Shoulder Complex Examination Flashcards
How is the DASH scored?
-30 functional task
-0-4 Lickert scale
-max score 80
-lower score= greater disability
How is the SPADI scored?
-13 time scored on VAS
-8 item physical function
-5 item pain
-max score 100
-higher score = greater disability
How is ASES scored
- American Shoulder Elbow Surgeon
-10 item scored on VAS
-Max score 100
-Lower score = greater disability
What are some movement patterns that a patient can present with?
-Total neglect
-“elbow down” movement only
-Substitution
(Scapular, Trunk, Head)
What is Bakody’s Sign?
indicative of nerve root irritation C4-C6
What are some trigger symptoms complaints about the quality?
-Shifting or popping out
-Clicking, snapping, or grinding
-Ache
-Sharp pain
-Stiffness
-Numbness
-Burning
-Dead arm
What is Ehlers- Danlos?
-Rare genetic disorder that causes a defect In collagen fibers synethesis
- mild to life threatening with no cure
What is Marfan’s Syndrome?
-autosomal dominant genetic disorder of connective tissue
-disproportionate limbs
When evaluating the elevation painful arc what are the degrees that indicate glenohumeral pain?
60-120 degrees
When evaluating the elevation painful arc what are the degrees that indicate acromioclavicular pain?
170-180 degrees
What may be some neuromuscular issues causing extrinsic shoulder pain?
-Cervical radiculopathy
-upper trunk brachial plexopathy
-Neurologic amyotrophy
-Focal Mononeuropathy
-Muscular Dystrophy
What may be some Cardiovascular issues causing extrinsic shoulder pain?
-Cardiac ischemia
-Thoracic Outlet Syndrome
-Aortic disease
-Axillary thrombosis
What may be some causes of Pulmonary issues causing extrinsic shoulder pain?
-Upper lobe pneumonia
-Pulmonary embolism
-Pneumothorax
-Pneumoperitoneum
What may be some Malignacy issues causing extrinsic shoulder pain?
-Pancoast tumor
-metastatic cancer
What may be some Abdominal issues causing extrinsic shoulder pain?
-Biliary disease’s
-Hepatic disease
-Pancreatitis
-Splenic injury
-Perforated viscus
What is the Popeye defect?
-Proximal portion of long head of bicep tears which causes bulging
-will still have function but not as strong
Axillary nerve issues will cause atrophy to what muscles?
-Teres Minor
-Deltoid
Accessory nerve issues will cause atrophy to what muscles?
SCM & Trapezius
Suprascapular nerve issues will cause atrophy to what muscles?
-Supraspinatus
-Infraspinatus
Lower sub scapular nerve issues will cause atrophy to what muscle?
Teres Major
Long thoracic nerve issues will cause atrophy to what muscle?
Serratus Anterior
Upper & Lower Subscapular nerve issues will cause atrophy to what muscle?
Subscapularis
What is the normal value of flexion for the shoulder complex?
0-180 degrees
What is the normal value of abduction for the shoulder complex?
0-180
What is the normal value of extension for the shoulder complex?
0-60
What is the normal value of external rotation for the shoulder complex?
0-90
What is the normal value of internal rotation for the shoulder complex?
0-70
What glides are used to assess flexion osteokinematic motion?
-Posterior glide
-Inferior glide
What glides are used to assess extension osteokinematic motion?
-Anterior
What glides are used to assess ABDuction osteokinematic motion?
-Inferior glide humeral head
-Inferior glide clavicle on sternum
What glides are used to assess Internal rotation osteokinematic motion?
posterior glide
What glides are used to asses external rotation osteokinematic motion?
- Anterior glide (biomechanically)
- Posterior glide (when patient has poor posture)
What glides are used to assess horizontal ABDuction osteokinematic motion?
-Anterior glide
What glides are used to assess Horizontal ADDuction osteokinematic motion?
posterior glide
What is HHD Interrater Reliability?
Reliability of hand-held dynamometry in measuring isometric strength of the shoulder internal & external rotator musculature using a stabilizing device
What muscles contribute to flexion of the shoulder?
-Anterior deltoid
-Coracobrachialis
-Long head bicep & short head bicep
-Supraspinatus
-Pec Major
What muscles contribute to extension of the shoulder?
-Posterior Deltoid
-Lattissiums Dorsi
-Teres Major
- Long head tricep
What muscles contribute to abduction of the shoulder?
-Middle Deltoid
-Supraspinatus
What muscles contribute to External rotation of the shoulder?
-infraspinatus
-teres major
what muscles contribute to internal rotation of the shoulder?
Subscapularis
What muscles contribute to horizontal abduction of the shoulder?
Posterior deltoid
What muscles contribute to horizontal adduction of the shoulder?
Pec major
-clavicular head (60)
-Sternal head (120)
What scapular muscles contribute to abduction & upward rotation?
Serratus Anterior
What scapular muscles contribute to adduction & downward rotation?
Rhomboid major & minor
What scapular muscles contribute to retraction?
-middle trap
-rhomboid major/minor
What scapular muscles contribute to depression & adduction?
Lower & middle trap
What are some examples of RC Pathology?
-RC tear
-RC Tendinopathy
What are some examples of extra-articular pathology?
-AC Joint
-Long head bicep tendinopathy
-Long head bicep tendinitis
-Long head bicep rupture
-Bursitis
What are some examples of Intra-articular pathology?
Anterior instability
Posterior instability
Bankart Lesion
SLAP lesion
GH OA
What are some examples of other pathologies of the shoulder?
Adhesive Capsulitis
C-spine Radicular
Shoulder Referred (other body system)
What is Litaker diagnostic cluster for RC tear?
Age >65= +LR 2.61
Night Pain= +LR 2.61
ER weakness = +LR 6.96
All 3: +LR=9.84
what is park diagnostic cluster for RC tear?
Age > 60
+painful arc
+drop arm test
+infraspinatus test
What combination of tests used to confirm RC tendinopathy of full thickness tear of supraspinaus?
Jobe/Empty Can (deltoid little less activated) + Full Can + External Rotation Lag Sign (have pt in full extension & ask them to stay there)
What combination of tests used to confirm RC tendinopathy of full thickness tear of infraspinatus?
External rotation Lag sign
What combination of tests used to confirm RC tendinopathy of full thickness tear of subscapularis?
Lift off + Belly press or Belly press + bear hug
What does positive speed’s test indicate?
long head biceps tendinopathy
What does positive ludington’s test indicate?
long head of biceps tendon rupture
