Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

S3- Musculoskeletal > Shoulder Complex Examination > Flashcards

Shoulder Complex Examination Flashcards

1
Q

What is the order of the differential diagnosis process?

A
  1. ) Chart Review/ Patient Interview
  2. ) Visual Inspection
  3. ) Systems Review
  4. ) Elimination Tests
  5. ) Structural Stress Testing
  6. ) Palpation and Joint Mobility Tests
  7. ) Confirmation Tests
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

PATIENT INTERVIEW

A

PATIENT INTERVIEW

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are some screening questions to ask for the shoulder complex?

A
  • UE Trauma; specify mechanism
  • Hx neck pain/trauma
  • Hx shoulder dislocation
  • DM
  • Hx frozen shoulder
  • Pain referral from cardiopulmonary systems
  • UE paresthesia/anesthesia/weakness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are some common functional limitations of patients with shoulder issues?

A
  • lifting/carrying objects
  • pushing/pulling
  • reaching behind back/overhead/away from body
  • prolonged positioning
  • sleeping
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are some outcome measures used to assess shoulder involvement?

A
  • PSFS
  • DASH and QuickDASH (Disabilities of the Arm, Shoulder, and Hand)
  • SPADI (Shoulder Pain and Disability Index)
  • WOSI (Western Ontario Shoulder Instability Index)
  • PSS (Penn Shoulder Score)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

VISUAL INSPECTION

A

VISUAL INSPECTION

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are we looking for during a visual inspection of the shoulder?

A
  • Gross abnormalities
  • Integumentary
  • Resting posture vs ability to correct
  • Posture Assessment
  • Scapulohumeral rhythm during elevation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are some gross abnormalities we might see at the shoulder?

A
  • step-off deformity at ACJ
  • deformity of clavicle
  • deformity at SCJ
  • bulging posterior shoulder
  • self-supporting the UE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

With a postural assessment, what structures are we looking at?

A
  • head on neck
  • mandible on cranium
  • neck on trunk
  • scapulae on thorax (“winging” or “hiking”)
  • upper arms on scapulae (resting ER)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What comes after the visual inspection?

A

Systems Review

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

ELIMINATION TESTS

A

ELIMINATION TESTS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What screening tests are performed both at the neck and shoulder?

A
  • UQ screen
  • Neuro screen
  • Special tests w/ -LR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What elimination tests are used to rule out radiculopathy?

A

ULTT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What elimination tests are used to rule out fracture/bony abnormality?

A
  • Bony Apprehension Test

- Olecranon-Manubrium Percussion Test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What elemination test is used to rule out SLAP lesion/ Labral tear?

A

Active Compression Test (O Brien Test)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What elimination test is used to rule out ACJ dysfunction?

A

AC Joint Palpation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Why would a ULTT be used when assessing the shoulder?

A
  • Decrease suspicion of c-spine origin for UE symptoms
  • Sway focus to further testing to investigate origin of symptoms at neck or locally at the shoulder
  • Increase confidence that we can move on from further testing at the neck
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Bony Apprehension Test:

  • Indications?
  • Pt Position?
  • Examiner Position?
  • Procedure?
  • Positive test?
A
  • Indications: Anterior instability of shoulder due to bony lesion
  • Pt Position: Sitting
  • Examiner Position: Grasping proximal forearm and elbow to support, starting in 90 degrees of pt elbow flexion
  • Procedure: Abduct the patient’s shoulder to 45 (or less)degrees then externally rotate the shoulder to 45 degrees (or less)
  • Positive Test: Apprehension with the test
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Olecranon-Manubrium Percussion Test:

  • Indications?
  • Pt Position?
  • Examiner Position?
  • Procedure?
  • Positive test?
A
  • Indications: Fracture/dislocation between elbow and manubrium
  • Pt Position: Sitting/standing with arms crossing chest
  • Examiner Position: Beside/facing patient
  • Procedure: Percuss the olecranon while auscilating the manubrium. Repeat on non-involved side.
  • Positive Test: Difference in sound quality between tested sides
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Active Compression Test (O’Brien Test):

