shoulder conditions and tests

Question 1

what are the components of shoulder objective assessment

Answer 1

 Establish present pain
 Observation
 Clear joints above and below
 Active ROM
 Passive ROM
 Muscle strength testing (girdle and GHjt) – isometric/isotonic
 Passive accessory movement (PAMs)
 Special tests
 Palpation

Question 2

what are the key observable factors in shoulder observation

Answer 2

 Symmetry
 Muscle wasting / tone/ tension
 Acute inflammatory signs
 Scapular positions
 Clavicle
 ACJ/SCJ/ GHJ alignment
 Thoracic spine
 Elbow / hand positions
 Cervical spine posture

Question 3

what aspects are examined during assessment of AROM and PROM of the shoulder

Answer 3

 Range
 Quality
 Scapula control
 Clavicle movement
 Abnormal movement strategies
 Equal left & right (Note: due to hand dominance,
often not equal)
 Scapula-humeral rhythm
 Painful arc

Question 4

What are possible special tests of the glenohumeral joint?

Answer 4

Apprehension test / relocation joint
(tests joint integrity, anterior shoulder stability)

Empty can test (tendinopathy/ rotator cuff tear)

Hawkins-Kennedy (shoulder impingement syndrome)

Question 5

What can be done to test the acromioclavicular joint?

Answer 5

Scarf test

Question 6

How is the apprehension test / relocation test carried out?

Answer 6

assess integrity of the glenohumeral joint capsule

pt in supine, elbow flexed at 90 and shoulder abducted to 90, slowly external rotate arm to 90

apprehension is a positive test/ prevent further movement
pain indicates another pathology

if pt experiencing apprehension, perform AP glide if provides relief, or compress and release and see different

positive if relief is experienced

Question 7

how is the empty can test conducted

Answer 7

assesses for lesions on supraspinatus or the supraspinatus tendon

pt seated or standing
arm elevated to 90 in scapular plane, with extended elbow, full internal rotation and forearm pronation

stabilise shoulder and apply downward pressure to the arm and pt tries to resist

postive is patient is week or experiences pain

Question 8

how is the hawkins kennedy test conducted?

Answer 8

tests for shoulder inpingement

pt sitting, arm to 90 degree forward flexion, rests on therapist arm, then perform passive internal rotation

positive test is pain and can indicate subacromial inpingement

if its internal it would be negative

Question 9

how is the scarf test conducted

Answer 9

tests the integrity of the acromioclavicular joint

pt standing or sitting, passively pts arm brought to 90 degree flexion, elbow flexed at 90
physio horizontally adducts arm across patient body bringing elbow towards other shoulder, stabilize at scapula

positive if compression against medial acromial facet provokes symptoms, pain localized at AC joint, pt will be specific ab pain if on ACJ, check where pain

suggest OA or ligament injury at AC

Question 10

what are possible shoulder passive accessory movements

Answer 10

glenohumeral:
Anterorposterior AP
Posteroanterior PA
Longitudinal caudad

Acromioclavicular joint:
Anteroposterior
Posteroanterior

Sternoclavicular joint:
anteroposterior

Question 11

how are AP and PA performed at the glenohumeral joint

Answer 11

AP glide

supine at edge of table, 40-45 abduction out to side fixating on hip , inner hand translate posteriorly

PA glide

pt in supine, abduct 40-45 degrees, support on inside of body and put inside hand on humerus in arm pit, other hand fixates scapula and acromium

Question 12

how is longitudinal caudad conducted

Answer 12

pt in supine

palpate joint line, with wrist perform longitudinal traction, can also hold humeral epidcondyles

Question 13

how are acromioclavicular joints PA and AP conducted

Answer 13

find a V shaped area, hold with one hand and others finger on joint

Question 14

sternoclavicular AP glide

Answer 14

just under clavicular press thumb downward