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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
Functional testing includes
physical activity ADLs, AIDLs work simulation
26
General Observation - shoulder height, head position, upper quadrant position -->
``` check for rotations lateral flexion muscle bulk skin arm position clavicle ```
27
General observation - scapula position
medial border should be 2 in from spine | No winging or tipping
28
General observation - scapula position - if adducted think
short rhomboids, mid trap
29
General observation - scapula position - if abducted think
long/weak rhomboids and mid trap, short or stiff pec minor and maj, SA
30
General observation - scapula position - if elevated think
short upper trap | motor pattern issue is more common cause
31
General observation - scapula position - if depressed think
long or weak upper trap and levator short or stiff lat and lower trap less common
32
General observation - scapula position - if anteriorly tilted think
short pec minor | long lower trap
33
General observation - scapula position - if winging think
long/weak rhomboids, low mid trap and SA | short/stiff pec minor, infraspinatus, teres minor and major, post delt
34
General observation - scapula position - if IR think
Scap IR is caused by GH ER
35
General observation - scapula position - if ER think
caused by SA, trap, rhomboid
36
General observation - scapula position - if upwardly rotated think
short upper trap
37
General observation - scapula position - if downwardly rotated think
short rhomboids, and delt | long SA, and upper trap
38
Pattern 1 - scapulohumeral rhythm and dykskinesis
inf medial angle of scap is displaced post from post thorax, prominent during dynamic observation and palpation Tight pec minor
39
Pattern 2 - scapulohumeral rhythm and dykskinesis
Entire medial border of scap is displaced post from post thorax, prominent with dynamic obs and palpation, more of winging from serratus with activity
40
Pattern 3 - scapulohumeral rhythm and dykskinesis
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
41
Pattern 4 - scapulohumeral rhythm and dykskinesis
normal | no evidence of post displacement in medial border/inf angle of scapula or excessive/insufficient scapular movement
42
Functional testing - questionairres
``` UCLA shoulder rating scale Disabilities of the arm, shoulder and hand DASH Quick DASH Penn shoulder score GROC ```
43
Functional testing includes
Questionnaires ADLs/AIDLs Leisure activities Work simulation
44
C3-C4 referred pain to where
SC joint
45
C4 referred pain to where
AC joint
46
C5 referred pain to where
lateral shoulder
47
C5-C6 referred pain to where
GH joint structure innervation
48
Joint mobility - scapulothoracic joint assessment
``` Sidelying with pt facing PT Hold top of scap and inf angle Elevation/Depression Protraction/Retraction Up Rot/Down Rot ```
49
Joint Mobility - sternoclavicular joint assessment
Ant/Inf Glide | Post/Sup Glide
50
Joint Mobility - sternoclavicular joint assessment - Ant/Inf Glide is assessing what and is restricted by what
Assessing - ant sternoclavicular ligament | Restricted by - 1st rib, costochondral joint, costoclavicular ligament
51
Joint Mobility - sternoclavicular joint assessment - Ant/Inf Glide - how to
Patient in supine | Place thumbs at the sup aspect of the joint line and provide a glide in an ant/inf direction
52
Joint Mobility - sternoclavicular joint assessment - Post/Sup Glide is assessing what and is restricted by what
Assessing - post sternoclavicular ligament | Restricted by - sup joint capsule, interclavicular ligament
53
Joint Mobility - sternoclavicular joint assessment - Post/Sup glide - how to
Patient in supine | PT place thumbs at the inf aspect of the joint line and provide a glide in a post/sup direction
54
Joint Mobility - Acromioclavicular ligament
Can go ant to post or post to ant | Can stabilize either scap or clavicle and mobilize the other
55
Joint Mobility - Acromioclavicular ligament - how to for post to ant with stabilizing scap and mobilizing clavicle
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
With scapular retraction - the head of the clavicle moves
ant as the clavicular body rotates posteriorly
57
With scapular protraction, GH abduction or elevation - the head of the clavicle moves
posterior as the body rotates ant
58
With scapular elevation (GH abduction or elevation) - the head of the clavicle
slides and rolls inf, lateral end moves superiorly, and the body rotates ant
59
With scapular depression the body of the clavicle and acromion move
inferior, head of the clavicle moves superiorly
60
Joint mobility - GH joint - name the glides
Ant Post Lateral Inf
61
Joint mobility - GH joint - Inf glide
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
Joint mobility - GH joint - Lateral glide
Pt supine One hand of therapist in the proximal humerus (axilla region) and the other is at the distal humerus Glide laterally
63
Joint mobility - GH joint - Post glide
Pt supine Cap stabilized with bed PT hold arm with 1 hand and apply post glide with the other at the GH joint
64
Joint mobility - GH joint - Ant glide