  • Indications?
  • Pt Position?
  • Examiner Position?
  • Procedure?
  • Positive test?
A
  • Indications: Labral tear or abnormality/ SLAP lesion/ ACJ pathology
  • Pt Position: Standing w/ elbow straightened and shoulder at 90° flexion, 10° horizontal adduction, and max IR
  • Examiner Position: Standing behind patient
  • Procedure: Patient resists isometric extension moment placed on wrist. Pt moves to maximum ER and resists isometric extension moment placed on wrist again.
  • Positive Test: Pain and clicking in IR position > pain in ER position
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

AC Joint Palpation:

  • Indications?
  • Pt Position?
  • Examiner Position?
  • Procedure?
  • Positive test?
A
  • Indications: AC joint dysfunction
  • Pt Position: Sitting with arm at side
  • Examiner Position: Standing behind patient
  • Procedure: Palpate ACJ line
  • Positive test: concordant pain provocation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

STRUCTURAL STRESS TESTING

A

STRUCTURAL STRESS TESTING

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Structural stress testing AROM can be done in _______ or ________. With this we want to observe ____________ and ________ spine motions.

A
  • sitting or supine

- scapulothoracic and thoracic spine

24
Q

What movements are performed during AROM and PROM assessment?

A
  • flexion/extension
  • abduction/adduction
  • IR/ER
25
Q

Muscle length testing of what can be performed during structural stress testing?

A
  • Lats
  • Pec Minor
  • Levator Scap/ posterior scalene/ splenius cervicis
  • Upper trap/ SCM
26
Q

With AROM/PROM and Resistive testing, what 4 things are we assessing for?

A
  • Quality
  • Quantity
  • Provocation
  • Willingness to move
27
Q

What scapular MMT tests can be assessed during structural stress testing?

A
  • Abduction and upward rotation
  • Elevation
  • Adduction
  • Depression and adduction
28
Q

What shoulder MMT tests can be assessed during structural stress testing?

A
  • flexion/extension
  • abduction
  • horizontal ab/adduction
  • IR/ER
29
Q

PALPATION AND JOINT MOBILITY TESTS

A

PALPATION AND JOINT MOBILITY TESTS

30
Q

List the palpable bone and joint structures of the shoulder.

A
  • Clavicle
  • SC joint line
  • AC joint line
  • Coracoid process
  • Humerus (greater/lesser tuberosity, head)
  • Spine of scapula
  • Acromion
  • Sternum
  • Ribs/Costal cartilage
31
Q

List the palpable soft tissue structures of the shoulder.

A
  • Sub-Acromial Space
  • Supraspinatus tendon and muscle belly
  • Subscapularis tendon and muscle belly
  • Infraspinatus tendon and muscle belly
  • Supraspinatus tendon and muscle belly
  • Long head of biceps tendon
  • Deltoid muscle belly
  • Trapezius
  • Pec major/minor
32
Q

What joints can we apply joint mobilizations to in the shoulder?

A
  • GH
  • Scapulothoracic
  • SC
  • AC
33
Q

Joint Mobility:

  • The GH joint has a ______, ______, and ______ glide.
  • The SC joint has a _______, ______, and ______ glide.
  • The AC joint has a _______ glide.
A
  • caudal, dorsal, and ventral
  • caudal, dorsal, and ventral
  • anterior
34
Q

Describe the scapulothoracic glides.

  • Patient Position?
  • Examiner Position?
  • Procedure?
A

Patient Position
-side-lying, 90° elbow flexion
Examiner Position
-facing patient’s anterior trunk
-caudal UE: reaching medial to upper arm, support inferior angle of scapula
-Cranial UE: superior scapula
Procedure
-passively bring scapula through depression, elevation, retraction, upward rotation, and downward rotation
-move scapula and humerus as a unit
-ensure shoulder girdle musculature is relaxed

35
Q
  • For the dorsal (posterior) glide of the SC joint we push on the _______.
  • For the ventral (anterior) glide of the SC joint we push on the _______.
  • For the caudal glide of the SC joint we apply a caudal force on the medial _______ in a slight _______ and _______ direction.
A
  • clavicle
  • manubrium
  • clavicle, anterior and lateral
36
Q

For the ventral (anterior) glide of the AC joint we apply a ventral force on the ________ while the patient is sitting.

