Shoulder

Question 1

Observation of shoulder

Answer 1

• Shape and contour of shoulder joints
• posture+ position of neck, thoracic,scapula
• sulcus sign, misalignment of AC joint
• atrophy supra/infra rotator cuff tears
• bicep bulge (rupture bi brachii tendon)

Question 2

Palpation of shoulder joint

Answer 2

Behind patient: AC, subacromial space, supra + long head tendon, upper traps, supra/infra muscles, warmth TRP.
Tenderness,swelling,instability of AC SC GH joints, long head, bicipital groove (tendinitis)
Neck muscles for trigger points
Greater/lesser tuberosities
Subscapularis
Acromialhumeral sulcus (subacromial bursitis or a supraspinatus tear)
Axilla for lymphnodes

Question 3

Range of motion for shoulder + degrees

Answer 3

-Apley’s scratch test
-Flexion: 180
-Extension: 45
-Abduction: 180
-Adduction: 90
-internal rotation: 90
-External rotation: 90
Each should be done posteriorly and anteriorly/side. Done separately and together watching for movement patterns

Question 4

What is expected in tendon disorders VS capsulitis/subacromial bursitis while doing ROM?

Answer 4

Tendon disorders = pain in one direction

Capsulitis/subacromial bursitis = pain in all directions

Question 5

A painful arc between 60-120* is suggestive of what condition?
Most common cause?

Answer 5

Impingement

Supraspinatus tendinitis

Question 6

You should consider ______ If there is a capsular pattern of ROM loss

Answer 6

Adhesive capsulitis

Question 7

With a rotator cuff tear, what would be expected during abduction?

Answer 7

Shoulder shrugs to initiate movement + limited abduction of the arms and scapula as one unit.

Question 8

Jobe Test: what does is it testing?

Answer 8

Impingement of supraspinatus

• 90* of abduction, full internal rotation, angles 30* forward.
• muscle test is performed in this position.

Question 9

Modified hawkin-kennedy test: what is it testing?

Answer 9

Pain suggests rotator cuff pathology

-abduct arm to 90, stabilize shoulder girdle. Internally rotate arm throughout the frontal plane (45-90*)

Question 10

Neers Test: what is it testing for?

Answer 10

Pain suggests rotator cuff tear

-seated, passively flex internally rotated arm to overhead position.

Question 11

Drop arm test: what is it testing?

Answer 11

Pain suggests tear of the supraspinatus
-passively abduct arm to 120*, have patient take weight of arm, then slowly lower arm back to side, watching for jerky movement.

Question 12

In the combined absence of night pain, a painful arc, impingement signs and weakness, what is the probability of a rotator cuff tear?

Answer 12

5%

Question 13

speeds test: what is it testing?

Answer 13

Primarily tests for pathology of the tendon of the long head of Biceps

• Flex arm to 90* with palm facing up (internal rotation)
• Push down on the forearm while stabilizing shoulder.

Question 14

Load and shift Test: what is it testing?

Answer 14

Test stability (Ant.post.) of shoulder (Bankart lesion)

• stabilize scapula over coracoid and spine of scap.
• grasp head of humerus, load up, then shift anteriorly and posteriorly.
• feel for amount and quality of movement.

Question 15

Augmented anterior apprehension test: what is it testing?

Answer 15

Anterior shoulder instability.

• patient supine; abduct an internally rotated shoulder to 90*. Passively move arm into external rotation while supporting elbow and anterior GH joint.
• observe for apprehension in patients face.
• if apprehension appears, stabilize over humeral head, if pain is relieved anterior instability is positive.

Question 16

Posterior apprehension test: What are you testing?

Answer 16

Posterior instability

• patient supine; flex arm to 90* and internally rotate arm across chest.
• apply a downward force through elbow while internally rotating arm.
• pain or excessive movement is indicative of posterior instability.

Question 17

The active compression test: what is it testing?

Answer 17

Detection of lab rail tears and acromioclavicular joint abnormality.

• Patient standing; flex arm to 90*, stabilize shoulder.
• Patient adducts arm 15* and internally rotates arm till thumb points down.
• Dr. Apply downward force on arm in internal rotation.
• Return to starting position(hand supinated) and apply force again.
• positive test with pain on first maneuver but not on second.

Question 18

passive distraction test (PDT): what is it testing?

Answer 18

Indicative of a SLAP lesion(Superior labral Anterior-posterior lesion)
-patient supine: extend elbow, supinate forearm, elevate the arm 150* in the coronal plane.
-pronates the arm.
Looking for pain deep inside the GH joint

Question 19

Special tests for the acromioclavicular joint: pain during Active compression test suggests?
What other test can be used for AC joint?

Answer 19

• Acromioclavicular joint pathology
• Crossed body adduction test: flex arm to 90* and adduct arm across body.
• pain at AC joint = positive for AC joint dysfunction.