Midterm Flashcards
Describe apley’s scratch test I and II
These aren’t specific tests; often used as outcome markers. So they don’t diagnose specific structure. “Back scratch tests”
- Apley’s I reach overhead
- Apley’s II reach around and up
What are you testing with shoulder ortho tests?
Rotator cuff
Impingement
Biceps
Labrum
AC joint/instability
What tests are specific to rotator cuff?
Empty can test
Codman’s arm drop test
Napoleon and hug test
External rotators (Bugler’s and Arms at side/neutral)
Lift-off test
Perform the empty can test
What is this testing for?
Patient raises straight arms in scaption plane with thumbs up to approx 120°
Patient then turns thumbs down (empty can) and lowers arms to their side
Supraspinatus mm test may be added following the above procedure
Tests for: Rotator Cuff
Perform Codman’s arm drop test
What is this testing for?
Doctor slowly abducts patient’s arm and supports at 90, patient relaxes
Doctor informs the patient that he/she will quickly remove their support and patient needs to “catch” their arms to maintain position (90° ABD)
Tests for: Rotator Cuff
Perform Napoleon test
What is this testing for?
Patient’s arm across belly, Doctor stabilize patient’s elbow
Theory: mm test of subscapularis in 2 positions (including Hug Test, different flashcard).
Tests for: Rotator Cuff
perform Hug test
what does this test for?
Patient’s arm across chest with hand at contra shulder, elbow tucked near abdomen. Doctor stabilize patient’s elbow.
Muscle tests of suscapularis in 2 positions (including Napoleon test, on a different flashcard)
Test: Rotator Cuff
perform Lift-Off Test
What is this testing for?
Patient prone/seated/standing, places dorsum of hand on low back and attemps to lift their hand/arm away from low back. Doc can add overpressure on palmar side of patient’s hand.
Tests for: Rotator Cuff
perform Bugler’s test (2)
what does this test for?
Patient in seated, arm flexed between 45-60* and hand in front of mouth. Doctor stabilizes elbow and performs isometric mm test of external rotators.
Patient supine, arm at side and elbow flexed 90, thumb up. Doctor performs isometric mm test of external rotators.
Tests: external rotators of Rotator Cuff
what is the External Rotation Lag Sign?
Seated patient, arms at side, elbows at 90*. Ask them to hold G/H in external rotation and (+) if internal rotation drift
Note: less invasive than Buglers external rotator RC test
perform Hawkins Kennedy test
Test indicates?
doctor flexes patient’s shoulder and elbow to 90. Slight horizontal adduction of humerus. while stabilizing patient’s elbow, Doc internally rotates patient arm to endrange using patients forearm as a lever. Patient is relaxes.
Test for: impingement
perform Neer’s test
what does it test for?
- G/H flexion (flexion), palm up
- G/H flexion (flexion), palm down
- G/H flexion (flexion), palm up w/ Doc S-I overpressure at AC joint
- G/H flexion (flexion), palm down w/ Doc S-I overpressure at A/C joint
**1-4 are all passive
Tests: Impingement
Painful arc, Hawkins-Kennedy test, and Neer’s Test are all what kind of tests?
Impingement tests
when do you note a painful arc that suggests impingement?
in AROM ~70-120* of G/H ABD
Biceps Hyperextension, Speed’s, Yergason’s, Modified Yergason’s all test for?
Biceps tests
Perform Biceps hyperextension test
Stabilize patient’s shoulder. Position patient’s elbow fully flexed, palm up. Patient relaxed. Doc extends patient’s G/H joint to terminal extension then fully extends patient’s elbow while maintaining G/H extension.
Test for biceps
what is Speed’s test?
- patient’s arm straight, palm up, actively flexes should from 0 to 90˚
- patient resists doc’s downward force at 90˚ of g/h flexion (isometric)
- patient resists doc’s downward force from 0˚ to 90˚ against doc’s resistance (conentric)
- patient starts with arm at 90˚ and resists as doctor moves patients arm back to 0˚ (eccentric)
tests for biceps
Perform Yergason’s test
patient actively flexes and supinates forearm while simultaneously externally rotating the shoulder while doctor provides resistance by contacting distal forearm thorugh this ROM. Patient finishes in hitch-hiker position.
specific to SLAP lesion
perform Modified Yergason’s test
patient’s arm at side, flexed ~45˚, forearm fully pronated. patient actively flexes and supinates forearm while simultaneously externally rotating the shoulder and ABD arm to 90˚ while doctor provides resistance by contacting the distal forearm through this ROM. Patient finishes with the umpire “you’re out” position.
assess the shoulder for fx
first three first:
observe, Fx screen, AROM
Observe: antalgia, bruises/cuts, step defect, swelling, sulcus sign, shoulder hiking/depression, scars, protracted shoulders, head tilt
Fx Screen:
- light palpation, percussion, tuning fork **start far away from pain and move toward P**
- torsion test: pt seated with forearm resting on thigh, patient keeps his/her elbow at their side, doc instructs patient to “meet” doc’s hand with his/her hand in IR and ER stress. isometric (not through range). doc does not overpower patient.
AROM: abd, add, horizontal add & ABD, flexion, extension, ER and IR w/ arms ABD to 90˚, scaupulohumeral/scapulocostal observed from behind the gowned patient with scapulae exposed
during Fx screen, what locations need to be percussed and tuning forked?
medial and lateral epicondyles
spine of scapula
acromion
clavicle
what is the ˚ in full ABD AROM for shoulders?
180˚
What is Sulcus test
tests for?
pull inferiorly on a relaxed arm at the elbow. look for sulcus sign and compare bilaterally.
tests: inferior instability
what is Faegin’s test?
