Shoulder Exam Flashcards
What are the two main goals of a joint evaluation?
Is the pain from the joint itself, or elsewhere?
Find the specific tissue that is generating the pain
Why is it important that you are in appropriate lighting when evaluating the shoulder?
Atrophy
What is the posterior area to inspect with shoulder pain?
Nuchal ridge to T12
What is the anterior area to inspect with a shoulder exam?
From the bottom of the manubrium to the mastoid process, and across the front of both shoulders
What are the five specific factors that shoulder be evaluated with a shoulder exam?
- Bilateral shoulder heights
- Position of the humeral head
- Rubor, calor, swelling
- Muscle wasting
- Deformities
How should you screen in the C-spine initially?
Active ROM
What question should be asked prior to evaluating AROM of the neck?
“do you get dizzy when looking up”
If there is pain or referred pain to the shoulder, what should you inspect?
Neck/neurological exam
Each motion of the shoulder joint when performing an Apley scratch test assesses what?
Different glenohumeral and scapular motions
How should the Apley Scratch test procedure be performed and evaluated?
Performed bilaterally, but assessed unilaterally
What are you assessing for with the Apley scratch test?
Pain
Location of pain
Asymmetry of ROM
What is the defect in Ehler-Danlos syndrome?
The structure, production, or processing of collagen or proteins that interact with collagen, such as mutations in the COL5A or COL3A genes. (
What is the first position for the Apley scratch test? Where is the physician relative to the patient when performing this?
Front of the opposite shoulder
Dr. is in front of patient
What are the motions of the glenohumeral joint during the first position of the Apley scratch test?
Internal rotation
Adduction
Flexion
What are the motions of the scapula during the first position of the Apley scratch test?
Protraction
What is the second position of the Apley scratch test? Where is the physician relative to the patient when performing this?
Arm over and behind the back, to scratch the middle of their upper back
Dr is behind the patient
What are the motions of the glenohumeral joint during the second position of the Apley scratch test?
External rotation
Abduction
Flexion
What are the motions of the scapula during the second position of the Apley scratch test?
Upward rotation
Elevation
What is the third position of the Apley scratch test? Where is the physician relative to the patient during this?
Place hand on the small of the back
Dr. is posterior
What are the motions of the scapula during the third position of the Apley scratch test?
Internal rotation
Adduction
Extension
What are the motions of the scapula during the third position of the Apley scratch test?
Downward rotation
Retraction
What is the capsular pattern of the shoulder? (Abduction/adduction, external/internal rotation)
- Some limitation of abduction
- More limitation of external rotation
- Less limitation of internal rotation
A capsular pattern of shoulder pain may indicate what?
Lesion in the capsule of the joint
What is the cross arm test?
- Place hand on pts back
- Grasp arm at elbow, and flex shoulder and elbow to 90
- Move arm horizontally, and press gently at the end of PROM
What does a positive horizontal test indicate?
AC joint issue
What does the cross arm test assess for? Why?
AC joint
moving the arm across the chest closes the AC joint
What is the Hawkin’s test?
- Place hand on the shoulder and the other passively flex elbow and shoulder to 90
- Passively internally rotate the humerus to bring greater tubercle of humerus under AC joint
What does a positive Hawkin’s test indicate?
Suggests impingement or “pinching” of structures between the humerus and the underside of the AC joint
What is the basis for the Hawking’s test?
Pinches the structures between the humerus and the underside of the AC joint
What are the three structures that the Hawkin’s tests squeezes/assesses?
- Supraspinatus
- Long head of the biceps tendon
- Subacromial bursa
What is the Neer’s test?
Placing one hand on the posterior shoulder, and flex and internally rotate the shoulder
What does the Neer’s test assess for?
impingement of structures between the humerus and the underside of the AC joint
What does a positive Neer’s test suggest?
Impingement of:
- Supraspinatus
- long head of the biceps
- Subacromial bursa
How do you perform the Arm drop test?
Passively abduct the arms to 180.
Release pts and ask pt to slowly lower their arms to their sides
What is a positive Arm drop test? What does this indicate?
Arms do not drop in a smooth, curvilinear fashion
Large or complete tear of the supraspinatus
How do you perform the apprehension test?
- Grasp the anterior shoulder, while flexing shoulder and elbow to 90
- Bring flexed shoulder into horizontal abduction
- Apply pressure at wrist to fully externally rotate the shoulder
What does a positive apprehension test indicate?
Anterior glenohumeral capsule instability/laxity
How do you perform the empty can test?
- Flex patient’s shoulders to 90, and internally rotate the arms (thumbs down)
- Apply downward pressure while the pt resists this motion
What is a positive empty can test?
Pain or inability to resist downward pressure
What is the structure tested with the empty can test?
Supraspinatus
How do you perform the speed’s test?
- Palpate the long head of the biceps between the intertubercular groove
- Place pts shoulder in a partial forward flexion with the elbow fully extended, and the forearm supinated
- Pt flexes their shoulder as you resist
What indicates a positive Speed’s test? What does this indicate?
pain or tenderness in the bicipital groove
Bicipital tendinitis
What is the structure being tested with the speed’s test?
Long head of the biceps tendon
How do you perform Yergason’s test?
- Pt flexes elbow to 90
2. Dr externally rotates the arm as the pt resists, and pulls inferiorly
What indicates a positive Yergason’s test? What does this mean?
Pain or biceps tendon dislocation or movement
Biceps tendonitis
What are the three things that you shoulder do when examining the shoulder?
ROM
Neurological
If the C-spine is positive, and a neuro exam is positive, where is the pain likely coming from? What should be done?
Pain is from the cervical spine
Imaging
If there is a fracture, severe OA, or joint deformities of the shoulder, how will this be reflected in the shoulder exam?
Significant ROM deficits
When should you refer a shoulder pain to an OMM specialist?
2-4 treatments w/o improvements
If a shoulder lesions localizes to soft tissue, and the patient cannot do overhead activities, what is the likely etiology? How is this managed?
Lesion to the ligament, tendon, or muscle
imaging for severe problems, then OMM and PT if negative
If a shoulder lesion localizes to soft tissue, and patient can do overhead activities, what is the likely etiology? How is this managed?
Lesion to the ligament, tendon, or muscle
OMM or PT
Shoulder pain at rest is suspicious for what?
Inflammation
Shoulder pain that is only present with movement is suspicious for what?
Muscle pathology
Pain with overhead activities suggests what type of pathology?
acromial or impingement
What is the sulcus sign?
Inferior traction applied below the AC joint to a flexed elbow, to test for the inferior part of the glenohumeral capsule
