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MSK 1 > Shoulder Complex Examination > Flashcards

Shoulder Complex Examination Flashcards

1
Q

List 2 special considerations to take when performing a pt interview for a shoulder exam

A
  1. Screening questions
  2. Common functional limitations
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2
Q

Give some examples of screening questions you would want to ask during a pt interview in a shoulder exam

A
  1. UE trauma; specific mechanism
  2. Hx neck pain/trauma
  3. Hx prior shoulder dislocation
  4. Diabetes
  5. Hx frozen shoulder
  6. Pain referral from cardiopulmonary systems
  7. UE paresthesia/anesthesia/weakness
  8. Screening for other non-musculoskeletal health condition or MSK condition where referral is indicated
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3
Q

List some common functional limitations with a shoulder complex injury

A
  1. lifting/carrying objects
  2. pushing/pulling
  3. reaching behind back/OH/away from body
  4. prolonged positions (e.g. typing)
  5. sleeping
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4
Q

List some outcome measures that you may use during a shoulder examination

A
  1. PSFS
  2. DASH and QuickDASH
    • disability of the arm, shoulder and hand
  3. SPADI (Shoulder Pain and Disability Index)
  4. Western Ontario Shoulder Instability Index (WOSI)
  5. Penn Shoulder Score (PSS)
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5
Q

What types of things are you looking for during the visual inspection portion of the shoulder exam?

A
  1. gross abnormalities
  2. Integumentary
  3. Resting posture vs ability to correct
  4. Posture assessment
  5. Scapulohumeral rhythm during elevation
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6
Q

List some gross abnormalities that might catch your eye during the visual inspection portion of the shoulder exam

A
  1. step-off deformity at ACJ
  2. Deformity of clavicle
  3. Deformity at SCJ
  4. Bulging posterior shoulder
  5. Self-supporting the UE
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7
Q

List elimination tests you must perform in a shoulder exam

A
  1. UQ screen
  2. Neuro Screening Tests
    • Dermatome/Myotome/Reflexes
  3. Special tests
    • ULTT
    • Bony Aprehension Test
    • Olecranon-Manubrium Percussion Test
    • Active Compression Test
    • AC Joint Palpation
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8
Q

What elimination tests are for a fracture/bony abnormality?

A

Bony apprehension test

Olecranon-Manubrium Percussion Test

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9
Q

What elimination tests are for a SLAP lesion/Labral Tear?

A

Active Compression Test

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10
Q

Describe how to conduct a bony apprehension test

A
  1. support UE w/one hand under proximal forearm
  2. flex elbow to 90
  3. other hand on supraclavicular region
  4. Abduct pt’s shoulder to 45 (or less)
  5. ER pt’s shoulder to 45 (or less)

+ test = apprehension w/test

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11
Q

describe how to conduct an olecranon-manubrium percussion test

A
  1. pt sits with arms crossing chest
  2. Examiner taps on olecranon process while ausculating the manubrium/SC joint
  3. conduct first on non-involved side

+ test = difference in sound quality between tested sides

+ test indicates need for radiographic assessment

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12
Q

describe how to conduct an active compression test

A
  1. pt sits tell them to hold arms in front of them and touch the backs of their hands together
    • shoulder flexes to 90
    • max shoulder IR
    • horizontal ADD 10
  2. stand behind pt and push down on the wrists telling them to resist the push
  3. tell pt to turn palms all the way to the sky (max ER) and repeat procedure

+ test = pain and clicking in IR rotated position > pain in ER position

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13
Q

What is included in structural stress testing during a shoulder exam?

A
  1. AROM
  2. PROM
  3. Muscle length
  4. Resistive testing/MMT
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14
Q

What muscle length tests may be appropriate to include during a shoulder exam?

A
  1. Lats
  2. Pec minor
  3. Levator Scapula/Posterior scalene/splenius cervicis
  4. Upper Trap/SCM
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15
Q

When performing joint mobility during a shoulder exam, what joints are assessed?

A
  1. GH
  2. SC
  3. AC
  4. Scapulothoracic
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16
Q

What glides are performed at each joint during the joint mobilty portion of the shoulder exam?

A
  1. GH
    • caudal glide (S/I)
    • dorsal glide (A/P)
    • ventral glide (P/A)
  2. SC
    • caudal
    • ventral
    • dorsal
  3. AC
    • anterior glide
  4. Scapulothoracic
    • elevation/depression/upward and downward rotation, retraction and protraction
17
Q

what disorders of the shoulder have confirmation tests?

