PD - upper limb Flashcards
Shoulder complex: 3 joints and 1 articulation
glenohumeral joint
acromioclavicular joint
sternoclavicular joint
scapulothoracic articulation
Muscles and tendons surrounding the shoulder joint
rotator cuff (SItS: supraspinatus, infraspinatus, teres minor, subscapularis)
Causes of referred shoulder pain
coronary artery disease
pulmonary tumors
gallbladder disease
Shoulder ROM 3 main components
GH motion
scapulothoracic motion
combined GH/scapulothoracic motion
Shoulder ROM (motions and angle)
aBduction: 0-180 (2:1, GH and scapulothoracic) aDduction: 0-45 flexion: 90 extension: 45 internal rotation: 55 external rotation: 40-45
2 general screening maneuvers to evaluate AROM of shoulder
- Apley scratch test
2. “Shoulder Arc”
Apley scratch test
tests AROM of shoulder
pt…
reaches up behind head and touches superior medial angle of opp scapula w/ fingertips (external rotation, abduction)
reaches in front of the chest to touch opposite acromion (internal rotation, adduction)
reaches down behind back to touch inferior aspect of opp scapula (internal rotation, adduction)
shoulder arc
tests AROM of shoulder
pt aBducts arms to 90 degrees w/ elbows straight, turns palms up, then continues to aBduct until hands are over head
pain –> “painful arc”
- pain btwn 60-120 –> subacromial (tendonitis or impingement)
- pain after 120 –> acromioclavicular
Grading of muscle strength
5 – Normal: Complete range of motion against gravity with full resistance
4 – Good: Complete range of motion against gravity with some resistance
3 – Fair: Complete range of motion against gravity
2 – Poor: Complete range of motion with gravity eliminated
1 – Trace: Evidence of muscle contraction, but no joint motion
0 – Zero: No evidence of muscle contractility
Shoulder abduction muscles
middle deltoid (C5, 6) supraspinatous (C5, 6) - 1st 15
secondary: serratus anterior, remainder of deltoid
Shoulder adduction muscles
pectoralis major (C5-T1) latissimus dorsi (C6-C8))
secondary: teres major, anterior deltoid
shoulder flexion muscles
Anterior deltoid (C5) corocobrachialis
Secondary: teres major, anterior deltoid
Shoulder extension muscles
Latissimus dorsi (C6-8) Teres major and minor (C5-6) Posterior deltoid (C5-6)
Secondary: triceps, teres minor
Shoulder internal rotation muscles
Subscapularis (C5-6) pectoralis major (C5-T1) latissimus dorsi (C6-8) teres major (C5-6)
Secondary: deltoid
Shoulder External rotation muscles
Infraspinatous (C5-6) Teres minor (C5)
Secondary: deltoid
Shoulder Scapular elevation muscles
Trapezius (CN XI) Levotor scapulae (C3, 4)
Secondary: rhomboids
dermatome vs. peripheral nerve distribution
dermatome: specific area of skin sensation supplied by a particular spinal nerve root
Peripheral nerve distribution: specific area of skin sensation supplied by a particular peripheral nerve (* peripheral n. may receive input from multiple spinal nerve roots)
How to test C5 dermatome
touch a round patch of skin on lateral aspect of deltoid muscle
How to test T1 dermatome
touch medial aspect of arm
T4
nipple line
Which nerve is frequently damaged in shoulder dislocation?
Axillary nerve
If injured —> patch of decreased sensation on lateral aspect of deltoid & deltoid muscle itself will be weak
Special tests for shoulder
Impingement test Apprehension test Drop arm test Inferior sulcus sign Empty can test Subscapularis lift-off test
Impingement test
tests for impingement of rotator cuff m. and tendons
- Hawkin’s test: pt internally rotates arm w/ thumb facing downward, flex pt’s arm (if impingement —> pain as arm is flexed)
- Neer’s test (modified Hawkin’s test)
Apprehension test
tests for anterior shoulder instability
- Pt supine, shoulder abducted to 90 and ext. rotated.
- Attempt to further ext. rotate shoulder while simult. apply ant. force on post. side of humeral head
- If shoulder ready to dislocate —> will be a look of apprehension on pt’s face and/or pt will resist addl forced ext. rotation
- Relocation test: if post. directed force on ant. shoulder alleviates sx —> evidence of compromised ant. capsule.
