OSCE 6 shoulder joint competency

Question 1

GH joint ROM and muscles involved

Answer 1

Flexion Anterior Deltoid and Coracobrachilais (180)
Extension Latissimus Dorsi and Teres Major (60)
ABduction Supraspinatus and Mid-deltoid (180)
*Horizontal aBduction (40-55 or 130-145)
ADduction Pectoralis Major and Latissimus Dorsi
*Horizontal aDduction (40-50 or 130-140)
External rotation Infraspinatus and Teres Minor (90)
Internal rotation Subscapularis and Pectoralis Minor (90)

Question 2

SC joint abd/ add, flex/ ext

Answer 2

Abduction Distal end of clavicle moves superiorly and proximal end moves
inferiorly
Adduction Distal end of clavicle moves inferiorly and proximal end moves
superiorly
Horizontal flexion Distal end of clavicle moves anteriorly and proximal end moves
posteriorly on the sternum
Horizontal extension Distal end of clavicle moves posteriorly and proximal end moves
anteriorly on sternum
Rotation Multidirectional

Question 3

Scapula motions and muscles

Answer 3

Retraction Rhomboid major and minor
Moving closer to the spine (“attention”)
Protraction Serratus Anterior
Moving away from the spine (reaching)
Elevation Upper Trapezius and Levator Scapulae
Upward and parallel to spine (shoulder shrug)
Depression Lower Trapezius and Lower Rhomboids
Return from elevation
Upward/Downward Rotation Combined motions of the scapula

Question 4

Rotator Cuff (Supraspinatus-specific) tests

Answer 4

Empty Can Test
*Can also do Full Can Test
Flex patient’s shoulders to 90° while also abducting approximately
45°. Then internally rotate both arms so thumbs are pointing down.
Press down on forearms while patient resists.
(+) Test = Pain or weakness
Indicates rotator cuff pathology (specifically supraspinatus)

Drop-Arm Test - Patient abducts arm 90°-180°. Then slowly drops arm.
(+) Test = Arm will drop or gentle tap on wrist will cause arm to drop
Indicates full thickness tear of supraspinatus

Question 5

Glenohumeral Instability tests

Answer 5

Apprehension Test Patient is seated or supine. Shoulder abducted to 90° and elbow
flexed to 90°. Stabilize shoulder with one hand and force arm into
external rotation with the other hand.
(+) Test = Patient apprehensive of repeat dislocation.
Indicates glenohumeral instability

Sulcus Sign Grasp patients elbow and apply inferior traction
(+) Test = Indention appears in area beneath the acromion
Indicates glenohumeral instability

Question 6

Long Head of Bicep tests

Answer 6

Yergason Test -
Patient’s arm at side with elbow flexed at 90°. Examiner uses one
hand to palpate bicipital groove and monitors there, while the other
hand grasps the patient’s wrist. Have patient supinate and externally
rotate against doctor’s resistance.
(+) Test = Pain and/or tendon subluxation out of groove
Indicates unstable bicipital tendon/subluxation, bicipital
tendonitis

Speed’s Test- Patient’s arm forward flexed (50°-90°) at the shoulder with hand
supinated. Slightly flex patient’s elbow. Resist at forearm while
patient further flexes shoulder. (Resist cephalad motion)
(+) Test = Pain in bicipital groove
Indicates bicipital tendonitis of longhead biceps

Question 7

Rotator Cuff Impingement test

Answer 7

Neer Impingement - Stabilize patient’s shoulder, forearm is pronated. Passively flex
shoulder to fully flexed position.
(+) Test = Pain
Indicates subacromial bursa or rotator cuff impingement

Hawkins Test - Flex shoulder to 90°, flex elbow to 90°, slightly adduct, and passively
rotate the humerus into internal rotation. This opposes the rotator cuff
against coracoacromial ligament and acromion.
(+) Test = Pain
Indicates rotator cuff or subacromial bursa impingement

Question 8

test to check ROM of shoulder joint?

Answer 8

Apley Scratch

Test 2 maneuvers. Doc should make note of how far the patient can reach.
Upper: patient abducts arm placing palm of hand behind their neck
with palm facing toward the body. Patient should attempt to scratch
the lowest possible vertebrae. (coupled external rotation and
abduction)
Lower: patient places arm behind their back with palm facing
outward and dorsum of hand resting on their midback. Patient should
attempt to scratch the highest possible vertebrae. (coupled internal
rotation and adduction)

Question 9

Subscapularis

Answer 9

Lift Off Test -
Place patient’s arm into internal rotation and aDduction. Patient extends arm into as doctor resists.
(+) Test = Weakness (inability to resist)
Indicates subscapularis weakness