Ortho 2 (special tests/glides): Shoulder Flashcards
GH joint - observation (don’t forget 4 point palpation!)
Posterior
- Scoliosis, Scapula (Lower, protracted, Winging, Spine of scap - Any atrophy above (supraspinatus) below (infraspinatus))
Anterior
- Shoulders level, Clavicle asymmetry, Atrophy (pect, deltoid), LH biceps atrophy
Humeral head position (relative to acromion)
- Can use the four (4) Point Palpation to Ax it (One hand on acromion anteriorly & posteriorly, One hand on humeral head anteriorly & posteriorly)
- Normal (ant-post) = 1/3 anterior
- Abnormal: > 1/3 anterior or posterior, Inferior max 1 finger = inferior hypermobility/instability
Scapula normal position
- Inferior angle: around T7
- Sup angle: T2
- Look for any: Superior/inferior rotation, Internal rotation = Winging, Ant tilt, Winging, Lat distance med scap & SP (protraction)
GH joint ROM/OP - flexion
Done in standing
With every movts look at:
- HH movt
- Scap movt
- Any Tx or Lx extension (compensation)
GH joint ROM/OP - extension
Done in standing
With every movts look at:
- HH movt
- Scap movt
- Any Tx or Lx extension (compensation)
GH joint ROM/OP - adbuction
Done in standing
With every movts look at:
- HH movt
- Scap movt
- Any Tx or Lx extension (compensation)
GH joint ROM/OP - synamic scapula assessment
Done in standing
With every movts look at:
- HH movt
- Scap movt
- Any Tx or Lx extension (compensation)
GH joint ROM/OP - IR
Done in standing
With every movts look at:
- HH movt
- Scap movt
- Any Tx or Lx extension (compensation)
GH joint ROM/OP - ER
Done in standing
With every movts look at:
- HH movt
- Scap movt
- Any Tx or Lx extension (compensation)
GH joint ROM/OP - horizontal add
Done in standing
With every movts look at:
- HH movt
- Scap movt
- Any Tx or Lx extension (compensation)
GH joint ROM/OP - horizontal abd
Done in standing
With every movts look at:
- HH movt
- Scap movt
- Any Tx or Lx extension (compensation)
GH joint ROM/OP - Apley scratch test
GH joint ROM/OP - HBB test
GH joint PROM - flexion
To do if:
- AROM limited
- GH pain with no AROM limitation (There could be some compensation from Scapula or Tx spine/ribs and Therefore need to Ax all GH PROM)
- Use goniometer to measure limitation (obj info)
Always assess contralateral side first
Done in supine
Stabilise scapula (sup or lat border)
Move humerus
Ax end feel (EF)
GH joint - prom abduction
To do if:
- AROM limited
- GH pain with no AROM limitation (There could be some compensation from Scapula or Tx spine/ribs and Therefore need to Ax all GH PROM)
- Use goniometer to measure limitation (obj info)
Always assess contralateral side first
Done in supine
Stabilise scapula (sup or lat border)
Move humerus
Ax end feel (EF)
GH joint - prom ext
To do if:
- AROM limited
- GH pain with no AROM limitation (There could be some compensation from Scapula or Tx spine/ribs and Therefore need to Ax all GH PROM)
- Use goniometer to measure limitation (obj info)
Always assess contralateral side first
Done in supine
Stabilise scapula (sup or lat border)
Move humerus
Ax end feel (EF)
GH joint - prom ER
To do if:
- AROM limited
- GH pain with no AROM limitation (There could be some compensation from Scapula or Tx spine/ribs and Therefore need to Ax all GH PROM)
- Use goniometer to measure limitation (obj info)
Always assess contralateral side first
Done in supine
Stabilise scapula (sup or lat border)
Move humerus
Ax end feel (EF)
GH joint - prom IR
To do if:
- AROM limited
- GH pain with no AROM limitation (There could be some compensation from Scapula or Tx spine/ribs and Therefore need to Ax all GH PROM)
- Use goniometer to measure limitation (obj info)
Always assess contralateral side first
Done in supine
Stabilise scapula (sup or lat border)
Move humerus
Ax end feel (EF)
GH joint - RISOM
GH joint - palpation: greater tuberosity, bicipital groove, lesser tuberosity
GH joint - palpation: supraspinatus tendon
GH joint - palpation: infraspinatus tendon
GH joint - palpation: teres minor tendon
GH joint - palpation: subscapularis tendon
GH joint - posterior glide
*Pt always in supine!
GH resting position
- Anterior glide (ER/Ext)
- Posterior glide (IR/Flex)
- Inferior glide (Abd)
- Traction/compression
GH joint - anterior glide
*Pt always in supine!
GH resting position
- Anterior glide (ER/Ext)
- Posterior glide (IR/Flex)
- Inferior glide (Abd)
- Traction/compression
GH joint - inferior glide
*Pt always in supine!
GH resting position
- Anterior glide (ER/Ext)
- Posterior glide (IR/Flex)
- Inferior glide (Abd)
- Traction/compression
GH joint - traction and compression
*Pt always in supine!
GH resting position
- Anterior glide (ER/Ext)
- Posterior glide (IR/Flex)
- Inferior glide (Abd)
- Traction/compression
GH joint: antero-superior HBB with ER
GH joint: apprehension test
GH joint: relocation test
* to be done with apprehension test!!
