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Semester 4 PM Exam 1 > Shoulder Exam and Eval > Flashcards

Shoulder Exam and Eval Flashcards

1
Q

Questionnaires

A

Neck disability index
QuickDASH - most common for UE
Global Rating of Change

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2
Q

Global Rating of Change questionnaire

A

a visual analog scale that measures patients perception of change
7 point scale
Can be done every 5 treatments

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3
Q

Tests and Measures - General obs and postural assessment - important to look at

A

Scapulothoracic position - if scapular position changes, the GH position will change too

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4
Q

AROM - flexion - Norm and end-feel

A

180 degrees

Firm/tissue stretch

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5
Q

AROM - scaption - Norm and end feel

A

180 degrees

Firm/tissue stretch

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6
Q

AROM - abduction - Norm and end feel

A

180 degrees

Firm/tissue stretch

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7
Q

AROM - extension - Norm and end feel

A

60 degrees

Firm/tissue stretch

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8
Q

AROM - ER - Norm and end feel

A

90 degrees

Firm/tissue stretch

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9
Q

AROM - IR - Norm and end feel

A

70 degrees

Firm/Tissue stretch

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10
Q

AROM - Horizontal abduction - Norm and end feel

A

135 degrees

Firm/Tissue stretch

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11
Q

AROM - horizontal adduction - Norm and end feel

A

45 degrees

Firm

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12
Q

Palpation - position

A

often in standing to make sure and get to ant and post aspects

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13
Q

PROM - what are you assessing

A

Condition of non-contracile tissues

END FEELS

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14
Q

bone to bone end feel

A

Abrupt halt; no pain

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15
Q

capsular end feel

A

stretching leather

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16
Q

tissue approximation end feel

A

soft

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17
Q

Empty end feel

A

voluntary cessation of movement

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18
Q

Spasm end feel

A

involuntary muscle guarding

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19
Q

Springy end feel

A

rebound effect

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20
Q

Neuro testing

A 
very common
dermatomes - C5 = most common
reflexes
myotomes
proprioceptive and kinesthetic testing
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21
Q

Reflexes - C5, C6, C7

A

Biceps, brachioradialis, triceps

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22
Q

Proprioception

A

awareness of posture, movement and changes in equilibrium

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23
Q

Kinesthesia

A

ability to perceive movement

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24
Q

Special testing used to

A

confirm tissue involvement
determine degree of tissue damage
determine appropriateness of PT

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25
Q

Functional testing includes

A

physical activity
ADLs, AIDLs
work simulation

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26
Q

General Observation - shoulder height, head position, upper quadrant position –>

A 
check for rotations
lateral flexion
muscle bulk
skin
arm position 
clavicle
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27
Q

General observation - scapula position

A

medial border should be 2 in from spine

No winging or tipping

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28
Q

General observation - scapula position - if adducted think

A

short rhomboids, mid trap

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29
Q

General observation - scapula position - if abducted think

A

long/weak rhomboids and mid trap, short or stiff pec minor and maj, SA

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30
Q

General observation - scapula position - if elevated think

A

short upper trap

motor pattern issue is more common cause

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31
Q

General observation - scapula position - if depressed think

A

long or weak upper trap and levator
short or stiff lat and lower trap
less common

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32
Q

General observation - scapula position - if anteriorly tilted think

A

short pec minor

long lower trap

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33
Q

General observation - scapula position - if winging think

A

long/weak rhomboids, low mid trap and SA

short/stiff pec minor, infraspinatus, teres minor and major, post delt

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34
Q

General observation - scapula position - if IR think

A

Scap IR is caused by GH ER

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35
Q

General observation - scapula position - if ER think

A

caused by SA, trap, rhomboid

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36
Q

General observation - scapula position - if upwardly rotated think

A

short upper trap

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37
Q

General observation - scapula position - if downwardly rotated think

A

short rhomboids, and delt

long SA, and upper trap

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38
Q

Pattern 1 - scapulohumeral rhythm and dykskinesis

A

inf medial angle of scap is displaced post from post thorax, prominent during dynamic observation and palpation
Tight pec minor

