Shoulder Flashcards
What are some things that you are looking for in observation?
Redness, bumps, bruising, swelling, discolouration, alignment/asymmetry
What do you palpate in a shoulder exam?
Sternoclavicular into clavicle, coracoid process, bicipital groove, ac joint, inferior border of scapula, spine of scap
Where is the coracoid process and how do you find it in an assessment?
In the depression below the lateral aspect of the clavicle, there should be a golf ball shaped bony projection.
Which muscles insert to the coracoid process?
Short head of the biceps
Pec Minor
What movements do you ask your patient to do in Active ROM?
Flexion
Extension
ABduction
ADduction
External rotation
Internal rotation
Elevation, Depression, Protraction, Retraction
What is the normal range of shoulder flexion?
170-180 degrees
What is the normal range for shoulder extension?
45-60 degrees
What is normal range for shoulder external rotation?
45-60 degrees
What is normal range of motion for internal rotation of shoulder?
T5 or above when done behind back
How do you get your patient to demonstrate external rotation of the shoulder in Active ROM?
elbow up to 90 degrees, keep elbow in contact with ribs and move hand out laterally
How do you get your patient to demonstrate shoulder ABduction in Active ROM?
arm out to the side and rise up as high as can
How do you get your patient to demonstrate Shoulder ADduction in Active ROM?
either across the front of the body to opposite leg or into 90 degree rotation (like bouncing a ball) and move across body
How do you get your patient to demonstrate internal rotation of the shoulder in Active ROM?
hand behind back in dip and fingers up as high as can
How do you get your patient to demonstrate shoulder extension in active ROM?
arm back down as far to back as can go
How do you get your patient to demonstrate shoulder flexion in active ROM?
lift above head (hands up)
How would you demonstrate shoulder flexion in passive ROM?
Stabilise the clavicle and scapula only up until 90 degrees then take pressure off of there and push to end range - lifting patients arm up a high as it can go via distal humerus
How would you demonstrate shoulder extension in passive ROM?
Stabilise scap, move patients arm back by guiding bicep section of humerus back to end range
How would you demonstrate shoulder ABduction in passive ROM?
Hold on to the patients wrist and bring this out to the side and upwards. Should be able to get mid bicep close to the ear.
Stabilise clavicle and scap
How would you demonstrate shoulder ADdcution in passive ROM?
Stand on opposite side of the arm you are going to test. Move arm into shoulder and elbow flexion of 90 degrees. Stabilise on lateral border of the scapula with one hand and bring the arm across holding on to the pt’s distal humerus. Only 10 degrees with scap stabilisation then let go. Bicep should get close to opposite side of chest
How do you demonstrate external rotation of the shoulder in passive ROM?
Block the scapula with body. Use ipsilateral arm to support just below elbow keeping it close to the body. Hold on with other hand to just below wrist and pull the arm out laterally
How do you demonstrate internal rotation of the shoulder in passive ROM?
Ask patient to put hand in lower back. Stand infront of patient. Stabilise clavicle and then use torso to do this. Place left hand on pt’s wrist and right hand on elbow to keep in tight. Pull arm back with and holding wrist - should only be about 10 degrees
What is the best position to be in for shoulder joint tests?
Pt lying supine. Pt’s forearm stabilised between clinicians legs. Webbing of hand right up into the axilla, reinforced thumb with other hand.
What movements can you do with special tests?
A-P P-A INF-SUP and SUP to INF
Long axis distraction - stay in same position and lean back
Circumduction
Counter rotation - scissor action, one hand up in axilla moving laterally and the other hand is lower and moves medially
What is the painful arc test?
To see if the patient displays pain between 60-120 degrees of shoulder ABdution - patient lifts their arm in abduction actively
