Shoulder Flashcards
Instructions for Dugas Test
Patient Seated
Examiner instructs patient to place the hand of the affected side on the opposite shoulder and bring the affected elbow to the chest.
State Positives for Dugas Test
Inability to touch the opposite shoulder and/or inability of the elbow to touch the chest.
What does Dugas Test indicate?
Acute dislocation of the glenohumeral joint
Instructions for Anterior Apprehension Test
Patient Seated
Examiner abducts the patient’s shoulder, flexes the patients elbow and then gradually externally rotates the patient’s shoulder
Positive Anterior Apprehension Test
Patient will have noticeable look of apprehension or alarm on their face with possible pain
What does a positive Anterior Apprehension Test indicate?
Chronic anterior dislocation of the glenohumeral joint
What is a confirmation test for a positive anterior apprehension test?
Dugas Test
Radiography
Instructions for Posterior Apprehension Test
Patient Supine
Examiner flexes patient’s shoulder, flexes patient’s elbow and internally rotates the shoulder.
Examiner places his/her hand on the patient’s distal humerus and gradually applies increasing posterior pressure
Positive Posterior Apprehension Test
Apprehension
Pain
What does a positive Posterior Apprehension Test indicate?
Chronic posterior dislocation of the glenohumeral joint
Instruction for Drop Arm Test
Patient Seated
Examiner passively abducts patients arm to slightly over 90 degrees and removes support, if patient can maintain arm, then instructs patient to slowly lower their arm
Positive Drop Arm Test
Patient will not be able to lower the arm slowly or the arm drops suddenly
What does the Drop Arm Test indicate?
Rotator cuff tear, usually supraspinatus
Confirmation test for Drop Arm test
Apley Scratch
Impingement
Instructions for Dawbarn Test
Patient Seated
Examiner applies pressure below the affected acromial process with fingertips. Note for pain or tenderness.
Examiner continues to apply pressure while abducting the patient’s arm PAST 90 degrees
State the positive for Dawbarn Test
Decrease in pain and or tenderness
What does a positive Dawbarn Test indicate?
Subacromial bursitis
How can you confirm a positive Dawbarn Test
MRI
What is another name for Yergason Test
Cipriano
Instructions for Yergason Test
Patient Seated
Examiner flexes patient’s elbow to 90 degrees. Examiner stabilizes patient’s elbow with one hand and exerts slight inferior traction.
Examiner uses their other hand and grasps slightly above patient’s wrist
Examiner offers resistance while patient is instructed to externally rotate his/her humerus and slightly supinate the forearm
Positives for Yergason Test
Localized pain or tenderness at the bicipital groove
Audible click or the bicep tendon sub luxes or dislocates
What does a positive Yergason Test indicate?
Tendinitis
Instability of the biceps tendon possibly associated with a torn transverse humeral ligament
Tests to confirm a positive Yergason Tests?
Speed Test
Abbott-Saunders Test
Abbott-Saunders Test instructions?
Patient Seated
Examiner fully abducts and externally rotates the patient’s affected arm.
Examiner places his fingers on patients bicipital groove and then slowly lowers the patients affected arm to their side
What is a positive Abbott-Saunders Test
Palpable and or audible click
What does Abbott-Saunders Test indicate?
Subluxation or dislocation of the biceps tendon (rupture of transverse ligament or tendon subluxation beneath subscapularis muscle belly)
Confirmation test for Abbott-Saunders Test
Speed Test
Yergason Test
Instruction for Speed Test
Patient Seated
Forearm supinated and elbow flexed to 45 degrees
Examiner places fingertips on patient’s bicipital groove with their opposite hand on the patients forearm.
Instruct the patient to flex his/her shoulder, maintain supination and completely extend the elbow as the DC applies resistance.
State the positive for Speed Test
Pn or tenderness @ bicipital groove
Speed test indicates?
Bicipital Tendinitis
What tests can confirm a positive Speed Test
Abbot-Saunders Test
Yergason Test
Instructions for Apley Test
Patient Seated
Have them place the affected hand behind the head and touch the opposite superior angle of the scapula = Apley Scratch Superior.
Then instruct patient to place the hand behind the back to touch the inferior angle of scapula = Apley Scratch Inferior
Positive Apley Test
Exacerbation of Pain
+ Apley Test indicates?
