Midterm Practical Prep Flashcards
Open pack of shoulder
55 degrees flexion with 30 degrees horizontal ABD and slight external rotation (scaption plane)
Closed pack of shoulder
maximal ABDuction and ER
capsular pattern of shoulder
ER> ABD>IR
Glenohumeral lateral distraction
for all motions
Glenohumeral inferior glide
For abduction
Glenohumeral Posterior glide
Flexion, horizontal ADDuction
shoulder instability history
History
-Multiple recurrent subluxations
-Injury to the shoulder
-Dislocation
Sensation of something slipping/ unstable or anxiety in certain positions
Sulcus sign
for shoulder instability
Patient sitting. Inferior glide of humerus. Measured in centimeters inferior acromion to humeral head
Load and shift (inferior, posterior, anterior)
sitting- must stabilize scapula. Starting position: passively position humerus within glenoid. 0-3 scale. 0=no laxity, 3= complete loss of humeral position on glenoid
NORMAL=anterior is half distance of humeral head
Apprehension/ relocation/ release RULE IN
Apprehension
Patient is supine. Arm positioned in 90 degrees abduction and moved towards full ER. Positive= Apprehension (spec .99, sens .53, +LR 53)
Relocation
From above position of apprehension, apply posterior glide of humerus. Positive= decreased apprehension (sens .46, spec .54, +LR 1.0, -LR 1.0)
Release (surprise test)
From above position, release posterior force. Positive= return of apprehension (sens .64, spec .99, +LR 64, -LR .36)
Labral tear history
Fall on outstretched arm or shoulder
Brace one self with an outstretched arm in a MVA
Lifting heavy objects repeatedly
Overhead activities
labral tear symptoms
Popping, clicking, or catching in the shoulder.
Pain when you move your arm over your head or throw a ball
A feeling of weakness or instability in the shoulder
Aching pain of vague location
labral tear anterior slide test
Patient standing or sitting. Hand on hip. Examiner stabilizes scapula with one hand and with other hand on elbow, applies an anterior/superior force. Patient instructed “don’t let me move you.” Positive= click in anterior shoulder
crank test
for labral tear
Patient supine. Examiner passively elevate arm to 160 degrees scaption. Axial load applied to humerus and shoulder is IR and ER. Positive=Pain(+LR 1.05, -LR .96)
Active compression test
for labral tear
Patient standing. Active flexion to 90 degrees with 10 degrees ADDuction and full IR. Examiner provides a downward force versus resistance. Patient then ER shoulder and test is repeated. Positive= pain with first maneuver and decreased pain with second maneuver
Bicep load test
for labral tear,
Patient supine. Arm is passive ABDucted 90 degrees with elbow in 90 degrees flexion and supinated. Examiner ER arm until patient reports apprehension. Resisted elbow flexion performed. Positive= Pain
sub-acrominal impingement history
overhead activities
Subacromial Impingement symptoms
Difficulty reaching up behind the back
Pain with overhead use of the arm
Weakness of shoulder muscles
Test Item Cluster for Identification of Subacromial Impingement Syndrome
Hawkins and Kennedy Impingement sign
Painful arc sign
Infraspinatus muscle test
Hawkins and Kennedy Test
for subacromial impingement
Patient standing. Passive elevation of shoulder to 90 degrees scaption, elbow in 90 degrees flexion. Passive IR to pain or end range. Positive= pain
Painful arc sign
for subacromial impingement
Patient instructed to fully flex arm in scapular plane and then slowly lower. The test is positive if the patient has pain between 60 and 120 degrees.
Infraspinatus Muscle Test
for subacromial impingement
Arm in neutral and elbow flexed to 90 degrees. The patient resists internal rotation force. A positive test is pain and weakness when pressure applied.
Neer Test (+LR 1.5, -LR 0.68)
for subacromial impingement
Patient sitting or standing. Examiner stabilizes scapula with one hand.
Passive shoulder elevation with full IR. Positive=pain.
Rotator cuff history
Age (>40)
Overhead sports
Overhead occupations
rotator cuff symptoms
dull ache deep in the shoulder
Disturb sleep, particularly if you lie on the affected shoulder
Painful to reach behind back
weakness
Test item cluster for the identification of a full-thickness rotator cuff tear
Drop arm sign
Painful arc sign
Infraspinatus muscle test
Drop arm test
for supraspinatus tear
The patient is asked to elevate arm in scaption plan and slowly lower. The test is positive if the arm drops suddenly.
