Shoulder Flashcards
How should you start the examination?
Wash hands Introduction Identification Consent Exposure
What should you ask before starting?
Do you have any pain?
WHat do you look for when inspecting from the front?
Symmetry Posture Swelling Deformity Muscle wasting Scars Skin changes
What do you look for when inspecting from behind?
Muscle bulk
Scapula abnormalities
Scars and skin changes
How do you palpate at the front?
Medial to lateral
What two ways should you palpate?
Back of hand (temp)
Normally for swelling, joint line tenderness
Where do you initially palpate for temp?
Shoulder area
What bone landmarks should you palpate for?
Sternoclavicular joint Clavicle Acromioclavicular joint Acromion process Glenohumoral joint (ant and post) Spine of scapula Scapula
What muscles should you palpate?
Deltoid
Supraspinatus
Infraspinatus
Trapezius
Where does the supraspinatus lie?
Above scapula wings
Where does the infraspinatus lie?
Below scapula wings
What is the screening examination for the shoulder?
Patient to put hands behind back, push elbows back (external rotation and abduction)
Patient to put hands behind their back (internal rotation, abduction)
How far can they reach hands up behind back
How do you assess rotation?
Flex patients elbow to 90
Fix to side
Ask to rotate outwards
Repeat with inwards
How do you assess flexion and extension?
Ask patient to raise arms in front and behind
How do you assess abduction?
Patient to raise arms from side, palms down
Observe from in front and behind
Observe symmetry of scapula movement
What will alleviate pain on abduction in rotator cuff injury?
Repeat with palms facing upwards
Pain at what degree of movement suggests rotator cuff pathology?
60-120
Pain at what degree of movement suggests acromioclavicular joint arthritis?
120-180
What should you remember to do when assessing passive ROM?
Palpate shoulder for crepitus
How do you assess shoulder function?
Do you have any problems dressing
Do you have any problems washing your hair
What are the special tests for rotator cuff injury?
and which muscles
Resisted active abduction (supraspinatus)
Resisted active external rotation (infraspinatus, teres minor)
Resisted active internal rotation (subscapularis)
How do you perform resisted active internal rotation? (lift off test)
Patient places hand on back (dorsum of hand on mid lumbar spine)
Lift dorsum of hand from spine
Positive is if they can’t
What is the speicial test for acromio-clavicular pathology?
Place the arm into forced adduction across body with 90 flex in the elbow
Any pain or tenderness over ACJ
How do you complete the exam?
Examine cervical spine and elbow
Neuro and vasc status of the limb
What do you do at the end of the exam?
Thank patient
redress
wash hands
present
