Shoulder exam Flashcards
What is the role of the glenohumeral ligament?
- prevent humeral head from displacing anteriorly
What are the different ligaments around the shoulder joint?
- glenohumeral
- coracohumeral
- coracoacromial
- coracoclavicular
Name the different rotator cuff muscles. Where do they attach and what movements are they responsible for?
- Supraspinatus: attaches to greater tubercle
- responsible for external rotation and initiating abduction (first 15° of movement) - Infraspinatus: attaches to greater tubercle
- responsible for external rotation - Teres minor: greater tubercle
- responsible for external rotation - Subscapularis: attaches to lesser tubercle
- responsible for internal rotation
What muscle is usually responsible for painful arc? When is this pain usually felt and why?
supraspinatus
- pain usually occurs around middle of abduction when the affected area is in contact with the acromion
Name bursae around the shoulder joint. Which one is most commonly associated with shoulder pain?
- sub scapular
- subcoracoid
- subacromial
Subacromial bursitis is a common cause of shoulder pain
What are the steps in examination of the shoulder?
- introduction
- preparation
- look
- feel
- move
- special tests
- function
- summary + close
How should the patient be positioned?
Sitting/standing (depending on part of examination you are doing)
- remove any clothes obscuring the shoulder
What are you looking for when assessing the shoulder?
- look anteriorly and posterioly
- skeletal abnormalities - varus or valgus deformity, is there a step that could indicate dislocation?
- muscle bulk - particularly deltoid, compare both sides
- swelling - oedema, bursitis
- skin - scars, redness, psoriasis etc
What are you feeling for when assessing the shoulder?
- temperature
- joint line - feel along the clavicle and the acromioclavicular joint, around the joint capsule and along the scapular spine
- swelling/effusion
- tense the bicep against resistance to feel for proximal tendon
What movements are you performing when assessing the shoulder? In which ways should these movements be assessed?
- flexion + extension, abduction + adduction, internal and external rotation
1. active
2. passive
3. resisted
If there is limited ROM in active movement, but you are able to elicit full range of movement passive without pain, what does this indicate?
Muscular pathology
What are the different special tests for the shoulder?
- Reverse empty can tests
- lower back push
- Winging scapula
- Speed test
- Scarf test
- Neer’s test
- Hawkin’s test
What is the reverse can test and what is it assessing?
- assessing supraspinatus
1. ask the patient to hold their arms out in front
2. ask them to point their thumbs towards the ground as if they’re pouring a drink away
3. push down on their arms, asking them to resist
4. any pain or weakness suggests a supraspinatus pathology
What is the lower back push test and what is it assessing?
- assessing subscapularis
1. ask patient to put the back of their hands on their lower back
2. push hands into back and ask patient to resist by pushing hands away from their back
3. pain or weakness indicates subscapularis pathology
What is the winging of scapula test and what is it assessing?
- assessing serrates anterior
1. ask patient to push against a wall
2. see if either scapula ‘wings out’
3. winging of scapula suggests damage to long thoracic nerve/weakness to serratus anterior