Degenerative tendinitis of rotator cuff tendons - usually supraspinatus
Impingement Sign instructions
Patient Seated
Arms at side & examiner slightly abducts patient’s arm (hand pronated) and moves it fully through flexion (will jam greater tuberosity and anterior/inferior surface of the acromion)
+ Impingement Sign indicates?
Overuse injury to the supraspinatus and possible biceps tendon
ROM Flexion (forward) of shoulder
180 degrees
Extension ROM of shoulder
60 degrees
Abduction ROM of shoulder
180 degrees
Adduction ROM of shoulder
50 degrees
T or F
Internal rotation of shoulder (from horizontal abduction of arm) is 90 degrees
False!
90=external
70=internal
T or F
Scapular protraction is seen in movements like reaching
True
Name the rotator cuff muscles
Supraspinatus
Infraspinatus
Teres Minor
Subscapularis
Name the 16 muscles that attach to the scapula
Serratus Anterior Supraspinatus Subscapularis Trapezius Teres Major Teres Minor Triceps Brachii long head Biceps Brachii Rhomboid Major Rhomboid Minor Coracobrachialis Omohyoid inferior belly Lattisimus Dorsi Deltoid Levator Scapula Infraspinatus Pectoralis Minor
What are the primary functions of the shoulder?
- Position hand in space
- suspend the upper extremity
- provide some point of fixation so motion can occur
- Serve as a fulcrum for arm elevation
What is scaption?
Movement of the scapula -> lateral, superior and anterior
The should joint complex consists of what bones and joints?
3 bones: humerus, clavicle, and scapula
3 joints: SC, AC & GH
Name the pseudo joint of the shoulder
ST articulation
Name the physiological area of the shoulder complex
Suprahumeral or subacromial space
What type of joint is the GH joint?
True synovial lined diathrodial joint
Name the structure that makes the Glenoid Fossa 50% deeper
Fibrocartilage called the Labrum
Name the 2 primary functions of the humeral head and glenoid fossa contact
- Spreads the joint loading over a broad area
2. Permits movement with minimal friction and wear
The scapula lies along the thoracic cage at ___ degrees to the frontal plane, ____ superiorly relative to the transverse plane, and ___ degrees forward in the sagittal plane
30
3
20
What are the 3 types of acromion morphology
Flat Undersurface
Slightly Convex
Hooked
What morphology of the acromion predisposes the shoulder to rotator cuff pathology?
Hooked
What muscles originate on the coracoid process?
Coracobrachialis and short head of biceps.
The lateral attachment of the GH joint capsule attaches where?
The anatomical neck of the humerus
Medially the GH joint capsule attaches where?
To the periphery of the glenoid and its labrum
The greater tuberosity serves as an attachment for what muscles?
Supraspinatus
Infraspinatus
Teres Minor
What muscle attaches on the lesser tuberosity?
Subscapularis
What runs in the intertubercular groove?
The long head of the biceps tendon
What is an aka for the G-H ligaments?
Z ligaments
T or F
The superior Z ligament limits external rotation and anterior translation of the humeral head with the arm in 0 degree and 45 degrees of abduction
False
* this was describing the middle Z ligament.
Superior = Limits external rotation and inferior translation of the humeral head with the arm at the side
What is the name of the structure that covers the GH ligament anterior-superiorly and fills the space between the tendons of the supraspinatus and subscapularis muscles?
Coracohumeral Ligament.
What is the main function of the Coracoacuromial Ligament?
Prevents separation of the AC joint surfaces
The Coracoacuromial arch is also known as??
Supraspinatus Outlet
Describe the action of the Supraspinatus tendon when the arm is elevated and internally rotated compared to elevated and externally rotated
Internally rotated = supraspinatus tendon passes under the coracoacromial ligament
Externally rotated = the tendon passes under the acromion itself.
The Subacromial/Suprahumeral space is at its narrowest between what degrees of caption?
60-120
Name the contents of the Subacromial Space
Long head of biceps tendon Supraspinatus Upper margins of subscapularis Infraspinatus Subdeltoid - subacromial bursa
What/Where is the Hypovascular Zone of the Supraspinatus tendon?
It is a critical zone just proximal to the supraspinatus insertion point.
Impingement Syndrome is thought to cause what other problems in the shoulder?
Thought to precipitate attritional (degenerative) changes in the rotator cuff leading to rotator cuff tears.
Describe the clinical findings of Impingement Syndrome
Pain will often become worse at night, as the subacromial bursa becomes hyperaemic after activity or use.
