Shoulder Flashcards
Shoulder ROMs
Flexion: 170-180
Extension: 50-60
Abduction: 150-180
Horizontal Adduction: 60-70
External Rotation: 90-100
Internal Rotation: 70-80
Sulcus Sign
testing for multidirectional instability, inferior instability
patient seated, grasp humeral condyles and distract
look for dip in acromion or feeling of subluxation in patient
Load and shift
testing for multidirectional instability, anterior/posterior instability
patient seated, one hand stabilises scapula. glide humeral head anteriorly and posteriorly
positive test: if pain reproduced or humeral head translates excessively compared to other side
Apprehension
Testing anterior instability
patient in supine with elbow/arm off bed. Externally rotate shoulder and look for apprehension. Positive if pain or fear of subluxation
Re do, but stabilise front of shoulder. Should have less apprehension now. Positive if it feels more stable, greater ROM or reduction in symptoms
Sub Acromial Impingement Cluster
assessing shoulder impingement
Hawkins Kennedy
Neer
Empty Can
Painful Arc
Resisted external rotation
Obriens
assessing for labral injury (SLAP)
patient in supine. flex shoulders to 90 degrees, horizontally adduct, pronate forearms, internally rotate and resist downward pressure
Then repeat with arms externally rotated
positive if pain provoked in first position is lessened or absent in second position
Jerk
Assess for SLAP, posterior inferior labral tear
patient seated. stabilise scapula. Put arm into 90 degrees abduction and internal rotation. Compress humerus and move arm into horizontal adduction
This test is positive if the patient experiences a sudden onset of posterior shoulder pain and a click in the shoulder.
Biceps load II
assess for SLAP, superior labral tear
patient in supine. Therapist move the patient shoulder to 120 degrees of elevation and full external rotation, while the elbow is in 90 degrees of flexion, and the forearm in supination.
The patient is then asked to flex the elbow as the clinician provides resistance
Positive test is reproduction of shoulder pain, apprehension or weakness.
Compressive
Assessing for SLAP
patient side lying. Stabilise AC joint. rotate the patient’s arm externally with 30 degrees of abduction and then push the arm proximally while extending the shoulder, which results in the passive compression of the superior labrum onto the glenoid.
The test is positive if pain or a painful click is elicited in the glenohumeral joint
Gerbers lift off test
testing subscapularis
Patient places hand on lumbar spine and tries to actively lift hand off into internal rotation.
Physiotherapist can add resistance if pain and symptom free with active movement.
Positive test is reproduction of pain or weakness.
Belly press test
assessing subscapularis
patient standing
The patient places their elbow flexed to 90 degrees, with the palm of the hand on the upper abdomen, just below the xyphoid process (‘hand to the belly’)
The patient is asked to press the palm of the hand against the abdomen, through shoulder internal rotation (belly press)
The test is positive for subscapularis muscle dysfunction if the patient compensates the movement through started wrist flexion, shoulder adduction and shoulder extension, or reports pain
What is sub acromial impingement
injuries of sub acromial space which include RC tendinopathy, partial thickness tears and bursitis
Lag Sign
assessing supraspinatus and infraspinatus
Standing
The examiner places the patient’s elbow flexed to 90 degrees while the shoulder is held at 20 degrees elevation in the scapular plane in a position of near maximum external rotation
The patient should be able to maintain the position for a negative test.
The test is positive if the patient is unable to maintain positon and their arm may spring back anteriorly.
Muscles of the rotator cuff
Supraspinatus
Infraspinatus
Subscapularis
Teres minor
Stab and Action of Supraspinatus
Stab: compresses the head of the humerus into the glenoid cavity
Action: external rotation and abduction
