Shoulder Exam / Eval Flashcards by Maria Jose Holguin

What are the 3 likely causes of shoulder dysfunction?

Compromise of:
1. Passive restraint components of the shoulder girdle
2. Neuromuscular system’s production or control of shoulder girdle motion
3. One or more of the neighboring joints that contribute to the shoulder girdle motion

How well did you know this?

Not at all

Perfectly

What are the joints that contribute to shoulder girdle motion?

GH
AC
SC
Scapulothoracic: upper t/s joints and ribs
Lower c/s joints

How well did you know this?

Not at all

Perfectly

Patient Hx / Observation Include:

MOI
Location of symptoms to narrow what tissues could be pathologic
Nature of the symptoms and how they behave
Analyze common motions restrictions and movement patterns to narrow tissue involvement
Determine stage of healing for the tissues involved

How well did you know this?

Not at all

Perfectly

________ may have epiphysitis (growth plate malformation) of the humerus or osteogenic sarcoma

Children and adolescents

How well did you know this?

Not at all

Perfectly

Calcific deposits in the shoulder are more common between 20 and ___ years of age

How well did you know this?

Not at all

Perfectly

______________ usually occur after age 30

Chondrosarcomas

How well did you know this?

Not at all

Perfectly

RC degeneration usually occurs in the ____ and 50s.

40s

How well did you know this?

Not at all

Perfectly

A ______________ is more common in 45- to 60- year-olds and is often associated with DM and ischemic heart disease

Frozen shoulder

How well did you know this?

Not at all

Perfectly

Overhead exertion involving repetitive motion is a common mechanism for:

Subacromial pathology

How well did you know this?

Not at all

Perfectly

Subacromial pathologies encompass what?

Subacromial bursitis
Subacromial impingement syndrome (SIS)
RC tendinopathy
RC tear

How well did you know this?

Not at all

Perfectly

What is repetitive OH exertion a common cause of, other than subacromial pathology?

Bicipital tendinopathy

How well did you know this?

Not at all

Perfectly

FOOSH injury can result in _____ or _______ injury to the wrist, elbow, and shoulder.

sprain; strain

How well did you know this?

Not at all

Perfectly

More serious injuries from falls on outstretched hand include _______ of the wrist and elbow, ________, __________, and ____________.

Fractures; A-C separations; clavicular fractures; GH fractures and dislocations

How well did you know this?

Not at all

Perfectly

What is the most common mechanism for a A-C separation?

Fall on the tip of the shoulder

How well did you know this?

Not at all

Perfectly

What other injuries appear similar to A-C separation in the early stages?

Bone contusion (compression periostitis) or cervical spine injury

How well did you know this?

Not at all

Perfectly

Common mechanism for anterior dislocation

Forced horizontal abduction of the abducted, externally rotated arm

How well did you know this?

Not at all

Perfectly

What are some common complaints associated with shoulder pathology?

Pain
Instability
Stiffness
Deformity
Locking
Swelling
Other - catching, clunking, grinding, or popping

How well did you know this?

Not at all

Perfectly

How is radicular pain described?

Sharp, burning, and radiating

How well did you know this?

Not at all

Perfectly

How is bone pain described?

Deep, boring, and localized

How well did you know this?

Not at all

Perfectly

How is tendon pain described?

Hot and burning

How well did you know this?

Not at all

Perfectly

How is vascular pain discribed?

Diffuse, aching, and poorly localized (may be referred)

How well did you know this?

Not at all

Perfectly

Common complaints of RC tear

Difficulty with arm elevation (in abd., ER) and when pt attempts to put hand behind the head or back

How well did you know this?

Not at all

Perfectly

Pain due to RC pathology and impingement, usually felt over the ______ or _______ part of the shoulder, is characterized by radiation down the upper arm and is aggravated with OH activities.

Anterior; lateral

How well did you know this?

Not at all

Perfectly

Inability to abduct the arm beyond 90 degrees and/or pain in the shoulder with abduction might be due to peripheral nerve lesion in ___?

Spinal accessory nerve (CN XI and C3-4)

How well did you know this?

Not at all

Perfectly

Weak elbow flexion with forearm supinated might be due to peripheral nerve lesion in ___?

Musculocutaneous nerve (C5-7)

Pain on flexing a fully extended arm/ inability to fully flex and extended arm/ winging of the scapula at 90 degrees of forward shoulder flexion might be due to peripheral nerve lesion in ___?

Long thoracic nerve (C5-7)

Increased pain on forward flexion/ pain increased with scapular abduction and cervical rotation to opposite side might be due to peripheral nerve lesion in ___?

Suprascapular nerve (C5-6)

Inability to abduct the arm with neutral rotation might be due to peripheral nerve lesion in ___?

Axillary nerve (C5-6)

Marked difficulty to resist shoulder extension or IR might be due to peripheral nerve lesion in ___?