(+) test?
tests for?
Grasp near humeral head and glide inferiorly.
(+) = pain, clunk, or increased translation as compared to the other side
Test for: inferior instability
perform Dugas test
(+) is?
tests for?
when an unreduced anterior dislocatino is suspected, the patient is asked to place the hand on the opposite shoulder and attempt to lower the elbow to the chest.
(+) pain because this action is imposible if humerus is anterior to the fossa. if P only over AC joint, further investigation of joint should be performed.
Test for anterior instability
perform relocation and release
(+) is?
Tests for?
This test is a continuation of Anterior Apprehensino Test. Once a (+) is found, doctor praces the patient’s shoulder A-P then:
- externally rotates at wrist
- slowly lifts stabilizing hand
(+) apprehension, splinting/bracing
Tests for: anterior instability
Perform Anterior load & shift test
test for?
Pre-load by “setting” humeral head into glenoid fossa. Doc then translates/shifts the humerus from P-A
“the examiner grasps the head of the humerus with the thumb over posterior humeral head and fingers over anterior humeral head… the humerus is then gently pushed ant or post in the glenoid to set it properly in the glenoid fossa. the seating places the head of humerus in its normal position relative to glenoid”
Tests for: G-H laxity
perform Posterior Apprehension
(+) is?
tests for?
Patien seated or supine. Doc/table brace scapula. Flexion to 90˚, internal rotation until pt hand is near/on shoulder. Grip elbow and drive A-P.
(+) clunk, apprehension, pain (which may be nonspecific)
tests for: posterior instability
perform posterior load and shift
tests for?
preload by “setting” humeral head into glenoid fossa.
doc then translates/shifts humerus from A-P
tests for posterior instability
Perform Norwood Test
(+) is?
what does it indicate?
UE is ABD to 90˚ and brought across the body while the shoulder is simultaneously loaded into a posterior direction.
(+) apprehension, clunk, or hypermobility (w/ or w/o P)
Indicates: P clunk or apprehension indicates posterior humeral instability. a non-P clunk or is equivocal.
perform O’Brien’s Active Compression test
position 1
patient extends elbow with thumb pointing down; actively flexes arm to 90˚ with 15˚ ADD.
doc applies S-I force (pushes down)
Perform O’Brien’s Active Compression test
Position 2
same as position 1 except Patient fully supinates arm and doc applies S-I pressure again.
(+) for superior labral injury if pain is elicited in position 1 and reduced/eliminated in position 2
Summary of O’Brien’s Compression Test findings:
if more pain in position 1 than 2, indicates:
more pain in position 2 than 1, indicates:
P in 1>2 indicates labrum
P in 2>1 indicates biceps tendon
perform Clunk test
(+) finding?
suggests?
patient supine or seated with arm ABD near 160-180˚
Doc applies A-P pressure at wrist and P-A pressure at shoulder
(+) P w/ clunk or grinding
suggests labral tear
perform Crank test
(+) is?
test indicates?
Patient supine or seated with arm ABD 160-180˚. Doc applies axial load down the humerus and then IR and ER.
(+) pain inside joint or Pful crepitus
Indicates: Labrum tear (slap lesion)
“patient is supine or seated with elbow flexed to 90˚. examiner raises patient’s arm to 160-180 in the scauplar plane. now examiner applies long axis compressive load on the GH joint while pressing down on the patietn’s elbow with one hand, while rotating the humerus externally and internally with the other hand. Shoulder pain and crepitis indicate possible labral tear).”
perform Passive Compression Test
(+) is?
test indicates?
Patient side lying. doctor stabilizes AC joint with one hand. Other hand on patient’s elbow, ER at 30˚ of ABD and applies axial compression while extending patient’s arm.
(+) P
Indicates labral tear
perform Passive Distraction Test
(+) is?
indicates?
Pt supine with shoulder at 150˚ ABD, palm up, elbow extended. Doc stabilizes upper arm, distraction occurs where biceps attach to labrum, pronates forarm
(+) P
indicates labral tear
Perform Anterior Slide Test
(+) is?
test indicates?
Patient standing, hand on hip.
Doc’s passive hand near joint, Doc’s active hand is over elbow. Load up in the direction of the joint, and foward into flexion. Patient resists doc’s pressure (maintains position).
(+) Pain or palpable clunk
Test indicates unstable SLAP lesion
Perform Biceps Provocation Test
Patient sitting with shoulder at 90˚, elbow at 90˚. Doc palm facing patient. Patient externally rotates until point of apprehension. Patient actively rotates palm toward doctor.
(+) apprehension, pain
Perform Biceps Load test
(+) is?
tests for?
Same position as Biceps Provocation Test: Patient sitting with shoulder at 90˚, elbow at 90˚. Doc externally rotates until apprehension. Have patient contract against resistance.
(+) Pain and/or snap
Indicates SLAP lesion
Perform Passive Cross Body ADD
Patient seated or supine. Doc passively horizontally ADD the arm as far as possible
(+) local P over AC joint
(P over SC joint is possible but is not +)
Perform Paxinos Pinch / Squeeze Test
(+) is?
indicates?
patient seated, affected arm relaxed by side
Doc places thum on posterolateral acromion and fingers on anterior clavicle and applies squeezing force.
(+) local AC P or exacerbation
indicates AC lesion
Perform Active (Resisted Horizontal) ABD Test
(+) is?
indicates?
Seated or standing patient, shoulder and elbows flexed to 90˚ and arm IR.
Doc stabilizes the ipsi shoulder with 1 hand and applies resisted force against horizontal ABD with the other hand.
(+) when local AC P is produced
Indicates AC lesion
