MSK - Shoulder

Question 1

“What are you looking for on General Examination of the Patient?”

Answer 1

• Body Habitus - RF for Osteoarthritis
• Scars
• Wasting of Muscles
• Peripheral Paraphenalia

Question 2

“What are you looking for on Closer Examination of the Shoulder?

Answer 2

• Scars
• Bruising
• Asymmetry of the Shoulder Girdle (Scoliosis, Arthritis, Fractures, Dislocation)
• Swelling
• Abnormal Bony Prominences
• Deltoid Wasting (Disuse Atrophy or Axillary Nerve Injury)
• Trapezius Muscle Wasting (Disues Atrophy or Spinal Accessory Nerve Injury)
• Supraspinatus/Infraspinatus Muscle Wasting (Disuse Atrophy or Suprascapular Lesion)
• Winging of the Scapula - Serratus Anterior Muscle Weakness 2o to Long Thoracic Nerve Injury

Question 3

“What is the relevance of the Wall-Push Test?”

Answer 3

This tests the function of the Serratus Anterior Muscle - responsible for protraction of the scapula.

Winging may indicate wasting/injury to the Serratus Anterior Muscle OR damage to the long thoracic nerve.

Question 4

“Describe some Special Tests to identify Shoulder Impingement Syndrome?”

Answer 4

1. The Painful Arc
   Impingement or supraspinatus tendonitis typically causespain between 60-120° of abduction, however, this test is not specific as many other conditions can cause pain in this arc of motion and therefore it should not be used in isolation for diagnosis.
2. Neer’s Test
   - > Passively internally rotate the Shoulder, then raise the arm in an anterior arc
   - > Pain - Shoulder Impingement Syndrome
3. Hawkins-Kennedy Test
   - > Flex the shoulder to 90 and then internally rotate the shoulder and see if the pain occurs.
   - > Pain - Shoulder Impingement Syndrome

Question 5

“Describe some Special Tests to identify Rotator Cuff Injury?”

Answer 5

1. Empty Can Test - Supraspinatus
   - > Abduct arm to 90o, bring anterior, empty can and resist
   - > Weakness - Tendon Tear, Muscle Wastage, Suprascapular Nerve Injury
   - > Pain - Impingement
2. External Rotation against Resistance - Infraspinatus/Teres Minor
   - > Weakness - Tendon Tear, Muscle Wastage, or LMNL i.e. Suprascapular or Axillary Nerve
   - > Pain - Tendonitis
3. Hornblower’s Test - Teres Minor
   - > Abduct the arm to 90, then Externally Rotate
   - > Hornblower Sign - Arm falls back into internal rotation. Teres Minor Pathology or Axillary Nerve Lesion
4. Lift Off Test - Subscapularis
   - > Internally Rotate Arm up the Spine, push away from back
   - > Waeaknesss - Pathology of muscle, Subscapular Nerve Lesion.

Question 6

“Describe some Special Tests to assess Joint Stability”

Answer 6

Scarf Test - Acromioclavicular Joint

Apprehension Test - Glenohumeral Joint Capsule