Full and empty can
for supraspinatus tear,
Positive= pain and or mus weakness.
ER lag sign Rule IN
for supraspinatus tear
Patient seated. Shoulder scaption 20 degrees with elbow flexed 90 degrees. Examiner passively ER shoulder to within 5 degrees of full motion. Patient told to hold in position when examiner releases. Positive= patient unable to maintain ER
Dropping sign
infraspinatus tear
Patient seated. Examiner passively places shoulder in 90 degrees ABDuction with 45 degrees ER and elbow flexed 90 degrees. Patient instructed to hold position when released. Positive= patient unable to maintain position.
Horn blower’s sign
for teres minor tear
Patient seated. Examiner passively places shoulder in 90 degrees scaption and asks patient to ER against resistance. Positive= unable to ER shoulder
IR lag sign
for subscapularis tear
Patient seated. Examiner passively IR shoulder by placing hand behind back. With elbow in 90 degrees flexion, examiner passively extends shoulder. Patient instructed to hold position when released. Positive= patient unable to maintain position.
AC joint separation history
FOOSH (fall on outstretched hand), direct blow to shoulder
Cradling arm decreases pain
Pain directly over AC joint
AC joint separation symptoms
Horizontal ADDuction painful
Positive active compression test
AC Joint Separation type I
AC ligament disruption but coracoclavicular ligaments intact
AC Joint Separation type II
AC joint ligaments torn and coracoclavicular ligaments disrupted
AC Joint Separation type III
All ligaments torn and complete AC joint separation.
Active compression test Rule IN and OUT
AC joint lesion
Patient standing. Active flexion to 90 degrees with 10 degrees ADDuction and full IR. Examiner provides a downward force versus resistance. Positive = pain localized to AC joint
ULTT- A
Patient is supine. Upper extremity is passively moved into the following position IN ORDER
-Scapular depression
-Forearm supination
-Wrist and finger extension
-Shoulder ER
-Elbow extension
-Shoulder ABDuction
No symptoms: ask patient to SB away and towards UE
Pain with cervical compression
Disc
Vertebral body fracture
Nerve root irritation (radiating)
Decreased pain with cervical distraction
Disc
Spinal Facet
Nerve root (centralizing)
Spurling’s
Patient seated
Cervical extension with SB
PT applies compression gently
Positive= radiating symptoms
Test Item Cluster- Radiculopathy
ULTT-A
Spurling’s
Distraction
Cervical rotation < 60 degrees to ipsilateral side
Test for upper cervical instability
sharp purser, tests transverse ligament
Vertebral artery tests
Hautant
Cervical quadrant test
Pre manipulative position test
Hautant test
Patient is seated
Shoulders are flexed to 90 degrees
Patient closes eyes 10 sec
If arms move, proprioceptive loss has a NON vascular cause
If negative, have patient open eyes and extend and rotate neck to one side. Hold 10-30 sec
If arms move or nystagmus or dizziness, vascular cause suspected
cervical quadrant test
Patient supine, eyes open
Passive movement of head into extension, and ipsilateral SB and ROT
Hold 30 sec
neck flexor muscle endurance test
Patient positioned in supine/ hooklying
Chin is maximally retracted and maintained isometrically as the head and neck is lifted 1 inch above the table
PT places fingers in space to ensure height is maintained
Test is terminated with patient loses retraction or head falls
Normal: 38 sec
shoulder abduction test
Patient is seated and asked to place symptomatic extremity on head. Positive if symptoms reduce
Strength parameters for novice
Load: 60-80% of 1RM
Volume: 1-4x7-12 reps
Rest: 2-3 min for multijoint, 1-2 min for assistive exercises
Frequency: 2-3x/week
Hypertrophy parameters for novice
Load: 70-85% of 1RM
Volume: 1-3x6-10 reps
Rest: 1-2 min for assistive exercises
Frequency: 2-3x/week
Power parameters for novice
Load: 30-80% of 1RM
Volume: 1-3x7-30 reps
Rest: 1-2 min for assistive exercises, 2-3 min for multi-joint exercises
Frequency: 2-3x/week
Endurance parameters for novice
Load: 30-60% of 1RM
Volume: 4-7x12-30 reps
Rest: <1 min
Frequency: 2-3x/week
