Shoulder

Question 1

What are some things that you are looking for in observation?

Answer 1

Redness, bumps, bruising, swelling, discolouration, alignment/asymmetry

Question 2

What do you palpate in a shoulder exam?

Answer 2

Sternoclavicular into clavicle, coracoid process, bicipital groove, ac joint, inferior border of scapula, spine of scap

Question 3

Where is the coracoid process and how do you find it in an assessment?

Answer 3

In the depression below the lateral aspect of the clavicle, there should be a golf ball shaped bony projection.

Question 4

Which muscles insert to the coracoid process?

Answer 4

Short head of the biceps
Pec Minor

Question 5

What movements do you ask your patient to do in Active ROM?

Answer 5

Flexion
Extension
ABduction
ADduction
External rotation
Internal rotation
Elevation, Depression, Protraction, Retraction

Question 6

What is the normal range of shoulder flexion?

Answer 6

170-180 degrees

Question 7

What is the normal range for shoulder extension?

Answer 7

45-60 degrees

Question 8

What is normal range for shoulder external rotation?

Answer 8

45-60 degrees

Question 9

What is normal range of motion for internal rotation of shoulder?

Answer 9

T5 or above when done behind back

Question 10

How do you get your patient to demonstrate external rotation of the shoulder in Active ROM?

Answer 10

elbow up to 90 degrees, keep elbow in contact with ribs and move hand out laterally

Question 11

How do you get your patient to demonstrate shoulder ABduction in Active ROM?

Answer 11

arm out to the side and rise up as high as can

Question 12

How do you get your patient to demonstrate Shoulder ADduction in Active ROM?

Answer 12

either across the front of the body to opposite leg or into 90 degree rotation (like bouncing a ball) and move across body

Question 13

How do you get your patient to demonstrate internal rotation of the shoulder in Active ROM?

Answer 13

hand behind back in dip and fingers up as high as can

Question 14

How do you get your patient to demonstrate shoulder extension in active ROM?

Answer 14

arm back down as far to back as can go

Question 15

How do you get your patient to demonstrate shoulder flexion in active ROM?

Answer 15

lift above head (hands up)

Question 16

How would you demonstrate shoulder flexion in passive ROM?

Answer 16

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

Question 17

How would you demonstrate shoulder extension in passive ROM?

Answer 17

Stabilise scap, move patients arm back by guiding bicep section of humerus back to end range

Question 18

How would you demonstrate shoulder ABduction in passive ROM?

Answer 18

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

Question 19

How would you demonstrate shoulder ADdcution in passive ROM?

Answer 19

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

Question 20

How do you demonstrate external rotation of the shoulder in passive ROM?

Answer 20

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

Question 21

How do you demonstrate internal rotation of the shoulder in passive ROM?

Answer 21

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

Question 22

What is the best position to be in for shoulder joint tests?

Answer 22

Pt lying supine. Pt’s forearm stabilised between clinicians legs. Webbing of hand right up into the axilla, reinforced thumb with other hand.

Question 23

What movements can you do with special tests?

Answer 23

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

Question 24

What is the painful arc test?

Answer 24

To see if the patient displays pain between 60-120 degrees of shoulder ABdution - patient lifts their arm in abduction actively

Question 25

What could it indicate if there is a positive painful arc test ?

Answer 25

The patient could have a shoulder impingement

Question 26

If patient has pain below 60 degrees or above 120 degrees, is this a positive test on the painful arc test?

Answer 26

No, the result will be negative

Question 27

What problem could be indicated if the patient has pain at the end range of ABduction?

Answer 27

AC joint problem

Question 28

How do you perform the Hawkin’s test?

Answer 28

Ask patient to move arm across body at 90 degrees.
Face the patient and use closest arm to patient to stabilise opposite shoulder, using bicep to stabilise elbow, and use other arm to use wrist as a lever, pushing the wrist down.

Question 29

What is Hawkin’s test used for?

Answer 29

it is a very sensitive test, good for ruling out shoulder impingement