A

clavicle

37
Q

CONFIRMATION TESTS

A

CONFIRMATION TESTS

38
Q

What confirmation tests are used for rotator cuff tear?

A
  • External Rotation Lag Sign
  • Lift-Off Test
  • Internal Rotation Lag Sign
  • Empty can Test
  • Belly Press Test
  • Drop Arm Test
  • Infraspinatus Test
39
Q

External Rotation Lag Sign:

  • Indications?
  • Pt Position?
  • Examiner Position?
  • Procedure?
  • Positive test?
A
  • Indications: Rotator Cuff Tear
  • Pt Position: Sitting
  • Examiner Position: Behind patient with medial hand stabilizing patient UE at elbow, and lateral hand grasping patients wrist
  • Procedure: Passively places elbow in 90° flexion and shoulder in 20° scaption, passively externally rotate shoulder to near-end-range and ask patient to maintain position
  • Positive test: Inability to maintain shoulder in externally rotated position
40
Q

Lift Off Test:

  • Indications?
  • Pt Position?
  • Examiner Position?
  • Procedure?
  • Positive test?
A
  • Indications: Rotator Cuff Tear
  • Pt Position: sitting, tested UE behind pt’s back with dorsum of wrist/hand contacting posterior trunk
  • Examiner Position: posterior for observation
  • Procedure: pt instructed to lift arm off back
  • Positive test: inability to lift arm off of the back
41
Q

Internal Rotation Lag Sign:

  • Indications?
  • Pt Position?
  • Examiner Position?
  • Procedure?
  • Positive test?
A
  • Indications: Rotator Cuff Tear
  • Pt Position: sitting, tested UE behind pt’s back
  • Examiner Position: behind stabilizing patient’s elbow wth more lateral UE, grasping patient’s wrist with more medial UE
  • Procedure: pt’s UE lifted away from back (passive IR), pt instructed to maintain position
  • Positive test: inability to maintain position
42
Q

Empty Can Test:

  • Indications?
  • Pt Position?
  • Examiner Position?
  • Procedure?
  • Positive test?
A
  • Indications: Rotator Cuff Tear
  • Pt Position: sitting, edge/corner of table
  • Examiner Position: behind pt
  • Procedure: pt elevates shoulder to 90° scaption, isometric extension moment placed at wrists in thumbs-up and thumbs down position
  • Positive test: weakness and/or pain in thumbs-down position (relative to thumbs-up)
43
Q

Belly Press Test:

  • Indications?
  • Pt Position?
  • Examiner Position?
  • Procedure?
  • Positive test?
A
  • Indications: Rotator Cuff Tear
  • Pt Position: sitting, elbow flexed 90°, palm on abdomen
  • Examiner Position: standing in front of patient
  • Procedure: patient internally rotates shoulder to press hand into abdomen
  • Positive test: elbow drops into extension
44
Q

Drop Arm Test:

  • Indications?
  • Pt Position?
  • Examiner Position?
  • Procedure?
  • Positive test?
A
  • Indications: Rotator Cuff Tear
  • Pt Position: sitting
  • Examiner Position: behind pt on symptomatic side
  • Procedure: grasping at the wrist, examiner passively abducts the shoulder to 90°, examiner then releases the UE with instruction to slowly lower the UE
  • Positive test: inability to lower the arm
45
Q

Infraspinatus Test:

  • Indications?
  • Pt Position?
  • Examiner Position?
  • Procedure?
  • Positive test?
A
  • Indications: Rotator Cuff Tear
  • Pt Position: standing, elbow flexed to 90° and neutral rotation
  • Examiner Position: behind on symptomatic side
  • Procedure- supporting the pt elbow, examiner applies an internal rotation force at the wrist
  • Positive test- pain or weakness with resistance
46
Q

What are the 4 components of the Rotator Cuff Tear Diagnostic Cluster?

A
  • Age >60 years
  • Painful Arc
    • Drop Arm Test
    • Infraspinatus Test
47
Q

What confirmation tests are used for Torn Labrum/ Instability?