Thoracodorsal nerve (C6-8)

What does the systems review determine?

Suitability of the pt for PT Look for red flags to see if we need to refer back to physician or another appropriate healthcare provider

What are the most common causes of numbness in the shoulder and arm?

Cervical or upper thoracic involvement, specifically segmental/nerve roots or brachial plexus

Severe progressive pain not affected by movement, persistent throughout the day and night, and associated with systemic signs, may indicate referred pain from a __________.

Malignancy

Test and Measure Include:

Performing a systems review to ensure proper care and intervention for the patient Scan surrounding anatomy for involvement or contribution to the pathology

What does the PT observe during a shoulder exam?

How the pt holds the arm, overall position of the UE, and their willingness to move Muscle symmetry Scapula's position and attitude

What does a low shoulder be a result of?

Adaptive laxity of the shoulder, Leg length discrepancy, Scoliosis, Soft-tissue hypertonicity, Mechanical dysfunction of the pelvis, Hand dominance

What can posture analysis point to?

Area of movement disturbance or excessive stress

What can palpation tell us?

The degree and location of tenderness

What can AROM within pain tolerance tell us?

-Willingness to move -Overall functional capacity -Reproduce symptoms/pain -Quantity of movement -Developed compensatory/modifications to movement -New signs/symptoms -Presence of capsular pattern -Detect painful arc -Irritability of a structure -End-feels

ROM shifts and deficits are the clinical indicators of posterior shoulder tightness (PST), with 3 tissue alterations potentially contributing to these modifications. What are the 3 alterations?

1. increased humeral retroversion 2. reduced posterior G-H joint capsule extensibility 3. reduced posterior shoulder muscle/tendon extensibility

G-H IR deficit or GIRD is defined as the loss in IR between the throwing and non-throwing shoulders. What does this result of?

A posterior capsule shortening

What is examination of movement patterns concerned with?

Coordination, timing, or sequence of muscle activation during movement

Interscalene triangle:

Located above the clavicle, this space is formed by the anterior and middle scalene muscles, with the first rib at its base. The brachial plexus trunks and the subclavian artery pass through this space

Costoclavicular Space:

Situated between the clavicle and the first rib, this space contains the brachial plexus, subclavian artery, and subclavian vein

Subcoracoid (subpectoral minor) Space:

Located beneath the clavicle, this space is formed by the pectoralis minor muscle and the ribs. The brachial plexus cords, axillary artery, and axillary vein pass through this space

Arterial TOS

Young adult with vigorous arm activity Pain in the hand Claudication Pallor Cold intolerance Paresthesias S/s usually appear spontaneously

Venous TOS

Younger men with vigorous arm activity Cyanosis Feeling of heaviness Paresthesia in fingers and hand (result of oedema) Oedema of the arm

True TOS

Hx of neck trauma Pain, paresthesia, numbness, and/or weakness Occipital headaches S/s present-day and/or night Loss of fine motor skills Cold intolerance (possible Raynaud's phenomenon) Objective weakness Compressors*: s/s day>night

Superior G-H and coracohumeral ligaments restrain inferior translation at _____ degrees of G-H abduction

Inferior G-H ligament (post. band in ER, ant. band in IR) restrain inferior translation at _____ degrees of G-H abduction

Posterior band of inferior G-H ligament, teres minor, posterior capsule (superior) restrain IR at _____ degrees of G-H abduction

Anterior and posterior bands of the inferior G-H ligament restrain IR at _____ degrees of G-H abduction

Posterior band of the inferior G-H ligament, posterior capsule (inferior) restrain IR at _____ degrees of G-H abduction

Subscapularis, superior G-H, and coracohumeral ligaments restrain ER at _____ degrees of G-H abduction

Subscapularis, middle G-H ligament, superior fibers of the inferior G-H ligament restrain ER at _____ degrees of G-H abduction

Inferior G-H ligament restrain ER at _____ degrees of G-H abduction

What does OH motions require?

Stability and mobility of multiple segments for proper mechanics

Symptoms in early morning indicate

Symptoms with repetitive use OH indicate

impingement

Heavy/cold symptoms indicate

TOS

Nature of symptoms - Goal

ID tissues involved in the pathology Aggravating and easing factors Quality of pain

Contractile tissue Nature?

Intermittent cramping, dull, and aching pain with muscle spasm end-feel

Inert tissue Nature?

Intermittent dull-sharp pain with boggy and hard capsular end-feel

Neural tissue Nature?

Intermittent-constant burning and lancinating pain with a stretch end-feel. Dermatomal distribution Paresthesia Peripheral nerve sensory distribution if peripheral nerve involved

Muscle strains

Grades I, II, III Tear Chronic in nature, or an acute exacerbation Muscle tone changes