Osteopathic Testing of the Shoulder OSCE Flashcards
what 3 bones make up the shoulder joint?
- clavicle
- humerus
- scapula: coracoid process and acromion
what are the three true joints of shoulder joint?
- glenohumeral
- sternoclavicular
- acromioclavicular
what kind of joints are glenohumeral, sternoclavicular, acromioclavicular?
synovial joints
what level of the spinal cord is the spine of the scapula?
T3
what level of the spinal cord is the inferior border of the scapula?
T7
What are the 4 rotator cuff muscles?
SITS
- supraspinatus
- infraspinatus
- teres minor
- subscapularis
ROM for flexion of shoulder in sagittal plane
180 deg
ROM for extension of the shoulder
60 deg
ROM for abduction of the shoulder
180 deg
ROM for adduction of the shoulder
40-50 deg
ROM for internal rotation of the shoulder
90 deg
ROM for external rotation of the shoulder
90 deg
ROM for horizontal abduction of the shoulder
130-145 deg from arm straight out in front
ROM for horizontal adduction of the shoulder
40-50 deg
circumduction
combination of movements causing the humeral head to travel in a small irregular circle and the hand in a wide circular motion (“pin wheel”)
evaluation of glenohumeral joint for somatic dysfunction
Face seated patient. With one hand, grip humeral head. Other hand blocks linkage at remainder of shoulder.
- Load into the GH joint and translate joint Ant/Inf and Post/Sup to assess for ease and restriction of glide. - Similar to Load and Shift test & can also assess adequacy of glenoid rim.
- Restriction to Ant/Inf glide is a Posterior- Superior SD of the GH joint.
- Restriction to Post/Sup glide is an Anterior- Inferior SD of the GH joint.
evaluation of acromioclavicular joint for somatic dysfunction
- Doctor contacts AC joint and palpates for TART findings (tenderness, tissue texture changes).
- Bring GH joint into 60° coronal abduction and 60° horizontal abduction maximizing AC joint motion.
- Internally & externally rotate the GH joint.
- Internal rotation of GH joint causes IR of AC joint.
- External rotation of the GH joint causes ER of the AC joint.
- *Normal AC rotation is estimated to be 10° both ways.
- Restriction to IR is an Ext. Rotation dysfunction of the AC joint.
- Restriction to ER is an Internal Rotation dysfunction of the AC joint.
evaluation of sternoclavicular joint for somatic dysfunction (flexion and extension)
- Place fingers bilaterally anterior on the medial clavicular heads next to sternum.
- Assess SC joint motion under monitoring fingers in horizontal flexion by having patient flex shoulders to 90° and reach to the ceiling. –Extension occurs as patient returns to neutral.
- Horizontal Flexion–>proximal clavicle moves posterior and distal clavicle moves anterior.
- Horizontal Extension–>proximal clavicle moves anterior and distal clavicle moves posterior.
- **Horizontal Extension SD (restriction in Horizonal Flexion) is more common.
evaluation of sternoclavicular joint for somatic dysfunction (abduction and adduction)
- place index fingers on the superior aspect of proximal clavicular heads
- have patient shrug shoulders, abduction of the SC joint.
- Adduction occurs as patient returns to neutral.
- Abduction–>proximal end moves inferiorly & distal end moves superiorly
- Adduction–>proximal end moves superiorly & distal end moves inferiorly
- **Adduction SD (restriction in abduction) is more common.
elevation of the scapula
upward/cephalad and parallel to the spine
depression of scapula
return from elevation
abduction (protraction) of scapula
away from the spine, combined with lateral tilt around thorax
adduction (retraction) of scapula
moving closer to spine
upward rotation of scapula
Turning on a horizontal axis so that the posterior surface faces upward and the inferior angle protrudes
