
What do resisted movements test?
Tendons and tendon/bone junctions, as
well as power
What are the special tests for the shoulder? (4)
Painful arc and scarf sign (impingement/subacromial bursitis)
Empty can sign (supraspinatous) - abduct arm, and ‘empty can’ (full internal rotation)
Lift off sign/Gerbers Test (subscapularis) - hand behind back, try to lift off from back
Speeds test (biceps) - supinate arm, resist flexion and this causes pain in bicipital groove
What is frozen shoulder/adhesive capsulitis?
The capsule of the joint becomes inflamed; thus the
patient complains of pain on moving their shoulder
away from the body (until they are unable to use the
joint).
How can frozen shoulder be demonstrated?
Ask patient to flex their elbows to 90 degrees with arms held in adduction. Then passively moving the
shoulder into external rotation.
What must you isolate when doing the MOVE part of the shoulder exam?
Isolate glenohumeral joint (place your hand
firmly on the top of the patient’s shoulder).
How do you examine the hip?
Look, feel, move, special tests and function
Look - lying as flat as possible. Compare for symmetry (e.g. one leg shorter than the other). Can check with tape measure (ASIS to medial malleolus). Check for scars.
Feel - palpate greater trochanter for tenderness.
Move - flexion, extension, internal and external rotation (with hip and knee flexed to 90 degrees). Active, passive, resisted.
Special tests - Thomas’ test (check if lumbar lordosis removed during full flexion of the hip, if positive contralateral leg lifts off bed) and Trendelenberg’s (stand on each leg alone, if positive hip drops)
Function - ask to walk