Pt can be supine or prone - we practiced prone | Put towel under shoulder and glide joint ant
65
Sensitivity of a test
A tests ability to detect a patient actually presenting with a pathology True positive SnOUT - high Sn = rule out
66
Specificity of a test
A tests ability to detect patients who do not have a pathology True negative SpIN - high Sp = rule in
67
Liklihood ratios
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
Subacromial impingement special tests
Hawkins kennedy test Neer impingement test Painful arc test Yergason's test
69
Hawkinds Kennedy Test What for Sn Sp
Subacromial Impingement both pretty high Sn = 0.78 Sp = 1.00
70
Hawkins Kennedy Test - what is it
PT place pt into position of 90 GH flexion, 90 elbow flexion PT force arm into IR Pos = pain
71
Pos Hawkins Kennedy Test - if positive indicates possible involvement of what
supraspinatus, biceps tendon, bursa
72
Neer Impingement Test What for Sn Sp
Supacromial impingement Sn = 0.39 Sp = 1.00
73
Neer impingement Test - what is it
PT stabilizes scap and passively (and max) elevates the patients arm with humerus in IR Pos = pain
74
Positive Neer impingement test - indicates possible involvement of what
supraspinatus, bursa
75
Painful arc test What for Sn SP
Subacromial impingement Sn = .33 Sp = .81 Not a really good test
76
Painful arc test - how to
Patient actively elevates arm and if patient reports pain during an arc of the motion then it is positive
77
Yergason Test What for Sn Sp
Subacromial impingement Sn = 0.37 Sp = 0.86 Not a very good test
78
Yergason Test - how to
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
Tendonitis special tests
Empty Can Test Speeds Test Gerber Lift Off Test
80
Empty Can Test What for Sn Sp
Tendonitis - Supraspinatus Sn = 0.89 Sp = 0.50
81
Empty Can Test - how to
Patient actively elevates their arm in scaption with thumbs down - they hold while PT applies force downward Pos = pain or weakness
82
Speeds Test - What for Sn Sp
Tendonitis - Biceps Sn = 0.91 Sp = .14
83
Speeds Test - how to
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
Gerber Lift Off Test - What for Sn Sp
Subscapularis Sn = 0.5 Sp = 0.88
85
Gerber lift off test - how to
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
Rotator Cuff Special tests
Dec passive elevation and ER Hornblower Drop Arm
87
Dec passive elevation and ER What for Sn Sp
``` Rotator Cuff Sn = 0.3 Sp = 0.78 Sn = 0.19 Sp = 0.84 ```
88
Dec passive elevation Dec passive ER How to
Passive elevation less than 170 | Passive ER less than 70
89
Hornblowers Sign What for Sn Sp
``` Rotator Cuff (biases infraspinatus and teres minor) Sn = 1 Sp = 0.93 REALLY GOOD ```
90
Hornblower - how to
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
Drop Arm Test What for Sn Sp
``` Rotator Cuff (bias supraspinatus) Sn = 0.88 Sp = 0.77 ```
92
Drop Arm Test - how to
Passively abduct patient arm to 90 Patient tries to slowly lower their arm Pos if patient is unable to do so
93
Labral tear special tests
Active Compression Test (Obriens) Crank Test Biceps Load Test
94
Active Compression Test (Obriens) - what for Sn Sp
Labral tear Sn = 1 Sp = 0.98 Really good!
95
Active compression test (obriens) - how to
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
Crank Test What for Sn Sp
``` Labral Tear (for bankhart or slap) Sn = 0.91 Sp = 0.93 ```
97
Crank Test - how to
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
Biceps Load test What for Sn Sp
``` Labral tear (SLAP lesion) Sn = 0.90 Sp = 0.97 ```
99
Biceps Load Test - how to
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
AC lesion - tests
Crossover AC resisted ext test Active compression test
101
Crossover test - for what and how to
AC lesion | Cross arm over chest
102
Active compression test - for what and how to
Compress the AC joint | For AC lesion
103
AC resisted extension test - for what and how to
AC lesion Patient standing with arm flexed 90, elbow flexed 90 Pt extends arm against PT resistance Pos if painful at AC joint
104
Instability at GH joint - tests
Apprehension Relocation Sulcus Sign
105
Apprehension - for what, Sn, Sp
Instability GH 0. 53 = Sn 0. 99 = Sp
106
Apprehension - how to
Patient supine with arm in 90 of shoulder abduction, elbow 90 and then you passively ER their shoulder and look for apprehension
107
Relocation test - for what, Sn, Sp
GH instability Sn = 0.46 Sp = 0.54
108
Relocation test - how to
Do the apprehension and then move humerus post and then if symptoms decrease then is positive
109
Sulcus Sign - for what and how to
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
Thoracic Outlet Syndrome - tests
Adson's test Costoclavicular test Hyperabduction test Roos test
111
Adsons test - how to and what for
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
Costoclavicular Test - how to and what for
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
Hyperabduction Test - what for and how to
THoracic outlet syndrome - pec minor involvement | Palpate radial pulse and then passively hyperabduct to above head
114
Roos Test - what for and how to
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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