Shoulder Exam Flashcards
What scars might you see in the shoulder?
Anterior diagonal - hemiarthroplasty or total shoulder replacement
Arthroscopy ports
Lateral vertical - shoulder fracture/reconstruction
What pathologies might you expect in young, middle aged, and elderly patients?
Young - Instability
Middle aged - Impingement, frozen shoulder
Elderly - OA, rotator cuff injury
Where does pain from the shoulder typically radiate to?
Down the arm but stops at the elbow
What tests are for impingement?
Hockings test - internal rotation of the flexed arm
Scarf test - for AC arthritis/impingement
Speed’s test - Biceps grove - elbow flexion against resistance
Brian test for Slap tear
Which shoulder muscles are most commonly wasted?
Deltoid
Supraspinatus
Infraspinatus
What are the special tests in the shoulder exam?
Apprehension test - anterior instabilty
Scarf test - AC joint tenderness
Rotator cuff muscles
- Emptying the can - supraspinatus
- External rotation against resistance - infraspinatus, teres minor
- Supscapularis - Dorsum of hand rests on lumbar spine, palms to press examiner’s hand away (Gerber’s test)
Winged scapula - push against wall - subscapularis
What things might limit external rotation?
Frozen shoulder - adherent capsule
OA
Posterior dislocation of shoulder (more acute)
What tests are for instability?
Sulcus sign - Pull arm down and look for indent
Anterior and posterior draw shoulder tests
Anterior apprehension test - abduct and external rotate
What might deltoid wasting reflect?
Injury to the axillary nerve - ?shoulder dislocation
What do you find on examination in a patient with shoulder impingement?
Painful arch of abduction between 70-120 degrees
What causes of pain can refer to the shoulder?
Neck pain radiating down the neck
Diaphragmatic/Cardiovascular
What do you want to test for with the special tests?
Impingement
Rotator cuff
Instability
What should you think of with pain that radiates down to the hand?
Pathology in the neck eg reticulopathy
What tests are for rotator cuff?
Supraspinatus - Empty can test and push down on the arm
Infraspinatus/Teres minor - External rotation against force also Lag/Horn blowers test
Subscapularis - Gerber’s lift off - push posteriorly in a internal rotated position or Napoleon’s belly test
What is the Neer’s test for? How it is performed?
Supraspinatus impingement
Hold the patient’s supraspinatus region
Flex and internally rotate their affected arm
If pain on flexion, the test is considered positive