The shoulder complex is embryologically derived from what spinal nerve roots?
C 5-8 except the AC joint which is derived from C 4
The sympathetic nerve supply to the shoulder originates primary in what region of the spine?
Thoracic region from T2-T8
This condition results from an upper brachial plexus (C5-C6) injury and can be from forceful depression of the shoulder during birth or trauma to the shoulder later in life.
Erb’s Palsy aka Erb-Duchenne Paralysis
How will a patient with Erb’s Palsy present?
Internally rotated and adducted shoulder
Biceps relex is lost and there is muscle wasting
The vascular supply to the rotator cuff muscles of the shoulder consists of what main sources?
- Thoracoacromial artery
- Suprahumeral artery
- Subscapular artery
Describe the closed packed position of the GH joint
90 degrees of GH abduction & full external rotation
OR
full abduction and external rotation (depending on source)
Describe open packed position of the GH joint
No internal or external rotation traditionally has been cited as 55 degrees of semi-abduction and 30 degrees of horizontal adduction.
A number of ligaments provide support for the SC joint. Please list them
Anterior sternoclavicular ligament
Posterior sternoclavicular ligament
Interclavicular
Costoclavicular
Name the scapular pivoter muscles
Trapezius, serratus anterior, levator scap, rhomboids
Lat D, pec major and minor are grouped together as ________ _________
Humeral propellers
Name the humeral positioner muscles
the 3 parts of the deltoid
What muscles are the shoulder protectors
Rotator cuff muscles and biceps brachii
A study by Inman determined that a ______ ratio occurs between the motion at the GH joint and scapula respectively
2:1
What does Reverse Scapulohumeral rhythm mean?
The scapula moves MORE than the humerus
This patient will likely hike the shoulder this condition is called Frozen Shoulder
What muscles are the principle movers during the first 30 degrees of upward rotation of the scapula?
Serratus Anterior
Upper & Lower divisions of the Trapezius
What are the 3 possible causes of Shoulder girdle dysfunction
- Compromise of the passive restraint components of the shoulder girdle
- Compromise of the neuromuscular system’s production or control of shoulder girdle motion
- Compromise to one or more of the neighbouring joints that contribute to shoulder girdle.
What type of movements are commonly seen with subacromial bursitis, impingement syndromes and rotator cuff problems?
Overhead exertion with repetitive motion
FOOSH means?
Falling on outstretched hand
Falling on the tip of the shoulder is a common cause for what shoulder pathology?
A/C separations
With a FOOSH injury describe the force path through the shoulder complex
The source bounces off scapula as the scapula is strong and hits the anterior inferior part of the shoulder complex causing an anterior dislocation.
T or F
The most common dislocation of the G/H joint is Anterior/Superior
False
Anterior/Inferior
What is the chance of a recurrent dislocation after the initial event?
95% in patients 25 years old or younger.
With an AC separation does the shoulder look more sunk in or squared off?
Squaring off
What is the Ruler of Hamilton?
This is describing Anterior Dislocations of the G/H Joint where a straight edge can rest simultaneously on the acromial tip and the lateral epicondyle.
How many degrees of separation must occur for an A/C joint separation?
6 degrees
A patient with a clavicle fracture will have difficulty elevating their arm past how many degrees?
60
T or F
Horizontal adduction is painful with clavicular fractures
True
Systemic causes of insidious shoulder pain include?
RA Lupus Gallbladder Liver Disease Chronic respiratory and cardiovascular conditions
Discuss pain and the associations with systemic signs that could indicate referred pain from a malignancy
Severe progressive pain not affected by movement. Persistent, constant throughout the day and night
T or F
Frozen shoulder involves lack of motion in the GH and ST articulations
False
ST will still have motion
What age of men and women are usually more susceptible to experiencing frozen shoulder?
Women = 40-50 Men = 50-60
When a patient is standing where is the scapula located in relation to the spine and describe vertebral levels
Medial border = 5-9cm lateral to the thoracic sp
Spine of scapula = level of the T3 sp
Inferior angle = T7 sp standing T6 sp laying
Name the muscles of the shoulder that are prone to tightness (10)
Upper Trapezius Levator Scapulae Pec Major and Minor Upper Cervical Extensors SCM Scalenes Trees Major and Minor
What shoulder complex muscles are prone to inactivity or lengthening?
Middle and lower Trapezius Rhomboids Serratus Anterior Deep Neck Flexors Subscapularis Supra and Infraspinatus
