Shoulder Complex Examination Flashcards
List 2 special considerations to take when performing a pt interview for a shoulder exam
- Screening questions
- Common functional limitations
Give some examples of screening questions you would want to ask during a pt interview in a shoulder exam
- UE trauma; specific mechanism
- Hx neck pain/trauma
- Hx prior shoulder dislocation
- Diabetes
- Hx frozen shoulder
- Pain referral from cardiopulmonary systems
- UE paresthesia/anesthesia/weakness
- Screening for other non-musculoskeletal health condition or MSK condition where referral is indicated
List some common functional limitations with a shoulder complex injury
- lifting/carrying objects
- pushing/pulling
- reaching behind back/OH/away from body
- prolonged positions (e.g. typing)
- sleeping
List some outcome measures that you may use during a shoulder examination
- PSFS
- DASH and QuickDASH
- disability of the arm, shoulder and hand
- SPADI (Shoulder Pain and Disability Index)
- Western Ontario Shoulder Instability Index (WOSI)
- Penn Shoulder Score (PSS)
What types of things are you looking for during the visual inspection portion of the shoulder exam?
- gross abnormalities
- Integumentary
- Resting posture vs ability to correct
- Posture assessment
- Scapulohumeral rhythm during elevation
List some gross abnormalities that might catch your eye during the visual inspection portion of the shoulder exam
- step-off deformity at ACJ
- Deformity of clavicle
- Deformity at SCJ
- Bulging posterior shoulder
- Self-supporting the UE
List elimination tests you must perform in a shoulder exam
- UQ screen
- Neuro Screening Tests
- Dermatome/Myotome/Reflexes
- Special tests
- ULTT
- Bony Aprehension Test
- Olecranon-Manubrium Percussion Test
- Active Compression Test
- AC Joint Palpation
What elimination tests are for a fracture/bony abnormality?
Bony apprehension test
Olecranon-Manubrium Percussion Test
What elimination tests are for a SLAP lesion/Labral Tear?
Active Compression Test
Describe how to conduct a bony apprehension test
- support UE w/one hand under proximal forearm
- flex elbow to 90
- other hand on supraclavicular region
- Abduct pt’s shoulder to 45 (or less)
- ER pt’s shoulder to 45 (or less)
+ test = apprehension w/test
describe how to conduct an olecranon-manubrium percussion test
- pt sits with arms crossing chest
- Examiner taps on olecranon process while ausculating the manubrium/SC joint
- conduct first on non-involved side
+ test = difference in sound quality between tested sides
+ test indicates need for radiographic assessment
describe how to conduct an active compression test
- 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
- stand behind pt and push down on the wrists telling them to resist the push
- 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
What is included in structural stress testing during a shoulder exam?
- AROM
- PROM
- Muscle length
- Resistive testing/MMT
What muscle length tests may be appropriate to include during a shoulder exam?
- Lats
- Pec minor
- Levator Scapula/Posterior scalene/splenius cervicis
- Upper Trap/SCM
When performing joint mobility during a shoulder exam, what joints are assessed?
- GH
- SC
- AC
- Scapulothoracic
What glides are performed at each joint during the joint mobilty portion of the shoulder exam?
- GH
- caudal glide (S/I)
- dorsal glide (A/P)
- ventral glide (P/A)
- SC
- caudal
- ventral
- dorsal
- AC
- anterior glide
- Scapulothoracic
- elevation/depression/upward and downward rotation, retraction and protraction
what disorders of the shoulder have confirmation tests?
- rotator cuff tear
- Impingement
- labrum tear
- AC Joint dysfunction
List confirmation tests for a rotator cuff tear
- ER lag sign
- IR lag sign
- Lift-off test
- Empty can test
- Belly press test
- Drop Arm test
- Infraspinatus test
- Hawkins-Kennedy Test
- Neer Test
describe how to perform an ER lag sign test
- Passively place pt elbow in 90 flexion and shoulder in 20 scaption
- passively ER shoulder to near-end range
- ask pt to maintain position and remove hands from pt
+ test = inability to maintain shoulder in ER position
strong test for Supra/Infraspinatus tears
describe how to perform an IR lag sign test
- Instruct pt to reach arm behind back and place it in the small of their back
- passively lift arm away from back
- instruct pt to keep arm there and then remove your hand
+ test = inability to maintain position
moderate strength for confirming a subscap tear
describe how to perform a lift-off test
- Place pt’s arm behind them in the small of their back (max IR)
- 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
describe how to perform an empty can test
- pt elevates shoulder to 90 deg scaption (tell them to make a Y for YMCA than lower their arms to parallel to the floor)
- 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
what is a + test for the Belly Press test?
What is the clinicial implication for this test?
+ test = elbow drops into extension
best utility to confirm a subscap tear
requires less IR ROM than lift-off test
Describe how to perform the drop arm test
- grasp pt’s wrist and passively move their arm to 90 ABD
- release UE and instruct pt to slowly lower their arm
+ test = inability to lower arm
use with caution limited supporting research
describe how to perform an infraspinatus test
- have pt sit with elbows flexed to 90
- 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
What are the components of the Rotator Cuff Tear Diagnostic Cluster?
- Age > 60
- Painful arc
- drop arm test
- infraspinatus test
(+LR 28; -LR 0.09)
describe how to perform a Hawkins-Kennedy test
- pt sitting, passively move their arm to 90 flex
- or abduction
- apply overpressure for IR
+ test = concordant shoulder pain provocation
generally poor diagnostic research properties
describe how to perform the Neer Test
- passively flex pt arm w/one hand while stabilizing scapula with the other hand
- apply overpressure for flexion end-range
+ test = concordant shoulder pain provocation
generally poor diagnostic research properties
What confirmation tests can help confrim the presence of a labral tear/instability?
- Biceps Load II Test
- Yeargaon’s Test
- Crank Test
- Speed’s Test
- Modified Relocation Test
Describe how to perfrom the Biceps Load II Test
- pt in supine
- instruct pt to place arms over head on the table
- shoulder ABD 120
- full ER
- elbow at 90 flexion
- forearm supinated
- examiner then resists elbow flexion
+ test = concordant pain provocation with resisted elbow flexion
describe how to perform Yergason’s Test
- pt is seated/supine w/elbow 90 flexion and full forearm pronation
- 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
describe how to peform a Crank Test
- pt is supine
- passively move shoulder to 160 abd and 90 degree elbow flexion
- axial compression imposed on upper arm in line with long axis of humerus
- repeated IR/ER passively in small motions (“crank”)
+ test = concordant pain provocation with/out click
conflicting research support utility of test
describe how to perform Speed’s test
- pt is standing w/palms up
- shoulder flexion is resisted from 0-60 degrees of motion
+ test = concordant pain provocation in bicipital groove
generally poor diagnostic research properties
describe how to perform the modified relocation test
- pt supine
- 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
- anterior force applied to posterior humeral head, if painful = + test
