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MSK - Shoulder Flashcards

1
Q

What are the active movements in the shoulder, normal ranges and end feels?

A 
Abduction 170-180° - tissue stretch
Flexion 160-180° - tissue stretch
Scaption 170-180° - tissue stretch
Extension 50-60° - tissue stretch
Adduction 50-70° - STA
IR 60-100° - tissue stretch
ER 80-90° - tissue stretch
Horizontal Adduction 30° - tissue stretch/STA
Horizontal Abduction 90° - tissue stretch
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2
Q

LTT - Internal Rotators

A

Supine ER with shoulder at 90° abduction and elbow flexion

+ve = should go to 90°, if not then tight

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3
Q

LTT - External Rotators

A

Supine IR with shoulder at 90°

+ve = should go to 70°, if not then tight

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4
Q

LTT - Pec Major (clavicular head)

A

Supine, shoulder in full horizontal abd and ER

+ve = should be able to drop to table level

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5
Q

LTT - Pec Major (sternal head)

A

Supine, shoulder in 135° abd and full horizontal abd and ER

+ve = shoulder should drop to table level

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6
Q

LTT - Teres Major, Lats, Rhomboids

A

Raises arms in sagittal plane full shoulder flexion

+ve = shoulder should drop to table level

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7
Q

MMT - Scap elevators

A

Position - sitting; gravity eliminated prone

Resistance - into shoulder depression

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8
Q

MMT - Shoulder Flexors

A

Position - sitting; gravity eliminated side lying

Resistance - prox to elbow in extension direction

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9
Q

MMT - Shoulder Extensors

A

Position - prone; gravity eliminated side lying

Resistance - prox to elbow into flexion

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10
Q

MMT - Shoulder Abductors

A

Position - sitting; gravity eliminated supine

Resistance - prox elbow into adduction

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11
Q

MMT - External Rotators

A

Position - prone with arm off table supported in 90° abd and elbow flex; gravity eliminated sitting arm at side
Resistance - support humerus and resist into IR prox to wrist

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12
Q

MMT - Internal Rotators

A

Position - prone arm over edge of table; gravity eliminated sitting arm at side
Resistance - into ER at prox wrist

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13
Q

MMT - Anterior Deltoid

A

Axillary C5-C6
Position - supine in shoulder abduction, slight flexion, IR
Resistance - into extension and adduction on ant arm prox to elbow

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14
Q

MMT - Posterior Deltoid

A

Axillary C5-C6
Position - prone with shoulder in abd and slight ER; flex elbow to 90
Resistance - obliquely down into adduction/horizontal add

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15
Q

MMT - Pec Major Upper Clavicular

A

Lat Pectoral Nerve C5-C7
Position - supine with shoulder in 90° flex and slight med rotation
Resistance - stabilize opposite shoulder and into horizontal abd and slight ext against forearm distal to elbow

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16
Q

MMT - Pec Major Lower Sternal

A

Medial Pectoral Nerve C6-T1
Position - supine with shoulder in less than 90° flex and slight IR
Resistance - stabilize opposite iliac crest and resist forearm in lateral and cranial direction (horizontal abd and slight shoulder flex against forearm distal to elbow)

17
Q

MMT - Pec Minor

A

Medial Pectoral Nerve C6-T1
Position - shoulder protraction and depression
Resistance - against ant aspect of shoulder toward table

18
Q

MMT - Serratus Anterior

A

Long Thoracic Nerve C5-C8
Position - supine, shoulder 90° flex, scapula protracted
Resistance - downward toward table

19
Q

MMT - Rhomboids

A

Dorsal Scapular Nerve C4-C5
Position - prone with arm abducted with thumbs to floor
Resistance - stabilize opposite scapula, resist downward

20
Q

MMT - Middle Traps

A

Accessory Nerve C1-C3
Position - prone with 90° abd, thumbs to ceiling
Resistance downward

21
Q

MMT - Lower Traps

A

Accessory Nerve C1-C3
Position - Y scap retraction and depression, thumbs up
Resistance - downward, stabilize opposite scap

22
Q

MMT - Supraspinatus

A

Suprascapular Nerve C4-C6
Position - seated, abd to 90°, slight ER, elbow to 90, head tipped to same side to eliminate UFT
Resistance - into add and IR

