Shoulder and cervical spine examination Flashcards
What are the two components of the shoulder joint
Glenohumeral joint
Scapulothoracic joint
Infraspinatus
Below scapula at the back
Supraspinatus
Above scapula at the back
Where is flexion of the shoulder
up
Where is extension of the shoulder
down
Hands behind head is testing
External rotation and abduction
Hands joined behind back is testing
Internal rotation, abduction and extension
Supraspinatus function
Initates abduction below 90 degrees
Which muscle takes over abduction above 90 degrees
Deltoid
Infraspinatus function
External rotation
Where is subscapularis
Front between scapula and rib cage
Subscapularis function
Internal rotation
Teres minor function
External rotation
Deltoid function
Abducts after 90 degrees
Trapezius function
Shrugs shoulders, controls scapula movement
Shoulder exam, what are you looking at
Posture and symmetry Muscle wasting Scars, skin changes Swelling Deformity
Shoulder exam, what are you feeling for
Temperature
Bony landmarks
Muscle bulk
Which 4 muscles are you assessing the bulk of
Deltoid
Infraspinatus
Supraspinatus
Trapezius
Shoulder exam, what do you move initially
“put your hands between your head”
“put your hands behind your back”
Watch from front and back
What does pain at 120-180 degrees suggest
Acromioclavicular joint
What does pain at 120-180 degrees suggest
Acromioclavicular joint
How should the elbows be when assessing external rotation
Elbows tucked into the side
How should the hand be for rotator cuff arc
Facing down
Rotator cuff pathology angles of pain
60-120 degrees
Specific test for supraspinatus
Resisted abduction (<90degrees)
Specific test for infraspinatus
Resisted external rotation
Specific test for subscapularis
Life off test- resisted internal rotation
How do you test the acromioclavicular test
‘scarf test’ forced adduction across body.
Questions for function
Dressing?
Washing hair?
Reach into high cupboards?
End questions for MSK exams
Assess joint above and below
Assess neurological and vascular function
Examination feel
Temperature
Bony landmarks
Joint line
Surrounding muscles
Frozen shoulder
Adhesive capsulitis. Painful restriction of external rotations
Risk factors for ashesive capsultis
> 40
RA, Diabets, post sroke
Minor trauma
Postoperative
Cause of rotator cuff pathology
Narrowing of gleniohumeral joint
3 thing which make the rotator cuff gap smaller
Osteophyte impingement
Subacromial bursitis
Suprspinatus tenditis
What are you looking for in the cervical spine
Normal lordosis
What is normal in the spine as cuves
C: Lordosis
T: Kyphosis
L: Lordosis
What are you feeling for in the cervical spine
Spinous processes
Paraspinal muscles
What are you moving in the cervical spine
Flexion/extension
Lateral rotation
Lateral flexion (ear ato elbow)
Which nerves control biceps reflex
C5 and 6
Which nerves control triceps reflex
C7 and 8
Which nerves control supinator ceflex
C5 and C6
Which nerve controls shoulder abduction and flexion
C5
Which nerve controls elbow flexion
C5/6
Which nerve controls elbow extension
C7/8
Which nerve controls wrist flexion/ extension
C6/7
Which nerve controls finger flexion/extension
C7/8
Which nerve controls finger abduction/adduction
T1
Signs of OA of neck (cervical spondylosis)
Pain, stiffness, restricted movement, crunching sensation, nerve root symptoms
Extension of big toe nerve
L5
What are the changes in OA spine
Narrowed disc and bone spurs
Signs of spinal disc disease
Pain (worse on bending forwards)
Radiculopathy
Burning, electric shock, running water
What is a radiculopathy
Nerve root pain from impingement
In the neck, compression of C5/6 disc would cause
Compression of C6
Where does the corresponding nerve root come out of the cervical spine
Above
Where does the correpsonding nerve root come out of the thoracic and lumbar nerve roots
Below
Prolapse of L4/5 disc causes
Compression of L5 (or L4) as often comes out posteriorly
