Shoulder Flashcards
Flexion
180
Extension
60
Int/Ext rotation
90/80
Abduction
180
Adduction
35
Horizontal Add/ Abd
130/45
Flexor
Delt ( ant)
Pec mj( upper fiber)
Biceps brachii
Coracobrachialis
Extensor
Delt( post) Lats Teres mj Pec mj ( lower fiber) Tricep brachii( long head)
Horizontal Abduction
Delt( posterior)
Horizontal adduction
Delt ( ant) Pec major ( upper fiber)
Abduction
Delt ( all fibers)
Supraspinatus
Adduction
Lats Teres mj Infraspinatus Teres minor Pec mj ( all fibers) Tricep brachii ( long head) Coracobrachialis
Lateral rotation( external rotation )
Delt ( post fiber)
Infraspinatus
Teres minor
Medial rotation( Internal rotation)
Delt ( ant fibers) Lats Teres mj Subscapularis Pec mj ( all fibers)
Adson’s test
P: tos caused by ant Scalene
Clt :
1: seated
2:stand behind clt
3: extend and slight ext rotate clt affected arm
4 : monitor Radial pulse of this arm
5: instruct clt to turn head Towords affected arm / slight elevate chin to take a deep breath / hold at least 15-20 secs ( this elevates ribs , compressing neurovascular bundle against tight ant Scalene)
+ = diminished radial pulse or symptom occur
Travell’s
Same as adson
For Middle scalene
Same as Adson
But Look AWAY from affected side
Wrights Hyperabduction
Tos - pec minor
Monitor pulse
NO need to HOLD breath
Costoclavicular
Tos - clavicle . First ribs cause it
Passively depress and retract shoulder
Monitor Radial pulse
Eden’s test
Tos- clavicle , first rib
Instruct clt to bring shoulder as far in retracti and depressin as possible
ULTT 1
P: c5,6,7 Median Nerve as source of clt painful shoulder
Clt:
Beginning n what th One hand on clt shoulder and apply constant repressive force
1: abduct GH 110 - extend Arm to 10 degree below Coronal plane
60 Ext Rot
2:Extens Clt wrist / fingers
3: Fully supinate the Forearm / slowly extend elbow
+ = Reproduction of pain is positive
If not reproduce
1:.Client turn Head away
If reproduced bend clt head back toward the sde being test - symptom should diminish
ULTT2
P : Median - Musculocutaneous - Auxillary
Clt :
1: Depress clt shoulder Abduct GH to 10 Degree
2: Slow extend the Wrist and Fingers
3: Fully Supinate and extend the Elbow / Tissue tightness in the shoulder or elbow or tingling in the elbow
+= reprocduction of pain
ULTT3
P: Radial nerve
Clt:
1: Depress shoulder - Abduct to 10 degree
2:Slowly flex and fingers / Deviate them Ulnarly
3: Fully pronate the forarm and extend Elbow As tightness and tingling are normal
ULTT4
P: c8, T 1 and Radial Nerve
Clt:
1: Depress the clt shoulder and Abduct the Humerus to 90 Degree
2: Flex the Elbow , Bringing the Hand towards the Clt Ears
3: Supinate the Forearm
4: Slow extend the Wrist and Fingers and Deviate Radially / As tissue tighness and tingling are normal
Neer Impingement
P: assess overuse injury to the Supraspinatus tendon
Clt :
1:Seated
2: passively Flex the Client Humerus forword through its Range - Compressing the Tendons against Acromion
Hawkins - Kennedy Impingement
Variation Neer
Arm forward at 90 degree
Internally Rotate the GH
Painful Arc
P: Subacromial Impingement of Supraspinatus Tendon and Subacrmial Bursa
Clt : Instruct Client to Abduct GH through its Range
1: positive Pain starting at 70 Degree of Abduction , WHICH Ease OFF after 130 degree of Abduction ( this range Soft tissue compressed by humerus against Acromion , before and after the range the tissue are no longer compressed . Pain must lessen above 130 degree.
