Shoulder assessment

Question 1

1.

Functional tests for the shoulder

Answer 1

Ask patient to replicate action/movement for symptoms

If required do it passively then with resistance (iso) to distinguish between contractile and non contractile (passive)

Use as objective measure. Can be used as treatment technique.

Look at kinetic chain duirng gait (inc arm swing) and single leg stand

Assess proprioception (rotator cuff) in 4 point kneeling

Question 2

Role of rotator cuff in proprioception

Answer 2

Non-specific pre-setting phase, enhancing joint stiffness and stability. (David et al. 2000)

Movement specific (David et al. 2000)

Prevent excessive translations of the humeral head ensuring dynamic shoulder stability (Myers and Lephart 2002)

Question 3

Palpation - as per human movement

Answer 3

AC joint / SC joint when considering AC / SC joint pathology

Acromial arch, lesser and greater tuberosity and bicipital groove when considering rotator cuff disorders.

GH joint line – palpate for heat when considering RA/ infection/ septic arthritis.

Question 4

What should you test first before glenohumeral AROM

Answer 4

Neck and elbow AROM

Question 5

GH AROM in standing

Answer 5

Flexion
Extension
Abduction
Adduction
Medial and lateral rotation with elbows at 90 degrees
Horizontal flexion

Question 6

Flexion +/- scapular plane

Answer 6

*Painful arc 70-120 in rotator cuff disorders,

high arc in AC joint pathology- 170-180

Remember the first 110 degrees occurs at GH joint

180 degrees achieved from shoulder girdle (scapula and clavicle rotation) and thoracic extension.

Question 7

Abduction AROM

Answer 7

(*Painful arc in rotator cuff disorders) Remember between 30-180 degrees of Abduction, scapula rotation augments shoulder abduction in a ratio of 1:2.

The terminal part of abduction is accompanied by lateral rotation of the humerus.

Question 8

Can test medial rotation by doing

Answer 8

hands behind the back

Question 9

Horizontal flexion is what pathology

Answer 9

AC joint

Question 10

SHoulder AROM in standing

Answer 10

Protraction
Retraction
Elevation
Depression

Question 11

PROM in lying supine

Answer 11

GH joint
Flexion/ extension
Abduction/ adduction
Medial rotation
Lateral rotation (Adhesive Capsulitis)
Horizontal flexion (AC joint Pathology)

If needed could do passive elevation, depression, protraction and retraction in sitting.

Question 12

Isometric muscle testing in sitting

Answer 12

GH joint
Flexion and Extension
Abduction and adduction
Medial and lateral rotation (*Rotator cuff integrity)

Shoulder girdle
Elevation
Depression (under elbow and 90 degrees flexion)
Protraction and retraction.

Question 13

Accessory movements in the GH joint

Answer 13

AP glide in supine associated with physiological flexion and int. rotation

PA glide in prone associated with physiological extension and ext rotation.

Question 14

Accessory movements of the AC joint

Answer 14

Longitudinal caudad on clavicle

Question 15

Special tests for instability

Answer 15

Anterior apprehension test in supine (Elbow flex to 90, shoulder Ab to 90, External rotation) . Positive if patient displays or reports apprehension/fear of subluxation. Resolved when AP pressure applied (Relocation test)

Sulcus sign (inferior instability) caudad force on humerus in sitting. Positive test if larger sulcus in comparison to other side.