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PCM exam 1 > Shoulder Competency > Flashcards

Shoulder Competency Flashcards

1
Q

What are some observations for the shoulder?

A
  • SC joint
  • AC joint
  • glenohumeral
  • scapula
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2
Q

What are palpable landmarks of the shoulder?

A
  • 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
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3
Q

ROM of the glenohumeral joint: flexion

A
  • ant deltoid and coracobrachialis

- 180 deg

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4
Q

ROM of the glenohumeral joint: extension

A
  • latissimus dorsi and teres major

- 60 deg

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5
Q

ROM of the glenohumeral joint: horizontal abduction

A
  • supraspinatus and med-deltoid

- 40-55 or 130-145 deg

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6
Q

ROM of the glenohumeral joint: horizontal adduction

A
  • pec major and lats

- 40-50 or 130-140 deg

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7
Q

ROM of the glenohumeral joint: external rotation

A
  • infraspinatus and teres minor

- 90 deg

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8
Q

ROM of the glenohumeral joint: internal rotation

A
  • subscapularis and pec minor

- 90 deg

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9
Q

ROM of the acromioclavicular joint: axial rotation

A

~10 deg

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10
Q

ROM of the sternoclavicular joint: abduction

A
  • Distal end of clavicle moves superiorly and proximal end moves
    inferiorly
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11
Q

ROM of the sternoclavicular joint: adduction

A
  • Distal end of clavicle moves inferiorly and proximal end moves
    superiorly
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12
Q

ROM of the sternoclavicular joint: horizontal flexion

A
  • Distal end of clavicle moves anteriorly and proximal end moves
    posteriorly on the sternum
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13
Q

ROM of the sternoclavicular joint: horizontal extension

A
  • Distal end of clavicle moves posteriorly and proximal end moves
    anteriorly on sternum
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14
Q

ROM of the sternoclavicular joint: rotation

A
  • multifactorial
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15
Q

ROM of the scapula: retraction

A
  • rhomboid major and minor

- Moving closer to the spine (“attention”)

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16
Q

ROM of the scapula: protraction

A
  • serratus anterior

- Moving away from the spine (reaching)

17
Q

ROM of the scapula: elevation

A
  • Upper Trapezius and Levator Scapulae

- Upward and parallel to spine (shoulder shrug)

18
Q

ROM of the scapula: depression

A
  • Lower Trapezius and Lower Rhomboids

- Return from elevation

19
Q

ROM of the scapula: upward/downward rotation

A
  • combined motions of the scapula
20
Q

Empty can test (and full can test)

A
  • 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)
21
Q

Drop-arm test

A
  • 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
22
Q

Apprehension test

A
  • 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
23
Q

Sulcus sign

A
  • grasps patient’s elbow and apply inf traction
  • if (+): indention appears in area beneath the acromion
  • indicates glenohumeral instability
24
Q

Yergason test

A
  • 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
25
Q

Speed’s test

A
  • 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
26
Q

Neer impingement

A
  • Stabilize patient’s shoulder, forearm is pronated.
  • Passively flex
    shoulder to fully flexed position.
  • if (+): pain
  • indicates subacromial bursa or rotator cuff impingement
27
Q

Hawkin’s test

A
  • 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
28
Q

Apley Scratch test

A
  • 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
29
Q

Lift off test

A
  • Place patient’s arm into internal rotation and adduction. Patient
    extends arm into as doctor resists.
  • if (+): weakness (inability to resist)
  • indicates subscapularis weakness
30
Q

describe an OSE of the glenohumeral joint

A
  • anterior and posterior glide of humeral head

- similar to load and shift

31
Q

ROM of SC joint: horizontal flexion

A
  • 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
32
Q

ROM of SC joint: horizontal extension

A
  • return from horizontal flexion

- proximal clavicle moves anterior and distal clavicle moves posterior

33
Q

ROM of SC joint: abduction

A
  • 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
34
Q

ROM of SC joint: adduction

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

PCM exam 1 (7 decks)

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