Shoulder

Question 1

What is included in the shoulder girdle?

Answer 1

SC joint

AC joint

Glenohumeral joint

Scapula

Question 2

What are the muscles of the rotator cuff

Answer 2

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

Question 3

Of the 4 rotator cuff muscles, which one is not palpable?

Answer 3

Subscapularis

Question 4

What are the palpable landmarks of the humerus and axilla?

Answer 4

Greater tubercle of humerus
Bicipital groove
Axilla lymph nodes
Latissimus dorsi
Pectoralis major

Question 5

What are the palpable landmarks associated with the shoulder joint?

Answer 5

Sternoclavicular joint
Clavicle
Acromioclavicular joint
Acromion process
Coracoid process
Spine of scapula (Level of T3)
Inferior border of scapula (level of T7)

Question 6

Normal ROM of flexion at glenohumoral joint

Answer 6

180

Anterior deltoid m. and coracobrachialis m.

Question 7

Normal ROM of extension at glenohumoral joint

Answer 7

60

Latissimus dorsi m. and teres major m.

Question 8

Normal ROM of horizontal adduction at glenohumeral joint

Answer 8

40-50 (or 130-140 depending on starting position)

Pectoralis major and latissimus dorsi mm.

Question 9

Normal ROM of horizontal abduction at glenohumoral joint

Answer 9

40-55 (or 130-145 depending on starting position)

Supraspinatus and mid-deltoid mm.

Question 10

Normal ROM of external rotation at glenohumoral joint

Answer 10

90

Infraspinatus and teres minor mm

Question 11

Normal ROM of internal rotation at glenohumoral joint

Answer 11

90

Subscapularis and pectoralis minor

Question 12

Normal ROM of axial rotation at AC joint

Answer 12

Approximately 10

Question 13

What supine action would the patient perform in order to ABDUCT the SC joint? Describe this motion

Answer 13

Shrug up

Distal end of clavicle moves superiorly; Proximal end of clavicle moves inferiorly

Question 14

What supine action would the patient perform in order to ADDUCT the SC joint? Describe this motion

Answer 14

Relax to neutral from shrug position

Distal end of clavicle moves inferiorly; proximal end moves superiorly

Question 15

What supine action would the patient perform in order to horizontally flex the SC joint? Describe this motion

Answer 15

Reach to ceiling

Distal end of clavicle moves anteriorly; proximal end moves posteriorly on sternum

Question 16

What supine action would the patient perform in order to horizontally extend the SC joint? Describe this motion

Answer 16

Scapula into table

Distal end of clavicle moves posteriorly; proximal end moves anteriorly on sternum

Question 17

Describe seated retraction of scapula

Answer 17

“Attention position”

Rhomboid major and minor; scapula move closer to spine

Question 18

Describe seated protraction of scapula

Answer 18

Reaching forward

Serratus anterior m.

Scapula move away from spine

Question 19

Describe seated elevation of scapula

Answer 19

Shrug up

Upper trapezius and levator scapulae mm.

Scapula move upward and parallel to spine

Question 20

Describe seated depression of scapula

Answer 20

Depress down

Lower trapezius and lower rhomboid mm.

Return scapula from elevation

Question 21

Normal muscle strength is 5/5; what are the 5 levels?

Answer 21

0: no evidence of muscle contraction
1: trace; evidence of contraction with no joint movement
2: poor; complete ROM with gravity eliminated
3: fair; complete ROM against gravity
4: good; complete ROM against gravity and some resistance
5: normal; complete ROM against gravity and full resistance

Question 22

What special tests might you do to assess for glenohumeral instability?

Answer 22

Apprehension test

Sulcus sign

Question 23

What special tests might you do to assess the long head of the bicep?

Answer 23

Yergason’s test

Speed’s test

Question 24

What special tests might you do to assess the supraspinatus m. of the rotator cuff?

Answer 24

Empty can test (can also do full can test)

Drop-arm test

Question 25

What special tests might you do to assess for rotator cuff impingement?

Answer 25

Neer impingement

Hawkins test

Question 26

What special tests might you do to assess the subscapularis m.?

