Shoulder Flashcards
What is inspected for in a shoulder anteriorily?
- Slings?
- Asymmetry of shoulder girdle
- Scars
- Deltoid wasting
- Step deformity
- Lump in antecubital fossa
- Swelling
What is inspected for in a shoulder laterally?
Scars
What is inspected for in a shoulder posteriorly?
- Winged scapula
- Scoliosis
- Tarpezius and deltoid wasting/bulk
- Paravertebral muscles - swelling/wasting
- Supra/infraspinatus fossa muscle wasting
c
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c
c
c
c
c
c
c
c
c
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What should be felt for in the shoulder?
- Temperature
- Tenderness/swelling in shoulder girdle
What does temperature indicate in the shoulder?
- Inflammatory arthropathy
- Infection
Palpation of shoulder girdle
- Sterno-clavicular joint
- Clavicle
- Acromio-clavicular joint
- Coracoid process – 2cm inferior and medial to the clavicular tip
- Head of humerus
- Greater tuberosity of humerus
- Spine of scapula
Surface anatomy of coracoid process? 2 attachments?
2cm inferior and medial to the clavicular tip
- Short head of biceps
- Pec minor
What screening shoulder compound movements are used? (2)
- Place hands behind head
- Move hands far up back
Put your hands behind your head - functions assessed? (2)
- External rotation
- Abduction
Put your hands as far up your back as you can - function assessed?
Internal rotation
What specific active shoulder movements should be assessed? And how? (6)
- Lift arm backwards keeping them straight (extension)
- Raise arms forwards until points upwards (flexion)
- Lift arms away from sides as far as possible until top (abduction)
- Bring arms across trunk to opposite sides (adduction)
- Tuck elbows in like riding a bike then
a) Bring elbows out (external rotation)
b) Bring elbows in (internal rotation) then reach up back
Normal ROM for shoulder flexion
150-180
Normal ROM for shoulder extension
40
Normal ROM for shoulder abduction
Up to 180
Normal ROM for shoulder adduction
30-40
Normal ROM for external rotation
80-90
Normal ROM for internal rotation
T4-T8
If aduction is painful 70-120 what is this a sign of?
Subacromial impingement
If aduction is painful 140-170 what is this a sign of?
AC joint disruption
What does passive movement assess for?
Crepitis
What 2 shoulder conditions lead to generalised reducitions in passive as well as active range of movement? (other pathologies don’t restrict passive) (2)
- Adhesive capsulitis
- Glenohumeral joint arthirtus
Which movements are most effected by glenohumeral joint pathology (osteoarthiritus + adhesive capsulitus)? (2)
- External rotation
- Abduction
How is the scapula assessed? (3)
- Ask patient to abduct shoulder
- Palpage inferior pole of scapula (hand around armpit)
- Assess degree and smoothness of scapular movement
When does scapula dysfunction occur?
Impingement
Name the special shoulder tests
- Supraspinatus = “empty can”
- Impingement of supraspinatus = “Painful arc”
- Capsulitis/AC joint pathology = “scarf test
What does a positive scarf test indicate?
Capsulitus/AC joint patholgy
How to carry out scarf test? (2)
Get patient to stretch arm across to opposite shoulder and put hand on it
- Then push elbow in to opposite shoulder
What is a positive scarf test?
Pain felt specifc to AC joint (lateral end of clavicle) during horizontal adduction
How to carry out empty can test? (4)
- Abduct arm by 90
- Angle arm forward by 30 (shoulder in plane of scapula)
- Internally rotate arm so thumb down to floor
- Then push down on arm - patient resists pressure
Weakness in empty can test?
Weakness/impingment in supraspinatus