23
Q

MMT - Lats

A

Thoracodorsal Nerve C6-C8

Position - prone, have them adduct and extend arm in IR position

24
Q

MMT - Teres Major, Subscap

A

Lower subscap and Upper and Lower Subscap Nerve C5-C7
Position - sitting hand behind back, elbow at 90, head turned to same side
Resistance - into flex and abd

25
MMT - Infraspinatus
Suprascapular Nerve C5-C6 Position - prone humerus of edge of table in 90 abd and elbow flex (seated for gravity eliminated) Resistance - into IR
26
MMT - Teres Minor
Axillary Nerve C5-C6 Position - supine, slight abd, elbow at 90 flex Resistance - into IR, stabilize medial humerus to prevent more abd
27
Yergason's Test
Sitting, elbow flexed to 90 and stabilized against thorax, forearm pronated. Resist supination while pt laterally rotates arm against resistance. Palpate biceps tendon in bicipital groove. +ve = tendon pops out of groove Indicates: transverse ligament is torn
28
Neer's Impingement Test
Structure: Supraspinatus tendinopathy (sometimes LH biceps tendon) – movement causes greater tuberosity to jam under acromion Technique: Pt starts with shoulder in full medial rotation then PT moves arm into full elevation in scapular plane Positive Test: Pain reproduction +/- limited ROM
29
Hawkins-Kennedy Impingement Test
Structure: Supraspinatus impingement or tendinosis (causes supraspinatus to be pushed up against coracoacromial ligament and coracoid) Technique: Arm into 90° flexion, elbow flexed to 90 then into full GH medial rotation Positive Test: Pain reproduction +/- limited ROM
30
Supraspinatus Empty Can Test
Structure: Supraspinatus (primary), could also be suprascapular N issue (if non painful weakness) Technique: Standing – resisted abduction first, then move arm into scapular plane and medially rotate arm (thumbs down) before resisting abduction Positive Test: Pain or weakness
31
Speed's Test
Standing, resist forward flexion while hand is supinated, then pronated. Elbow extended. +ve = increased tenderness in bicipital groove, especially with supination
32
Lift Off Sign
Standing with dorsum of hand on mid lumbar spine, lifts hand away from back. If able to lift off then resist movement to test strength of subscap +ve = inability to lift off or strength imbalance Indicates: lesion of subscap
33
Adson Maneuver
Head rotated to face test shoulder, locate radial pulse. Pt extends neck while shoulder is laterally rotated and extended. Pt takes deep breath and holds it. +ve = pulse disappears and reproduction of symptoms Indicates: TOS
34
Halstead Maneuver
Head rotated away from test side, locate radial pulse. Apply downward traction on test extremity (arm in ext, ER) while neck is hyperextended and rotated away. Deep breath. +ve = pulse disappears and symptom reproduction Indicates: TOS
35
Allen Maneuver
Head rotated away from test side, palpate radial pulse. Flex elbow to 90 while shoulder is extended and laterally rotated. +ve = pulse disappears and symptom reproduction Indicates: TOS
36
Apprehension Test for Anterior Shoulder Dislocation | + relocation test
Supine, abduct arm to 90 and slowly ER shoulder. Compare to other side. +ve = looks apprehensive, resists further motion, says ti feels like when they dislocated Indicates: traumatic instability problems Can then apply posterior translation to head of humerus to see if loss of apprehension, more ROM, pain, etc.
37
Posterior Apprehension of Stress Test
Supine, elevate shoulder in scapular plane to 90 while scap is stabilized by weight of body. Apply a posterior force on elbow and then horizontally adduct and medially rotate arm. +ve = apprehension, reproduction of symptoms, resistance of movement Indicates: posterior instability
38
Load and Shift Test
Structure: GH capsule, ligaments (primarily designed to detect atraumatic multidirectional instability) Technique: Anterior – load humerus by placing it in mid position with glenoid (center HH) then glide humerus anteriorly; Posterior – Load HH then glide posteriorly Positive Test: Symptom reproduction, endfeel, apprehension, amount of translation. Ant – 0-25% translation of diameter of HH = normal; 25-50% = gr 1; beyond 50% but spontaneously reduces = gr 2; HH goes beyond ant rim of glenoid and does not reduce = gr 3. Posterior – 0-50% translation considered normal but results vary
39
Clunk Test
Supine, one hand on posterior aspect of shoulder over humeral head. Other hand holds humerus above elbow. Fully abduct shoulder and push anteriorly with hand of humeral head. Rotate humerus into lateral rotation. +ve = clunking or grinding sound Indicates: labral tear

PNE (17 decks)

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