PHYSICAL EXAMINATION OF THE UPPER EXTREMITY MUSCULOSKELETAL SYSTEM Flashcards
A prominent scapular spine and loss of lateral shoulder contour
indicates atrophy of the _____ muscles
supraspinatus / infraspinatus
Tenderness of Subacromial bursa usually indicates what?
subacromial bursitis or tear of the supraspinatus
While evaluating flexion and abduction note the _______ rhythm
glenohumeral
What is this on ROM
With patient arm at the side, ask the patient to raise arm posteriorly in the sagittal plane
Extension
What is this on ROM
With patient arm at the side ask patient to raise arm anteriorly in the sagittal plane
Flexion
What ROM test is this?
With patient arm at the side ask the patient to lower the arm to the side and continue midline of the body in the frontal plane
Adduction
What ROM test is this?
With patient arm at the side ask the patient to raise to the side in the frontal plane
Note any “clunking” or painful arc of motion
Abduction
What rom test is this
1) Place arm behind the head with elbows out
2) Have patient lower his thumb along the spine to their lowest point
3) Note what spinous process the patient can reach
External rotation
What rom test is this
1) Ask the patient to place the arm behind the back and reach as high as possible
2) Note the highest spinous process that can be reached with hiking the thumb
Internal Rotation
What shoulder strength test?
1) Anterior Deltoid
2) Have patient raise the arm forward in the sagittal plane and provide resistance
3) Pain may be suggestive of biceps tendinitis
Flexion
What shoulder strength test?
1) Posterior Deltoid
2) Have patient raise the arm backward in the sagittal plane and provide resistance
Extension
What shoulder strength test
1) Middle Deltoid
2) Have patient raise arm to 90 degrees of abduction with the elbow flexed at 90
degrees
abduction
What shoulder strength test?
1) Place arm in 90 degrees of abduction with slight horizontal adduction and
internal rotation
2) Push down on the distal arm as the patient resists this pressure
3) Pain may be suggestive of rotator cuff tendinitis
Supraspinatus
What shoulder strength test?
1) Have patient place their hand behind the back with the palm facing away from
the body
2) Have patient lift away from the back while providing resistance
3) AKA Gerber lift off
Subscapularis
What shoulder strength test?
1) Have patient tightly hold their humerus next to the chest
2) Attempt to abduction patients arm while they provide resistance
Adduction
What shoulder strength test?
1) Place the patients arm at the side in neutral rotation with elbow flexed to 90 degrees
2) Attempt to externally rotate the arm, maintain this position while applying moderate to firm pressure at the distal forearm
External rotation
What shoulder strength test?
1) Place the patients arms at the side in neutral rotation with elbow flexed to 90 degrees
2) Attempt to internally rotate the arm, maintain this position while applying moderate to firm pressure at the distal forearm
3) Test the strength of the Infraspinatus and Teres Minor
Internal Rotation
What shoulder strength test
1) Have patient forward flex their arms as you depress the arm with one hand and palpate the scapula with the other
2) When weak, the scapula will “wing” at the vertebral border
Serratus Anterior
What shoulder strength test?
1) Have the patient place both hands on the iliac crest
2) Push patients arm forward with your hand at the elbow and palpate the vertebral border of the scapula with the other hand
3) If the rhomboids are functional then the scapula will lay flat against the chest wall
Rhomboid
Neurovascular
(a) Have patient close their eyes
(b) Lightly touch the following locations for the corresponding dermatone
1) ______ - Superior Region of the shoulder
2) ______ - Middle deltoid region
1) C4
2) C5
What Special test
1) Used to diagnose shoulder impingement or rotator cuff tears
2) Place one hand on the posterior aspect of the scapula to maintain in the anatomical position and use your hand to take the patients internally rotated arm by the wrist into full flexion
3) This maneuver compresses the greater tuberosity against the anterior acromion
Neer’s Impingement Sign
What Special test
1) This test reinforces a positive Neer sign for impingement
2) Flex the patients shoulder to 90 degrees, flex the elbow to 90 degrees and place the forearm in neutral rotation
3) Support the elbow and then passively internally rotate the humerus
4) Pain to the subacromial space is indicative of rotator cuff tear or tendinitis
Hawkin’s Impingement Sign
What Special test
1) Place patients arm in 90 degrees of abduction, 30 degrees of horizontal abduction and internal rotation with the elbow extend.