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39
Q

Pattern 2 - scapulohumeral rhythm and dykskinesis

A

Entire medial border of scap is displaced post from post thorax, prominent with dynamic obs and palpation, more of winging from serratus with activity

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40
Q

Pattern 3 - scapulohumeral rhythm and dykskinesis

A

Early scapular elevation or excessive/insufficient scapular upward rotation during dynamic obs and palpation compared to asymptomatic side
Maybe it is moving right away or not at all

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41
Q

Pattern 4 - scapulohumeral rhythm and dykskinesis

A

normal

no evidence of post displacement in medial border/inf angle of scapula or excessive/insufficient scapular movement

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42
Q

Functional testing - questionairres

A 
UCLA shoulder rating scale
Disabilities of the arm, shoulder and hand DASH
Quick DASH
Penn shoulder score
GROC
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43
Q

Functional testing includes

A

Questionnaires
ADLs/AIDLs
Leisure activities
Work simulation

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44
Q

C3-C4 referred pain to where

A

SC joint

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45
Q

C4 referred pain to where

A

AC joint

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46
Q

C5 referred pain to where

A

lateral shoulder

47
Q

C5-C6 referred pain to where

A

GH joint structure innervation

48
Q

Joint mobility - scapulothoracic joint assessment

A 
Sidelying with pt facing PT
Hold top of scap and inf angle
Elevation/Depression
Protraction/Retraction
Up Rot/Down Rot
49
Q

Joint Mobility - sternoclavicular joint assessment

A

Ant/Inf Glide

Post/Sup Glide

50
Q

Joint Mobility - sternoclavicular joint assessment - Ant/Inf Glide is assessing what and is restricted by what

A

Assessing - ant sternoclavicular ligament

Restricted by - 1st rib, costochondral joint, costoclavicular ligament

51
Q

Joint Mobility - sternoclavicular joint assessment - Ant/Inf Glide - how to

A

Patient in supine

Place thumbs at the sup aspect of the joint line and provide a glide in an ant/inf direction

52
Q

Joint Mobility - sternoclavicular joint assessment - Post/Sup Glide is assessing what and is restricted by what

A

Assessing - post sternoclavicular ligament

Restricted by - sup joint capsule, interclavicular ligament

53
Q

Joint Mobility - sternoclavicular joint assessment - Post/Sup glide - how to

A

Patient in supine

PT place thumbs at the inf aspect of the joint line and provide a glide in a post/sup direction

54
Q

Joint Mobility - Acromioclavicular ligament

A

Can go ant to post or post to ant

Can stabilize either scap or clavicle and mobilize the other

55
Q

Joint Mobility - Acromioclavicular ligament - how to for post to ant with stabilizing scap and mobilizing clavicle

A

Patient in sidelying facing away from you
Stabilize scap with your abdomen
Mobilize clavicle post to ant
Can do ant to post here too

56
Q

With scapular retraction - the head of the clavicle moves

A

ant as the clavicular body rotates posteriorly

57
Q

With scapular protraction, GH abduction or elevation - the head of the clavicle moves

A

posterior as the body rotates ant

58
Q

With scapular elevation (GH abduction or elevation) - the head of the clavicle

A

slides and rolls inf, lateral end moves superiorly, and the body rotates ant

59
Q

With scapular depression the body of the clavicle and acromion move

A

inferior, head of the clavicle moves superiorly

60
Q

Joint mobility - GH joint - name the glides

A

Ant
Post
Lateral
Inf

61
Q

Joint mobility - GH joint - Inf glide

A

Two approaches
1 - pt supine, PT stabilize coracoid with one hand and glide inf with other
2 - pt supine, PT at pt head and glide inf from there

62
Q

Joint mobility - GH joint - Lateral glide

A

Pt supine
One hand of therapist in the proximal humerus (axilla region) and the other is at the distal humerus
Glide laterally

63
Q

Joint mobility - GH joint - Post glide

A

Pt supine
Cap stabilized with bed
PT hold arm with 1 hand and apply post glide with the other at the GH joint