A
  1. rotator cuff tear
  2. Impingement
  3. labrum tear
  4. AC Joint dysfunction
18
Q

List confirmation tests for a rotator cuff tear

A
  1. ER lag sign
  2. IR lag sign
  3. Lift-off test
  4. Empty can test
  5. Belly press test
  6. Drop Arm test
  7. Infraspinatus test
  8. Hawkins-Kennedy Test
  9. Neer Test
19
Q

describe how to perform an ER lag sign test

A
  1. Passively place pt elbow in 90 flexion and shoulder in 20 scaption
  2. passively ER shoulder to near-end range
  3. ask pt to maintain position and remove hands from pt

+ test = inability to maintain shoulder in ER position

strong test for Supra/Infraspinatus tears

20
Q

describe how to perform an IR lag sign test

A
  1. Instruct pt to reach arm behind back and place it in the small of their back
  2. passively lift arm away from back
  3. instruct pt to keep arm there and then remove your hand

+ test = inability to maintain position

moderate strength for confirming a subscap tear

21
Q

describe how to perform a lift-off test

A
  1. Place pt’s arm behind them in the small of their back (max IR)
  2. instruct pt to try and lift their arm off of back

+ test = inability to lift arm off back

moderate strength for confirm a subscap tear

22
Q

describe how to perform an empty can test

A
  1. pt elevates shoulder to 90 deg scaption (tell them to make a Y for YMCA than lower their arms to parallel to the floor)
  2. Apply force at the wrist
    • Thumbs up position (full can)
    • Thumbs down position (empty can)

+ test = weakness and/or pain in thumbs down position relative to thumbs up position

23
Q

what is a + test for the Belly Press test?

What is the clinicial implication for this test?

A

+ test = elbow drops into extension

best utility to confirm a subscap tear

requires less IR ROM than lift-off test

24
Q

Describe how to perform the drop arm test

A
  1. grasp pt’s wrist and passively move their arm to 90 ABD
  2. release UE and instruct pt to slowly lower their arm

+ test = inability to lower arm

use with caution limited supporting research

25
Q

describe how to perform an infraspinatus test

A
  1. have pt sit with elbows flexed to 90
  2. stand behind pt and push against their arms as they resist IR

+ test = pain or weakness w/resistance

used as a part of a cluster/weak by itself

26
Q

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

A
  1. Age > 60
  2. Painful arc
    • drop arm test
    • infraspinatus test

(+LR 28; -LR 0.09)

27
Q

describe how to perform a Hawkins-Kennedy test

A
  1. pt sitting, passively move their arm to 90 flex
    • or abduction
  2. apply overpressure for IR

+ test = concordant shoulder pain provocation

generally poor diagnostic research properties

28
Q

describe how to perform the Neer Test

A
  1. passively flex pt arm w/one hand while stabilizing scapula with the other hand
  2. apply overpressure for flexion end-range

+ test = concordant shoulder pain provocation

generally poor diagnostic research properties

29
Q

What confirmation tests can help confrim the presence of a labral tear/instability?

A
  1. Biceps Load II Test
  2. Yeargaon’s Test
  3. Crank Test
  4. Speed’s Test
  5. Modified Relocation Test
30
Q

Describe how to perfrom the Biceps Load II Test

A
  1. pt in supine
  2. instruct pt to place arms over head on the table
    • shoulder ABD 120
    • full ER
    • elbow at 90 flexion
    • forearm supinated
  3. examiner then resists elbow flexion

+ test = concordant pain provocation with resisted elbow flexion

31
Q

describe how to perform Yergason’s Test

A
  1. pt is seated/supine w/elbow 90 flexion and full forearm pronation
  2. instruct pt to supinate forearm while examiner resists this motion at the wrist
    • can add in ER with the supination and resist that as well

+ test = concordant pain provocation at bicipital groove

use with caution, may have min value to confrim a SLAP lesion

32
Q

describe how to peform a Crank Test

A
  1. pt is supine
  2. passively move shoulder to 160 abd and 90 degree elbow flexion
  3. axial compression imposed on upper arm in line with long axis of humerus
  4. repeated IR/ER passively in small motions (“crank”)

+ test = concordant pain provocation with/out click

conflicting research support utility of test

33
Q

describe how to perform Speed’s test

A
  1. pt is standing w/palms up
  2. shoulder flexion is resisted from 0-60 degrees of motion

+ test = concordant pain provocation in bicipital groove

generally poor diagnostic research properties

34
Q

describe how to perform the modified relocation test

A
  1. pt supine
  2. shoulder passively abd to 120 and full ER
    • if they have pain/want you to stop during ER
    • posterior force applied to anterior humeral head, if pain relieved = + test
  3. anterior force applied to posterior humeral head, if painful = + test

MSK 1 (17 decks)

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