Shoulder Flashcards
Observation of shoulder
- 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)
Palpation of shoulder joint
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
Range of motion for shoulder + degrees
-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
What is expected in tendon disorders VS capsulitis/subacromial bursitis while doing ROM?
Tendon disorders = pain in one direction
Capsulitis/subacromial bursitis = pain in all directions
A painful arc between 60-120* is suggestive of what condition?
Most common cause?
Impingement
Supraspinatus tendinitis
You should consider ______ If there is a capsular pattern of ROM loss
Adhesive capsulitis
With a rotator cuff tear, what would be expected during abduction?
Shoulder shrugs to initiate movement + limited abduction of the arms and scapula as one unit.
Jobe Test: what does is it testing?
Impingement of supraspinatus
- 90* of abduction, full internal rotation, angles 30* forward.
- muscle test is performed in this position.
Modified hawkin-kennedy test: what is it testing?
Pain suggests rotator cuff pathology
-abduct arm to 90, stabilize shoulder girdle. Internally rotate arm throughout the frontal plane (45-90*)
Neers Test: what is it testing for?
Pain suggests rotator cuff tear
-seated, passively flex internally rotated arm to overhead position.
Drop arm test: what is it testing?
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.
In the combined absence of night pain, a painful arc, impingement signs and weakness, what is the probability of a rotator cuff tear?
5%
speeds test: what is it testing?
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.
Load and shift Test: what is it testing?
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.
Augmented anterior apprehension test: what is it testing?
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.
Posterior apprehension test: What are you testing?
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.
The active compression test: what is it testing?
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.
passive distraction test (PDT): what is it testing?
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
Special tests for the acromioclavicular joint: pain during Active compression test suggests?
What other test can be used for AC joint?
- 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.