64
Q

Joint mobility - GH joint - Ant glide

A

Pt can be supine or prone - we practiced prone

Put towel under shoulder and glide joint ant

65
Q

Sensitivity of a test

A

A tests ability to detect a patient actually presenting with a pathology
True positive
SnOUT - high Sn = rule out

66
Q

Specificity of a test

A

A tests ability to detect patients who do not have a pathology
True negative
SpIN - high Sp = rule in

67
Q

Liklihood ratios

A

combine a tests Sn and Sp to indicate the shift of probability
Pos LR shift = probably have disorder
Neg LR shift = probably do not have disorder

68
Q

Subacromial impingement special tests

A

Hawkins kennedy test
Neer impingement test
Painful arc test
Yergason’s test

69
Q

Hawkinds Kennedy Test
What for
Sn
Sp

A

Subacromial Impingement
both pretty high
Sn = 0.78
Sp = 1.00

70
Q

Hawkins Kennedy Test - what is it

A

PT place pt into position of 90 GH flexion, 90 elbow flexion
PT force arm into IR
Pos = pain

71
Q

Pos Hawkins Kennedy Test - if positive indicates possible involvement of what

A

supraspinatus, biceps tendon, bursa

72
Q

Neer Impingement Test
What for
Sn
Sp

A

Supacromial impingement
Sn = 0.39
Sp = 1.00

73
Q

Neer impingement Test - what is it

A

PT stabilizes scap and passively (and max) elevates the patients arm with humerus in IR
Pos = pain

74
Q

Positive Neer impingement test - indicates possible involvement of what

A

supraspinatus, bursa

75
Q

Painful arc test
What for
Sn
SP

A

Subacromial impingement
Sn = .33
Sp = .81
Not a really good test

76
Q

Painful arc test - how to

A

Patient actively elevates arm and if patient reports pain during an arc of the motion then it is positive

77
Q

Yergason Test
What for
Sn
Sp

A

Subacromial impingement
Sn = 0.37
Sp = 0.86
Not a very good test

78
Q

Yergason Test - how to

A

Pt elbow placed in 90 flexion and full forearm pronation and then they are to try to move into supination and ER as the PT provides resistance
Pos = pain in bicipital groove

79
Q

Tendonitis special tests

A

Empty Can Test
Speeds Test
Gerber Lift Off Test

80
Q

Empty Can Test
What for
Sn
Sp

A

Tendonitis - Supraspinatus
Sn = 0.89
Sp = 0.50

81
Q

Empty Can Test - how to

A

Patient actively elevates their arm in scaption with thumbs down - they hold while PT applies force downward
Pos = pain or weakness

82
Q

Speeds Test -
What for
Sn
Sp

A

Tendonitis - Biceps
Sn = 0.91
Sp = .14

83
Q

Speeds Test - how to

A

Patient actively into 90 shoulder flexion with scaption, elbow ext, forearm supination
They hold while therapist provides force into shoulder extension
Pos = pain or tenderness at bicipital groove

84
Q

Gerber Lift Off Test -
What for
Sn
Sp

A

Subscapularis
Sn = 0.5
Sp = 0.88

85
Q

Gerber lift off test - how to

A

Pt stand with hand behind back at waist level and see if they can lift off 5-10 degrees - see if they can hold position
Pos for tear if unable to hold
Pos for lesion if pain with position

86
Q

Rotator Cuff Special tests

A

Dec passive elevation and ER
Hornblower
Drop Arm

87
Q

Dec passive elevation and ER
What for
Sn
Sp

A 
Rotator Cuff 
Sn = 0.3
Sp = 0.78
Sn = 0.19
Sp = 0.84
88
Q

Dec passive elevation
Dec passive ER
How to

A

Passive elevation less than 170

Passive ER less than 70

89
Q

Hornblowers Sign
What for
Sn
Sp

A 
Rotator Cuff (biases infraspinatus and teres minor)
Sn = 1
Sp = 0.93
REALLY GOOD
90
Q

Hornblower - how to

A

Therapist places pt arm into 90 scaption with elbow flexed and pt is asked to ER against resistance
Pos if unable to ER shoulder

