Shoulder

Question 1

How is the shoulder assessment performed ?

Answer 1

Compare by look, feel, move and special tests.

Question 2

What should I look for when comparing the shoulder by looking ?

Answer 2

• Assess posture from front, back and both sides.

Look for, symmetry, swelling, redness, bruising, scars, deformity around shoulders and scapula.

Question 3

What should I look for when feeling the shoulders?

Answer 3

• Palpate over shoulder joints for HEAT- compare sides.
  NOTICEABLE DIFFERENCE: sign of inflammation or septic arthritis.

Palpate from sternoclavicular joint across the clavicle to the acronym-clavicular join - NOTE ANY - Pain, tenderness, heat or swelling.

• palpate Caracoid process - NOTE ANY- heat, swelling, crepitus or tenderness.
• palpate down the humerus - NOTE ANY- heat crepitus, pain, bony tenderness.
• palpate scapula spine and boarders - NOTE ANY- Heat, pain, crepitus or bony tenderness.
• Assess for ‘winged scapula’- ask patient to put hands on the wall and assess scapula.
• winged scapula is caused by - the long thoracic nerve getting damaged or the serratus anterior muscle becomes weak.
• If the LONG THORACIC NERVE, becomes damaged or bruised it can cause PARALYSIS OF THE SERRATUS MUSCLE causing winged scapula.
• palpate down cervical spine - NOTE ANY- pain crepitus, heat or tenderness.
• check C4, 5 and 6 for deficits.

Question 4

Compare shoulder by moving?
Flexion and extension (1)

Answer 4

Ask the patient to move there arms from their sides all the way up and then all the way back down and behind them.

Question 5

Compare by moving ?
Abduction and addiction (2)

Answer 5

Ask pt to move there arms from there sides laterally all the way up and then back down and then do arm folding.

Question 6

Compare by moving
External rotation

Answer 6

With tucked elbow ask the patient to move their arms out.

Question 7

Compare by moving
Internal rotation.

Answer 7

Ask patient to move each arm up there spine as far as they can go. (Average around T5).

Question 8

Compare by moving ?
Does the 4 steps need repeating ?

Answer 8

Yes repeat this passive and resisted.

Question 9

What does the compare by movement assess for ?

Answer 9

Active flexion and extension
Lateral flexion and rotation movements of the neck.

Question 10

Compare by special tests ?
Painful arc

Answer 10

Ask the patient to move there arms laterally upwards.

Pt will have pain around 60-70 degrees - 120 then pain should go away.

Question 11

What does painful arc test, test for ?

Answer 11

Supraspinatus impingement

And is associated with rotator cuff injury and bursitis of the joint.

Question 12

Compare by special test
Drop arm

Answer 12

Ask the patient to to hold arms at 90 degrees.
You are then going to say to the patient I’m going to let go of the arm in a minute and you need to take control.