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PACES Examinations > Should3r > Flashcards

Should3r Flashcards

1
Q

What are the principles of any ortho exam?

A 
Look
Feel 
Move
Special tests
(Measure, Neurovascular assessment, associated joints)
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2
Q

What do you look for in shoulder examination?

A

Normal shoulder contour/asymmetry
Skin: erythema, scars, lacerations
Soft tissue: swelling, inflammation, muscle wasting
Bones: clavicular deformity, winging of scapulae

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3
Q

What might deformity in the middle of the clavicle suggest?

A

Previous clavicular fracture

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4
Q

What might deformity at the distal end of the clavicle suggest?

A

Acromio-clavicular joint subluxation

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5
Q

What can cause winging of the scapulae?

A

Damage to long thoracic nerve supplying serratus anterior

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6
Q

What do you feel for in shoulder examination?

A

Deformity
Tenderness
Temperature
Swelling

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7
Q

What may tenderness over the acromio-clavicular joint suggest?

A

Osteoarthritis

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8
Q

What may tenderness over the greater tuberosity suggest?

A

Impingement

Rotator cuff pathology

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9
Q

What movement may suggest impingement syndrome?

A

Painful arc of abduction between 60 - 120 °

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10
Q

What is normal flexion?

A

180°

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11
Q

What is normal extension?

A

50°

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12
Q

What is normal external rotation?

A

60°

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13
Q

What condition most affects the movement of external rotation?

A

Frozen shoulder

Also lost early in glenohumeral joint arthritis

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14
Q

How do you assess flexion/extension?

A

Move straight arms all the way up in front of you then behind

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15
Q

How do you assess abduction?

A

Move straight arms all the way up laterally

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16
Q

How do you assess external rotation?

A

Bend elbows to 90° then move forearms outwards

17
Q

How do you assess internal rotation?

A

Reach as far up as you can on your back with your thumb

Measure according to corresponding vertebrae

18
Q

What would be considered normal internal rotation?

A

Reach at least inferior border of scapula

19
Q

How can you assess subscapularis?

A

Patient’s hand behind back, try to lift off against resistance

20
Q

How can you assess infraspinatus (and teres minor)?

A

External rotation against resistance

21
Q

How can you assess supraspinatus?

A

Patient hold at 30° abduction and flexion against resistance

22
Q

Which rotator cuff muscle tear is most common?

A

Supraspinatus tears

23
Q

What are the special tests for impingement?

A

Jobe’s test (empty can test)

Hawkins -Kennedy Test

24
Q

How do you carry out Jobe’s test?

A

Flex to 90, abducted in scapula plane with thumbs up - push up against resistance
Same with thumbs down

25
Q

Why is impingement pain more likely when thumbs down in Jobe’s test?

A

Internal rotation brings greater tuberosity of the humerus under the acromion process, compressing the supraspinatus tendon

26
Q

How do you conduct the Hawkins-Kenney test?

A

Abduct shoulder and flex elbow 90°

Passively rotate arm downwards and continue while adducting the humerus

27
Q

What test can be performed to indicate acromioclavicular joint arthritis?

A

Cross arm test / scarf test

28
Q

How do you carry out cross arm test / scarf test?

A

Flex elbow to 90° and forcibly adduct across the chest

29
Q

What are the tests for instability?

A

Anterior/posterior draw test
Sulcus test
Apprehension test

30
Q

How do you perform the anterior/posterior draw test for laxity?

A

Stabilise shoulder with one hand, grip proximal humerus with the other
Then apply anterior and posterior traction force to humerus

31
Q

What does the sulcus test demonstrate?

A

Inferior instability of glenohumeral joint

32
Q

How do you perform the sulcus test?

A

Stabilise shoulder with one hand
Downward traction force to epicondyles of the humerus
Positive test if sulcus visible under acromion process

33
Q

How do you perform the apprehension test?

A

Patient upright or supine
Abduct shoulder and flex elbow to 90°
Then externally rotate shoulder whilst watching face
Positive test - look of apprehension on patient’s face as shoulder feels close to dislocating

34
Q

How do you assess for winging of the scapulae?

A

Push off test

Get patient to push off the wall using both hands

35
Q

How would you complete the shoulder examination?

A

Assess joints above and below - cervical spine and elbow
Neurovascular assessment of affected limb
Thank patient and consider ordering appropriate imaging

PACES Examinations (2 decks)

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