Performance Exam 1

Question 1

(1) Conducting a general scan of the upper extremity

Answer 1

“Hi, my name is…
I am going to be your therapist today…
Today, I will be assessing you for shoulder flexibility and strength…”

Question 2

(2) Evaluation of the scapula

Answer 2

“I am going to see how much you can move your shoulder blades…”

Question 3

(2a) AROM of scapular elevation

Answer 3

introduction and explanation: “…”
patient in correct start position: sitting
directions and demonstration accurate: “Can you shrug your shoulders for me?” “Like this.”
accurate recording of ROM: WNL
precautions and safety of patient: “Are you experiencing any pain?”

Question 4

(2b) AROM of scapular depression

Answer 4

introduction and explanation: “…”
patient in correct start position: sitting
directions and demonstration accurate: “Can you push down your shoulders?”“Like this.”
accurate recording of ROM: WNL
precautions and safety of patient: Are you experiencing any pain?”

Question 5

(2c) AROM of scapular protraction (abduction)

Answer 5

introduction and explanation: “…”
patient in correct start position: sitting
directions and demonstration accurate: “Can you reach your hands forward?”“Like this.”
accurate recording of ROM: WNL
precautions and safety of patient: Are you experiencing any pain?”

Question 6

(2d) AROM of scapular retraction (adduction)

Answer 6

introduction and explanation: “…”
patient in correct start position: sitting
directions and demonstration accurate: “Can you touch your elbows together?”“Like this.”
accurate recording of ROM: WNL
precautions and safety of patient: Are you experiencing any pain?”

Question 7

(2e) AROM of scapular upward rotation

Answer 7

introduction and explanation: “…”
patient in correct start position: standing
directions and demonstration accurate: “Do the top part of a jumping jack?”“Like this.”
accurate recording of ROM: WNL
precautions and safety of patient: Are you experiencing any pain?”

Question 8

(2f) AROM of scapular downward rotation

Answer 8

introduction and explanation: “…”
patient in correct start position: standing
directions and demonstration accurate: “Rest your hands behind your back?”“Like this.”
accurate recording of ROM: WNL
precautions and safety of patient: Are you experiencing any pain?”

Question 9

(3) Evaluation of the Glenohumeral (GH) joint

Answer 9

“I am going to see how much you can move your arms…”

Question 10

(3a) AROM of shoulder flexion

Answer 10

introduction and explanation: “…”
patient in correct start position: supine
directions and demonstration accurate: “Can you raise your arm over your head?” “Like this.”
axis correct placement: Acromion process
stationary arm correct placement: // to trunk
moveable arm correct placement: // to humerus
accurate measurement: 0-180
accurate recording of ROM: WNL
precautions and safety of patient: “Are you experiencing any pain?”

Question 11

(3b) AROM of shoulder extension

Answer 11

introduction and explanation: “…”
patient in correct start position: prone
directions and demonstration accurate: “Can you reach towards the ceiling?” “Like this.”
axis correct placement: Acromion process
stationary arm correct placement: // to trunk
moveable arm correct placement: // to humerus
accurate measurement: 0-60
accurate recording of ROM: WNL
precautions and safety of patient: “Are you experiencing any pain?”

Question 12

(3c) AROM of shoulder abduction

Answer 12

introduction and explanation: “…”
patient in correct start position: supine
directions and demonstration accurate: “Can you slide your arms on the table to reach overhead?” “Like this.”
axis correct placement: Coracoid process
stationary arm correct placement: // to sternum
moveable arm correct placement: // to humerus
accurate measurement: 0-180
accurate recording of ROM: WNL
precautions and safety of patient: “Are you experiencing any pain?”

Question 13

(3d) AROM of shoulder horizontal abduction

Answer 13

introduction and explanation: "..."
patient in correct start position: sitting
directions and demonstration accurate: "
axis correct placement: 
stationary arm correct placement: 
moveable arm correct placement: 
accurate measurement: 
accurate recording of ROM: 
precautions and safety of patient:

Question 14

(3e) AROM of shoulder horizontal adduction

Answer 14

introduction and explanation: "..."
patient in correct start position: sitting
directions and demonstration accurate: "
axis correct placement: 
stationary arm correct placement: 
moveable arm correct placement: 
accurate measurement: 
accurate recording of ROM: 
precautions and safety of patient:

Question 15

(3f) AROM of shoulder internal rotation

Answer 15

introduction and explanation: “…”
patient in correct start position: prone
directions and demonstration accurate: “Can you reach your palm to the ceiling?” “Like this.”
axis correct placement: Olecranon process
stationary arm correct placement: I to floor
moveable arm correct placement: // to ulna
accurate measurement: 0-70
accurate recording of ROM: WNL
precautions and safety of patient: “Are you experiencing any pain?”