GH joint - sulcus sign test
GH joint - posterior apprehension test
GH joint - compression rotation test
Better diagnostic utility when using specific combination of 3 tests:
1) By selecting 2 highly sensitive tests (true positive)
- Compression rotation test
- O’Brien test
2) And 1 highly specific test (true negative)
- Biceps load II
User can be fairly confident in both ruling out & in SLAP lesions
GH joint - O’Brien’s test
Better diagnostic utility when using specific combination of 3 tests:
1) By selecting 2 highly sensitive tests (true positive)
- Compression rotation test
- O’Brien test
2) And 1 highly specific test (true negative)
- Biceps load II
User can be fairly confident in both ruling out & in SLAP lesions
GH joint - biceps load 2 test
Better diagnostic utility when using specific combination of 3 tests:
1) By selecting 2 highly sensitive tests (true positive)
- Compression rotation test
- O’Brien test
2) And 1 highly specific test (true negative)
- Biceps load II
User can be fairly confident in both ruling out & in SLAP lesions
GH joint - Hawkin’s-Kennedy test
Both Hawkins-Kennedy & Neer tests would be minimally helpful for both ruling in & out subacromial impingement
The presence of a painful arc during elevation may additionally be helpful in identifying impingement
Impingement would not identify which structure is at fault would only identify which movt/mechanism is at fault
GH joint - Neer’s impingement test
Both Hawkins-Kennedy & Neer tests would be minimally helpful for both ruling in & out subacromial impingement
The presence of a painful arc during elevation may additionally be helpful in identifying impingement
Impingement would not identify which structure is at fault would only identify which movt/mechanism is at fault
GH joint - posterior impingement test
Both Hawkins-Kennedy & Neer tests would be minimally helpful for both ruling in & out subacromial impingement
The presence of a painful arc during elevation may additionally be helpful in identifying impingement
Impingement would not identify which structure is at fault would only identify which movt/mechanism is at fault
GH joint - full can test
Remember:
Special tests done
- To isolate the involved structure
- Help to confirm the diagnosis
- But the result of a single test is usually not enough
GH joint - empty can test
Remember:
Special tests done
- To isolate the involved structure
- Help to confirm the diagnosis
- But the result of a single test is usually not enough
GH joint - drop arm test
Remember:
Special tests done
- To isolate the involved structure
- Help to confirm the diagnosis
- But the result of a single test is usually not enough
GH joint - external rotation lag sign (ERLS)
Remember:
Special tests done
- To isolate the involved structure
- Help to confirm the diagnosis
- But the result of a single test is usually not enough
GH joint - internal rotation lag sign
Remember:
Special tests done
- To isolate the involved structure
- Help to confirm the diagnosis
- But the result of a single test is usually not enough
GH sup lig stress test
Pt supine
Pht
Medial hand: Stabilizes scapula superiorly by applying a gentle pressure on the coracoid process
Lateral hand: Grasps proximal humerus
GH mid lig stress test
Pt supine
Pht
Medial hand: Stabilizes scapula superiorly by applying a gentle pressure on the coracoid process
Lateral hand: Grasps proximal humerus
GH inf lig stress test (ant segment)
Pt supine
Pht
Medial hand: Stabilizes scapula superiorly by applying a gentle pressure on the coracoid process
Lateral hand: Grasps proximal humerus
GH inf lig stress test (post segment)
Posterior GH ligaments stress tests
AC joint AROM
AC joint PROM ant rot
AC joint PROM post rot
AC joint - ant glide
AC joint post glide
AC joint inf glide
AC joint sup glide
AC joint compression
stability test trapezoid ligament
stability test conoid ligament
AC joint special tests
coracoclavicular joint special tests
SC joint - post glide
SC joint - inf glide
SC joint sup glide
SC joint ant glide
SC joint syability test (compression test)
SC joint syability test (anterior stability)
ST joint - 4-point palpation
Dynamic Scapula Test (bilat abd)
Bilateral abduction with thumbs up
Dynamic Scapula Test (abd elevation test)
To assess when Pt’s symptoms are produced in abduction & Scapula dysfunction is present
Pht corrects scapula position
- Stand behind your pt on the side of the shoulder being assessed
- Place one hand anteriorly over the acromion (your arm is between the pt’s arm and their body)
- The other hand is on the scapula posteriorly
- Correct the observed dysfunction (Eg: if the pt’s scapula is not upwardly rotating, create the upward rotation of the scapula with your hands)
- Ask pt to repeat GH abduction as you correct the scapula position & guide the scapula through abduction
*Be aware not to block GH ROM as you are doing the correction q (+)ve test: Improve ROM or reduced pain
Dynamic Scapula Test (ER scapula stability test)
Scapula stability test (Kibler’s lateral slide - lateral scapula slide test)
scapula combined movements (ax ms flexibility)
scapula combined movements (ax ms strength)
SC joint ROM
Pt in sitting:
- Palpate the SC jt
- Assess using scapulo-thoracic physiological movts
Depression: Superior glide clavicle on sternum (♂)
Elevation: Inferior glide clavicle on sternum (♂)
Retraction: Posterior glide clavicle on sternum (♀)
Protraction: Anterior glide clavicle on sternum (♀)
