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Osteopathic Skills--Lexie > Osteopathic Testing of the Shoulder OSCE > Flashcards

Osteopathic Testing of the Shoulder OSCE Flashcards

1
Q

what 3 bones make up the shoulder joint?

A
  • clavicle
  • humerus
  • scapula: coracoid process and acromion
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2
Q

what are the three true joints of shoulder joint?

A
  1. glenohumeral
  2. sternoclavicular
  3. acromioclavicular
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3
Q

what kind of joints are glenohumeral, sternoclavicular, acromioclavicular?

A

synovial joints

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4
Q

what level of the spinal cord is the spine of the scapula?

A

T3

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5
Q

what level of the spinal cord is the inferior border of the scapula?

A

T7

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6
Q

What are the 4 rotator cuff muscles?

A

SITS

  • supraspinatus
  • infraspinatus
  • teres minor
  • subscapularis
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7
Q

ROM for flexion of shoulder in sagittal plane

A

180 deg

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8
Q

ROM for extension of the shoulder

A

60 deg

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9
Q

ROM for abduction of the shoulder

A

180 deg

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10
Q

ROM for adduction of the shoulder

A

40-50 deg

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11
Q

ROM for internal rotation of the shoulder

A

90 deg

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12
Q

ROM for external rotation of the shoulder

A

90 deg

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13
Q

ROM for horizontal abduction of the shoulder

A

130-145 deg from arm straight out in front

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14
Q

ROM for horizontal adduction of the shoulder

A

40-50 deg

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15
Q

circumduction

A

combination of movements causing the humeral head to travel in a small irregular circle and the hand in a wide circular motion (“pin wheel”)

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16
Q

evaluation of glenohumeral joint for somatic dysfunction

A

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.
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17
Q

evaluation of acromioclavicular joint for somatic dysfunction

A
  • 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.
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18
Q

evaluation of sternoclavicular joint for somatic dysfunction (flexion and extension)

A
  • 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.
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19
Q

evaluation of sternoclavicular joint for somatic dysfunction (abduction and adduction)

A
  • 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.
20
Q

elevation of the scapula

A

upward/cephalad and parallel to the spine

21
Q

depression of scapula

A

return from elevation

22
Q

abduction (protraction) of scapula

A

away from the spine, combined with lateral tilt around thorax

23
Q

adduction (retraction) of scapula

A

moving closer to spine

24
Q

upward rotation of scapula

A

Turning on a horizontal axis so that the posterior surface faces upward and the inferior angle protrudes

25
Q

downward rotation of scapula

A

Turning on a horizontal axis so that the posterior surface faces downward and the inferior angle comes anterior

26
Q

evaluation of somatic dysfunction of scapulothoracic joint

A
  • Dr faces patient.
  • Contact inferior scapular angle with caudad hand, acromion with the cephalad hand.
  • go through flexion, extension, abduction, adduction, upward and downward rotation
27
Q

what muscles are responsible for elevating the scapula?

A

upper Trapezius and Levator Scapulae

28
Q

what muscles are responsible for depressing the scapula?

A

lower Trapezius and lower Rhomboids (R. major)

29
Q

what muscles are responsible for protraction and abduction of the scapula?

A

Serratus Anterior

30
Q

what muscles are responsible for retraction and adduction of scapula?

A

Rhomboids and middle Trapezius

31
Q

what muscles are responsible for upward rotation?

A

serratus anterior and upper trapezius

32
Q

what muscles are responsible for downward rotation?

A

levator scapulae, rhomboid major and minor, latissimus dorsi

33
Q

muscle strength testing steps

A

- Resist the motion

  •  Test bilateral
  •  Use the grading scale listed below
34
Q

muscles responsible for flexion of shoulder

A

Anterior Deltoid and Coracobrachialis

35
Q

muscles responsible for extension of the shoulder

A

Latissimus Dorsi and Teres Major

36
Q

muscles responsible for abduction of shoulder

A

Supraspinatus (first 10-15°) and Mid-Deltoid (remainder of 180°)

37
Q

muscles responsible for adduction of shoulder

A

Pectoralis Major and Latissimus Dorsi

38
Q

muscles responsible for internal rotation of shoulder

A

Subscapularis and Pectoralis Major

39
Q

Lift Off Test

A

Have pt’s arm behind back w/dorsum of hand contacting low back. Then have pt try to force their hand away from their back against your resistance

**testing internal rotation

40
Q

muscles responsible for external rotation of shoulder

A

Infraspinatus and Teres Minor

41
Q

muscles responsible for shoulder shrug

A

Trapezius and Levator Scapulae

42
Q

muscles responsible for scapular retraction

A

Rhomboid Major and Minor

Grasp upper arm/shoulder and resist position of “attention”

43
Q

muscles responsible for scapular protraction

A

Serratus Anterior

Stabilize spine, grasp flexed elbow and resist forward motion. Or have patient do wall push-up.

44
Q

what are the functional joints of the shoulder?

A
  • suprahumeral

- scapulothoracic

45
Q

what are the accessory joints of the shoulder?

A
  • costosternal

- costovertebral

Osteopathic Skills--Lexie (16 decks)

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