2) Push down on the distal arm as the patient resists this pressure
3) A positive sign is pain focal to the middle aspect subacromial space
Empty Can Test
What Special test
1) Detects tears in the rotator cuff tear (supraspinatus)
2) Instruct patient to fully abduct their arm then ask them to slowly lower it to the side
3) If there are tears in the rotator cuff the arm will drop to the side from a position of about 90 degrees
4) If the patient is able to hold his arm in abduction, a gentle tap on the forearm will cause the arm to fall to his side.
Drop Arm Test
What Special test
1) Evaluates the teres minor
2) Support patient’s arm in 90 degress, slightly adducted, elbow flexed to 90 degress
3) Apply resistance as patient externally rotates arm
4) Weakness indicates a positive sign
Hornblower’s Test
What Special test
1) This test is helpful in diagnosing biceps tendonitis
2) Test the bicep strength
3) Have patient forward flex the shoulder to 45 degrees while flexing the elbow to 90 degrees
4) Have the patient resist you as you attempt to pull their arm into shoulder and elbow extension
5) Patient will be positive for biceps tendinitis if they experience pain in the bicipital groove
Speed’s Test
What Special test
1) Test subscapularis strength and possible tendon rupture
2) Instruct the patient to place the hand behind the back, palm facing away from the body
3) Apply resistance as the patient lifts away from the back
Gerber Lift-off Test
What Special test
1) With patient standing or supine (for acute or chronic dislocations), place patients arm in 90 degrees abduction, with elbow flexed to 90 degrees
2) Gently externally rotate humerus to 90 degrees
3) Patients with anterior instability may be apprehensive in this position because of the sense of impending dislocation
4) Pain with apprehension is less specific
Apprehension Sign for Anterior instability
What Special test
1) With patient supine, place patients arm in 90 degrees abduction, with elbow flexed to 90 degrees, and 90 degrees of external rotation
2) Apply posterior force to the anterior proximal humerus at point of external rotation when patient feels apprehensive
3) This should precent anterior subluxation
4) Test is positive if relief of pain and aprehension occurs
5) Suggests anterior glenohumeral instability
Relocation Test of Jobe
What Special test
1) With patient’s arm relaxed to side place one hand on the posterior scapula and use the other hand to apply traction to the patient’s arm in an inferior direction
2) This maneuver will cause inferior subluxation of the humeral head and a widening of the sulcus between the humerus and acromion
3) A visible dimple is a positive sulcus sign
4) A positive sulcus suggest that the patient has inferior shoulder instability
Sulcus Sign
What Special test
1) Place the patient’s arm in 90 degrees of flexion with maximal internal rotation with the elbow flexed at 90 degrees
2) Adduct the arm cross body in the horizontal plane while applying an axial load at the elbow to push the humerus in a posterior direction
3) If the maneuver causes a posterior subluxation or dislocation, the humeral head can be felt to clunk or jerk back into the joint as the arm is then horizontally abducted
Jerk Test
What special test
1) Flex patients shoulder to 90 degrees and then horizontally adduct the arm across the body
2) Pain over the acromioclavicular joint pathology
Cross Body or Horizontal Adduction Test
What special test
1) Place the patient’s arm in flexion 90 degrees of flexion, horizontally adduct to 20-30 degrees.
2) Have patient point thumb down, apply downward force against resistance.
3) Apply force again, but with forearm supinated.
4) Positive: Pain is worse with thumbs down, relieved with forearm supinated. Suggest labral pathology.
Obrien’s Test
