Lab - Shoulder Special Tests & Injuries Flashcards
History questions for shoulder pain?
Chronic/ gradual onset or acute/ traumatic onset?
MOI
Specific location?
Crepitus, weakness, numb or tingly
What makes it better or worse (aggravating and easing)
Any neck involvement?
Any radiation to arm/ hand
Observation for Shoulder?
One shoulder higher?
Scapula positioning?
Deformation at joints (SC, AC, GH)
Color changes
msc bulk/ asymmetry
Watch ScapuloHumeral rhythm
Forward Head Posture (FHP), rounded shoulders, T-spine kyphosis
Are scapula the same height? - Sprengel’s deformity
Palpation for Shoulders?
Feel SC, AC, GH joints
SC - press gently inferiorly, posterior, superior
AC - press inf, ant, post - step deformity?
GH - press into ant, med, post - any differences in msc bulk
Notice any differences in msc bulk
Glenohumeral Stability Tests?
Crank/ Apprehension test
- tests anterior capsule
- Abduction, 90 degree elbow flexion, start to ER until client shows apprehension/ pain - pain = + test.
Jerk Test
- posterior apprehension test
- Supine – shoulder and elbow flexed to 90 – add axial load while adding horizontal adduction and internal rotation
SPecial Tests for HSoulders>
First assess AROM, then PROM, then RROM
1) Resisted msc testing (Don’t do if AROM and PROM are really bad) –> know which mscs do what
- flex, abduct, ext, add, IR, ER, elbow flex/ ext/ supination/ pronation.
Have patient sit and flex elbow to 90 and have the patient resist against you for each mvm.
- Use this to narrow down the number of muscles you will then do specific manual msc tests
Glenohumeral Impingement Tests?
Neer Test
- for subacromial impingement
- Patient sitting - depress scapula - perform forced flexion in an overhead position (can also add IR)
Hawkins-Kennedy Test
- for subacromial/ supraspinatus impingement
- sit or stand - 90 degree flex for shoulder and elbow - add forced IR (can also add horizontal adduction)
Supraspinatus Tests?
Empty can test
- for supraspinatus impingement/ weakness
- stand - 90 degree shoulder flex in scapular plane , full IR so thumbs point at floor. Patient resists downward applied pressure
Drop Arm Test
- Only for supraspinatus/ rotator cuff tear/ major deltoid injury
- stand - passively raise arm to 90 degrees abduction - then let go –> See if patient can slowly lower/ control it as It falls.
Serratus Anterior Test?
Wall Push-Up
- serrates anterior weakness
- Have patient face wall - arms shoulder width apart on wall - perform wall pushup - look for scapula winging
Can also be done sitting and passively
Biceps Tests?
Yurgason’s Test
- for transverse humeral lig rupture/ biceps pathology
- Elbow flexed at 90 - fully pronated - resist supination (can also resist forced extension in combination)
Speed’s Test
- for biceps tendonitis or tnedonopathy
- Start in extension and supination - resist flexion and palate the bicipital groove OR –> shoulder flexed to 90 - elbow extended - forearm supinated - resist flexion
Thoracic Outlet Syndrome?
Compression of the neuromuscular bundle in the neck and shoulder
- Under clavicle and b/w first rib
- From car accidents or sports
S&S
- numb/ tingles
- weakness
- lack of blood flow
- Poor control
- color change
- pain/ annoying
?
Clavicle (quite common)
Humeral
Scapular
Shoulder Spains?
SC joint
- should be seen by ER Dr. b/c is close to major blood vessels and trachea
AC joint
- Separated shoulder
- grades 1-6 based on which lig. is sprained/ ruptured
- Look for step deformity
GH joint
- Can occur in any of those ligs.
Dislocation?
Anteriorly, posteriorly, or Inferiorly
- also get reduced by doctor and get X-ray
Don’t try to relocate on our way
- might pinch axillary n. or blood vessels
- However, if there is already impingement and you can’t get to hospital quick then might be best to do yourself.
Dislocation MOI?
Anterior = abd, ER, extension
Posterior = FOOSH or add/ IR
Inferior = arm above head and fall onto it
Labral Tears?
Lesions/ tears to the glenoid labours
- Bankart lesion = detached labrum and capsule anteriorly
- Hill-Sachs Lesion = divot in the humeral head posteriorly/ laterally
SLAP lesion = Superior aspect of the Labrum Anterior to Posterior: affects the attachment of the long head of bicep
FOOSH?
Fall On Out-Stretched Hand
S&S of Labral Tear?
Catching sensation
Pain
Feel like shoulder is coming out of socket
Difficulty lifting arm
Caused by trauma
Chronic Instabilities?
Trauma
Repetitive use
Congenital
Neuromsc (stroke)
Focus on rehab - maybe surgical stabilization if that fails
Shoulder Impingement?
Swimmer’s shoulder
- compression of LHB, supraspinatus, and/ or subacromial bursa under the coracoacromial arch
Why? –> weakness due to traumatic tear or msc imbalance - weakness of rotator cuff mscs.
Treatment for Impingement?
Msc length? –> stretch tights mscs
Strengthen scapula and shoulder mscs
Joint capsule flexibility
Coordination of the SH rhythm
Bursitis?
most common in subacromial bursa
from trauma or overuse
Frozen Shoulder?
Cause unknown
Thickening and contraction of joint capsule
Adhesive Capsulitis
Decreased Synovial fluid
Chronic inflammation w/ joint fibrosis
RC mscs contract and become inelastic
Rehab can take up to a year
Phases of Frozen Shoulder?
Phase 1
- Lots of pain and inflammation
- ROM limited b/c of pain
- use meds, gentle ROM exercises
Phase 2
- still lots of pain
- now decreased ROM - stiff and painful
- Meds, gentle active and passive ROM
Phase 3
- reduced pain
- ROM is now very limited
- Meds
- Aggressive stretch of capsule and surrounding mscs
- Increase ROM
Biceps Rupture?
May require surgery
- Distinct MOI w/ sound
- Look for Popeye’s Sign
- Do Bicep squeeze test
-Don’t usually surgically repair for gen-pop - other mscs compensate
Biceps Tendonitis/ tenosynovitis?
Repeated stretch of the LHB can lead to irritation of tendon or synovial sheath as ut passes under the transverse humeral lig. in bicipital groove
Complete rupture of the
transverse ligament can occur,
then the LHB is constantly
inflamed (degeneration,
scarring, and/or a subluxed
tendon)
Peripheral Nerve Injuries?
Blunt trauma or a traction stretch injury
S&S of Peripheral Nerve Injuries?
Constant pain
Msc weakness
Paralysis
Msc atrophy of hand/ palm
nerve palsy can result in wrist drop
