Lab 7 : Shoulder Complex Exam Flashcards
What is the order to shoulder complex examination
- pt hx
- observation
- UQ scam (if needed)
- AROM , PROM ,flexibility
- mm performance
- joint play
- palpation
- special test
What are the active shoulder ROM that we MUST measure
Flexion
Abduction
IR
ER
When do u test passive ROM for shoulder
Only if AROM is limtited adn then do over pressure in neutral if AROM is painful
What is the painful arc sign
Painful arc w AROM of elevation
GH pain in mid ROM ; 60-120° (max stress on sub acromial space)
AC pain at end ROM (max stress on AC joint)
What should pain ful arc sign increased ur suspicion of
RC pathology
What is painful arc sign a sign of
Impingement
At what degress will someone have pain with a painful arc sign
60-120 (mid range- GH joint)
170-180 (end range - AC joint)
Painful arc is a indicates RC impingement , SA bursitis between what ROM
70-110
How do u perform the scapular dyskinesis test
Have pt raise and lower arms 3-5x , if necessary increased reps to 10 &/or ass weight
Test results are either normal or obvious
What can scapula dyskinesis be related to
SA impingement
What is a SICK scapula
Malposition of scapula , inferior medial boarder , coracoid w pain and malposion , scapular dyskinesia
Limitations in AROM and PROM may suggest what ?
Capsular involvement
What ROM do we suspect to be limited if we think there is a mm invovlment
AROM but not PROM
How long should u hold for isometric hold resisting movements
5 seconds
What part of the capsule does distraction hit
Whole capsule
What mob grade would u do if a patient has exctreme pain
Grade 1
What kind of GH joint glide should u do for frozen shoulder
Anterior
When would u assess joint play at the AC joint
- pain over theAC joint
- pain w palpation
When would u do a SC joint play assessment
Pain w breathing , redness or swelling
What joint play would u assess if the scap is invovled
ST joint play
If we palpate and there is pain near the deltoid tuberosity (anterior/lateral) what do we think
RC
What are the 4 special test for impingement testing in the shoulder
- Neer
- Hawkins-Kennedy
- Cross-body adduction
- Painful arc (usually do when doing ROM so dont have to assess again)
What are the 7 special test for MM/tendon pathology test
• Speed’s test
• Empty can
• Full can
• ER lag sign
• Belly press
• Lift-off sign/IR lag sign
• Drop arm
If someone has a painful arc what joint mob would u do
Postieor glide bc painful arc is flexion (antihero roll , posterio glide)
What kind of test is the Neer test
Provocation test for impingement
How do u perform the Neer test and what is a (+) test
Pt arm passively into elevatation w arm IR by PT and then repeat with ER .. this motion causes greater tuberosity to jam against anterior inferior boarder of acromion
(=) concordant pain - indicated overuse or injury to supraspinatus mm $ maybe biceps tendon
Is teh Hawkins Kennedy test a active or passive test
for impingement
Passive
How do u perform the Hawkins Kennedy test and what is positive sign
Pt sits while PT puts arm into horizontal ADD at 90° and then go into IR and then u can go further into horizontal ADD
(+) pain , indicated supraspinatus tendinopathy
What does the movement of the Hawkins Kennedy test do to the supraspinatus tendons
Presses it against anterior surface of Coraco acromial ligament and coracoid process
How do u perform the cross body adduction test and what is positive test
Pt sits and PT elevates are to 90° of flexion and then horizontally adducts arm to end range
If they have pain ask where and if they point to th lateral side of delta then impingement if pain on top think AC joint
(+)= sub acromial pain
Which mm/ tendon pathology test is testing the long head of the biceps
Speeds test
Which mm/ tendon pathology test is testing the supraspinatus
Full can test and empty can test
Which mm/ tendon pathology test is testing the infraspinatus
Infraspinatus strength test ( ER lag sign)
Which mm/ tendon pathology test is testing the subscapularis mm
Belly press test (napoleon sign)
Lift off test
How do u do the speed’s test and what is a (+) test
PT resist flexion while arm is fully extended and forearm supinated
(+)= increase tenderness around bicipital groove , indicates long head of biceps tendinopathy
How do u do a full can test and what is a (+) test
Patient arm is elevated in shoulder scaption plane and then ER (w thumbs up) and PT pushes down on arms
(+)= weakness and reproduction of patients` SYMTOMS , may indicate supraspinatus tendinopathy
What test do u do if full can is (-) and then how do u perform the test and what is a (+) sign
Empty can test .. same position and test as full can but now thumbs down into IR
(+)= weakness and reproduction of symptoms and may indicate supraspinatus tendinopathy
How do u perform the infraspinatus strntgth test and what is a (+) sign
Pt asked to hold arm 45° out to side in scapular plan and then maintain ER positions against resisting
