shoulder Flashcards
neers test
near to ear- r/o impingement
Scapula stabilized
Arm fully pronated
Examiner brings to max forward flexion, pain = impingement
Yergasons
biceps tendon injury
Elbow flexed to 90 with thumbs up, grasp hand, patient supinates and flexes against resistance
Palm up- arm up – resist my pressure and feel shoulder without pain, if pain= tendinitis up at shoulder
apley scratch test
r/o test ROM
attempt to touch opposite scapula
behind above head- scratch other shoulder= abduction and external rotation
go below and behind body to reach other shoulder= adduction and internal rotation
spurlings test
r/o cervical source of pain
Neck extended, head rotated toward affected shoulder, place axial load on cervical spin
Reproduction of pts arm/shoulder pain= possible nerve root compression- stenosis?
painful arch
rotator cuff disease
Positive test is characteristic shoulder pain during abduction of the arm between 60 and 120 degrees. Suggesting a subacromial impingement syndrome or rotator cuff disorder due to compression of the rotator cuff muscles and subacromial bursa between the humeral head, acromion, or coracoid process.
drop arm test
rotator cuff disease
Assesses the integrity of the supraspinatus muscle. Patient is asked to lower the arm slowly from abduction. Positive test is if there is an immediate drop of the arm accompanied by pain.
hawkins
r/o impingement
Arm forward flexed to 90, elbow flexed to 90
Shoulder forcibly internally rotated by examiner
neurovascular testing
Neurovascular status Distal pulses Capillary refill Sensation Reflexes - biceps and radial C6- c7-c8
C5
lateral neck/upper trapezius
lateral arm dermatome
bicep reflex
deltoid/biceps motor
lateral neck/upper trapezius
lateral arm dermatome
bicep reflex
deltoid/biceps motor
C5
C6
Base of neck/upper trap to superior glenohumoral joint
dermatome- Radial aspect of distal forearm
Refelx Brachioradialis
muscle- Biceps, extensor carpi radialis longus and brevis (writst extensor
Base of neck/upper trap to superior glenohumoral joint
dermatome- Radial aspect of distal forearm
Refelx Brachioradialis
muscle- Biceps, extensor carpi radialis longus and brevis (writst extensor
C6
c7
Base of neck, almost entire upper quadrant of back
dermatone- Third finger
refelx- Triceps
muscle- Triceps, wrist flexion, finger extension
Base of neck, almost entire upper quadrant of back
dermatone- Third finger
refelx- Triceps
muscle- Triceps, wrist flexion, finger extension
C7
c8
No shoulder pain
dermatone- 4th and 5th fingers, distal half of forearm (ulna side)
reflex- None
muscle -Finger flexion (grip strength)
No shoulder pain
dermatone- 4th and 5th fingers, distal half of forearm (ulna side)
reflex- None
muscle -Finger flexion (grip strength)
C8
Apprehension
Pt supine, arm abducted 90 deg., externally rotated w anteriorly directed force applied to humeral head.
Pain/apprehension w force suggests anterior instability.
Relocation
Pt supine, posteriorly directed force applied to humeral head
Relief w force suggests anterior instability.
Crank
Pt sitting, arm abducted 90 deg, elbow flexed 90 deg, humerus supported w forced external rotation
Pain/apprehension w forced external rotation suggests anterior instability
Load and Shift
Pt supine, arm held by examiner and abducted 90 deg., force applied along axis of humerus to “seat” the humerus within glenoid, followed by anterior force directed to humeral head.
Pain and appreciable translation felt w anterior force suggests anterior instability.
Drawer
Pt sitting, arm at side, proximal humeral shaft grasped by examiner, seating the humeral head within the glenoid then applying anterior translational force.
Pain and appreciable translation felt with anterior force suggests anterior instability.
Sulcus
Pt sitting, arm at side, forearm grasped by examiner with an inferior/caudally directed force applied.
Sulcus or depression seen inferior to acromion as humeral head subluxes posteriorly, pathognomonic for multidirectional instability.
Clunk
Pt supine, examiner grasps at forearm and humeral shaft, with humeral head seated within the fossa taking the arm through passive ROM from extension through forward flexion.
Clunk sound or clicking sensation suggests labral tear.
Obrien
Pt sitting, arm is forward flexed to 90 deg and fully adducted and internally rotated; pt resists downward motion. If pain elicited, the maneuver is repeated in external rotation.
Pain elicited with resisted downward motion in internal rotation but relieved with external rotation suggests labral pathology.
test for rotator cuff triad/involvement
f all 3 are positive, there is a 98% chance of rotator cuff tear. If 2 positive and >60 yo, findings suggest tear. IF all 3 negative, <5% chance of major rotator cuff tear. Tests include Empty can test French horn test Hawkins impingement test
