shoulder exam Flashcards
what to look for in anterior inspection in a shoulder exam
scars, brusing, asymmetry of the shoulder girdle, swelling, abnormal bony prominance and deltoid wasting
what can asymmetry of the shoulder girdle be caused by
scoliosis, arthritis, fractures or dislocation
what can cause swelling in the shoulder joints
effusion, inflammatory arthropathy, or dislocation
what can an abnormal bony prominence on the shoulder indicate
a clavicular fracture or anterior dislocation of the glenohumeral joint
what can deltoid wasting indicate
disuse atrphy or axillary nerve injury
what to look for on lateral inspection in a shoulder exam
scars and deltoid wasting
what to look for on posterior insepction in a shoulder exam
scars, trapezous muscle asymmetry, supraspinatus and infraspinatoid asymmetry, scoliosis, winged scapula
what is trapezius muscle asymmetry suggestive of
muscle wasting secondary to disuse atrophy spinal accessory nerve lesion
what is supraspinatoud and infraspinatous asymmetry suggestive of
muscle wasting secondary to chronic rotator cuff tear of a suprascapular nerve lesion
what is a winged scapula indicative of
ipsialtral serratus anterior muscle weakness secondary to long thoracic nerve injury
what to do in a shoulder exam after looking
feel the temperature of the shoulder joint
what to do after assessing joint temperature in a shoulder exam
palpate the sernoclavicular joint, the clavicle, the acromioclavicular joint, acromion, coracoid process, head of the humerus, greater tubercle of the humerus and the spine of the scapula
what to do after palpating in a shoulder exam
ask patient to place hands behind their head
what does asking the patients to place their hands behind their head asses
external rotation and abduction of the shoulder joint
what to do in a shoulder exam after asking patients to place their hands behind their head
ask the patient to place each hand nehind their back and reach as far up their spine as they can
what does asking the patient to put their hand behind their back asses in a shoulder exam
internal rotatoin and adduction of the shoulder joint
what to do after asking the patient to put their hand behind their back in a shoulder exam
ask the patient to raise their hands forwards until theyre pointing towards the ceiling (shoulder flexion)
what to do after asking the patient to put their hands forwards to the sky in a shoulder exam
ask the patient to stretch their arms out behind them (shoulder extension)
what to do after asking the patient to put their arms out behind them in a shoulder exam
ask the patient to raise their arms out to the sides in an arc like motion until their hands touch above their head (abduction)
what to do after the arc movemnet in a shoulder exam
ask the patient to keep their arms straight and move them across the front of their body to the opposite side (adduction)
what to do after adduction in a shoulder exam
ask the pateint to keep their elbows by their sides flexed at 90 degrees they move their forearms out (external rotation)
what to do after asking a patient to keep their elbows by their side flexed at 90 degrees and moce their forearms out in a shoulder exam
ask the patient to place each hand behind their back and reach up as far as they are able to (internal rotation)
how far up their own spine should a patient to able to reach
T4-T8
what to do in a shoulder exam after asking the patient to place each hand behind their back and reach up as far as they are able
wing scapular test (wall)
what does jobes test assess
the function of the supraspinatous muscle
how to perform jobes test
abduct the patients arm to 90 degrees and then angle the arm forwards by 30 degrees so the shoulder is the plane of the scapula, internally rotate the arm so the thumb points to the floor, now push down the arm whilst the patient resists
how to interpret jobes test
weakness - tear in supraspinatous pain - impingement
what to do after jobes test
painful arc test
what does pain between 60-120 degrees suggest
impingemnet or supraspinatour tendonitis
what to do after the painful arc test
assess the function of infraspinatour and teres minor muscles
how to assess the function of infraspinatous and teres minor muslces
position the patients arm with the elbow flexed at 90 degrees on slight abduction then passively externally rotate the arm to its maximum
pain on resisted external rotation suggets
infraspinatois tendonitis
if the arm falls back to internal roation or their is loss of power in the external rotation against resistance test what does this indicate
a tear in the infraspinatus or teres minor tendon, muscle wasting or lower motor neurone lesion
how test test the function of the teres minor muscle
external rotation in abduction
how to peform external rotation in abduction
position the arm in 90 degree of abduction and bend the elbow to 90 degrees, passively externally rotate the shoulder to its maximum degree
what is hornblowers sign
inability to keep the arm in a 90 degrees whilst passively rotating the shoulder
what can hornblowers sign suggest
teres minor pathology or an axillary nerve lesion
what test assesses internal rotation against resistance
gerbers lift off test
how to perform gerbers lift off test
ask the patient to place the dorsu of their hand on their lower back and apply light resistance to the heand and ask the patient to move their hand off the bacl
how to interprate gerbers lift off test
if the patient is unable to move their hand of their back it indicates pathology of the subscapularis muscle or subscapular nerve lesion
what does the scarf test assess
the function of the acromioclavicular joint
how to perform the scarf test
passively flex the shoulder to to degrees and ask the patient to place the hand on the side you are examining to the contrateral shoulder and apply resistance to the elbow in the direction of the contralateral shoulder
interpratation of the scraf test
id the patient experiences pain in the test there is acromioclavicular joint pathology
