Shoulder Complaint Flashcards
What is special about the shoulder joint? Why is it so susceptible to injury?
It is the only joint in the body where the tendons pass between the bones
This makes the joint flexible but very susceptible to injury
What is the painful arc test testing for?
Subacromial impingement and rotator cuff tendon injuries
Describe the painful arc test
You have the patient adduct their arm from 60 degrees to 120 degrees. If they have pain, then the test is positive and indicative of a subacromial impingement or rotator cuff injury
Which population of upper extremity pathologies is the most common in the elderly?
Proximal humerus fractures
Where do the most clavicular fractures occur?
69% happen in the middle third
What is the most common glenohumeral dislocation? How would the patient present?
Anterior dislocation happens in about 95-97% of cases
Arm would be slightly abducted and externally rotated with resistance of all movement
Describe acromioclavicular joint issues.
Occurs from direct trauma to the superior or lateral aspect of the shoulder with the arm adducted
Describe impingement syndrome in the rotator cuff pathology
Compression of the rotator cuff tendons and the subacromial bursa between the humeral head and the acromion
Describe a tendon injury of the shoulder. In which tendon do most of these occur?
Sprain or tear of the tendon from the result of a subacromial impingement
most injuries are in the supraspinous tendon
Describe tendinopathy of the shoulder
Chronic injury to the supraspinatus/infraspinatus tendons
consequence of repetitive activity
Describe the apprehension test
The patient is seated with the shoulder abducted and flexed to 90 degrees
Shoulder is stabilized and the other forces the arm into external rotation
IF THE PATIENT is apprehensive, then there is a sign that they have had a dislocation before
What does a positive apprehension test insinuate?
Glenohumeral instability
Describe the empty can test
Have the patient flex their arms to 90 degree s and horizontally abduct to 45 degrees. Internally rotate both arms so that the thumbs are pointing down. Press down on the forearms while the patient resists
Describe the drop arm test
Patient abducts arms to 90 degrees then slowly drops arms
a positive test would be the arm dropping at about 20 degrees to the side OR the arm dropping with a gentle tap on the arm
What does a positive empty can test indicate?
Rotator cuff pathology
What does a positive drop arm test indicate?
full thickness tear of the supraspinatous
Describe a Neer Impingement test
Stabilize the patients shoulder
With the forearm pronated, passively flex the shoulder to the fully flexed position
***basically you are grabbing the patients hand and keep taking it up into the flexed position
IF the patient experiences pain, then the test is positive
What does a positive neer impingement test indicate?
Subacromial bursa or rotator cuff impingement
Describe a Hawkins test
Flex the shoulder and the elbow to 90 degrees and rotate the humerus into internal rotation (like a wing flapping)
Pain is a positive test
What does a positive Hawkins test indicate?
Rotator cuff or subacromial bursa impingement
The movement itself opposes the rotator cuff against the coracoacromial ligament and acromion
Describe a cross arm test
Physician adducts the arm across their chest and holds the hand on the patients opposite shoulder
A positive test results in pain in the AC joint with end range adduction
What does a positive cross arm test indicate?
AC joint pathology
What are the tests for glenohumeral instability?
Apprehension test
What are the tests for rotator cuff pathology?
Empty can test
Drop arm test