A
  • Biceps Load II Test
  • Yeargaon’s Test
  • Crank Test
  • Speed’s Test
  • Modified Relocation Test
48
Q

Biceps Load II Test:

  • Indications?
  • Pt Position?
  • Examiner Position?
  • Procedure?
  • Positive test?
A
  • Indications: SLAP Lesion
  • Pt Position: supine
  • Examiner Position: symptomatic side
  • Procedure: shoulder passively placed in 120° abduction and end-range ER, elbow 90° flexion, forearm supinated. Examiner resists isometric elbow flexion
  • Positive test: concordant pain provocation with resisted elbow flexion
49
Q

Yergason’s Test:

  • Indications?
  • Pt Position?
  • Examiner Position?
  • Procedure?
  • Positive test?
A
  • Indications: SLAP Lesion/ labral lesion
  • Pt Position: sitting or standing, 90° elbow flexion, forearm pronation
  • Examiner Position: patients symptomatic side
  • Procedure: pt instructed to supinate forearm while examiner resists this motion at the wrist
  • Positive test: concordant pain provocation at bicipital groove
50
Q

Crank Test:

  • Indications?
  • Pt Position?
  • Examiner Position?
  • Procedure?
  • Positive test?
A
  • Indications: Labral Tear
  • Pt Position: supine
  • Examiner Position: facing patient on symptomatic side
  • Procedure: examiner passively abducts shoulder to 160° and flexes elbow 90°, axial compression imposed on upper arm in line with long axis of humerus, repeated IR/ER passively performed (small motions)
  • Positive test: concordant pain provocation
51
Q

Speed’s Test:

  • Indications?
  • Pt Position?
  • Examiner Position?
  • Procedure?
  • Positive test?
A
  • Indications: subacromial impingement, SLAP lesion, labral lesion, biceps pathology
  • Pt Position: standing, elbow extended, forearm supinated
  • Examiner Position: standing, facing patient
  • Procedure: shoulder flexion resisted from 0° to 60° of motion
  • Positive test: concordant pain provocation in bicipital groove
52
Q

Modified Relocation:

  • Indications?
  • Pt Position?
  • Examiner Position?
  • Procedure?
  • Positive test?
A
  • Indications:labral pathology, traumatic anterior instability
  • Pt Position: supine
  • Examiner Position: standing beside patient
  • Procedure: shoulder passively abducted to 120° and full ER, anterior force applied to posterior humeral head. If painful, a posterior force is applied to anterior humeral head
  • Positive test: pain and/or apprehension
53
Q

What confirmation test is used for AC joint dysfunction?

A

AC Resisted Extension Test

54
Q

AC Resisted Extension Test:

  • Indications?
  • Pt Position?
  • Examiner Position?
  • Procedure?
  • Positive test?
A
  • Indications: AC Joint Pathology
  • Pt Position: sitting
  • Examiner Position: standing
  • Procedure: patient placed in 90° shoulder flexion and IR, 90° elbow flexion. Examiner resists shoulder horizontal abduction
  • Positive test: concordant pain provocation at AC joint line
55
Q

What confirmation tests are used for impingement/RC tear?

A
  • Hawkins-Kennedy Test

- Neer Test

56
Q

Hawkins-Kennedy Test:

  • Indications?
  • Pt Position?
  • Examiner Position?
  • Procedure?
  • Positive test?
A
  • Indications: subacromial impingement, RC integrity, superior labral tear
  • Pt Position: seated, elbow flexed to 90°
  • Examiner Position: standing, anterior to involved shoulder
  • Procedure: passively elevate shoulder to 90° of shoulder flexion or abduction (stabilize scapula superiorly with other hand)
  • Positive test: concordant shoulder pain provocation
57
Q

Neer Test:

  • Indications?
  • Pt Position?
  • Examiner Position?
  • Procedure?
  • Positive test?
A
  • Indications: subacromial impingement
  • Pt Position: seated, elbow extended
  • Examiner Position: standing to side of patient
  • Procedure: passively flex the arm with one hand while stabilizing the scapula with the other hand, apply overpressure for flexion at end-range
  • Positive test: concordant shoulder pain provocation

S3- Musculoskeletal (27 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions