Shoulder Flashcards
Normal Ranges of Motion
Flexion: 160
Extension: 60
Abduction: 180
Adduction: 20
Internal Rotation: 80
External Rotation: 80
PROM End Feels
Shoulder Flexion
AROM: “Standing tall with your hands by your hips, with your thumbs forward, please raise your arms up above your head as far as you can”
PROM: Lying supine, stabilize scapula and grab wrist joint, bring arm overhead into flexion
RROM: Seated position, bring arm into 90 degrees shoulder flexion with palm facing upwards, stabilize scapula and push downwards on anterior wrist, “Meet my resistance and bring your palm upwards to the ceiling”
Shoulder Extension
AROM: “Standing tall with your hands by your hips, with your thumbs facing forward, please bring your arms back behind you as far as you can”
PROM: Lying supine, stabilize scapula and cup elbow joint with a slightly bent elbow, pull arm down to floor into extension
RROM: Seated position, bring elbow into 90 degrees flexion with palm facing inwards in fist, stabilize scapula and cup back of upper arm, “Meet my resistance and bring your elbow to the back wall”
Shoulder Abduction
AROM: “Standing tall with your hands by your hips, thumbs pointing up to the side, please bring your arms up as close to your ears as you can”
PROM: Lying supine, stabilize scapula and grab wrist joint, bring arm laterally and upwards to ear
RROM: Seated position, bring arm into 90 degrees shoulder abduction with palm facing downwards, stabilize scapula and push downwards on posterior wrist, “Meet my resistance and bring the back of your hand upwards”
Shoulder Adduction
AROM: “With your arms to your sides at 90 degrees, can you please bring them back to the sides of your body as far as you can”
PROM: Lying supine, stabilize scapula and grab wrist joint, bring arm towards body and cross body into adduction
RROM: Seated position, bring arm into 90 degrees shoulder abduction with palm facing upwards, stabilize scapula and pull upwards on anterior wrist, “Meet my resistance and bring your palm down to the floor”
Shoulder Internal Rotation
AROM: “Please bend your elbows to 90 degrees and have your thumbs pointing up, palms facing in towards each other. Keeping your elbows at your side, Can you bring the palms of your hands to your stomach as far as you can?” OR “With your arms out to your sides bent at 90 degrees, and your palms facing forward and toes pointing to the ceiling, Can you please try to bring the palms of your hands down and as far to point the back wall as you can?”
PROM: Lying supine, have elbow bent to 90 degrees and arm abducted 45 degrees, stabilize elbow and grab wrist joint, pull arm from wrist to floor into internal rotation (Hands at hip) ALSO stabilize at scapula
RROM: Seated position, bring elbow into 90 degrees flexion with palm facing inwards in fist, stabilize scapula and meet forearm to forearm, “Meet my resistance and bring your palm in towards your body”
Shoulder External Rotation
AROM: “Please bend your elbows to 90 degrees and have your thumbs pointing up, palms facing in towards each other. Keeping your elbows at your side, Can you bring the back of your hands as far to the back wall as you can?” OR “With your arms out to your sides bent at 90 degrees, and your palms facing forward and toes pointing to the ceiling, Can you please try to bring the backs of your hands back and as far to point to the floor wall as you can?”
PROM: Lying supine, have elbow bent to 90 degrees and arm abducted 45 degrees, stabilize elbow and grab wrist joint, pull arm from wrist to floor into external rotation ALSO stabilize at scapula
RROM: Seated position, bring elbow into 90 degrees flexion with palm facing inwards in fist, stabilize scapula and push on posterior wrist joint, “Meet my resistance and bring the back of your hand out towards to side and back wall”
MMT: Deltoids
Anterior deltoid:
-Seated, bring arm straight into 90 degrees shoulder flexion
-Stabilize scapula
-Push downwards above elbow joint as they resist upwards
Middle Deltoid:
-Seated, bring arm into 90 degrees shoulder abduction
-Stabilize scapula
-Push downwards above elbow joint as they resist upwards
Posterior Deltoid:
-Seated, bring arm into 90 degrees shoulder abduction
-Stabilize scapula
-Push forwards above posterior elbow joint as they resist and push backwards
MMT: Supraspinatus Empty VS Full Can
Empty Can
-Seated, bring arm into 90 degrees shoulder abduction
-Empty can position with thumb pointing downwards
-Push down on wrist joint as they resist and push upwards
Full Can
-Seated, bring arm into 90 degrees shoulder abduction
-Full can position with thumb pointing upwards
-Push down on wrist joint as they resist and push upwards
DO FULL CAN FIRST ; if they can’t do full can, don’t do empty can at all
Long Head Biceps Brachii
-Seated, bring arm into 90 degrees shoulder flexion
-Palm upwards
-Stabilize scapula
-Push downwards on anterior wrist as they resist and bring palm upwards
Long Head Biceps Brachii
-Seated, bring arm into 90 degrees shoulder flexion
-Palm upwards
-Stabilize scapula
-Push downwards on anterior wrist as they resist and bring palm upwards
Palpation Structures
Sternum (Lying supine, centre of chest)
Clavicle (Trace with index belly)
AC Joint (Lateral ends of clavicle)
Acromion Process (Posterior to AC joint)
Coracoid Process (Medial to AC Joint)
Deltoid heads (Relax arm and find deltoid heads with finger bellies)
Long Head Biceps Brachii (Contract bicep slightly, lateral muscle belly with thumb pad)
Short head biceps Brachii (Contract bicep slightly, medial muscle belly with thumb pad)
Pectoralis Major (Bring their hand cross over their chest, palpate above their hand and laterally to border close to axilla to find tendon)
Inferior angle of scapula (Bring shoulder back off table slightly and find interior border with index pad, bony strocuturs)
Medial Border of scapula (follow medial side)
Superior border of scapula (Follow superior side)
Scapular spine (superior follow back into acromion)
Greater tuberosity of humerus (Supine or prone, distal to Acromion)
Supraspinatus (Find scapular spine and cup over it with fingers to fall into fossa of muscle, Deep to trapezius)
Infraspinatus (Find medial border and scapular spine, it falls within the bones)
Latissimus Dorsi (Find sacrum and follow muscle belly diagonally to axilla)
Rhomboids (Ask to bring shoulder blades together, retract shoulders, and find medially the rhomboids)
Upper, lower and middle fibre trapezius (Along the Superior border of scapula and middle border of scapula)
Functional Movement: Abduction and Adduction, Scapulohumeral rhythm
“Standing with your hands at your sides, and palms facing forwards, please bring your arms up to your sides as far as you can upwards; and back down”
Posterior view:
-First 30 degrees look for upwards rotation of scapula and humerus
-30-90 degrees look for upward rotation of scapula and humeral movement
-Past 90 degrees, look for 1:1 ratio
-Winging scapula, abnormal movement, scapulohumeral rhythm
-Look for interior and medial border in relation to humerus
Functional Movement: Pushups
“With your wrists under your elbows and shoulders, please move downward and back up into pushups on the floor”
Can do from floor, wall, on knees, if necessary
View:
-Straight line from ankle to shoulder
-Quality of scapula movement through pushup
-At top, does scapular protract or retract?