91
Q

Drop Arm Test
What for
Sn
Sp

A 
Rotator Cuff (bias supraspinatus)
Sn = 0.88
Sp = 0.77
92
Q

Drop Arm Test - how to

A

Passively abduct patient arm to 90
Patient tries to slowly lower their arm
Pos if patient is unable to do so

93
Q

Labral tear special tests

A

Active Compression Test (Obriens)
Crank Test
Biceps Load Test

94
Q

Active Compression Test (Obriens) -
what for
Sn
Sp

A

Labral tear
Sn = 1
Sp = 0.98
Really good!

95
Q

Active compression test (obriens) - how to

A

While seated - patient positions arm into shoulder flex to 90 and elbow ext and IR (thumb down) and add 10
Therapist applies force downward
Test repeated with ER
Pos if report pain or clicking - and if pain or clicking is decreased with ER

96
Q

Crank Test
What for
Sn
Sp

A 
Labral Tear (for bankhart or slap)
Sn = 0.91
Sp = 0.93
97
Q

Crank Test - how to

A

Patient in supine
Therapist elevates arm to 160 in scapular plane
Axial load applied to humerus with ER and with IR
Pos if pain or clicking

98
Q

Biceps Load test
What for
Sn
Sp

A 
Labral tear (SLAP lesion)
Sn = 0.90
Sp = 0.97
99
Q

Biceps Load Test - how to

A

Patient supine
PT abducts arm to 90 with em ulbow flex and forearm supinatedPT ER pt arntil pt is apprehensive

Then pt flexes elbow against resistance
Pos if apprehension remains or pain is produced

100
Q

AC lesion - tests

A

Crossover
AC resisted ext test
Active compression test

101
Q

Crossover test - for what and how to

A

AC lesion

Cross arm over chest

102
Q

Active compression test - for what and how to

A

Compress the AC joint

For AC lesion

103
Q

AC resisted extension test - for what and how to

A

AC lesion
Patient standing with arm flexed 90, elbow flexed 90
Pt extends arm against PT resistance
Pos if painful at AC joint

104
Q

Instability at GH joint - tests

A

Apprehension
Relocation
Sulcus Sign

105
Q

Apprehension - for what, Sn, Sp

A

Instability GH

  1. 53 = Sn
  2. 99 = Sp
106
Q

Apprehension - how to

A

Patient supine with arm in 90 of shoulder abduction, elbow 90 and then you passively ER their shoulder and look for apprehension

107
Q

Relocation test - for what, Sn, Sp

A

GH instability
Sn = 0.46
Sp = 0.54

108
Q

Relocation test - how to

A

Do the apprehension and then move humerus post and then if symptoms decrease then is positive

109
Q

Sulcus Sign - for what and how to

A

GH instability
In sitting - palpate subacromial sace, stabilize scap and then apply inf glide to humerus - if visible and or palpable drop off then is positive

110
Q

Thoracic Outlet Syndrome - tests

A

Adson’s test
Costoclavicular test
Hyperabduction test
Roos test

111
Q

Adsons test - how to and what for

A

Thoracic Outlet Syndrome - Scalene involvement
Pt sitting - PT palpate radial pulse and then ER and extend patient shoulder
Have the patient turn their head toward arm being tested and ext their head - take deep breath and hold
Pos - symptoms provoked - pulse lost

112
Q

Costoclavicular Test - how to and what for

A

Thoracic Outlet Syndrome - Clavicle and 1st rib
Pt sitting - PT palpate pulse and then retract and depress scapular
Pos is sx provoke or pulse gone

113
Q

Hyperabduction Test - what for and how to

A

THoracic outlet syndrome - pec minor involvement

Palpate radial pulse and then passively hyperabduct to above head

114
Q

Roos Test - what for and how to

A

Thoracic outlet syndrome - both neuro and vascular
Pt hold arms with 90 abduc and full ER - repeatedly open and close hands for 3 minutes
Pos if inc swelling, pallor, pain, numbness

Semester 4 PM Exam 1 (3 decks)

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