(+)= pt can’t resist ER 2/2 pain to weakness
What is the ERlag sign
Same position as infraspinatus strength test but u ask pt to hold the positions of ER before releasing wrist
(+)= inability to hold position , arm falls , indicating infraspinatus tear - big tear
How do u perform the Belly Press test (napoleon sign) and what is a (+) sign
Pt sitting w hand across belly and PT grasps pt wrist and attmesp to pull hand away from belly
(+)= hand moves away from belly or elbow moves posteriorly to compensate , indicates subscapularis mm weakness
How do u perform the lift off test and what is a (+) sign
Pt stands and places dorsum of hand on belt line and lifts hands away from back .. if they can do this then PT adds resistance
(+)= inability to do so indicating subscapularis path
What is the IR lag sag and what is a (+) sign
PT places pt arm in testing position of life off and asks them to hold their arms in IR
(+)= pt unable to hold their arm in IR behind back
How do u perform the Drop arm test and what is a (+) sign
Place pt arm passively into 90° of abduction w elbow straight and shoulder ER and tell pt to hold position and PT release wrist
(+) cant hold arm up , indicated significant RC path
What special test are for instability
- Apprehension & relocation tests
- Sulcus sign
- Posterior apprehension test
What special test are for SLAP lesion tests
- Active compression/O’Brien’s test
- Biceps Load I
- Biceps Load II
What special test are for labral tests
Clunk test
What special test are for scapular stability test
- Scap dyskinesis test
- Scap assistance test
- Wall (floor) push up
- Pec minor tightness
What special test are for AC joint pathology test
- Presence of step deformity
- Palpation
- Cross-body adduction test
- Active compression/O’Brien’s test
How do u perform the Apprehension test for GH instability and what is a (+) sign
Pt is supine w arm in 90° of abduction and max ER and PT applies over pressure in ER
(+)= apprehension (feels like shoulder is coming out of place)
Indicated anterior GH instability
When and how do u perform the Jobe relocation test and what is (+)
Only if apprehension test is (+)
Same position as apprehension test but PT applied a posterior stress to hmerual head
(+)= decreased apprehension/ decrease SYMTOMS
Indicated anterior GH instability
What kind of instability is the sulcus sign testing for
Multidirectional instability
How do u perform the sulcus sign and what is a (+) sign
Pt is sited and PT abducts arm 20-50° and then applies a downward traction force to distal humerus
(+)= depression greater then 1 finger between acromion and humerus head
Indicates inferior or multi directional GH instability
What are the 3 grades from Sulcus sign
• Grade1+=1cm
• Grade 2+ = 1-2 cm • Grade3+=>2cm
When and how do u do the posterior apprehension test and what is a (+) sign
Only do if u think posteior instability
In supine PT flexion pt arm into 90° then horizontally adduct shoulder ( to move humeral head away from scap) then provides a posteriorly directed force
(+)= pain , apprehension in posterior shoulder
How do u do the acute compression/O’briens test (SLAP lesion)
- pt arm flexed to shoulder height and elbow fully extended , arm is horizontally abducted 15° and then IR , PT applied a downward force while pt resist and then start over and do ER
(+)= pain/reproduction of symptoms w/ IR that improves w/ ER, indicate labral path
How do u do the biceps load 1 test and what is a (+) sign
Pt supine w shoulder in 90° of elevation , full ER and elbow flexed to 90° w forearm supinated then PT resist elbow flexion (90-90 w palm facing head)
(+)= reproduction of shoulder pain
w/ resisted elbow flexion, indicate slap
How do u do the biceps load 2 test and what is (+) sign …better then biceps load 1
Same position as biceps 1 test but w pt shoulder in 120° of shoulder elevation instead of 90°
(+)= reproduction of shoulder pain w/ resisted elbow flexion
How do u perfomr the clunk test and what is a (+) test
Pt in supine and PT places 1 hand posterior to humeral head and grasp elbow w other and fully abducts arm over pt head and pushes hummer head anteriorly while other hand is ER humerus
(+) clunk or grinding sound, may cause apprehension if instability is present.. indicated labral tear
How do u perform the scapular assistance test and what is (+) sign
Pt in stnading and PT places 1 hand on superior angle of scap and other on inferior angle and then pt actively elevated UE while PT upwardly rotates scap
(+)= decreased shoulder symptoms .. and then we know it is caused by scapular dyskinesis
How does the scapular assistance test help
Opens up the subacromial space
How do u perform the pec minor tightness test and what is a (+) sign
Pt supine w arms at side , PT places hands over coracoid and pushes down
(+)= difference in shoulder heights from table (used acromion as land mark)
What may tight pec minor lead to
Scapular protraction and tilting of inferior angle
