Should3r Flashcards
What are the principles of any ortho exam?
Look Feel Move Special tests (Measure, Neurovascular assessment, associated joints)
What do you look for in shoulder examination?
Normal shoulder contour/asymmetry
Skin: erythema, scars, lacerations
Soft tissue: swelling, inflammation, muscle wasting
Bones: clavicular deformity, winging of scapulae
What might deformity in the middle of the clavicle suggest?
Previous clavicular fracture
What might deformity at the distal end of the clavicle suggest?
Acromio-clavicular joint subluxation
What can cause winging of the scapulae?
Damage to long thoracic nerve supplying serratus anterior
What do you feel for in shoulder examination?
Deformity
Tenderness
Temperature
Swelling
What may tenderness over the acromio-clavicular joint suggest?
Osteoarthritis
What may tenderness over the greater tuberosity suggest?
Impingement
Rotator cuff pathology
What movement may suggest impingement syndrome?
Painful arc of abduction between 60 - 120 °
What is normal flexion?
180°
What is normal extension?
50°
What is normal external rotation?
60°
What condition most affects the movement of external rotation?
Frozen shoulder
Also lost early in glenohumeral joint arthritis
How do you assess flexion/extension?
Move straight arms all the way up in front of you then behind
How do you assess abduction?
Move straight arms all the way up laterally
How do you assess external rotation?
Bend elbows to 90° then move forearms outwards
How do you assess internal rotation?
Reach as far up as you can on your back with your thumb
Measure according to corresponding vertebrae
What would be considered normal internal rotation?
Reach at least inferior border of scapula
How can you assess subscapularis?
Patient’s hand behind back, try to lift off against resistance
How can you assess infraspinatus (and teres minor)?
External rotation against resistance
How can you assess supraspinatus?
Patient hold at 30° abduction and flexion against resistance
Which rotator cuff muscle tear is most common?
Supraspinatus tears
What are the special tests for impingement?
Jobe’s test (empty can test)
Hawkins -Kennedy Test
How do you carry out Jobe’s test?
Flex to 90, abducted in scapula plane with thumbs up - push up against resistance
Same with thumbs down
Why is impingement pain more likely when thumbs down in Jobe’s test?
Internal rotation brings greater tuberosity of the humerus under the acromion process, compressing the supraspinatus tendon
How do you conduct the Hawkins-Kenney test?
Abduct shoulder and flex elbow 90°
Passively rotate arm downwards and continue while adducting the humerus
What test can be performed to indicate acromioclavicular joint arthritis?
Cross arm test / scarf test
How do you carry out cross arm test / scarf test?
Flex elbow to 90° and forcibly adduct across the chest
What are the tests for instability?
Anterior/posterior draw test
Sulcus test
Apprehension test
How do you perform the anterior/posterior draw test for laxity?
Stabilise shoulder with one hand, grip proximal humerus with the other
Then apply anterior and posterior traction force to humerus
What does the sulcus test demonstrate?
Inferior instability of glenohumeral joint
How do you perform the sulcus test?
Stabilise shoulder with one hand
Downward traction force to epicondyles of the humerus
Positive test if sulcus visible under acromion process
How do you perform the apprehension test?
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
How do you assess for winging of the scapulae?
Push off test
Get patient to push off the wall using both hands
How would you complete the shoulder examination?
Assess joints above and below - cervical spine and elbow
Neurovascular assessment of affected limb
Thank patient and consider ordering appropriate imaging
