Shoulder Exam PPT Flashcards by Owen Honroth

Patient Specific Functional Scale
- scoring (ability or disability?)
- MCID

0-10 scale
ability = 10 is best function

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Quick DASH
- region or condition specific?
- scoring (ability or disability)
- MCID

region
disability = 0 (none) to 100 (total)
10

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Penn Shoulder Scale
- region or condition specific?
- scoring (ability or disability)
- MCID

region specific
ability = 0 (worst pain) to 100 (no pain)
11.4

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SPADI
- region or condition specific?
- scoring (ability or disability)

region
disability
– 0 (no pain and no disability) to
100 (pain and disability)

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scapular dyskinesis test
- patient position
- therapist position
- test component

patient = standing
therapist = standing/seated behind

test = raise arm slowly from anatomical position into max elevation in scapular plane for 5 reps with 3-5 lbs in hands

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positive shoulder dyskinesis test result

obvious abnormality
– deviation from thorax by >1” on 3/5 reps

reproduction of pain

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what is the scapular assist test looking at? what will abnormality point out?

upward rotation of the scapula

abnormal = weakness in lower trap / serratus anterior

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what is the scapular reposition test looking at? what will abnormality point out?

anterior tilt of scapula

abnormal = weakness in lower trap and serratus anterior
– could have anterior muscle (pectoralis) tightness

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what is the scapular retraction test looking at? what will abnormality point out?

medial border stabilization of scapula

abnormal = rhomboid or middle trap weakness

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explain the scapular reposition test? when is it indicated?

upper scapula is pulled posteriorly to increase posterior tilt

if there is inferior border winging of the scapula

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scapular assist test protocol

hand on medial inferior border of the scapula to assist upward rotation

hand on superior border applying posterior tilt

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scapular reposition test protocol

grasp scapula with fingers on AC jt anteriorly
– palm and thenar eminence on spine of scapula

pull obliquely toward inferior angle while applying force to inferior angle

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screen of the shoulder included

ROM
Strength

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what ROM do you want to test? how do you do this?

functional movement via
reach overhead
reach behind head (RBH)
reach behind back (RBB)

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how to test strength in shoulder screen

lifting weight OH
wall push up
grip strength

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when lifting weight over head, what weight (sets x reps) are the most effective way to screen

2-3 lbs x 10 reps
10 lbs x 1 reps

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what does the wall push up test

ROM and Strength

open pack position of shoulder

~ 50° elevation in scaption

closed pack position of the shoulder

abduction with ER

general ROM at shoulder

flex = 180
ext = 50
ER = 90
IR = 80

in what position can the supraspinatus tendon be palpated

max adduction
IR
hyperextension

– between clavicle and acromion junction

in what position can the infraspinatus and teres minor tendon be palpated

shoulder flexion, adduction and lateral rotation
- “thinking man” position

infraspinatus above teres minor

mobility deficit characteristics

decreased A/PROM
joint mobility deficits
muscle length deficits
joint tenderness

movement coordination characteristics

PROM > AROM
weak resisted testing
hypermobile joint mobility
joint and ligamentous tenderness

muscle power deficit characteristics

pain with AROM pain with PROM w/stretch joint mobility present muscle/tendon tenderness

radiating pain characteristics

pain with spinal motion/compressive action weak and painless neurological signs joint mobility tenderness via tinel

muscle power tests goal

isolate and stress or activate the muscle tendonous unit of region

movement coordination test goal

stress the static stabilizing structures at end range

findings to rule in subacromial pain syndrome

impingement signs painful arc pain with resisted ER positive long head of bicep tests

positive findings to rule in substantial RTC tear

age > 60 lag signs weakness atrophy

positive findings to rule in Adhesive Capsulitis

insidious progressive pain loss of motion in multiple planes -- ER the most

positive findings to rule in glenohumeral joint instability

age <40 with atraumatic onset history of dislocation/sublux apprehension relocation test systemic laxity (≥5/9 beighton) SLAP lesion test

negative findings to rule out subacromial pain syndrome / RTC repair

significant loss of PROM apprehension with instability test

negative findings to rule out adhesive capsulitis

imagining for GHJ OA age <40 years normal PROM

negative findings to rule out GHJ joint instability

no history of dislocation or sublux no apprehension with instability tests

T-FAST shoulder functional performance testing includes

hand to head/back CW and CCW rotations gallon lift

what is the protocol for performance based testing of shoulder

how many reps of each exercise can be done in 30 seconds

closed chain performance based shoulder testing

UE Y-Balance CKCUEST

posterior shoulder endurance test

90° horizontal abduction straight arm in prone with arm off table move from horizontal adduction to abduction count reps until fatigue (30bpm metronome)

seated medicine ball throw

test of upper body power sit in chair throw 1 or 3 kg ball as far as possible

red flags by system related to shoulder - msk - neuro - cardio - GI - other

MSK = fx or malignancy Neuro = CRPS / shingles Cardio = MI / compartment syndrome GI =cholecystitis / peptic ulcer other = local infections

spinal level associated with: - acromion -spine of scapula on medial border - inferior border of scapula - iliac crest

C7 T3 T7 L4-5