Answer 26

Lift off test

Question 27

What special orthopedic test involves an assessment of ROM using two maneuvers in which physician observes how far the patient can reach?

Answer 27

Apley Scratch test

Question 28

Describe the apprehension test of the shoulder including structure being assessed, positive test, and indication

Answer 28

Apprehension tests for glenohumeral instability

Patient is seated or supine. Shoulder is abducted to 90 and elbow flexed to 90. Stabilize shoulder with one hand (blocking linkage) and force arm into external rotation with other hand

+ test = patient apprehensive of repeat dislocation –> indicates glenohumeral instability

Question 29

Describe the sulcus sign of the shoulder including structure being assessed, positive test, and indication

Answer 29

Sulcus sign = assessing glenohumeral instability

Grasp patient’s elbow and apply inferior traction

+ test = indention appears in area beneath the acromion –> indicates glenohumeral instability

Question 30

Describe the Yergason’s test including structure being assessed, positive test, and indication

Answer 30

Yergason’s = assesses long head of the bicep

Patient’s arm at side with elbow flexed at 90. Examiner uses one hand to palpate bicipital groove and monitors there, while other hand grasps patient’s wrist. Have patient supinate and externally rotate against resistance

+ test = pain and/or tendon subluxation out of groove –> indicates unstable bicipital tendon/subluxation bicipital tendonitis

Question 31

Describe the Speed’s test including structure being assessed, positive test, and indication

Answer 31

Speed’s test = assesses long head of biceps

Patient’s arm forward flexed (50-90) at the shoulder with hand supinated. Slightly flex patient’s elbow. Resist at forearm while patient forward flexes shoulder (resistance to cephalad/superior motion)

+ test = pain in bicipital groove –> indicates bicipital tendonitis of longhead biceps

Question 32

Describe the Empty Can Test including structure being assessed, positive test, and indication

Answer 32

Empty can test = assesses supraspinatus m. of rotator cuff

Flex patients shoulders/arms to 90 while horizontally abducting approximately to 45 degrees. Then internally rotate both arms so thumbs are pointing down. Press down on forearms while patient resists.

+ tests = pain or weakness –> indicates rotator cuff pathology (specifically supraspinatus)

Question 33

Describe the Drop-Arm Test including structure being assessed, positive test, and indication

Answer 33

Drop-Arm test = assesses supraspinatus m. of rotator cuff

Patient abducts arm to 90; then slowly drop arm

+ test = arm will drop or gentle tap on wrist will cause arm to drop –> indicates full thickness tear of supraspinatus m.

Question 34

Describe the Neer Impingement test including structure being assessed, positive test, and indication

Answer 34

Neer Impingement = assesses rotator cuff impingement

Stabilize patient’s shoulder, forearm is pronated. Passively flex shoulder to fully flexed position

+ test = pain –> indicates subacromial bursa or rotator cuff impingement

Question 35

Describe the Hawkins test including structure being assessed, positive test, and indication

Answer 35

Hawkins = tests for rotator cuff impingement

Flex shoulder to 90, flex elbow to 90 and passively rotate the humerus into internal rotation. This opposes rotator cuff against coracoacromial ligament and acromion

+ test = pain –> indicates rotator cuff or subacromial bursa impingement

Question 36

Describe the lift-off test including structure being assessed, positive test, and indication

Answer 36

Lift off = tests subscapularis m.

Place patient’s arm into internal rotation and extension. Patient pushes arm into further internal rotation as doctor resists

+ test = weakness (inability to resist) –> indicates subscapularis weakness

Question 37

Describe upper Apley Scratch test

Answer 37

Patient abducts arm placing palm of hand behind their neck with palm facing toward the body. Patient should attempt to scratch the lowest possible vertebrae (coupled external rotation and abduction)

Question 38

Describe Lower Apley Scratch test

Answer 38

Patient places arm behind their back with palm facing outward and dorsum of hand resting on their mid-back. Patient should attempt to scratch highest possible vertebrae (coupled internal rotation and adduction)