Shoulder Flashcards
Palpation – Narrate as you go, explain why palpating this area, show off your knowledge and accuracy on palpation
Soft – Infection/Bursitis , Hard – Fracture, cyst, osteophytes
SCJ -> Clavicle (any evidence of discontinuity=fracture) -> ACJ -> Coracoid process (see if there is any pain there insertion for biceps and pec minor) -> Head of humerus -> I.Spin & T.Minor tendons -> S.Spin (Anterior to acromion) -> Subscapularis tendon (Between bicipital groove and coracoid) -> Bicep brachii long head tendon (Hand in lap) -> Bicipital tendon – Tendinitis pain -> Triceps tendon.
Posterior – Spine of scapula – pain = Red flag sign of bony cancer
Palpate - Borders of the spine of scap -> medial border -> inferior angle of scap – Lateral border, Superior border
Supraspinatus -> Infra spinatus -> Teres minor (palpate for any pain, Obvious nots,) Move to the insertions of the muscles and see if you can notice any steps which could suggest tear)
Palpate – Deltoid -> Latissimus dorsi (inserts interbecular groove of the humerus) -> Trapezius -> Rhomboids Minor/Major -> Levator scapula
Active/Passive ROM – Good clear instructions, coach with external cues if required to get movement you want. Safe confident handling with PROM, ensure full end range on PROM, ensure stabilisation appropriate joints
Flexion – Can you bring your arms out in front of you as high as you can go 170-180*
* Reducing end range may suggest Rotator cuff or bursal inflammation
Extension – Bring them back down and can you take them as far backwards as you can go 50-60*
Abduction – Bring your arms to the side with your thumbs pointing upwards and lift them as far up as you can 160-180
* Painful arc around 60-120, Pain within 60-120°indicates compression of inflamed or tender structures under the acromion and the coracoacromial ligament.
* 90-180 pain could indicate AC joint disorders
* End range pain could indicate could indicate parital tear supraspinatus or bursitis
Adduction – Now bring them down and across your body like you’re trying to hug yourself 30-50*
* Anterior pain could indicate labral tear, subscap or subcoracoid bursitis.
* Posterior pain could indicate suggest problems with posterior deltoid, infra,teres minor or supraspin.
* Decreased ROM could indicate AC DJD or posterior capsule tightness
External Rotation – Now keep your elbows on your side and bring your arms out 60-90*
* Pain anteriorly may suggest anterior instability and posterior pain may suggest posterior impingement
* Any pain may also indicate adhesive capsulitis or muscle tightness
Internal rotation – And now across your body 55-80*
* Posterior shoulder pain impingement or tightness of posterior capsule
PROM-
Ok I’m going to move your arms now please stay as relaxed as possible, please let me know if you have any pain at all.
Safe handling – assess end feel
Resisted Isometrics (RIMS) – Ensure good position on External/Internal rotation, Abduction muscle tests.
The oxford scale - A manual strength assessment tool that uses a scale of 0-5 to grade the strength of patients muscles
0/5 = No contraction
1/5 = Visible / or palpable muscle contraction, but no movement
2/5 = Movement with gravity eliminated
3/5 = Movement against gravity only
4/5 = Movement against gravity with some resistance
5/5 = Movement against gravity with full resistance
Ask patient to perform (flexion,extension,) and give resistance in the opposite direction
Flexion – give resistance into extension direction (Ant Deltoid, Pec Major and Coracobrachialis)
Extension – give resistance into flexion (Lat Dorsi, Teres Major/Minor and Post Deltoid.)
Abduction – Resistance (Supraspinatus (15-20 degrees), Deltoid.)
Adduction – Resistance (- Pec Major, Lat Dorsi, Teres Major, Triceps and Coracobrachialis)
External rotation – Resistance (Teres Minor & Infraspinatus )
Internal rotation – (Teres Major and Subscapularis )
Special tests
30 Tests