When the client cannnot actively move beyond this range , assist client to 130 degree and then ask to continue if possible
Apley’s Scratch test
P: assess the combined movement at shoulder
Clt:
1: seated
2:Stand behind clt observe rom of shoulder
3:instruct reach head to touch cown to spine as much as possible with fingertips ( this asses external Rotation and Abduction of one gh joint)
4: other hand reach up same time , check for int rot and adduction
5: note location of fingertips
6: instruct or reverse
7:repeat test asses full rom of gh
Shoulder Apprehension AF test
P: explore previous gh dislocation only when injury progressed to the chronic stage
Clt
1: instruct clt to move arm slowly into position which the dislocation took place e .g abduction
LOOK: apprehension on clt face or unwilling to complete the rom is POSITIVE ( if so Do not Perform PRROM) Instead AR Isometric test mm cross the joint
Shoulder Apprehension Test PR
P: passive asses integrety of gh capsule following chronic dislocation
1: SLOWLy men ve arm and joint toward position of injurt
2: Slowly Abduct clt arm
3: Monitor face for sign of apprehension
+ = look of apprehension or pulls away from the therapist to stop motion - empty end feel joint capsule is not fully healed
Adhesive Capsulitis Abduction Test PR
P: restricted motion at shoulder resulting from fibrosing and adhesion of the axillary fold of the inferior gh joint capsule
Clt:
1: Seated
2: Stand behind
3 : Palpate inferior angle of scapula with one hand monitor its position throuout the test
4: other hand just proximal on clt Elbow , Slowly Abduct client humerus , noting when inferior angle begins to move
In a normal shoulder , Leathery end feel encoutered at 90 degree of Abduction , the auxillary fold is stretched and scapula begins to move along with gh at greater 90 degree
+ = painful , leathery end feel encountered anywhere before 90 degree of abduction , since auxillary fold is Fibrosed , the scapula begins to move before 90 degree
Acromclavicular shear test
P: asses intregity of ac joint
1 : seated
2: stand behind
3: cupped hands over client shoulder , fingers interlaced , with one palm on clavicle other on spne of scapula
4: slowly squeeze heels of hands together
+ = pain. Assessive movemt of joint = joint pathologies , ac joint sprain
Drop Arm Test
P: asses integrety of rotator cuff , especially supraspinatus tendon
1: seated
2:Abduct arm to 90 , Instruct Clt to hold this position
3: instruct the client to slowly abduct the starting point
+ = unable to return smoothly and slowly to side and if theres is pain on te attempt
Supraspinatus strength Test AR ( Empty Can test)
P : asses supraspinatus Tendonitis , strain and weakness
1: seated
2:instruct abduct arm to 90 , then adduct humerus horizntally to 30 Degree
3 Instruct client internally rotate the humerus , as if they were holding Can full of liquid hen emptying it .
4: apply pressure to humerus in direction of adduction , instruct client not let arm be adducted
+= pain or Weakness
Variation : meet client resistance while client try to abduct ( this does not distinguish Deltoid )
Infraspinatus strength test AR
Asses the infraspinatus muscle for tendonitis , strain or weakness
1:Seated or Prone
2: Abduct humerus to 90 and flex elbow to 90
3: apply pressure on client wrist while they try to externally rotate
+ = pain along infra or weakenss
Does not Distinguish Teres minor
Subscapularis strength test AR
P: subscap tendonitis , strain , weakenss
1: seated, Supine
2: Humerus by side , Elbow flex 90
Apply resistance while client try to internally rotate
+ = pain along subscap
Does not Distinguish btw subscap , pec mj, lats , Teres mj
Speed’s test
P: asses for Bicep tendonitis
1: seated
2: completely extend elbow while supinating e arm
3: resist flexion of arm by placing one hand on the shoulder and other hand Distal to client elbow
+ = pain at tendon on resistance indicates positive
Yerguson’s test
P: asses stability of biceps tendon in bicipital groove
1: seated , elbow of affected arm flexed 90 degree and forarm pronated
2: stabilize client elbow agaisnt clients thorax with one hand
3: with other hands , apply resistance while clt actively supinates the forearm , extend the elbow and externally rotates the humerus at the same time
+= pain biceps tendons instability and loss of integrety of transverse ligament HOWEVER ; motion of tendon along groove is required for true positive tendonitis test
Pec Minor Length test
Muscle length
1: Supine
2: Sit at Head of the Table
3: observe shoulder protraction on affected side , since they protract scapula
Variation:
1:supine or seated
2: Apply palmar surface one hand to ant surface of shoulder test on
3: compress affected shoulder posteriorly into table / if seated , stabilize mid thoracic spine wih other hand then push client s affected shoulder into retraction
+ = reduce rom in retraction
Pec mj length test
P: mm length
1: supine
2: asses superior or clavicle fibre , instruct clt to abduct affected arm to 90 degree
+ = short clavicle fiber= arm does not drop below level of table into extension and external rotation
Abduct150 degree for sternal fiber
Shoulder Adductor Length test
Asses Lats and Teres Major
1: supine
2: flex hips and knee with plantar both feet on table ( pelvis posterior tilt so low back is flat on table)
3: instruct client Raise both arms above Head , Through Full Flexion at gh joint , allow posterior surface of arm to contact table
+= gh cannot fully flexed , arm des not rest on table above client head
Rhomboids strength test
Strengh of rhomboids
1: prone , affect humerus abducted to 90 and internally rotate
2:.ask client to lift arm into extension , 3 on mm scale if clt hold agaisnt gravity
Stabilize the unaffected shoulder with one hand / with other hand apply pressure to distal end of anterior direction
+ = unable to hold arm in the original position
Middle traps strength test
1: prone with affect shoulder abducted 90 and externally rotate
2: Ask client lift arm into Extension grade 3 against gravity
3: stabilize unaffected shoulder with one hand
4: other hand apply pressure to distal end of affected humerus in anterior direction
+ = unable to hold arm or weakeness