Question 16

(3g) AROM of shoulder external rotation

Answer 16

introduction and explanation: "..."
patient in correct start position: sitting
directions and demonstration accurate: "
axis correct placement: 
stationary arm correct placement: 
moveable arm correct placement: 
accurate measurement: 
accurate recording of ROM: 
precautions and safety of patient:

Question 17

(4) MMT of the Glenohumeral (GH) joint

Answer 17

“I am going to see how strong your shoulders are…”

Question 18

(4a) MMT for shoulder flexion to 90

Answer 18

introduction and explanation: 
patient in correct start position: 
directions and demonstration accurate: 
patient performs motion (against gravity): 
gravity eliminated position (if needed): 
stabilization applied correctly: 
manual resistance applied correctly: 
assign grade:

Question 19

(4b) MMT for shoulder extension

Answer 19

introduction and explanation: 
patient in correct start position: 
directions and demonstration accurate: 
patient performs motion (against gravity): 
gravity eliminated position (if needed): 
stabilization applied correctly: 
manual resistance applied correctly: 
assign grade:

Question 20

(4c) MMT for shoulder abduction to 90

Answer 20

introduction and explanation: “…”
patient in correct start position: sitting; arm at side and elbow slightly flexed
directions and demonstration accurate: (first, check ROM in all planes); “Lift your arm out to the side to shoulder level. Hold it.”
patient performs motion (against gravity): “Now lets see how strong you are.”
gravity eliminated position (if needed): supine, arm at side; “Take your arm out to the side.”
stabilization applied correctly: scapula
manual resistance applied correctly: prox. to elbow
“Don’t let me push it down.”
assign grade: against=3-5; eliminated=3-0
palpation: middle deltoid (lateral surface of upper 1/3 of arm)

Question 21

(4d) MMT for shoulder horizontal abduction

Answer 21

introduction and explanation: “…”
patient in correct start position: prone
directions and demonstration accurate: “Lift your elbow up towards the ceiling. Hold it.”
patient performs motion (against gravity): “Now lets see how strong you are.”
gravity eliminated position (if needed): sitting, arm raised or supported by table; “Slide your arm backward.”
stabilization applied correctly: scapula
manual resistance applied correctly: post. arm, prox. to elbow; “Don’t let me push it down.”
assign grade: against=3-5; eliminated=3-0
palpation: posterior deltoid (over posterior shoulder just superior to axila)

Question 22

(4e) MMT for shoulder horizontal adduction

Answer 22

introduction and explanation: “…”
patient in correct start position: supine
directions and demonstration accurate: “Move your arm across your chest. Hold it.”
patient performs motion (against gravity): “Now lets see how strong you are.”
gravity eliminated position (if needed): sitting, arm raised or supported by table; “Slide your arm forward.”
stabilization applied correctly: opposite shoulder
manual resistance applied correctly: ant. arm, prox. to elbow; “Don’t let me pull it back.”
assign grade: against=3-5; eliminated=3-0
palpation: pectoralis major

Question 23

(4f) MMT for shoulder internal rotation

Answer 23

introduction and explanation: “…”
patient in correct start position: prone
directions and demonstration accurate: “Move your forearm up and back. Hold it.” “Like this.”
patient performs motion (against gravity): “Now lets see how strong you are.”
gravity eliminated position (if needed): sitting, arm at side, elbow slightly bent; “Keep your hand flat and move it toward your belly.”
stabilization applied correctly: humerus to prevent adduction
manual resistance applied correctly: ant. forearm, prox. to wrist; “Don’t let me push it down.”
assign grade: against=3-5; eliminated=3-0
palpation: None (subscapularis)

Question 24

(4g) MMT for shoulder external rotation

Answer 24

introduction and explanation: “…”
patient in correct start position: prone
directions and demonstration accurate: “Raise your forearm to the level of the table. Hold it.” “Like this.”
patient performs motion (against gravity): “Now lets see how strong you are.”
gravity eliminated position (if needed): sitting, arm at side, elbow slightly bent; “Keep your hand flat and move it away from your belly.”
stabilization applied correctly: humerus to prevent adduction
manual resistance applied correctly: post. forearm, prox. to wrist; “Don’t let me pull it back.”
assign grade: against=3-5; eliminated=3-0
palpation: infraspinatus (inferior to spine of scapula)