Shoulder Competency

Question 1

What are some observations for the shoulder?

Answer 1

• SC joint
• AC joint
• glenohumeral
• scapula

Question 2

What are palpable landmarks of the shoulder?

Answer 2

• sternoclavicualr joint
• clavicle
• acromioclavicular joint
• acromion process
• coracoid process
• spine of scapula - at T3
• inf angle of scapula - at T7
• Greater Tubercle of Humerus
• Bicipital Groove
• Axilla lymph nodes
• Latissimus dorsi
• Pectoralis major
• Rotator Cuff (SITS): Supraspinatus; Infraspinatus; Teres minor; Subscapularis (not palpable

Question 3

ROM of the glenohumeral joint: flexion

Answer 3

• ant deltoid and coracobrachialis

- 180 deg

Question 4

ROM of the glenohumeral joint: extension

Answer 4

• latissimus dorsi and teres major

- 60 deg

Question 5

ROM of the glenohumeral joint: horizontal abduction

Answer 5

• supraspinatus and med-deltoid

- 40-55 or 130-145 deg

Question 6

ROM of the glenohumeral joint: horizontal adduction

Answer 6

• pec major and lats

- 40-50 or 130-140 deg

Question 7

ROM of the glenohumeral joint: external rotation

Answer 7

• infraspinatus and teres minor

- 90 deg

Question 8

ROM of the glenohumeral joint: internal rotation

Answer 8

• subscapularis and pec minor

- 90 deg

Question 9

ROM of the acromioclavicular joint: axial rotation

Answer 9

~10 deg

Question 10

ROM of the sternoclavicular joint: abduction

Answer 10

• Distal end of clavicle moves superiorly and proximal end moves
  inferiorly

Question 11

ROM of the sternoclavicular joint: adduction

Answer 11

• Distal end of clavicle moves inferiorly and proximal end moves
  superiorly

Question 12

ROM of the sternoclavicular joint: horizontal flexion

Answer 12

• Distal end of clavicle moves anteriorly and proximal end moves
  posteriorly on the sternum

Question 13

ROM of the sternoclavicular joint: horizontal extension

Answer 13

• Distal end of clavicle moves posteriorly and proximal end moves
  anteriorly on sternum

Question 14

ROM of the sternoclavicular joint: rotation

Answer 14

• multifactorial

Question 15

ROM of the scapula: retraction

Answer 15

• rhomboid major and minor

- Moving closer to the spine (“attention”)

Question 16

ROM of the scapula: protraction

Answer 16

• serratus anterior

- Moving away from the spine (reaching)

Question 17

ROM of the scapula: elevation

Answer 17

• Upper Trapezius and Levator Scapulae

- Upward and parallel to spine (shoulder shrug)

Question 18

ROM of the scapula: depression

Answer 18

• Lower Trapezius and Lower Rhomboids

- Return from elevation

Question 19

ROM of the scapula: upward/downward rotation

Answer 19

• combined motions of the scapula

Question 20

Empty can test (and full can test)

Answer 20

• Flex patient’s shoulders to 90° while also abducting approximately
  45°.
• Then internally rotate both arms so thumbs are pointing down. (don’t do this in full can test)
• Press down on forearms while patient resists.
• if (+): pain or weakness
• indicates rotator cuff pathology (specifically supraspinatus)

Question 21

Drop-arm test

Answer 21

• Patient abducts arm 90°-180°.
• Then slowly drops arm.
• if (+): arm will drop or gentle tap on wrist will cause arm to drop
• indicates full thickness tear of supraspinatus

Question 22

Apprehension test

Answer 22

• Patient is seated or supine.
• Shoulder abducted to 90° and elbow flexed to 90°.
• Stabilize shoulder with one hand and force arm into external rotation with the other hand.
• if (+): patient apprehensive of repeat dislocation
• indicates glenohumeral instability

Question 23

Sulcus sign

Answer 23

• grasps patient’s elbow and apply inf traction
• if (+): indention appears in area beneath the acromion
• indicates glenohumeral instability

Question 24

Yergason test

Answer 24

• Patient’s arm at side with elbow flexed at 90°. - Examiner uses one
  hand to palpate bicipital groove and monitors there, while the other
  hand grasps the patient’s wrist.
• Have patient supinate and externally
  rotate against doctor’s resistance.
• if (+): pain and/or tendon subluxation out of groove
• indicates unstable bicipital tendon/subluxation, bicipital tendonitis

Question 25

Speed's test

Answer 25

- Patient’s arm forward flexed (50°-90°) at the shoulder with hand supinated. - Slightly flex patient’s elbow. - Resist at forearm while patient further flexes shoulder. (Resist cephalad motion) - if (+): pain in bicipital groove - indicates bicipital tendonitis of longhead of biceps

Question 26

Neer impingement

Answer 26

- Stabilize patient’s shoulder, forearm is pronated. - Passively flex shoulder to fully flexed position. - if (+): pain - indicates subacromial bursa or rotator cuff impingement

Question 27

Hawkin's test

Answer 27

- Flex shoulder to 90°, flex elbow to 90°, slightly adduct, and passively rotate the humerus into internal rotation. - This opposes the rotator cuff against coracoacromial ligament and acromion. - if (+): pain - indicates rotator cuff or subacromial bursa impingement

Question 28

Apley Scratch test

Answer 28

- 2 maneuvers - Doc should make note of how far the patient can reach - UPPER: patient abducts arm placing palm of hand behind their neck with palm facing toward the body. Patient should attempt to scratch the lowest possible vertebrae. (coupled external rotation and abduction) - LOWER: patient places arm behind their back with palm facing outward and dorsum of hand resting on their midback. Patient should attempt to scratch the highest possible vertebrae. (coupled internal rotation and adduction) - checking for ROM

Question 29

Lift off test

Answer 29

- Place patient’s arm into internal rotation and adduction. Patient extends arm into as doctor resists. - if (+): weakness (inability to resist) - indicates subscapularis weakness

Question 30

describe an OSE of the glenohumeral joint

Answer 30

- anterior and posterior glide of humeral head | - similar to load and shift

Question 31

ROM of SC joint: horizontal flexion

Answer 31

- Place index finger on the clavicular head next to the sternum - Have patient flex arms to 90° and reach towards the ceiling, evaluating the motion of the clavicle beneath your fingers - Proximal end of clavicle moves posterior as the patient reaches towards the ceiling (horizontal flexion) and distal clavicle moves anterior

Question 32

ROM of SC joint: horizontal extension

Answer 32

- return from horizontal flexion | - proximal clavicle moves anterior and distal clavicle moves posterior

Question 33

ROM of SC joint: abduction

Answer 33

- Place index finger on the clavicular head Have patient shrug their shoulders - Proximal end of clavicle moves inferiorly and distal end of clavicle move superiorly

Question 34

ROM of SC joint: adduction

Answer 34

- Return from abduction - Proximal end of clavicle moves superiorly and distal end of clavicle moves inferiorly as patient lowers shoulders to neutral