Shoulder Exam PPT Flashcards
Patient Specific Functional Scale
- scoring (ability or disability?)
- MCID
0-10 scale
ability = 10 is best function
Quick DASH
- region or condition specific?
- scoring (ability or disability)
- MCID
region
disability = 0 (none) to 100 (total)
10
Penn Shoulder Scale
- region or condition specific?
- scoring (ability or disability)
- MCID
region specific
ability = 0 (worst pain) to 100 (no pain)
11.4
SPADI
- region or condition specific?
- scoring (ability or disability)
region
disability
– 0 (no pain and no disability) to
100 (pain and disability)
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
positive shoulder dyskinesis test result
obvious abnormality
– deviation from thorax by >1” on 3/5 reps
reproduction of pain
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
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
what is the scapular retraction test looking at? what will abnormality point out?
medial border stabilization of scapula
abnormal = rhomboid or middle trap weakness
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
scapular assist test protocol
hand on medial inferior border of the scapula to assist upward rotation
hand on superior border applying posterior tilt
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
screen of the shoulder included
ROM
Strength
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)
how to test strength in shoulder screen
lifting weight OH
wall push up
grip strength
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
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
